ONLINE PRACTICE GUIDELINES - ISSUES, OBSTACLES, AND FUTURE-PROSPECTS

The ''guidelines movement'' was formed to reduce variability in practi ce, control costs, and improve patient care outcomes. Yet the overall impact on practice and outcomes has been disappointing. Evidence demon strates that the most effective method of stimulating awareness of and compliance with best practices is computer-generated reminders provid ed at the point of care. This paper reviews five steps along the path from the development of a guideline to its integration into practice a nd the subsequent evaluation of its impact on practice and outcomes. I ssues arising at each step and obstacles to moving from one step to th e next are described. Last, developments that could help overcome the obstacles are highlighted. These include 1) more rapid knowledge acqui sition using data mining, 2) better accommodation to imprecise knowled ge in clinical algorithms using fuzzy logic, 3) development of a share able model for guideline representation and execution, and 4) more wid espread availability of clinically robust information systems that sup port decision-making at the point of care.