OncoDoc: a successful experiment of computer-supported guideline development and implementation in the treatment of breast cancer

Originally published as textual documents, clinical practice guidelines hav e poorly penetrated medical practice because their editorial properties do not allow the reader to easily solve, at the point of care, a given medical problem. However, despite the proliferation of implemented clinical practi ce guidelines as decision support systems providing an easy access to patie nt-centered information, there is still little evidence of high physician c ompliance to guidelines recommendations, Apart from physicians' psychologic al reluctance, the incompleteness of guideline knowledge and the imprecisen ess of the terms used, another reason may be that, although suited to avera ge patients, clinical practice guideline recommendations are not a substitu te for the physician-controlled clinical judgement that should be applied t o each actual individual patient. Therefore, computer-based approaches base d on the automation of context-free operationalization of guideline knowled ge, although providing uniform optimal strategies to problem-focused care d elivery, may generate inappropriate inferences for a specific patient that the physician does not follow in practice. Rather than providing automated decision support, ONcoDoc allows the clinician to control the operationaliz ation of guideline knowledge through his hypertextual reading of a knowledg e base encoded as a decision tree. In this way, he has the opportunity to i nterpret the information provided in the context of his patient, therefore, controlling his categorization to the closest matching formal patient. Exp erimented in life-size ONcoDoc demonstrated good appropriation of the syste m by physicians with significantly high scores of compliance. We successful ly tested the implemented strategy and the knowledge base in a second medic al institution, giving then a noticeable example of reuse and sharing of en coded guideline knowledge across institutions. (C) 2001 Elsevier Science B. V. All rights reserved.