Value of XML in the implementation of clinical practice guidelines - the issue of content retrieval and presentation

The purpose of guidelines in clinical practice is to improve the effectiven ess and efficiency of clinical care. It is known that nationally or interna tionally produced guidelines which, in particular, do not involve medical p rocesses at the time of consultation, do not take local factors into accoun t, and have no consistent implementation strategy, have limited impact in c hanging either the behaviour of physicians, or patterns of care. The litera ture provides evidence for the effectiveness of computerization of CPGs for increasing compliance and improving patient outcomes. Probably the most ef fective concepts are knowledge-based functions for decision support or moni toring that are integrated in clinical information systems. This approach i s mostly restricted by the effort required for development and maintenance of the information systems and the limited number of implemented medical ru les. Most of the guidelines are text-based, and are primarily published in medical journals and posted on the internet. However, internet-published gu idelines have little impact on the behaviour of physicians. It can be diffi cult and time-consuming to browse the internet to find (a) the correct guid elines to an existing diagnosis and (b) and adequate recommendation for a s pecific clinical problem. Our objective is to provide a web-based guideline service that takes as input clinical data on a particular patient and retu rns as output a customizable set of recommendations regarding diagnosis and treatment. Information in healthcare is to a very large extent transmitted and stored as unstructured or slightly structured text such as discharge l etters, reports, forms, etc. The same applies for facilities containing med ical information resources for clinical purposes and research such as text books, articles, guidelines, etc. Physicians are used to obtaining informat ion from text-based sources. Since most guidelines are text-based, it would be practical to use a document-based solution that preserves the original cohesiveness. The lack of structure limits the automatic identification and extraction of the information contained in these resources. For this reaso n, we have chosen a document-based approach using eXtensible Markup Languag e (XML) with its schema definition and related technologies. XML empowers t he applications for in-context searching. In addition it allows the same co ntent to be represented in different ways. Our XML reference clinical data model for guidelines has been realized with the XML schema definition. The schema is used for structuring new text-based guidelines and updating exist ing documents. It is also used to establish search strategies on the docume nt base. We hypothesize that enabling the physicians to query the available CPGs easily, and to get access to selected and specific information at the point of care will foster increased use. Based on current evidence we are confident that it will have substantial impact on the care provided, and wi ll improve health outcomes.