From guideline modeling to guideline execution: Defining guideline-based decision-support services

We describe our ask-based approach to defining the guideline-based decision-support services that the EON system provides. We categorize uses of guidelines in patient-speciftc decision support into a set of generic tasks-making of decisions, specification of work to be performed, interpretation of data, setting of goals, and issuance of alert and reminders-that can be solved using various techniques. Our model includes constructs required for representing the knowledge used by these techniques. These constructs form a toolkit. from which developers can select modeling solutions for guideline task. Based on the tasks and the guideline model, we define a guideline-execution architecture and a model of interactions between decision-support server and clients that invoke services provided by the server. These services use generic interfaces derived from guideline tasks and their associated modeling constructs. We describe two implementations of these decision-support services and discuss how this work can be generalized. We argue that a well-defined specification of-guideline-based decision-support services will facilitate sharing of tools that implement computable clinical guidelines.