Table_5_Transforming evidence-based clinical guidelines into implementable clinical decision support services: the CAREPATH study for multimorbidity management.XLSX

IntroductionThe CAREPATH Project aims to develop a patient-centered integrated care platform tailored to older adults with multimorbidity, including mild cognitive impairment (MCI) or mild dementia. Our goal is to empower multidisciplinary care teams to craft personalized holistic care plans while adhering to evidence-based guidelines. This necessitates the creation of clear specifications for clinical decision support (CDS) services, consolidating guidance from multiple evidence-based clinical guidelines. Thus, a co-creation approach involving both clinical and technical experts is essential.
MethodsThis paper outlines a robust methodology for generating implementable specifications for CDS services to automate clinical guidelines. We have established a co-creation framework to facilitate collaborative exploration of clinical guidelines between clinical experts and software engineers. We have proposed an open, repeatable, and traceable method for translating evidence-based guideline narratives into implementable specifications of CDS services. Our approach, based on international standards such as CDS-Hooks and HL7 FHIR, enhances interoperability and potential adoption of CDS services across diverse healthcare systems.
ResultsThis methodology has been followed to create implementable specifications for 65 CDS services, automating CAREPATH consensus guideline consolidating guidance from 25 selected evidence-based guidelines. A total of 296 CDS rules have been formally defined, with input parameters defined as clinical concepts bound to FHIR resources and international code systems. Outputs include 346 well-defined CDS Cards, offering clear guidance for care plan activities and goal suggestions. These specifications have led to the implementation of 65 CDS services integrated into the CAREPATH Adaptive Integrated Care Platform.
DiscussionOur methodology offers a systematic, replicable process for generating CDS specifications, ensuring consistency and reliability across implementation. By fostering collaboration between clinical expertise and technical proficiency, we enhance the quality and relevance of generated specifications. Clear traceability enables stakeholders to track the development process and ensure adherence to guideline recommendations.

引言
CAREPATH项目旨在针对患有多种共病（含轻度认知障碍（MCI）或轻度痴呆）的老年群体，开发以患者为中心的整合照护平台。本项目的目标是赋能多学科照护团队，在遵循循证指南的前提下制定个性化整体照护方案。这需要针对临床决策支持（Clinical Decision Support, CDS）服务制定清晰的规范，整合多份循证临床指南的指导内容。因此，吸纳临床与技术专家共同参与的共创模式至关重要。

方法
本文阐述了一套稳健的方法体系，用于生成可落地的CDS服务规范以实现临床指南的自动化应用。本研究搭建了共创框架，以促进临床专家与软件工程师协同梳理临床指南内容。本研究提出了一套开放、可复现且可追溯的方法，可将循证指南的文本描述转化为可落地的CDS服务规范。本方法基于CDS-Hooks、HL7 FHIR等国际标准，可提升CDS服务在不同医疗系统间的互操作性与落地推广潜力。

结果
按照本方法体系，本研究已为65项CDS服务制定了可落地规范，实现了整合25份入选循证指南指导内容的CAREPATH共识指南的自动化应用。共正式定义了296条CDS规则，其输入参数为绑定至FHIR资源与国际编码体系的临床概念。输出结果包含346条定义清晰的CDS卡片，可为照护方案活动与目标建议提供明确指导。上述规范已助力65项CDS服务落地，并集成至CAREPATH自适应整合照护平台。

讨论
本方法体系提供了一套系统化、可复制的CDS规范生成流程，可确保各落地环节的一致性与可靠性。通过促进临床专业知识与技术能力的协同融合，本研究提升了所生成规范的质量与针对性。清晰的可追溯性可让相关利益方追踪开发全流程，并确保规范贴合指南的推荐意见。