Table_14_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项目旨在开发一款面向共病老年群体（包括轻度认知障碍（MCI）或轻度痴呆患者）的以患者为中心的整合照护平台。本项目旨在赋能多学科照护团队，使其在遵循循证指南的前提下制定个性化整体照护方案。为此，需明确临床决策支持（CDS）服务的规范细则，整合多项循证临床指南的指导建议，因此采用涵盖临床与技术专家的共创模式至关重要。

方法
本文阐述了一套用于生成可落地的CDS服务规范、以实现临床指南自动化的稳健方法论。本研究构建了一套共创框架，以促进临床专家与软件工程师就临床指南开展协同研讨。我们提出了一种开放、可复现且可追溯的方法，可将循证指南文本转化为可落地的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中的互操作性与可推广性。

结果
本研究已依据该方法论为65项CDS服务制定可落地规范，将整合了25项精选循证指南建议的CAREPATH共识指南实现自动化。共计正式定义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。输出项包含346条定义清晰的CDS卡片，可为照护计划活动与目标建议提供明确指导。上述规范已推动65项CDS服务落地，并整合至CAREPATH自适应整合照护平台。

讨论
本方法论提供了一套系统化、可复制的CDS规范生成流程，可确保实施过程中的一致性与可靠性。通过促进临床专业能力与技术能力的协同协作，本研究提升了所生成规范的质量与适用性。清晰的可追溯性可使相关方追踪开发全流程，并确保符合指南建议。