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Automated Clinical Practice Guidelines (ACPG)



Highly complex, difficult to manage disease states, like diabetes, are extremely expensive in dollars and human suffering. With the explosion of information in medicine, no doctor has the time to keep up with research and still treat a normal patient load. They must rely on practice guidelines. The practice guidelines, in turn, need to be easily accessible. CTA, worked with Tripler Army Medical Center to provide a family of solutions centered on the automation of Clinical Practice Guidelines. The problem is how to provide busy physicians:

  • One place to see all of the relevant information on a patient.
  • Seamlessly integrate the Clinical Practice Guidelines so the patient gets "Best Practices" care.
  • Provide extra value to busy health care practitioners by using built-in intelligence and automation.

The Physician's Desktop

This provides a graphical user interface for the clinic. The baseline functionality lets Nurses, technicians, receptionists, interns and physicians do what they used to do (email, medical alerts, patient information, writing orders, etc.) under the older, terminal emulation systems. And, the new interface includes the ability to jump into a terminal emulator mode at any point without having to first go through the tedious command-line menu system.

The Physician's Desktop provides simple patient selection. Once selected, a summary screen displays their key information. From this summary screen, a single click drills down to detail information on prescriptions, radiology results, lab results, hospitalizations and vital signs. Data is displayed in color-coded sortable columns and as trend-line graphs. Administratively maintainable business rules govern the automatic display of alerts when a patient's clinical values fall into danger areas.

Wizards, templates, and auto-generated patient data make the creation of patient notes rapid and simple while ensuring compliance with Clinical Practice Guidelines.

The architecture is comprised of an n-tier Visual Basic 6.0 client-server application that separates the user interface from the business rules and data access logic. This separation allows flexibility in connecting to the different data stores - now and in the future - using any of the different data access methods. A custom MUMPS "Listener" was written to allow TCP/IP connections with the CHCS database. CHCS is the main medical database used at the Tripler Army Medical Center and holds the medical records of over 1,000,000 patients, 25,000 medical providers, and occupies more than 158 gigabytes of storage. To ensure that the doctors and nurses still have access via the terminal emulator, a custom Visual Basic wrapper was written for the KEA terminal emulator. With ADO connections to several Microsoft SQL Server 2000 databases, the picture is complete. Doctors and nurses have real-time, graphically compelling views of all pertinent patient data and an intelligent helpful way to enter vital signs and patient notes.

The Patient's Point of View (POV)

Is a data capture system developed by CTA to address the critical need for speed, efficiency and accuracy. We took special care developing a program that could recognize patients, identify symptoms and generate "best practices" guidelines for doctors to reference before seeing the patient. The system's built-in intelligence and automation would allow greater access to information and system integration to generate the best course of treatment.

We started by developing a unique interface, a mobile digital device or "tablet" which would gather patient data through a series of questions. Each question had been carefully designed to fulfill the Clinical Practice Guidelines for that patient's disease. Microsoft Active Server pages drive multiple client workstations - each with a "tablet". When the patient comes in for an appointment a survey is selected, and loaded into the tablet programmatically - a survey that is specific to that patient. The answers they input to the 'tablet' device are uploaded when they finish and saved in Microsoft SQL. From there, they are available for display in the Physician's Desktop application - where nurses, medical technicians, and physicians can view them. They are also programmatically formatted and entered in the health care provider's notes.

By providing a uniform, patient "interview," valid research protocols can be applied. Trends and variations can be studied in a meaningful way - both for single patients over time, and across populations of patients. This approach makes it possible to research the efficacy of the practice guidelines. It also ensures that each patient is always asked the important questions. Since the patient enters the data while in the waiting room, the workload of the care providers is reduced. Thanks to the .NET framework we were able to cut development time and link hospital procedure and guidelines with patient's information. The .NET platform was instrumental in our development of a seamless user experience for both the practitioners and their patients.