ABSTRACT

The goals of a computer-based protocol system are to provide clinicians with access up-todate guidelines and to help them apply these guidelines in the management of patients. In Chapter 15, we saw that protocols either can be used as passive resources or can contribute actively in shaping the process of care. In this chapter, we examine the role that communication and computer-based systems can play in the delivery of protocol-based care. Computer-based guidelines are built and executed using specialized representations of clinical processes and are linked to systems such as the electronic health record (EHR). Several of the major competing computational approaches to clinical guidelines are described here, along with a more general description of their typical structure and function. We also review the continuing challenges in studying the effectiveness of such systems in actual use and explore why the evidence for their benefits is mixed and sometimes very difficult to interpret.