In 2005, as part of its Phase Two Work Program, the General Practice Computing Group (GPCG) contracted Pen Computer Systems (PCS) to develop an electronic prototype of the Guidelines for preventive activities in general practice (colloquially known as the Red Book). The purpose of this project was to demonstrate that a clinical guideline of this type could be developed into a decision support tool. The eRedBook would be interoperable with GP clinical software and deliver patient-appropriate clinical reminders for preventive health activities.
In that project, interoperability specifications were developed to assist clinical software vendors in configuring the eRedBook software to their respective clinical systems. This resulted in an eRedBook that was demonstrable with three clinical packages (Medical Director, Locum and MedTech32). Each package delivered the Red Book advice in a consistent and reproducible manner using a published interface. This project was acknowledged as a successful step in electronic decision support from the Integrated Care Program Phase 2 project in which DoHA and its Joint Venture Partners invested between 2001 and 2004.
At the conclusion of this pilot, it was recognised by the GPCG that there was still more to be done to complete the delivery of the eRedBook from a paper-based resource to an e-format that can be widely and reliably used in general practice.
With funding from the Managed Health Network Grants, the RACGP and PCS have continued development of the eRedBook based on the 6th edition guidelines. The end point of this project will be an XML version of the eRedBook ready for integration with clinical software packages. The second deliverable is an eGuideline Editor to remotely update eRedBook content. This eGuideline Editor will be a technological solution to outdated paper-based resources.
This second phase is not a pilot, but an actual implementation of an electronic decision support tool designed to improve the quality and consistency of advice clinical software packages offer during patient consultations.
How are we going?
The further you get down the path, the more you can see just where you are headed, and this path has a few speed bumps. Development of the eRedBook has highlighted a number of issues that require further attention from a range of parties. Once again, it gets back to the need to build firm eHealth foundations.
Demographic rule sets are able to refine risk data sets to a certain level. However, the development of complex decision support matrices is dependent on reliable and usable information relating to a range of histories and diagnoses being available in clinical software. Whilst some data may exist in a format that is reliable (e.g. tick boxes and pick lists), there is still a lot of data that lives in free text boxes. This may be relatively common in clinical packages, but it does make data useless for any number of interrogation tools, including the eRedBook.
In looking to future versions of the eRedBook, the RACGP and PCS will continue to develop complex rule sets that using the eGuideline Editor can be integrated as clinical software packages change and evolve. A mapping exercise also needs to take place, to be confident that all possible locations for eRedBook related data within the clinical software are recorded.
Version 1.0 of the eRedBook is an example of the tremendous steps that can be taken toward competent and reliable decision support tools that are interoperable with clinical software. Thinking about Version 2.0 is equally as exciting, but we need to create headway on other fronts in order for that to happen.
Just the other day I caught myself at my desk looking off into the distance and wistfully imagining a world of functional specifications for clinical software packages and the widespread uptake to SNOMED-CT.
Thats not too much to ask, is it?
Posted in Australian eHealth