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What Do Doctors Need for Effective Adoption and Integration of Clinical Guidelines into Daily Practice?

Catheter-related bloodstream infection (CRBSI) is one of the major existing problems in Intensive Care Units (ICU). CRBSI has a high prevalence and its treatment is quite costly in time and medication. One of the essential efforts in the diagnosis and treatment of CRBSI is the use of existing Clinical Guidelines (CG). Nevertheless, its adoption and integration into daily practice is quite complex due to the lack of software tools that cover all the needs. Considering this problem, in this work we identify some of the needs detected in daily work, and we present two tools for ICUs that makes the introduction of CGs and patient's data visualization simple. As a first goal we propose to obtain a computerized model of the clinical guideline. Gewel is an application that allows the mapping of a textual CG into a workflow model. In this tool we propose a process that (1) organizes the parts of the textual document according to GEM, (2) maps concepts to the Electronic Health Record (EHR) system, called CH4, so that it can automatically retrieve data and send HL7 messages, (3) supports the design of a workflow model that assists the following up of the steps and the measure of adherence to the CG, and (4) according to Evidence Based Medicine principles, allows the doctors to trace from the task or decision point of the workflow to the exact part of the document where it was originated. Once the CG is computerized and integrated in the EHR, the next goal is to identify key clinical problems, such as CRBSI, and retrieve the relevant information from the EHR. Due to the big amount of the EHR data registered in an ICU, physician's attention should be drawn to the clinical information related to the problem to be solved. We propose a mobile application, called mProblem View, that permits to establish and visualize relations between the elements of the EHR in a Problem-Oriented EHR approach.