Insights from a user-centered approach to computerized guidelines for chronic disease

Abstract

For more than two decades, the medical informatics community has worked towards representing evidence-based guidelines in computer code, intended to be executed at the point of care. The purpose is to close the gap between evidence of best medical practices and the care that patients receive. Most informatics work has taken a "guideline-centric" approach, focusing primarily on the guidelines rather than the physicians who are the intended users. The HIT Asthma project took a "user-centric" approach towards developing, implementing and evaluating the effects of a computerized decision support (CDS) tool for ambulatory asthma care. The user-centricity yielded findings that questioned the ability of guidelines to support medical work, raised ethical concerns, and challenged the epistemic foundations of the evidence which the guidelines are intended to impart. The approach also demonstrated how CDS tools for chronic disease could become prototypical technologies to support a "Healthcare System that Learns", a vision promulgated by the Institute of Medicine Roundtable on Evidence-Based Medicine.