Protocol system
Introduction
In a healthcare setting, a protocol, also called a medical guideline, is a set of instructions which describe a process to be followed to investigate a particular set of finding in a patient or the method which should be followed to control of a certain disease.
Computer protocol are generally constructed from a set of standard primitives and assembled to produce complete protocol [1].The main purpose of a computer-based protocol system is to provide a set of tools which allow health care providers access to current guidelines which they can apply in practice.[2] Studies have shown that protocols can aid in optimising patient care[3] There are two types of protocol systems: passive and active. There are two types of protocol systems: passive and active.
Passive Protocol Systems
Passive protocol systems are a source of information which healthcare providers have the freedom to choose to consult or not, they are not intrinsically incorporated into the healthcare process. The purpose of a passive protocol system is to give healthcare providers access to information which may remind healthcare providers of steps during patient care which may otherwise be forgotten or changed. A passive protocol system requires a user to make a conscious effort to check that their actions are appropriate.[2]
Active Protocol Systems
Active protocol systems are specific guidelines for healthcare providers to follow. They are a central way which healthcare is delivered. Examples of active protocol systems include trigger automated order-entry systems and appointment scheduling. Active protocol systems may provide an explanation function which offers background information, definitions and risks as well as the rationale that supported specific recommendations.[2]. Electronic communication services are needed to provide the interfaces between active protocol systems and the electronic medical record and to order-entry functions. [4] Protocols in an active system should be a natural part of the workflow. There are two ways which an active system can remind someone: computer-detected event or subtler.[2]
Computer-Detected Event
An example of a computer-detected event includes clinicians ordering medication or the arrival of laboratory results. Abnormal test results can generate an alert which can then be flagged once the electronic record is accessed. Alerts can also be transmitted via a communication system such as email or pager.[2]
Subtler
Subtler relies on the protocols being a natural part of the work situation. Active protocol systems can interact with healthcare professionals in simple ways that can work in traditional practices.[2]
Protocol Driven Record Keeping
For users accessing a patient's medical record protocol driven record keeping ensures that records reach a minimum standard of completeness and clarity.[2] This can be done in a few ways. Firstly a well designed system should be quicker and easier to use than a free input system and thus increasing the probability that an event will be documented. .[2]. Then it’s important to ensure the terms and phases used in the record can be standardised to ensure the event is documented precisely. This is particularly useful when clinical audits are being undertaken. .[2]. And finally specifying what data is to be documented the completeness of the patient medical record is enhanced [5]
References
- ^ Wang, D., Peleg, M.,& Tu, SW. (2002). “Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines: a literature review of guideline representation models”. International Journal of Medical Informatics, Vol 68: Pages 59-70.
- ^ a b c d e f g h i Coiera, E. (2003) Guide to Health Informatics. Great Britain: Hodder Education
- ^ Vissers, M., Biert, J., van der Liden, C., & Hasman, A. (1996). Effects of a supportive protocol processing system (ProtoVIEW) on clinical behaviour of residents in the Accident and Emergency department. Computer Methods and Programs in Biomedicine, Volume 49. Pages 177-184. Retrieved from http://0-www.sciencedirect.com.alpha2.latrobe.edu.au/science/article/pii/0169260795017143
- ^ Shiffman, RN., Liaw, Y., Brandt, CA., & Corb, GJ. (1999). "Computer-based guideline implementation systems - a systematic review of functionality and effectiveness". Journal of the American Medical Informatics Association, Vol 6: Pages 104-114.
- ^ Bouhaddou, O., Cofrin, K., Larsen, D., Warner, H., Huber, P., Sorenson, D., Turner, C., & Warner, H. (1993). “Implementation of practice guidelines in a clinical setting using a computerized knowledge base (Iliad)”. Proceedings of 17th Symposium on Computer Applications in Medical Care, pages 258-262.