In recent years, guidelines and protocols have gained support as the vehicles for promoting best practices in clinical medicine. They offer the possibilities of reducing unwarranted practice variations, of containing cost while maintaining high quality of care, and of defining standards of care for quality assurance purposes. These promises have led to an explosion of guideline publications. Yet, studies have shown that dissemination and effective use of guidelines in clinical care remain a major bottleneck.

A number of researchers have developed different technologies for delivering computerized guidelines in clinical care. These technologies range from alerts and reminders to knowledge-based systems, information-retrieval systems, and others. The tasks to which guidelines have been applied include classic clinical decision support, workflow management, quality assurance, and resource-requirement estimates. The research has spanned several communities (information retrieval, artificial intelligence, medical informatics, software engineering, clinical medicine), but unfortunately, there has been little cross fertilization between the communities working in this area.

Following the success of the first European Workshop on Computerized Guidelines and Protocols held at Leipzig, Germany, in 2000, the Symposium on Computerized Guidelines and Protocols (CGP-2004) was organized to identify use cases for guideline-based applications in healthcare, computerized methods for supporting the guideline development process, and pressing issues and promising approaches for developing usable and maintainable vehicles for guideline delivery. It brought together researchers from different communities to examine cutting-edge approaches to guideline modelling and application development and to consider how different communities can leverage each other's strengths. The papers collected in this volume represent the best of the contributions to this symposium.

We solicited two categories of papers for this symposium: (1) long (fifteen-page) papers that present mature research results and that review focused topics; and (2) short (five-page) papers that report early results and innovative ideas and that describe practical applications. In the first category we have papers that describe the use of formal and adaptive methods in applying protocols to clinical decision support; that review the representation of guideline goals and present an empirically derived way of categorizing them; that present methods for deriving temporal abstraction and temporal action specification in guidelines; that explore interactive visualizations for medical treatment plans; that discuss the relationship between guidelines and standard terminologies, and that demonstrate improvement in health outcomes and/or cost-effectiveness ratio with guideline compliance. In the second category we have papers that describe contrasting approaches to developing, searching, and evaluating guideline knowledge bases, formal representation and reasoning methods, the possibility of translating from one formalism to another, adapting workflow to implement treatment protocols, and the use of mark-up and data-mining technologies.

The diversity of the topics belies the fact that workers in the field share a number underlying concerns. The first is representation of medical knowledge embodied in clinical guideline and protocols. Several papers presented formal, empirical, and hybrid methods for representing such knowledge, especially the temporal aspects of guideline-based data abstractions and recommendations. For computer-supported guidelines and protocols to make a difference in clinical practices, they must be integrated into clinical information and workflow systems. Papers on deployment-driven guideline encoding, integration of standard terminologies, and adaptation of workflow processes speak to these concerns. Finally, the results of deploying computerized guidelines and protocols require evaluation. Evaluation can be done in terms of the correctness of guideline information presented to clinicians and of the effects on clinicians' compliance to guideline-recommended practices, and, ultimately, on quality and cost-effectiveness of patient care.

The symposium was held at the Novotek Hotel, Prague, in the Czech Republic, as part of the International Joint Meeting EuroMISE 2004. A number of organizations, including the University of Economics (Prague), European Centre for Medical Informatics, Statistics and Epidemiology (EuroMISE), Czech Society of Cybernetics and Informatics, Guidelines International Network (G-I-N), the Austrian Society for Artificial Intelligence (ÖGAI), and Health Level 7, endorsed the symposium and encouraged their members to participate.

Dr. Kitty Rosenbrand from the Dutch Institute for Healthcare Improvement (CBO) and Dr. Gunther Schadow from the Regenstrief Institute, Indiana University School of Medicine delivered invited talks to the Symposium. Dr. Rosenbrand trained as a physician and is employed at CBO as a senior consultant on medical guidelines She is, and has been, involved in the development of several medical guidelines by medical specialists associations as well as other societies supporting the life cycle of guidelines (like, AGREE collaboration and the Guidelines International Network (G-I-N)). Dr. Schadow has led much of the development effort for HL7 version 3 Reference Information Model and has proposed innovative ideas about how to integrate of guideline recommendations and clinical data standards.

The credit for the success of the symposium goes all of its participants. First and foremost are the authors who submitted papers and the presenters who gave talks, presented posters, and demonstrated their systems. A program committee consisting of more than 30 leading researchers reviewed submissions and gave constructive comments on them. Professor Vojtech Svatek from the University of Economics, Czech Republic and his colleagues provided the local logistical support. Peter Votruba at the Institute of Software Technology and Interactive Systems, Vienna University of Technology did the yeoman's work in formatting and preparing the papers for publication. Finally, we thank IOS Press for offering to issue the proceedings of the symposium as a volume in the “Studies in Health Technology and Informatics” book series.

December 2003

Katharina Kaiser

Silvia Miksch

Samson W. Tu