A template-based approach to support utilization of clinical practice guidelines within an electronic health record
This is a review of a paper from Henry SB, Douglas K, Galzagorry G, Lahey A, Holzemer WL.(1998),on A template-based approach to support utilization of clinical practice guidelines within an electronic health record. 
Are clinical practice guidelines an integral part of evidence-based healthcare delivery? Does a template-based approach produce positive results for an electronic health record system similar to a paper based health record system?
The authors developed a prototype application within the WAVE electronic health record that could be organized into a patient-encounter template. The advantages of this approach were to integrate guideline recommendations within an encounter form, the online interaction of the clinician with the system, and the ease of creation and modification of the guideline-based encounter form.
This approach focused on a nurse practitioner’s computer-based support for management of diabetes mellitus using recommendations of the American Diabetes Association. Nurse practitioners were engaged in the diagnostic and treatment activities to human responses related to actual and potential health problems. These capabilities included preventive services; treatments related to nursing diagnoses, such as self-care deficit, impaired coping, and knowledge deficit; and the management of acute and chronic illnesses. Their review of the literature capture three areas that would be integrated into their work flow processes. They consisted of strategies focused on the prevention of error of omission, delivering reminders at the point of care, and the facilitation of documentation and ordering of recommended procedures.
WAVEis an object-oriented electronic health record implemented in a network environment consisting of a server and three workstations. The operations designed to manage a patient’s chart, provide a health summary and generate health profiles. The user interface provided the ability to organize structured text, create a template manager, establish user-defined defaults for various subject matter, use of exception editing of the diabetes management physical exam, check boxes and blanks, use of free text in a structured-text template and auto citing from the profile.
There were a number of advantages noted that consisted of the prototype’s simplicity and amenable to implement, use by the clinician at the point of care, short time to create a template, no specialized skills required, ability of the template manager to update templates, links within the template, online interaction abilities and abilities to add more structure and unstructured text. Integration into other clinical systems and algorithms seemed to be the author’s chief concerns
While this software application improved the efficiency to create templates and maintain medical records, there were some concerns related to the inability do inference and the lack of integration with patient-specific data to trigger specific rules. There is a need for consensus-building amongst potential users that there is value in the practice guide approach. I would like additional information on how this system was used and the time it took at the clinician’s point of care to collect data and input the data into the WAVE application. There was not enough evidence to say that this is a better approach to a paper chart at a point of care site.
- Henry SB, Douglas K, Galzagorry G, Lahey A, Holzemer WL.(1998), A template-based approach to support utilization of clinical practice guidelines within an electronic health record, J Am Med Inform Assoc. 1998 May-Jun;5(3):237-44., http://www.ncbi.nlm.nih.gov/pubmed/9609493.