From guidelines to practice: improving clinical care through rule-based clinical decision support at the point of care

Healthcare Information Technology (HIT) is a dynamically evolving industry due to continuous advancements in healthcare technologies. This necessitates the availability of highly dynamic applications that accommodate frequent changes in business logic. The automation of Clinical Decision Support (CDS) in particular is most liable to changes in health business logic or rules. In terms of system’s architecture, there is a need to separate business logic and rules from the implementation/functionality of the Electronic Health Record (EHR) application, providing processes and rules as reusable components. We propose an architecture utilizing rule-based technologies to facilitate Decision Support to promptly adapt business logic changes, that are reflected immediately in application behavior. This allows real-time and robust CDS for the physician at point of care. Our rule-based implementation (Business Process Modelling Notation (BPMN)+Rules) was successfully used to emulate Clinical workflows, using as an example, the NICE Lung Cancer Clinical Guideline (CG121) as a test scenario.