" Introduction: In order to implement clinical practice guidelines for the Department of Neonatology of the Heidelberg University Medical Center a modular framework was developed consisting of tools for authoring, browsing and executing encoded clinical practice guidelines. Currently we are focusing on the integration of the adaptation process in our framework.
Methods: After formulating the requirements we extended the existing HELEN framework in order to implement an adaptation pathway and a control mechanism for the authors of the clinical practice guideline. Like the initial framework the additional functions where also developed using the Model-based Incremental Knowledge Engineering Process (MIKE).
Results: We have extended the HELEN system by functions to support a structured process of adaptation. Currently we are planning an evaluation project in the Department of Neonatology of the Heidelberg University Medical Center. A guideline for calculating total parenteral nutrition of newborns has been used as an example to demonstrate the flexibility of the HELEN framework as a whole and the usability of the new adaptation pathway. A weekly nutrition reminder system could be generated smoothly by applying the adaptation pathway to a master CPG.
Discussion: With our extension to the HELEN system we have reached the aim of controlling changes of clinical practice guidelines which have been provided on a national or international level. A pathway for the adaptation process is provided within the authoring environment. Future work shall focus on evidence representation and management. We plan optimized support for entering evidence in the authoring environment and are currently investigating the necessary changes to the ontology. "

" Adaptation is a central process in the life cycle of clinical practice guidelines (CPGs), if a broad acceptance is to be achieved. Currently, there is no fully integrated solution for this process available. Due to the risk of introducing errors or compromising the evidence base, users and persons in charge often hesitate. To overcome these problems, we present a manageable pathway for the adapters and a control mechanism for the authors of generic CPGs which is fully integrated into a methodological and technical framework for developing, authoring, and implementing CPGs, called HELEN. We have extended this framework by functions to support a structured process of adaptation; there is first evidence that the quality of the adapted CPG can be enhanced by our solution. However, further evaluation is still to be done. "