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Methods and tools for the development of computer-interpretable guidelines

PRODIGY
PRODIGY guideline model for support of chronic disease management.
keywords Clinical practice guidelines & protocols, knowledge representation, knowledge-based systems, chronic care
developed by Sowerby Centre for Health Informatics at Newcastle (SCHIN) (formerly part of Newcastle University before becoming a commercial enterprise.
introduced PRODIGY computer-based decision support system (for prescribing in particular) that integrates with commercial primary care information systems in England - 1996.
PRODIGY model release 1: 1998
PRODIGY model phase 3: 1999

status Discontinued.
support Department of Health (UK)
in use (i) PRODIGY 3 has been used to model 3 complex chronic disease guidelines (hypertension, asthma, ...)
(ii) 150+ Prodigy Release One guidelines have been converted into the PRODIGY 3 format
(iii) PRODIGY guideline knowledge base and execution engine have been integrated with two UK primary care vendor systems.
tools  
description
PRODIGY is a guideline-based decision support system in use by a large number of GPs in the UK.

PRODIGY I and PRODIGY II were implemented as extensions to proprietary UK electronic patient record systems. The PRODIGY system includes a guideline model, which in PRODIGY II was used to implement guidelines for the management of acute diseases.

PRODIGY 3 model

The PRODIGY 3 model was created to model guidelines for the management of chronic diseases, such as asthma, hypertension and angina, in primary care. Essentially, it supports guideline modelling a series of decisions that a GP may have to make in different patient encounters. The model enables a guideline to be organised as a network of patient scenarios, management decisions and action step which produce further scenarios. Scenarios are patient states defined by the patient's condition and current treatment. Scenarios are associated with:

  • A consultation template that describes the best-practice workup for a patient in that scenario;
  • A choice between alternative courses of action.
The PRODIGY3 decision model uses rule-in and rule-out conditions associated with each available alternative to determine the preferred course of action.

The management over time of a patient according to a guideline specification can be viewed as the traversal of a number of selected scenarios and associated actions and further decision points along a single path. Sequencing of actions is achieved by defined followed-by relations.

references
Johnson P, Tu S, Jones N. Achieving reuse of computable guideline systems. Medinfo. 2001;10(Pt 1):99-103.

[PubMed]   []

" We describe an architecture for reusing computable guidelines and the programs used to interpret them across varied legacy clinical systems. Developed for the PRODIGY 3 project, our architecture aims to support interactive, point of care use of guidelines in primary care. Legacy medical record systems in UK primary care are diverse, using different terminologies, different data models, and varying user-interface philosophies. However, our goal is to provide common guideline knowledge bases and system components, while achieving full integration with the host medical record system, and a user interface tailored to that system. In conjunction with system suppliers, we identified areas of standardization required to achieve this goal. Firstly, standardized interfaces were created for mediation with the legacy system medical record and for act management. Secondly, a standard interface was developed for communication with the User Interface for guideline interaction. Thirdly, a terminology mapping knowledge base and system component was provided. Lastly, we developed a numeric unit conversion knowledge base and system component. The standardization of this architecture was achieved by close collaboration with existing vendors of Primary Care computing systems in the UK. The work has been verified by two suppliers successfully building and deploying systems with User Interfaces which mirror their normal look and feel, communicating fully with existing medical records, while using identical Guideline Interpreter components and knowledge bases. Encouragingly further experiments in other areas of clinical decision support have not required extension of our interfaces. "
Johnson PD, Tu S, Booth N, Sugden B, Purves IN. Using scenarios in chronic disease management guidelines for primary care. Proc AMIA Symp. 2000;:389-93.

[PubMed]   [AMIA]

" The Prodigy system is a guideline-based decision-support system designed to assist general practitioners in England choose the appropriate therapeutic action for their patients. As part of the system, we developed a novel model for encoding clinical guidelines for managing patients with chronic diseases such as asthma and hypertension. The model structures a guideline as a set of choices to be made by the clinician. It models patient scenarios which drive decision making and are used to synchronize the management of a patient with guideline recommendations. The model is robust with respect to available input data and leaves the control of decision-making to the clinician. We have built execution engines to verify the computability of the model. We intend to test the model integrated in up to 200 live systems from at least four system vendors in English General practice. "
Purves IN, Sugden B, Booth N, Sowerby M. The PRODIGY project - the iterative development of the release one model Proc AMIA Symp. 1999;:359-63.

[AMIA]   []

" We summarise the findings of the first two research phases of the PRODIGY project and describe the guidance model for Release One of the ensuing nationally available system. This model was a result of the iterative design process of the PRODIGY research project, which took place between 1995 and 1998 in up to 183 general practices in the England. Release One of PRODIGY is now being rolled out to all (27,000) General Practitioners in England during 1999-2000. "
P. D. Johnson, S. Tu, N. Booth et al. Using Scenarios in Chronic Disease Management Guidelines for Primary Care Proc. AMIA Annual Symposium, 2000.

[AMIA]   []

" We summarise the findings of the first two research phases of the PRODIGY project and describe the guidance model for Release One of the ensuing nationally available system. This model was a result of the iterative design process of the PRODIGY research project, which took place between 1995 and 1998 in up to 183 general practices in the England. Release One of PRODIGY is now being rolled out to all (27,000) General Practitioners in England during 1999-2000. "
contact Sowerby Centre for Health Informatics at Newcastle Ltd. (SCHIN)
Bede House
All Saints Business Centre
Newcastle upon Tyne
NE1 2ES UK

links  bullet  SCHIN  bullet  PRODIGY DSS website
acknowledgements
Material on this page has been edited from documents on PRODIGY.
page history
Entry on OpenClinical: 2002
Last main update: 16 March 2004, 10 March 2005

 

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