Protocols, Pathways, and Practice Guidelines: Defining Multiple Step Clinical Algorithms for Automated Navigation

The automated alerting system (Event Engine) running at our institution is a well-developed tool for detecting individual clinical events and notifying the clinician with appropriate action suggestions.' However, protocols, critical pathways, and clinical practice guidelines (CPG's) typically involve more than the detection of a single event. Once an initiating event, e.g., a particular diagnosis or test result, has occurred, the steps followed by the clinician in the management of the problem may vary according to several factors. These include passage of time, such as waiting for a test to be done or a new protocol day; system data, such as the result of the test; or clinician input, such as answers to questions. We have designed an automated processing engine (Navigator) to assist clinicians in managing multiple step clinical algorithms.