SAGE project prepares to build off pilot test success

By Healthcare IT News
12:00 AM

The SAGE project is closing in on a universal framework for encoding clinical information and decision support so they can be based on standards and shared among healthcare organizations.

While most everyone agrees that bringing these guidelines to physicians when they're face-to-face with patients could improve care, it's easier said than done.

In the SAGE (Standards-Based Shareable Active Guideline Envir-onment) model, physicians could have guidelines available when they're seeing patients. The encoded guidelines would be able to interact with patient data in an organization's clinical information system, recommend an immediate course of ac-tion, and create care reminders and orders to be implemented in the future.

SAGE is nearing the end of a three-year, $18.5 million grant from the advanced technology program of the National Institutes of Science and Technology. Partners in the project include two vendors, IDX Systems Corp. and Apelon Inc.; three providers, Intermountain Healthcare, the Mayo Clinic and the University of Nebraska Medical Center; and Stanford Medical Informatics, a research group with Stanford University's School of Medicine.

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While work still is under way on the three essential components of the project, the overall effort has been making satisfactory progress, said Nick Beard, vice president of health informatics in the Seattle office of IDX, who's heading the project.

"Our goal is that, using SAGE technology, we would be able to embed guidelines in local clinical information systems," Beard said. "The guidelines would be active in the background, providing checks and balances and making sure care was optimal."

SAGE envisions an electronic representation of a clinical guideline, kind of an electronic decision tree that helps clinicians with care options. Then, such representations need to go to a "workbench," which encodes the guidelines with standardized programming objects and vocabularies. Finally, the guidelines can be deployed in a live setting.

The effort has just completed a successful pilot test, Beard said. Late last year, SAGE took a paper-based guideline for immunization, coded it through the workbench so that it included logic rules, and then implemented it on a trial basis so it would forward electronic recommendations to physicians.

In the pilot test, researchers were able to make changes in the clinical logic using the workbench, as well as export the guideline to a computer at another site.

While Beard said the pilot test was successful and SAGE is making significant progress, he acknowledges that it's a challenging and ambitious project.

For example, encoding of guidelines at the workbench requires the work of someone with clinical expertise and technical knowledge to work with complex information systems. And deployment of the technology is expected to be the most difficult piece because of the variety of clinical information systems and because guidelines will need to be modified for local preferences and idiosyncrasies.

Beard said SAGE expects to mount an effort this year to educate healthcare organizations and vendors on the project's progress and vision. Because SAGE will be based on industry standards, it can be adopted widely; SAGE is working to develop a standard specification so vendors' clinical systems can be SAGE-compliant, he said.

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