Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts

In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org webcite).The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context.When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.Numerous papers have proposed or described models and clinical guideline systems (CGS) to support computer-executable guidelines. Comprehensive comparative reviews of different CGSs, notably the reviews of Peleg et al. [1] and de Clerq et al. [2] and the more current review of Isern and Moreno [3] have assisted in defining high-level requirements of guideline systems. In addition, Sweidan et al. [4] deal with evaluation measures associated with clinical software that could be applied to CGSs. However, as the Isern and Moreno review points out, no model appears to have been deployed as production-level software that assists patient management on a daily basis: though one commercial product, Arezzo [5] is based on the PROforma model [6], no peer-reviewed publications describing its use in routine healthcare have appeared to date.Apart from content-related issues such as guideline quality and comprehensiv