From clinical practice guidelines, to clinical guidance in practice - impacts for computerization.

This paper presents a case study of clinical guidance within oncology clinics. Close to all patients treated within the observed clinics were treated according to clinical practice guidelines in the form of either a research or a standard treatment protocol. The clinical practice guideline artifacts were however rarely applied in clinical practice. It was first when the guidelines were translated and transformed into second order guiding artifacts (SOGAs) they were applied. The SOGAs applied in clinical practice were activity specific holding space for relevant documentation. The transformation from clinical practice guideline to SOGA was executed according to a standard operating procedure. A wide number of physical features were applied to support quick overview and application in clinical practice. The clinicians were actively participating in the translation and transformation process obtaining ownership to the resulting artifacts. The implications for computerization of clinical practice guidelines are discussed.