With good intentions

OBJECTIVE: To develop a framework for clinical practice guidelines that not only allows the representation of best practices, but also facilitates reasoning about acceptable alternatives for those best practices. METHOD: Design of an explicit representation formalism of intentions of guidelines and guideline steps. Implementation of this representation and reasoning mechanisms in GASTON, a tool for representing and executing computerized clinical guidelines. RESULTS: The developed formalism is used to represent a heart failure clinical guideline. It is demonstrated that the representation of intentions provides the needed flexibility to avoid unnecessary errors and warnings. CONCLUSION: By using an explicit representation of the intentions of guidelines and guideline steps, a flexible decision support system can be built that does not check only the adherence to the formal guideline but evaluates clinical activities in light of the intention of the guidelines