Improving the quality of public health guidance: A business rules approach.

Context: In this article, the authors discuss potential advantages that business rules methodology offers for improvement of public health operational guidance and documents.

Program: Immunization Information Systems (IIS) program at the Centers for Disease Control and Prevention (CDC).

Implementation: Systematic methods of business analysis and business rules were successfully employed in two multi-year efforts to develop guidance for various aspects of IIS operations.

Evaluation: Independent evaluation findings indicate that application of these best practice recommendations in the IIS domain of state and local health departments resulted in improved data quality, reduced staff time, and increased efficiencies across immunization programs, as well as in uniformity and reduced ambiguity for clinical decision support. Also, to illustrate the approach, a special case study presents a systematic analysis of highly regarded work by the prominent scientist and renowned writer Isaac Asimov, identifying inconsistencies, typical challenges, and areas for improvement.

Discussion: The two successful case studies in the IIS domain of public health point to the potential of applying business rules methods in rigorously documenting operational guidance, substantially reducing ambiguity, and ultimately, improving the uniformity, completeness, and practicality of information within critical documents of public health programs. Experience gained with these projects can be leveraged and built upon going forward. Also, a special study of writings by Dr. Asimov provides a strong word of caution about the unintended consequences and potential shortcomings of formulating guidance without leveraging a systematic approach, such as offered by business rules techniques. This is an opportune time for public health to embrace this proven methodology, expanding its arsenal of practicable tools to analyze and improve public health guidance.