Abstract
BACKGROUND: Best practice standards aim to standardize care and improve outcomes. However, variation in clinical practice exists, and not all deviations are inappropriate. Measuring adherence to best practice standards remains challenging due to limitations in representation methods and data fidelity. OBJECTIVE: This scoping review aims to survey and synthesize the existing literature on the computable representation of guideline recommendations and to explore methods for detecting and quantifying deviations from best practice standards. METHODS: We followed the Arksey and O'Malley framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Five databases (Ovid Medline, EMBASE, IEEE Xplore, Web of Science, and Scopus) were searched in November 2025. Studies were included if they either (1) described a computer representation of best practice standards or (2) assessed adherence to such standards using patient data, including patient data derived from electronic medical records or event logs. Screening was done using Covidence (Veritas Health Innovation). Data were extracted on representation, clinical context, data sources, adherence metrics, and modeling techniques. A narrative synthesis was conducted to identify themes. RESULTS: Twenty-four studies were included. Most studies were published as conference proceedings (13/24, 54%). Fourteen studies (14/24, 58%) included measurement of adherence to best practice standards. Cardiovascular conditions were the most common focus (13/24, 54%). Data sources included Health Level Seven (HL7) messages, structured electronic medical record data, event logs, and Fast Healthcare Interoperability Resources (FHIR)-transformed data. Best practice standards were formalized using Business Process Model and Notation (BPMN; 6/24, 25%), ontologies (7/24, 29%), FHIR (4/24, 17%), or hybrid approaches (4/24, 17%). The most common method for adherence measurement was rule-based alignment. Several studies incorporated weighted scoring to differentiate the severity of deviations. Process mining was used in a subset to detect sequence and timing variations. However, most models lacked contextual sensitivity and rarely incorporated patient-specific factors, such as comorbidities, patient acuity, or clinician rationale. Consequently, although deviations can be automatically identified, determining whether they were clinically warranted remained largely unresolved. CONCLUSIONS: Despite promising advances, challenges persist in computer-interpretable representation and measuring adherence in a clinically meaningful way. Current approaches predominantly assess technical alignment rather than clinical relevance and are limited by data quality and standardization, thereby limiting real-world utility. This scoping review offers an innovative contribution by synthesizing evidence from 2 separate domains-the computable representation of best practice standards and the measurement of adherence. The findings emphasize the need for context-aware, standardized modeling and integration with clinical workflows to distinguish warranted from unwarranted deviations. Such advances are essential for scalable, transparent, and real-time adherence monitoring-ultimately driving safer, patient-centered care delivery.