This paper describes a multi-year attempt to develop, implement and maintain an evidence-based international clinical decision support system for preventing and treating chronic wounds. Incidental to implementation efforts, over 37,000 wound assessments, risk assessments and treatment events were accumulated. These data allowed further confirmation of the evidence on which protocols and algorithms were based as well as empirically based rationales for refinement or the protocols and algorithms. However, during the decade-long project many challenges were faced. Key points of learning are also presented. An iterative incidental model for applied health informatics is presented as a context for viewing the efforts.
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