Reference: Mor Peleg, Aziz A. Boxwala, Elmer Bernstam, Samson Tu, Robert A. Greenes, and Edward H. Shortliffe. Sharable Representation of Clinical Guidelines in GLIF: Relationship to the Arden Syntax. Journal of Biomedical Informatics, in press.
Abstract: Clinical guidelines are intended to improve the quality
and cost effectiveness of patient care. Integration of guidelines into
electronic medical records and order-entry systems, in a way that enables
delivery of patient-specific advice at the point of care, is likely to
encourage guideline acceptance and effectiveness. Among the methodologies
for modeling guidelines and medical decision rules, the Arden Syntax for
Medical Logic Modules and the GuideLine Interchange Format version 3 (GLIF3)
emphasize the importance of sharing encoded logic across different medical
institutions and implementation platforms. These two methodologies have
similarities and differences; in this paper we clarify their roles. Both
methods can be used to support sharing of medical knowledge, but they do
so in complementary situations. The Arden Syntax is suitable for representing
individual decision rules in self-contained units called Medical Logic
Modules (MLMs), which are usually implemented as event-driven alerts or
reminders. In contrast, GLIF3 is designed for encoding complex multi-step
guidelines that unfold over time. As a consequence, GLIF3 has several mechanisms
for complexity management and additional constructs that may require overhead
unnecessary for expressing simple alerts and reminders. Unlike the Arden
Syntax, GLIF3 encourages a top-down process of guideline modeling consisting
of three levels that are created in order: Level 1 comprises a human-readable
flowchart of clinical decisions and actions. Level 2 comprises a computable
specification that can be verified for logical consistency and completeness,
and level 3 comprises an implementable specification that includes information
required for local adaptation of guideline logic as well as for mapping
guideline variables onto institutional medical records. A major emphasis
of the current GLIF3 development process has been to create the computable
specification that formally represents medical decision and eligibility
criteria. We based GLIF3’s formal expression language on the Arden Syntax’s
logic grammar, making the necessary extensions to the Arden Syntax’s data
structures and operators to support GLIF3’s object-oriented data model.
We discuss why the process of generating a set of MLMs from a GLIF-encoded
guideline cannot be automated, why it can result in information loss, and
why simple medical rules are best represented as individual MLMs. We thus
show that the Arden Syntax and GLIF3 play complementary roles in representing
medical knowledge for clinical decision support.
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Full Paper: Full paper available in PDF here .