Analysis of the Process of Encoding Guidelines: A Comparison of GLIF2 and GLIF3

Summary

Objectives: This study aims to evaluate the use of a modified version of the Guideline Interchange Format (GLIF), GLIF3, in the translation of clinical practice guidelines into an electronically encoded form such that they may be shared among various clinical institutions and settings.

Methods: Based on theories and methods from cognitive science, the encoding of two clinical practice guidelines into two guideline modeling methods (GLIF3 and an earlier version, GLIF2) by two medical informaticians was captured on video and transcribed and annotated for analysis.

Results: Differing in both content and structure, the representations developed in GLIF3 were found to contain a greater level of representational detail and less ambiguity than those developed in GLIF2.

Conclusions: The use of GLIF3 in the encoding of clinical guidelines offers significant improvements due to its greater formality as compared to earlier versions of GLIF.

Keywords

Knowledge - practice guidelines - evaluation studies - cognitive science

• References

• 1 Lobach D, Hammond W. Computerized decision support based on a clinical practice guideline improves compliance with care standards. Am J Med 1997; 102: 89-98.
• 2 Boxwala A, Greenes R, Deibel S. Architecture for a multipurpose guideline execution engine. Proc AMIA Ann Symp. 1999: 701-5.
• 3 Patel V, Kushniruk A. Understanding, navigating and communicating knowledge. Issues and challenges. Methods Inf Med 1998; 37: 460-70.
• 4 Fox J, Johns N, Rahmanzadeh A. Disseminating medical knowledge: The PROforma approach. Art Int Med 1998; 14: 157-81.
• 5 Purves I, Sugden B, Booth N, Sowerby M. The PRODIGY project – The interactive development of the release one model. Proc AMIA Ann Symp. 1999: 359-63.
• 6 Ohno-Machado L, Gennari J, Murphy S. et al. The guideline interchange format: A model for representing guidelines. JAMIA 1998; 5 (Suppl. 04) 357-72.
• 7 Shortliffe EH, Patel VL, Cimino JJ, Barnett G, Greenes RA. A study of collaboration among medical informatics research laboratories. Art Int Med 1998; 12: 97-123.
• 8 Shortliffe E, Barnett G, Cimino J, Greenes R, Huff S, Patel V. Collaborative medical informatics research using the Internet and the World Wide Web. Proc AMIA Ann Symp. 1996: 125-9.
• 9 Patel V, Allen V, Arocha J, Shortliffe E. Representing clinical guidelines in GLIF: Individual and collaborative expertise. JAMIA 1998; 5 (Suppl. 05) 467-83.
• 10 Larkin J, Simon H. Why a diagram is (sometimes) worth ten thousand words. Cog Sci 1987; 11 (Suppl. 01) 65-99.
• 11 Fridsma D, Gennari J, Musen M. Making generic guidelines site-specific. Proc AMIA Ann Symp. 1996: 597-601.
• 12 Patel V, Arocha J, Kaufman D. Diagnostic reasoning and medical expertise. Psych Learn Mot 1994; 31: 137-252.
• 13 Peleg M, Boxwala A, Ogunyemi O. et al. GLIF3: The evolution of a guideline representation format. Proc AMIA Ann Symp. 2000: 646-9.
• 14 Snow V, Lascher S, Mottur-Pilson C. Pharmacological treatment of acute major depression and dysthmia. Ann Int Med 2000; 132 (Suppl. 09) 738-42.
• 15 Helfand M, Redfern C. Screening for thyroid disease: An update. Ann Int Med 1998; 129: 144-58.
• 16 Patel V, Kushniruk A, Yang S, Yale J. Impact of a computer-based patient record system on data collection, knowledge organization, and reasoning. JAMIA 2000; 7 (Suppl. 06) 569-85.
• 17 Kushniruk A, Patel V. Cognitive evaluation of decision making processes and assessment of information technology in medicine. IJMI 1998; 51: 83-90.
• 18 Kushniruk A, Kauman D, Patel V, Levesque Y, Lottin P. Assessment of a computerized patient record system: A cognitive approach to evaluating an emerging medical technology. MD Comp 1996; 5: 406-15.
• 19 Roschelle J, Sibley J. CVideo User Guide. San Francisco: Envisionology; 1992
• 20 Boxwala A, Methta P, Peleg M. et al. Modeling guidelines using domain-level knowledge representation components. Proc AMIA Ann Symp. 2000: 645.