Clinical Guideline Representation and Sharing

A major part of this work has centered on the cooperative development and refinement of a common GuideLine Interchange Format(called GLIF). GLIF defines a logical structure and text-based exchange format that can be used as a basis for shared representation. The model includes a range of guideline step types and wrappers for patient data and action models that may be associated with a guideline.

As part of this work, we have been working on the development of a high-level guideline, patient data, and action modeling environment, a guideline server, guideline viewing and browsing capabilities, and a guideline interpretation engine.

For more information on GLIF, please visit http://www.glif.org or send an e-mail to greenes@harvard.edu.

The Clinical Guidelines Special Interest Group (co-chaired by Dr. Greenes) in the HL7 Decision Support Technical Committee is creating standards for guideline representation and implementation. The infrastructure components of the evolving standards are based in part on our GLIF work. In particular, an object-oriented expression and query language that is being developed by us is being proposed as an HL7 standard. The expression language can be used to write decision criteria and other logical and temporal expressions for clinical guidelines and Arden Syntax MLMs. The query language is used to specify in a platform-independent manner, the data items that are part of the expressions in guidelines and MLMs. The query language is thus an attempt to solve the “curly braces” issue.

Publications

1. Boxwala AA, Tu S, Peleg M, Zeng Q, Ogunyemi O, Greenes RA, Shortliffe EH, Patel VL. Toward a representation format for sharable clinical guidelines. J Biomed Inform. 2001;34(3):157-169.
2. Boxwala AA, Tu S, Peleg M, Zeng Q, Ogunyemi O, Greenes RA, Shortliffe EH, Patel VL. Sharable representation of clinical guidelines in GLIF: relationship to the Arden Syntax. J Biomed Inform. 2001;34(3):170-181.
3. Peleg M, Ogunyemi O, Tu S, Boxwala A, Zeng Q, Greenes RA, Shortliffe EH. Using features of Arden Syntax with object-oriented medical data models for guideline modeling. J of the American Medical Informatics Association, 2001 8(Suppl).
4. Peleg M, Boxwala AA, Tu S, Greenes RA, Shortliffe EH, Patel VL. Handling expressiveness and comprehensibility requirements in GLIF3. Medinfo. 2001;10(Pt 1):241-5.
5. Greenes RA, Peleg M, Boxwala A, Tu S, Patel V, Shortliffe EH. Sharable computer-based clinical practice guidelines: rationale, obstacles, approaches, and prospects. Medinfo. 2001;10(Pt 1):201-5.
6. Patel VL, Arocha JF, Diermeier M, Greenes RA, Shortliffe EH. Methods of cognitive analysis to support the design and evaluation of biomedical systems: the case of clinical practice guidelines. J Biomed Inform. 2001;34(1):52-66.
7. Elkin PL, Peleg M, Lacson R, Bernstam E, Tu S, Boxwala A, Greenes R, Shortliffe EH. Toward the standardization of electronic guidelines. MD Comput. 2000;17(6):39-44.
8. Peleg M, Boxwala AA, Ogunyemi O, Zeng Q, Tu S, Lacson R, Bernstam E, Ash N, Mork P, Ohno-Machado L, Shortliffe EH, Greenes RA. GLIF3: the evolution of a guideline representation format. Proc AMIA Symp. 2000;645-9.
9. Bernstam E, Ash N, Peleg M, Tu S, Boxwala AA, Mork P, Shortliffe EH, Greenes RA. Guideline classification to assist modeling, authoring, implementation and retrieval. Proc AMIA Symp. 2000;66-70.
10. Boxwala AA, Greenes RA, Deibel SR. Architecture for a multipurpose guideline execution engine. Proc AMIA Symp. 1999;701-5.
11. Greenes RA, Boxwala A, Sloan WN, Ohno-Machado L, Deibel SR. A framework and tools for authoring, editing, documenting, sharing, searching, navigating, and executing computer-based clinical guidelines. Proc AMIA Symp. 1999;261-5.
12. Patel VL, Allen VG, Arocha JF, Shortliffe EH. Representing clinical guidelines in GLIF: individual and collaborative expertise. J Am Med Inform Assoc. 1998 Sep-Oct;5(5):467-83.
13. Ohno-Machado L; Gennari JH; Murphy S; Jain NL; Tu SW; Oliver DE; Pattison-Gordon E; Greenes RA; Shortliffe EH; Barnett GO. The GuideLine Interchange Format: A Model for Representing Guidelines. Journal of the Americal Medical Informatics Association 1998;5(4):357-72.
14. E. Pattison-Gordon, J. J. Cimino, G. Hripsak, S. W. Tu, J. H. Gennari, N. L. Jain, & R. A. Greenes. Requirements of a Sharable Guideline Representation for Computer Applications. 1996.
15. Stoufflet P, Deibel RA, Lee D, Traum JH, Greenes RA. Integrating guidelines and information support into clinical workflow in a distributed environment: Data structures and knowledge represetation for GEODE-CM. Proc AMIA 1996 Spring Congress. Kansas City, MO. 1996; 109 (abstract).
16. Greenes RA, Karson T, Labkoff S, McHolm G, Obeid J, Pattision-Gordon E, Shareck EP, Stoufflet P. A conformance model for clinical guidelines to facilitate sharing and reuse in enterprise-based and telemedicine settings. Proc AMIA 1996 Spring Congress. Kansas City, MO. 1996; 108.
17. Stoufflet PE, Deibel SRA, Traum JH, Greenes RA. A state-transition method of modeling clinical encounters. Proc 1995 AMIA Spring meeting, 1995; 81 (abstract).
18. Liem EB, Obeid JS, Shareck P, Sato L, Greenes RA. Representation of clinical practice guidelines through an interactive WWW interface. Proc Nineteenth Annual Symposium on Computer Applications in Medical Care (SCAMC), New Orleans, LA. Nov, 94. Philadelphia: Hanley & Belfus. 1995; 22 3-227
19. Shiffman RN, Leape L, Greenes RA. Translation of appropriateness criteria into practice guidelines: Application of decision table techniques to the RAND criteria for coronary artery bypass graft. Proc Seventeenth Annual Symposium on Computer Applications in Medical Care (SCAMC), Washington, DC. Nov, 93. New York: McGraw-Hill. 1994; 248-252
20. Shiffman RN, Greenes RA. Improving clinical guidelines with logic and decision table techniques: Application to hepatitis immunization recommendations. Med Dec Making, 1994; 14(3): 245-254
21. Shiffman RN, Greenes RA. Rule set reduction using augmented decision table and semantic subsumption techniques: Application to cholesterol guidelines. Proc Sixteenth Annual Symposium on Computer Applications in Medical Care (SCAMC), Baltimore, MD, Nov 92. New York: McGraw-Hill. 1993; 339-343
22. Shiffman RN, Greenes RA. Improving clinical guidelines with logic and decision table techniques: Application to hepatitis immunization recommendations. Proc. Ann Meeting, Soc. of Med. Decis. Making, October, 1993;1 (abstract)
23. Shiffman RN, Greenes, RA. Consolidation of hypercholesterolemia treatment guidelines by subsumption. Proc. Ann. Meeting, Soc. of Med. Decis. Making, Portland, OR. Oct, 1992 (abstract)
24. Shiffman RN, Greenes RA. Use of augmented decision tables to convert probabilistic data into clinical algorithms for the diagnosis of appendicitis. Proc Fifteenth Annual Symposium on Computer Applications in Medical Care (SCAMC), Washington, DC. Nov, 91. New York: McGraw-Hill. 1992; 686-690
25. Kamae IR, Greenes RA. A computational model of approximate Bayesian inference for associating clinical algorithms with decision analyses. Proc Fifteenth Annual Symposium on Computer Applications in Medical Care (SCAMC), Washington, DC. Nov, 91. New York: McGraw-Hill. 1992; 691-695
26. McClay JC, Greenes RA, Sanchez R. Issues in converting published practice guidelines into electronic format. Proc AMIA Spring Meeting, Portland OR. May, 1992; 53 (abstract)
27. Abendroth TW. Greenes RA. A clinical algorithm processor: Enabling flowcharts to organize a variety of physician tasks. Proc Thirteenth Annual Symposium on Computer Applications in Medical Care (SCAMC), Washington, DC. New York: IEEE Computer Society Press. November, 1989; 983-984
28. Abendroth TW, Greenes RA. Computer presentation of clinical algorithms. MD Comput. 1989; 6(5): 295-299
29. Abendroth TW, Greenes RA, Joyce EA. Investigations in the use of clinical algorithms to organize medical knowledge. Proc Twelfth Annual Symposium on Computer Applications in Medical Care (SCAMC), Washington, DC. New York: IEEE Computer Society Press. November, 1988; 90-93