Review Paper: The InterMed Approach to Sharable Computer-interpretable Guidelines: A Review

InterMed is a collaboration among research groups from Stanford, Harvard, and Columbia Universities. The primary goal of InterMed has been to develop a sharable language that could serve as a standard for modeling computer-interpretable guidelines (CIGs). This language, called GuideLine Interchange Format (GLIF), has been developed in a collaborative manner and in an open process that has welcomed input from the larger community. The goals and experiences of the InterMed project and lessons that the authors have learned may contribute to the work of other researchers who are developing medical knowledge-based tools. The lessons described include (1) a work process for multi-institutional research and development that considers different viewpoints, (2) an evolutionary lifecycle process for developing medical knowledge representation formats, (3) the role of cognitive methodology to evaluate and assist in the evolutionary development process, (4) development of an architecture and (5) design principles for sharable medical knowledge representation formats, and (6) a process for standardization of a CIG modeling language.

[1]  William DuMouchel,et al.  A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. , 1996, Journal of the American Medical Informatics Association : JAMIA.

[2]  T A Pryor,et al.  Rationale for the Arden Syntax. , 1994, Computers and biomedical research, an international journal.

[3]  Aziz A. Boxwala,et al.  Applying Axiomatic Design Methodology to Create Guidelines That Are Locally Adaptable , 2002, AMIA.

[4]  Vimla L. Patel,et al.  Research Paper: Representing Clinical Guidelines in GLIF: Individual and Collaborative Expertise , 1998, J. Am. Medical Informatics Assoc..

[5]  Aziz A. Boxwala,et al.  Sharable Representation of Clinical Guidelines in GLIF: Relationship to the Arden Syntax , 2001, J. Biomed. Informatics.

[6]  Edward H. Shortliffe,et al.  GLEE-a model-driven execution system for computer-based implementation of clinical practice guidelines , 2002, AMIA.

[7]  Aziz A. Boxwala,et al.  Sharable computer-based clinical practice guidelines: rationale , 2001 .

[8]  Robert A. Greenes,et al.  Research Paper: The GuideLine Interchange Format: A Model for Representing Guidelines , 1998, J. Am. Medical Informatics Assoc..

[9]  R A Greenes,et al.  Toward a Framework for Computer-Mediated Collaborative Design in Medical Informatics , 1999, Methods of Information in Medicine.

[10]  Robert A. Greenes,et al.  Methods of Cognitive Analysis to Support the Design and Evaluation of Biomedical Systems: The Case of Clinical Practice Guidelines , 2001, J. Biomed. Informatics.

[11]  Lucila Ohno-Machado,et al.  GEODE-CM: A State-Transition Framework for Clinical Management , 1996 .

[12]  Vimla L. Patel,et al.  Cognitive psychological studies of representation and use of clinical practice guidelines , 2001, Int. J. Medical Informatics.

[13]  Massachusett Framingham,et al.  The Common Object Request Broker: Architecture and Specification Version 3 , 2003 .

[14]  Aziz A. Boxwala,et al.  Guideline classification to assist modeling, authoring, implementation and retrieval , 2000, AMIA.

[15]  Giordano Lanzola,et al.  Flexible guideline-based patient careflow systems , 2001, Artif. Intell. Medicine.

[16]  A. Watson,et al.  OMG (Object Management Group) architecture and CORBA (common object request broker architecture) specification , 2002 .

[17]  G O Barnett,et al.  An architecture for a distributed guideline server. , 1995, Proceedings. Symposium on Computer Applications in Medical Care.

[18]  Aziz A. Boxwala,et al.  Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines: : A literature review of guideline representation models , 2002, Int. J. Medical Informatics.

[19]  Samson W. Tu,et al.  From guideline modeling to guideline execution: defining guideline-based decision-support services , 2000, AMIA.

[20]  Henrik Eriksson,et al.  Knowledge modeling at the millennium : The design and evolution of Protégé-2000 , 1999 .

[21]  Sandra Simonsen-Anderson,et al.  Safe and sound. , 2002, Nursing management.

[22]  Aziz A. Boxwala,et al.  Combining a Document Model and an Execution Model for Clinical Guidelines , 2001, AMIA.

[23]  Aziz A. Boxwala,et al.  Representing Domain-level Knowledge Components Using Primitives , 2001, AMIA.

[24]  P. Clayton,et al.  Encoding a post-operative coronary artery bypass surgery care plan in the Arden Syntax. , 1994, Computers in biology and medicine.

[25]  Yuval Shahar,et al.  The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines , 1998, Artif. Intell. Medicine.

[26]  J. Marc Overhage,et al.  Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission , 1997, J. Am. Medical Informatics Assoc..

[27]  Richard N. Shiffman,et al.  Model Formulation: GEM: A Proposal for a More Comprehensive Guideline Document Model Using XML , 2000, J. Am. Medical Informatics Assoc..

[28]  Aziz A. Boxwala,et al.  Handling Expressiveness and Comprehensibility Requirements in GLIF3 , 2001, MedInfo.

[29]  Omolola Ogunyemi,et al.  Using features of Arden Syntax with object-oriented medical data models for guideline modeling , 2001, AMIA.

[30]  Omolola Ogunyemi,et al.  GLIF3: a representation format for sharable computer-interpretable clinical practice guidelines , 2004, J. Biomed. Informatics.

[31]  Jonathan M. Teich,et al.  P-CAPE: a high-level tool for entering and processing clinical practice guidelines. Partners Computerized Algorithm and Editor , 1998, AMIA.

[32]  Nick Booth,et al.  The PRODIGY project-the iterative development of the release one model , 1999, AMIA.

[33]  Nick Booth,et al.  Using scenarios in chronic disease management guidelines for primary care , 2000, AMIA.

[34]  Omolola Ogunyemi,et al.  GLIF3: the evolution of a guideline representation format , 2000, AMIA.

[35]  Robert A. Greenes,et al.  Support for guideline development through error classification and constraint checking , 2002, AMIA.

[36]  V. Patel,et al.  Analysis of the process of encoding guidelines: a comparison of GLIF2 and GLIF3. , 2002, Methods of information in medicine.

[37]  Samson W. Tu,et al.  A Typology for Modeling Processes in Clinical Guidelines and Protocols , 2010, AMIA.

[38]  Clement J. McDonald,et al.  Integrating medical information and knowledge in the HL7 RIM , 2000, AMIA.

[39]  Robert A. Greenes,et al.  A study of collaboration among medical informatics research laboratories , 1998, Artif. Intell. Medicine.

[40]  Omolola Ogunyemi,et al.  Toward a Representation Format for Sharable Clinical Guidelines , 2001, J. Biomed. Informatics.

[41]  Yuval Shahar,et al.  Synthesis of Research: EON: A Component-Based Approach to Automation of Protocol-Directed Therapy , 1996, J. Am. Medical Informatics Assoc..

[42]  Aziz A. Boxwala,et al.  Architecture for a multipurpose guideline execution engine , 1999, AMIA.

[43]  Colin Gordon,et al.  Guidelines in Healthcare: the experience of the Prestige project , 1999, MIE.

[44]  Donald E. Knuth,et al.  The errors of tex , 1989, Softw. Pract. Exp..

[45]  John Fox,et al.  Disseminating medical knowledge: the PROforma approach , 1998, Artif. Intell. Medicine.

[46]  Samson W. Tu,et al.  A flexible approach to guideline modeling , 1999, AMIA.

[47]  Aziz A. Boxwala,et al.  Sharable Computer-based Clinical Practice Guidelines: Rationale, Obstacles, Approaches, and Prospects , 2001, MedInfo.