A rule-based procedural specification for encoding medical knowledge in knowledge base form as individual Medical Logic Modules (MLMs). The first standard for representing medical knowledge.

In clinical and commercial use. Version 2.0 was adopted by HL7 and ANSI in August, 1999. Version 2.1 was certified as an ANSI standard in December, 2002.

MLM Library available at Arden Syntax website.

   Arden Syntax [OC]    Arden Syntax website by Robert Jenders (at Cedars-Sinai Medical Center, Los Angeles)

Asbru is a time-oriented, task-specific and intention-based plan representation language designed to embody clinical guidelines and protocols as time-oriented skeletal plans. Work on Asbru focuses on data and plan visualization during the design and execution of a computer-interpretable guideline application.

Asgaard project led by the Vienna University of Technology and Stanford Medical Informatics

In use / under continued development at Vienna University of Technology, Austria. Asbru-based work is being undertaken at Ben-Gurion University of the Negev, Israel.

Authoring tools: DELT/A (Vienna), URUZ (Israel); Visualization tools: AsbuView, CareVis (Vienna); Guideline execution tools: Asbru Interpreter (Vienna), SPOCK (Israel).

Prototype applications in diabetes, jaundice and breast cancer.

Clinical Practice Guideline – Reference Architecture: XML Schema for representing narrative clinical practice guidelines.

Under development by the Sowerby Centre for Health Informatics at Newcastle, England; HL7; members of the Guidelines International Network (GIN)

Available for use under an Open Source licence. Under continued development.

Schema is available for use under an Open Source licence.

Component-based guideline model influenced by the ONCOCIN project (in oncology), GLIF2 and PRODIGY3.

EON project, Stanford Medical Informatics.

Funding for EON ended in March 2003 - some of the results were carried forward into the SAGE project.

ATHENA, a hypertension advisory system based on the EON architecture, has been deployed at a number US Department of Veteran Affairs sites; T-HELPER (Therapy-Helper)
development of a data-management environment for patients with HIV.

Generic architecture for the design, development, validation and implementation of guideline-based medical decision support systems.

Eindhoven University of Technology, Maastricht University and Medecs BV, Eindhoven, the Netherlands.

Under development; prototype applications developed.

Application authoring and execution environments.

Guideline-based decision support systems have been implemented in the areas of critical care, family practice, psychiatry, oncology, cardiology and chronic disease management.

The Guideline Elements Model: an international ASTM standard for the representation of practice guidelines in XML format.

Yale Center for Medical Informatics

In use / under continued development.

GEM cutter: a GEM-specific XML editor; GEM-Q: a tool that supports appraisal of guideline quality.

Applications under development. GEM is being used for guideline appraisal and development at the American Academy of Pediatrics.

GuideLine Acquisition, Representation and Execution system.

Dipartimento di Informatica, Università del Piemonte Orientale "Amedeo Avogadro", Alessandria, Italy, in co-operation with the Laboratorio di Informatica Clinica, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy.

Under development; applications under evaluation.

GLARE architecture includes a graphical guideline acquisition tool and a guideline execution tool.

The system has been succesfully tested in different clinical domains (bladder cancer, reflux esophagitis and heart failure), at the Laboratorio di Informatica Clinica, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy.

Guideline specification method and interchange format. GLIF3 provides a task model for patient management and decision making, and executable action specifications.

Intermed Collaboratory

Funding of the InterMed Collaboratory ended in December 2003. GLIF research and implementation work continues however through the HL7 Clinical Guidelines Special Interest Group and various guideline development and integration activities. Research is being undertaken into the local adaptation, versioning and EMR integration of GLIF3-encoded guidelines.

GELLO, an object-oriented query and expression language for clinical decision support, largely derived from GLIF research, was incorporated as an HL7 standard in 2004.

A diabetes foot guideline has been locally adapted to the setting of Israeli primary care physicians in outpatient clinics, linked with a web-based EMR, and enacted using the GLEE execution engine. GLIF/GLEE are being used at Columbia University for post-CABG (Coronary Artery Bypass Grafting) patient care planning.

Component-based multi-level architecture designed to integrate a formalized model of the medical knowledge contained in clinical guidelines and protocols with both workflow management systems and Electronic Patient Record technologies.

Laboratory of Medical Informatics at the University of Pavia

Applications under evaluation.

Guideline authoring & execution environment

Applications: management of stroke patients in hospitals; management of breast cancer in hospital and home-care settings; management of patients with heart failure in primary care.

(Heidelberger Entwicklung von Leitlinien in der Neonatologie.) HELEN provides methods and tools for clinical practice guideline development and execution.

2005

In use / under continued development

Authoring environment based on Protege; GuidelineViewer - visualisation tool (Java Servlet); Guideline Execution Engine (GEE).

Evaluation planned.

HGML - Hypertext Guideline Markup Language

Under development by the Clinical Informatics Research Group, University of Medicine and Dentistry of New Jersey; Department of Computer Science Rutgers University

Under development / evaluation.

Guideline authoring tool (for markup); Guideline Evaluation Engine

Prototype applications based on HEDIS guidelines under development including Hypertension (JNC_VII), Cholesterol, Stroke, Immunization

Guideline interchange format; built on guideline modelling work undertaken in various previous European projects.

Prestige project (European Commission 4th Framework project, 1996-2000)

Funding ended 2000.

GAUDI: Guideline authoring and dissemination tool which incorprates a terminology server and model, GRAIL, developed by the GALEN project; GLEAM - Guideline editing and authoring module. Prestige Act Management software provides the application enactment environment.

Evaluated in primary care settings in five EU countries and in hospital environments in Portugal and the UK.

SCHIN: the Sowerby Centre for Health Informatics at Newcastle (at the time, a Newcastle University academic research centre; now a private company)

Discontinued.

Authoring tool: Protégé; dedicated PRODIGY3 execution environment.

Formal knowledge representation language for authoring, publishing and executing clinical guidelines.

Advanced Computation Laboratory, Cancer Research UK

Under continued development.

PROforma technology for authoring and publishing executable clinical guidelines has been commercialised (under the Arezzo brand name) by InferMed Ltd. in London. Java-based authoring and execution tools (Tallis) have been developed at Cancer Research UK and are available for research use.

Dedicated authoring and execution environments for Arezzo, a commercial implementation of PROforma. The Composer and Performer are products of InferMed Ltd. in London. The Advanced Computation Laboratory has developed the Tallis Composer and guideline publishing and exectiion environments. These are available for collaborative research use.

PROforma has been used to develop a wide range of prototype and routinely used clinical applications in domains incluing HIV, Cancer care and postoperative pain management.

standards-based Shareable Active Guideline Environment

SAGE project

The SAGE clinical decision support environment, incorporating immunization and diabetes guidelines, is being evaluated at 2005.

Dedicated workbench (authoring tool and execution engine) is available to download for evaluation purposes.

Applications for immunization, diabetes, and community-acquired pneumonia are under development and evaluation.

Mark-up tool for narrative guidelines

EuroMISE centrum – Cardio, University of Economics, Prague

Development on hold (2006)

Stepper mark-up tool (available for download for evaluation and research purposes)

Evaluation activities have taken place in hypertension.

Ontology-independent framework to support the development and implementation of a clinical guideline digital library.

Medical Informatics, Department of Information Systems Engineering, Ben-Gurion University of the Negev, Israel

Under continued development; applications under evaluation.

A large number of tools and services have been created including the URUZ web-based authoring tool, the VisiGuide guideline browsing and visualisation tool and the Vaidurya guideline search engine.

SEBASTIAN is a Web service-based framework for (i) encoding medical knowledge into a machine-executable format; (ii) integrating this knowledge into various clinical applications to enable clinical decision support.

Division of Clinical Informatics, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA

In use / under continued development.

The SEBASTIAN service interface is serving as the basis for the emerging HL7 Decision Support Service specification which seeks to standardize the input/output interface for services that use patient data to deliver patient-specific conclusions in a machine-interpretable format.

See annotated screens below illustrating use of SEBASTIAN tools.

SEBASTIAN has been used to implement four decision support systems to date:

An outpatient Diabetes Reminder System (DRS) at the Duke Family Medicine Center

Three systems to support the health management of approximately 16,000 Medicaid beneficiaries in Durham County, North Carolina. "One system provides patients’ primary care clinics with reports that list the patients most in need of services, along with identified care needs and recommended actions. A second system emails alerts to appropriate health care providers regarding care issues requiring follow-up, and a third system generates care reminder letters for patients in English and, when applicable, in Spanish."

Open Source ontology development and knowledge acquisition environment

Stanford Medical Informatics

Open Source tool freely available from Stanford University. Under continued development.

Protégé-2000 is an integrated knowledge-base editing environment for the creation of customized knowledge-based tools. Can be used, for example, to support the development of models and clinical knowledge applications.

Very wide user community in many domains including healthcare.