OpenClinical logo

Methods and tools for representing computerised clinical guidelines

Summary information on all methods is provided below - extended details on each are provided on separate pages.
Guideline modelling methods and tools Frameworks & other tools
Executable methods
Arden Syntax Asbru EON GASTON GLARE GLIF GUIDE HELEN Prestige PRODIGY PROforma SAGE
XML methods
CPG-RA GEM HGML Stepper

DeGeL - framework to support the development of a Digital electronic Guideline Library
SEBASTIAN - Web service-based framework for clinical decision support
Protégé - generic environment for ontology and knowledge-base development

spacer

Arden Syntax
summary

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.

developed by Initially: in 1990, by a group at the Arden Homestead in Harriman, New York State. Continued development and maintainance is co-ordinated by the Arden Syntax Special Interest Group of the Clinical Decision Support Technical Committee of HL7.
status

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.

tools

MLM Library available at Arden Syntax website.

in use A number of application-specific implementations of Arden MLMs have been developed by individual commercial vendors in the USA.
links

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

spacer

Asbru
summary

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.

developed by

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

status

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.

tools

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

in use

Prototype applications in diabetes, jaundice and breast cancer.

links  bullet  Asbru [OC]  bullet  Asgaard - Vienna site  bullet  Asgaard - Stanford site

spacer

GPG-RA
summary

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

developed by

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

status

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

tools

Schema is available for use under an Open Source licence.

in use

 

links  bullet  CPG-RA [OC]  bullet  Guidelines International Network (GIN) [OC]

spacer

EON
summary

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

developed by

EON project, Stanford Medical Informatics.

status

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

tools The EON project used Protégé-2000 for authoring applications.

in use

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.

links  bullet  EON [OC]  bullet  EON project at Stanford Medical Informatics  bullet  ATHENA [OC]  bullet  T-HELPER

spacer

GASTON
summary

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

developed by

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

status

Under development; prototype applications developed.

tools

Application authoring and execution environments.

in use

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

links  bullet  GASTON [OC]

spacer

GEM
summary

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

developed by

Yale Center for Medical Informatics

status

In use / under continued development.

tools

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

in use

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

links  bullet  GEM [OC]  bullet  GEM at Yale Center for Medical Informatics

spacer

GLARE
summary

GuideLine Acquisition, Representation and Execution system.

developed by

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.

status

Under development; applications under evaluation.

tools

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

in use

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.

links  bullet  GLARE [OC]  bullet  Dipartimento di Informatica, Università del Piemonte Orientale "Amedeo Avogadro"

spacer

GLIF
summary

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

developed by

Intermed Collaboratory

status

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.

The integration of GLIF and the GLEE execution engine with the clinical information system at the Columbia-Presbyterian Hospital as an infrastructure for clinical decision support is being explored.

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.

tools Dedicated tools to support browsing, authoring, validation, downloading, and execution of GLIF3-encoded guidelines. Protégé also serves as an authoring tool.

in use

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.

links  bullet  GLIF3 [OC]  bullet  GLIF  bullet  Intermed Collaboratory [Stanford]

spacer

GUIDE
summary

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.

developed by

Laboratory of Medical Informatics at the University of Pavia

status

Applications under evaluation.

tools

Guideline authoring & execution environment

in use

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.

links  bullet  GUIDE [OC]  bullet  Laboratory of Medical Informatics at the University of Pavia

spacer

HELEN
summary

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

developed by

2005

status

In use / under continued development

tools

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

in use

Evaluation planned.

links  bullet  HELEN [OC]

spacer

HGML
summary

HGML - Hypertext Guideline Markup Language

developed by

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

status

Under development / evaluation.

tools

Guideline authoring tool (for markup); Guideline Evaluation Engine

in use

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

links  bullet  HGML [OC]  bullet  HGML at University of Medicine and Dentistry of New Jersey

spacer

Prestige
summary

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

developed by

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

status

Funding ended 2000.

tools

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.

in use

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

links  bullet  Prestige [OC]  bullet  Prestige project description

spacer

PRODIGY
summary


The PRODIGY version 3 guideline model, 1998, uses a task-based formalism to represent the management of chronic diseases, particularly asthma and hypertension. Built on the EON model and earlier versions of the PRODIGY model. (PRODIGY is also a computerised clinical decision support system for general practice in the UK.)
developed by

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

status

Discontinued.

tools

Authoring tool: Protégé; dedicated PRODIGY3 execution environment.

in use

links  bullet  PRODIGY (NHS)  bullet  PRODIGY [OC]  bullet  SCHIN

spacer

PROforma
summary

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

developed by

Advanced Computation Laboratory, Cancer Research UK

status

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.

tools

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.

in 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.

links  bullet  PROforma [OC]  bullet  

PROforma clinical applications  bullet  Advanced Computation Laboratory, Cancer Research UK  bullet  InferMed Ltd.

spacer

SAGE
summary

standards-based Shareable Active Guideline Environment

developed by

SAGE project

status

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

tools

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

in use

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

links  bullet  SAGE [OC]  bullet  SAGE workbench download [OC]  bullet  SAGE project

spacer

Stepper
summary

Mark-up tool for narrative guidelines

developed by

EuroMISE centrum – Cardio, University of Economics, Prague

status

Development on hold (2006)

tools

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

in use

Evaluation activities have taken place in hypertension.

links  bullet  Stepper [OC]  bullet  EuroMISE centrum, University of Economics, Prague

spacer

Framework to support the development of an electronic Guideline Library
DeGeL
summary

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

developed by

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

status

Under continued development; applications under evaluation.

tools

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.

in use

links  bullet  DeGeL [OC]  bullet  Medical Informatics, Ben-Gurion University of the Negev, Israel

spacer

Web service-based framework for clinical decision support.
SEBASTIAN
summary

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.

developed by

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

status

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.

tools

See annotated screens below illustrating use of SEBASTIAN tools.

The SEBASTIAN toolset is maintained in-house and the software is not freely available.

Contact Kensaku Kawamoto at Duke University (click link below) if you are interested in accessing the SEBASTIAN toolset.

in use

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."

  • links  bullet  SEBASTIAN [OC]

    spacer

    Generic environment for creating knowledge models and task, ontology and problem-solving methods
    Protégé
    summary

    Open Source ontology development and knowledge acquisition environment

    developed by

    Stanford Medical Informatics

    status

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

    tools

    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.

    in use

    Very wide user community in many domains including healthcare.

    links  bullet  Protégé-2000 [OC]  bullet  Protégé at Stanford University

    links
     bullet  Report and invited presentations from workshop on Clinical Guideline Representation Methods held on September 6 2001  bullet  Software downloads related to electronic clinical guideline development [OC]  bullet  Comparison of six computer-interpretable guideline models (2003): Asbru, EON, GLIF, GUIDE, PRODIGY and PROforma

    spacer

    acknowledgements
    Paolo Ciccarese, Paul de Clercq, John Fox, C. Greg Hagerty, Robert Jenders, Kensaku Kawamoto, Silvia Miksch, Mor Peleg, Ian Purves, Marek Ružicka, Richard Schiffman, Yuval Shahar, Vojtech Svátek, Paolo Terenziani, Samson Tu, Ohad Young
    page history
    Entry on OpenClinical: 2002
    Redesigned 24 March 2005
    Last main updates: 09 May 2005; 13 December 2005; 14 February 2006; 12 May 2006

    Search this site
     
    Privacy policy User agreement Copyright Feedback

    Last modified:
    © Copyright OpenClinical 2002-2011