CIG Comparison
Preamble
Basis of the study: extracts of two guidelines were modelled in each of six formalisms (Asbru, EON, GLIF, GUIDE, PRODIGY and PROforma) for analysis and comparison. The guidelines were:
The American College of Physicians - American Society of Internal Medicine's guideline for managing chronic cough;
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
Eight aspects of the resulting models were analysed - four that capture the structure of a guideline:
organisation of guideline plans
representation of goals/intentions
representation of guideline actions
models of decision-making
and four that are prerequisites for linking a guideline model with patient data (a key requirement for enabling patient-specific decision support):
expression language
data interpretation
medical concept model
patient information model.
THE COMPARISON STUDY
Peleg M, Tu S, Bury J, Ciccarese P, Fox J, Greenes RA, Hall R, Johnson PD, Jones N, Kumar A, Miksch S, Quaglini S, Seyfang A, Shortliffe EH, Stefanelli M. Comparing computer-interpretable guideline models: a case-study approach. J Am Med Inform Assoc. 2003 Jan-Feb;10(1):52-68.
[PubMed]
"OBJECTIVES: Many groups are developing computer-interpretable clinical guidelines (CIGs) for use during clinical encounters. CIGs use "Task-Network Models" for representation but differ in their approaches to addressing particular modeling challenges. We have studied similarities and differences between CIGs in order to identify issues that must be resolved before a consensus on a set of common components can be developed. DESIGN: We compared six models: Asbru, EON, GLIF, GUIDE, PRODIGY, and PROforma. Collaborators from groups that created these models represented, in their own formalisms, portions of two guidelines: the American College of Physicians-American Society of Internal Medicine's guideline for managing chronic cough and the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. MEASUREMENTS: We compared the models according to eight components that capture the structure of CIGs. The components enable modelers to encode guidelines as plans that organize decision and action tasks in networks. They also enable the encoded guidelines to be linked with patient data-a key requirement for enabling patient-specific decision support. RESULTS: We found consensus on many components, including plan organization, expression language, conceptual medical record model, medical concept model, and data abstractions. Differences were most apparent in underlying decision models, goal representation, use of scenarios, and structured medical actions. CONCLUSION: We identified guideline components that the CIG community could adopt as standards. Some of the participants are pursuing standardization of these components under the auspices of HL7. "
The Guidelines
Comparison case study statement - Summary of the extracts from the cough and hypertension guidelines which were modelled in the study.
Modelling the COUGH guideline
Cough guideline: top level networks for the six models - A set of top-level diagrams showing how the cough guideline was modelled in each of the six formalisms.
Models and documentation
Presentations of the code representing the cough guideline in each formalism
Accompanying explanatory documentation.
Asbru Code (XML) Documentation
EON Documentation
GLIF Code (view in Protege 3.4.1) Documentation
GUIDE Code Documentation
PRODIGY N/A
PROforma Code Documentation
Detailed comparison of the different encodings of the cough guideline. See the 4 documents below:
Modelling the HYPERTENSION guideline
Models and documentation
Presentations of the code representing the hypertension guideline in each formalism
Accompanying explanatory documentation.
Asbru Code Documentation
EON Documentation
GLIF Code (view in Protégé) Documentation
GUIDE Code (MS Access) Documentation
PRODIGY Documentation
PROforma Code Documentation
Detailed comparison of the different encodings of the cough guideline.
Other documents
Execution issues - This document describes guideline execution issues related to each of the six guideline models. These are important for guideline usability but were not covered in the study document which focused on knowledge representation aspects of guideline models.
Support material - This document summarises the support material (from comments and explanations to references to strength of evidence and recommendations) provided by the six guideline modelling methods.
Related references
de Clercq PA, Blom JA, Korsten HH, Hasman A. Approaches for creating computer-interpretable guidelines that facilitate decision support. Artif Intell Med. 2004 May;31(1):1-27. [Pubmed]
"During the last decade, studies have shown the benefits of using clinical guidelines in the practice of medicine. Although the importance of these guidelines is widely recognized, health care organizations typically pay more attention to guideline development than to guideline implementation for routine use in daily care. However, studies have shown that clinicians are often not familiar with written guidelines and do not apply them appropriately during the actual care process. Implementing guidelines in computer-based decision support systems promises to improve the acceptance and application of guidelines in daily practice because the actions and observations of health care workers are monitored and advice is generated whenever a guideline is not followed. Such implementations are increasingly applied in diverse areas such as policy development, utilization management, education, clinical trials, and workflow facilitation. Many parties are developing computer-based guidelines as well as decision support systems that incorporate these guidelines. This paper reviews generic approaches for developing and implementing computer-based guidelines that facilitate decision support. It addresses guideline representation, acquisition, verification and execution aspects. The paper describes five approaches (the Arden Syntax, GuideLine Interchange Format (GLIF), PROforma, Asbru and EON), after the approaches are compared and discussed. "
acknowledgements
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