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. 2011 Dec;18 Suppl 1(Suppl 1):i132-9.
doi: 10.1136/amiajnl-2011-000334. Epub 2011 Nov 3.

A multi-layered framework for disseminating knowledge for computer-based decision support

Aziz A Boxwala  1 , Beatriz H Rocha, Saverio Maviglia, Vipul Kashyap, Seth Meltzer, Jihoon Kim, Ruslana Tsurikova, Adam Wright, Marilyn D Paterno, Amanda Fairbanks, Blackford Middleton
Affiliations

A multi-layered framework for disseminating knowledge for computer-based decision support

Aziz A Boxwala et al. J Am Med Inform Assoc. 2011 Dec.

Abstract

Background: There are several challenges in encoding guideline knowledge in a form that is portable to different clinical sites, including the heterogeneity of clinical decision support (CDS) tools, of patient data representations, and of workflows.

Methods: We have developed a multi-layered knowledge representation framework for structuring guideline recommendations for implementation in a variety of CDS contexts. In this framework, guideline recommendations are increasingly structured through four layers, successively transforming a narrative text recommendation into input for a CDS system. We have used this framework to implement rules for a CDS service based on three guidelines. We also conducted a preliminary evaluation, where we asked CDS experts at four institutions to rate the implementability of six recommendations from the three guidelines.

Conclusion: The experience in using the framework and the preliminary evaluation indicate that this approach has promise in creating structured knowledge, to implement in CDS systems, that is usable across organizations.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
A simplified representation of a diabetes guideline as a flowchart in GLIF. As can be seen in the figure, GLIF represents guidelines as a flow of activities. In comparison, the representation we describe in this paper represents guidelines as a collection of decisions (as shown in figure 3), with no explicit flow or sequencing among the decisions.
Figure 2
Figure 2
The top elements of the knowledge representation for the semi-structured recommendation.
Figure 3
Figure 3
Screenshot illustrating a semi-structured recommendation (top) and a structured recommendation (bottom) from a diabetes mellitus guideline.
See this image and copyright information in PMC

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