title: Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines: a literature review of guideline representation models.
abstract: Representation of clinical practice guidelines in a computer-interpretable format is a critical issue for guideline development, implementation, and evaluation. We studied 11 types of guideline representation models that can be used to encode guidelines in computer-interpretable formats. We have consistently found in all reviewed models that primitives for representation of actions and decisions are necessary components of a guideline representation model. Patient states and execution states are important concepts that closely relate to each other. Scheduling constraints on representation primitives can be modeled as sequences, concurrences, alternatives, and loops in a guideline's application process. Nesting of guidelines provides multiple views to a guideline with different granularities. Integration of guidelines with electronic medical records can be facilitated by the introduction of a formal model for patient data. Data collection, decision, patient state, and intervention constitute four basic types of primitives in a guideline's logic flow. Decisions clarify our understanding on a patient's clinical state, while interventions lead to the change from one patient state to another.
authors.affiliation: Department of Medical Informatics, Columbia University, VC5 622 West 168th Street, New York, NY 10032, USA. dongwen.wang@dmi.columbia.edu
authors.forename: Dongwen
authors.initials: D
authors.lastname: Wang
authors.forename: Mor
authors.initials: M
authors.lastname: Peleg
authors.forename: Samson W
authors.initials: SW
authors.lastname: Tu
authors.forename: Aziz A
authors.initials: AA
authors.lastname: Boxwala
authors.forename: Robert A
authors.initials: RA
authors.lastname: Greenes
authors.forename: Vimla L
authors.initials: VL
authors.lastname: Patel
authors.forename: Edward H
authors.initials: EH
authors.lastname: Shortliffe
mesh_terms: D001185:Artificial Intelligence; D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical; D006801:Humans; D016239:MEDLINE; D016347:Medical Records Systems, Computerized; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D011381:Programming Languages; D012984:Software