A pattern-based analysis of clinical computer-interpretable guideline modeling languages.
OBJECTIVE
Languages used to specify computer-interpretable guidelines (CIGs) differ in their approaches to addressing particular modeling challenges. The main goals of this article are: (1) to examine the expressive power of CIG modeling languages, and (2) to define the differences, from the control-flow perspective, between process languages in workflow management systems and modeling languages used to design clinical guidelines.


METHODS
The pattern-based analysis was applied to guideline modeling languages Asbru, EON, GLIF, and PROforma. We focused on control-flow and left other perspectives out of consideration.


METHODS
We evaluated the selected CIG modeling languages and identified their degree of support of 43 control-flow patterns. We used a set of explicitly defined evaluation criteria to determine whether each pattern is supported directly, indirectly, or not at all.


RESULTS
PROforma offers direct support for 22 of 43 patterns, Asbru 20, GLIF 17, and EON 11. All four directly support basic control-flow patterns, cancellation patterns, and some advance branching and synchronization patterns. None support multiple instances patterns. They offer varying levels of support for synchronizing merge patterns and state-based patterns. Some support a few scenarios not covered by the 43 control-flow patterns.


CONCLUSIONS
CIG modeling languages are remarkably close to traditional workflow languages from the control-flow perspective, but cover many fewer workflow patterns. CIG languages offer some flexibility that supports modeling of complex decisions and provide ways for modeling some decisions not covered by workflow management systems. Workflow management systems may be suitable for clinical guideline applications.
Mulyar
Nataliya
N
Eindhoven University of Technology Paviljoen J.08, NL-5600 MB Eindhoven, the Netherlands. n.mulyar@tue.nl
van der Aalst
Wil M P
WM
Peleg
Mor
M
D020000:Decision Support Systems, Clinical; D017410:Practice Guidelines as Topic; D011381:Programming Languages; D012984:Software
Artif Intell Med. 2004 May;31(1):1-27
15182844
J Am Med Inform Assoc. 2007 Nov-Dec;14(6):781-7
17712087
Artif Intell Med. 2001 May;22(2):111-31
11348843
Proc AMIA Symp. 2000;:863-7
11080007
Proc AMIA Symp. 2000;:389-93
11079911
J Biomed Inform. 2004 Jun;37(3):147-61
15196480
J Am Med Inform Assoc. 1997 Sep-Oct;4(5):364-75
9292842
Int J Med Inform. 2002 Dec 18;68(1-3):59-70
12467791
Comput Biomed Res. 1994 Aug;27(4):291-324
7956129
Artif Intell Med. 2006 Jul;37(3):203-18
16781851
Stud Health Technol Inform. 2004;107(Pt 1):57-61
15360774
Int J Med Inform. 2001 Dec;64(2-3):285-318
11734393
Artif Intell Med. 1998 Sep-Oct;14(1-2):29-51
9779882
J Am Med Inform Assoc. 2000 Sep-Oct;7(5):488-98
10984468
J Biomed Inform. 2001 Jun;34(3):170-81
11723699
Proc AMIA Symp. 1999;:420-4
10566393
Artif Intell Med. 2001 Apr;22(1):65-80
11259884
Int J Med Inform. 2005 Aug;74(7-8):553-62
16043084
J Am Med Inform Assoc. 2003 Jan-Feb;10(1):52-68
12509357
Artif Intell Med. 1998 Sep-Oct;14(1-2):157-81
9779888