title: A multi-layered framework for disseminating knowledge for computer-based decision support.
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.
  
  
  CONCLUSIONS
  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.
authors: Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California 92093-0728, USA. aboxwala@ucsd.edu
authors: Aziz A
authors: AA
authors: Boxwala
authors: Beatriz H
authors: BH
authors: Rocha
authors: Saverio
authors: S
authors: Maviglia
authors: Vipul
authors: V
authors: Kashyap
authors: Seth
authors: S
authors: Meltzer
authors: Jihoon
authors: J
authors: Kim
authors: Ruslana
authors: R
authors: Tsurikova
authors: Adam
authors: A
authors: Wright
authors: Marilyn D
authors: MD
authors: Paterno
authors: Amanda
authors: A
authors: Fairbanks
authors: Blackford
authors: B
authors: Middleton
mesh_terms: D001185:Artificial Intelligence; D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical; D017410:Practice Guidelines as Topic; D012985:Software Design