Publications

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.
Keywords: Practice guidelines; Knowledge representation; Theoretical models; Computer-assisted decision making; Clinical decision
support systems