Combining a Document Model and an Execution Model for Clinical Guidelines

Background: The Guideline Elements Markup (GEM) model [1] was developed at Yale as a way of tagging elements of narrative guidelines, to enable them to be more precisely accessed and retrieved. Many of these elements relate to the nature of the process used to develop the guideline, kinds of evidence, and explanations and references for recommendations. The GuideLine Interchange Format (GLIF) [2] is a modeling approach developed at Harvard, Stanford, and Columbia (the “InterMed Collaboratory”) aimed at creating a shared guidelines representation that is computer interpretable, in order to integrate guidelines into clinical systems, and deliver patient-specific recommendations at the point of care. GEM uses XML tags to identify various elements in a guideline document; hence it is a document model. The GLIF representation of a guideline is based on an object-oriented model of classes of guideline steps that support execution.