The Importance of Creating an Ontology-Specific Consensus Before a Markup-Based Specification of Clinical Guidelines

We have previously developed the Digital electronic Guideline Library (DeGeL) framework, which includes a methodology for a markup-based, increasingly formal structuring of free-text clinical guidelines (GLs), and tools to support guideline-based application. The methodology includes activities be-fore, during and after the markup process. To reduce the ambiguity of the interpretation of a GL among the Expert Physicians (EPs) who are marking up the GL, and to achieve an interpretation common to the EPs and the knowledge engineers (KEs), an indispensable step before markup is the creation of an Ontology Specific Consensus (OSC) regarding the semantics of the GL. To evaluate the role of the OSC, we created OSCs for three GLs in incremental level of de-tail, using the Asbru GL ontology. The EPs quantified the subjective aspects that most helped them in creating the OSC, while we assessed the clinical and ontological markup errors committed by the EPs. Using medical knowledge and understanding the GL ontology were considered more helpful than understanding the DeGeL tools; and the more detailed the OSC, the less the number of markup errors committed.