Towards a Representation Format for Sharable Clinical Guidelines

Clinical guidelines are being developed for the purpose of reducing medical errors and unjustified variations in medical practice, and for basing medical practice on evidence. Encoding guidelines in a computer-interpretable format and integrating them with the electronic medical record can enable delivery of patient-specific recommendations when and where needed. Since great effort is expended in developing high quality guidelines, and in making them computer-interpretable, it is highly desirable to be able to share them among institutions. Adoption of a common format for representing computer-interpretable guidelines (CIGs) is one way of sharing them. Factors that need to be considered in creating a format for sharable CIGs include (1) the scope of the guideline and its intended applications; (2) the method of delivery of the recommendations; and (3) the environment, consisting of the practice setting and the information system in which the guideline will be applied. Several investigators have proposed solutions that improve the sharability of CIGs and, more generally, of medical knowledge. These approaches can be useful in the development of a format for sharable CIGs. Challenges in sharing CIGs also suggest a different framework for disseminating guidelines and integrating them into practice. This framework includes processes for (1) local adaptation of recommendations encoded in shared generic guidelines and (2) integration of guidelines into the institutional information systems.