Creating a Local Logic Specification

Often referred to as the curly braces issue, there is a “zone of localization” in which central specification and knowledge structuring must interact with local standards and workflow without undermining the intent of the guideline authors. To help ensure that the local site design remains consistent with the goals and intention of the guideline transformation work, it is helpful to create a crosswalk table to specify the recommendations, decision variables, actions/directives, data source, and with what actions in the care process each decision would be answered.

This also enables implementers to begin to integrate the GEM output with the design conventions required for their existing EHR systems development processes. It also provides an overall framework for the intervention design process, including exceptions to be applied locally.

Details of the cross-walk process will vary depending on the details and complexity of the guideline to be implemented, as well as the specifics of the local environment (use of rules engines, existing application structure, programming and testing conventions, EHR standards, etc). Consequently, the cross-walk process and supporting tables for documentation should be reviewed and amended for each specific CDS project.