Knowledge Formalization is the process of translating narrative guidelines into structured knowledge that can be implemented consistently as automated CDS. A black box stands between the published document and the computer-based decision support tool. Following poorly defined, largely non-generalizable processes, a published guideline is input into the black box and emerges in some computable format. GLIDES is particularly interested in opening and understanding what goes on in the box.
GLIDES has designed and implemented a process for knowledge formalization that balances a core of structured processes, methods and tools, with a flexible approach that can be adapted to reflect the “on the ground” realities of how clinical systems are designed, built and implemented at clinical sites.
Establishing clear clinical goals for the CDS implementation project is a critical foundation for success. Ideally, the CDS project will be part of a specific quality improvement (QI) project, where goals are shaped by the QI priorities.
- GEM Cutter is used during the initial guideline mark-up phase. GEM Cutter is an XML editor specialized for transforming narrative guideline text into a semi-structured GEM file using an intuitive cut and paste metaphor.
Once the guideline has been “marked-up”, GEM provides tools that work with the GEM XML file to iteratively refine the information, highlighting conditional logic, decision variables and actions.
- In refining the logic specification, eligibility criteria, decision variables and actions types are iteratively refined and organized. Each recommendation is mapped to a standard action type.
GEM Cutter accepts as input a guideline text file. Users mark up the file, classifying guideline text into appropriate elements of the standardized GEM II hierarchy.