II. MarkUp Guideline

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. This tool is appropriate to use on guidelines that have reached final form.

The guideline’s natural language narrative text is marked up using the GEM Cutter editor to populate the GEM XML schema. At this point, inconsistencies and lack of clear logic in the original narrative text can be clarified and resolved. Using an editing tool, the recommendations are transformed into statement logic (in the natural language of the guideline developers).

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.

• The guidelines's intended audience
• The target population of patients
• The recommendations themselves including decision variables
• The reason(s) for making the recommendation
• The evidence quality and recommendation strength supporting each recommendation

Missing information must be filled in locally by Clinical Experts. By cataloging and documenting these circumstances, implementers can provide feedback to guideline development teams about content that is critical for implementation but missing from the published guideline. A careful record of modifications should be logged and reviewed by an independent team of clinical experts to assure that the meaning of the implemented recommendation is consonant with the published text.