Toward a representation format for sharable clinical guidelines

Aziz A. Boxwala, Samson Tu, Mor Peleg, Qing Zeng, Omolola Ogunyemi, Robert A. Greenes, Edward H. Shortliffe, Vimla L. Patel

Research output: Contribution to journalArticlepeer-review


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 must be expended in developing high-quality guidelines, and in making them computer-interpretable, it is highly desirable to be able to share computer-interpretable guidelines (CIGs) among institutions. Adoption of a common format for representing CIGs is one approach to sharing. Factors that need to be considered in creating a format for sharable CIGs include (i) the scope of guidelines and their intended applications, (ii) the method of delivery of the recommendations, and (iii) the environment, consisting of the practice setting and the information system in which the guidelines 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 include the need to extend the traditional framework for disseminating guidelines to enable them to be integrated into practice. These extensions include processes for (i) local adaptation of recommendations encoded in shared generic guidelines and (ii) integration of guidelines into the institutional information systems.

Original languageEnglish
Pages (from-to)157-169
Number of pages13
JournalJournal of Biomedical Informatics
Issue number3
StatePublished - 2001
Externally publishedYes

Bibliographical note

Funding Information:
The authors are supported in part by Grant LM06955 from the National Library of Medicine and Grant LM06594 from the National Library of Medicine, the Agency for Healthcare Research and Quality, and the Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command.

Funding Information:
Our own work on development of the GLIF has been motivated by the desire to create a sharable format for guidelines that can be used as a basis for adaptation and integration into disparate systems. The project has been a collaboration of informatics groups at Harvard, Columbia, and Stanford Universities, known as InterMed, with the American College of Physicians–American Society of Internal Medicine, and funded by the National Library of Medicine, the U.S. Army, and the Agency for Healthcare Quality and Research. Version 2 of GLIF (GLIF2) was published in 1998 [74] and provided a specification for a level of exchange that supported browsing and limited interpretation, but did not address computability. Version 3 of GLIF, currently in draft form [34], enables computability by providing more detailed and structured representation of decision criteria, recommendations, and patient data contained in CIGs.


  • Clinical guidelines
  • Computer-interpretable guidelines
  • Decision support
  • Functional requirements
  • Knowledge representation
  • Knowledge sharing
  • Local adaptation
  • Standards

ASJC Scopus subject areas

  • Health Informatics
  • Computer Science Applications


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