REPRESENTING CLINICAL GUIDELINES IN GLIF - INDIVIDUAL AND COLLABORATIVE EXPERTISE

Objective: An evaluation of the cognitive processes used in the transl ation of a clinical guideline from text into an encoded form so that i t can be shared among medical institutions. Design: A comparative stud y at three sites regarding the generation of individual and collaborat ive representations of a guideline for the management of encephalopath y using the Guideline Interchange Format (GLIF) developed by members o f the InterMed Collaboratory. Measurements: Using theories and methods of cognitive science, the study involves a detailed analysis of the c ognitive processes used in generating representations in GLIF. The res ulting process-outcome measures are used to compare subjects with vari ous types of computer science or clinical expertise and from different institutions. Results: Consistent with prior studies of text comprehe nsion and expertise, the variability in strategies was found to be dep endent on the degree of prior experience and knowledge of the domain. Differing both in content and structure, the representations developed by physicians were found to have additional information and organizat ion not explicitly stated in the guidelines, reflecting the physicians ' understanding of the underlying pathophysiology. The computer scient ists developed more literal representations of the guideline; addition s were mostly limited to specifications mandated by the logic of GLIF itself. Collaboration between physicians and computer scientists resul ted in consistent representations that were more than the sum of the s eparate parts, in that both domain-specific knowledge of medicine and generic knowledge of guideline structure were seamlessly integrated. C onclusion: Because of the variable construction of guideline represent ations, understanding the processes and limitations involved in their generation is important in developing strategies to construct shared r epresentations that are both accurate and efficient. The encoded guide lines developed by teams that include both clinicians and experts in c omputer-based representations are preferable to those developed by ind ividuals of either type working alone.