Abstract
Clinicians could benefit from decision support systems incorporating the knowledge contained in clinical practice guidelines. However, the unstructured form of these guidelines makes them unsuitable for formal representation. To address this challenge we translated a complete set of pediatric guideline recommendations into Attempto Controlled English (ACE). One experienced pediatrician, one physician and a knowledge engineer assessed that a suitably extended version of ACE can accurately and naturally represent the clinical concepts and the proposed actions of the guidelines. Currently, we are developing a systematic and replicable approach to authoring guideline recommendations in ACE.
This work was supported by the US National Library of Medicine and the Agency for Healthcare Research and Quality (grant R01 LM007199).
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
American Academy of Pediatrics. Practice Parameter: The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children. Pediatrics 103, 843–852 (1999)
Field, M.J., Lohr, K.N. (eds.): Guidelines for Clinical Practice: From Development to Use. National Academy Press, Washington (1992)
Fuchs, N.E., Kaljurand, K., Kuhn, T.: Attempto Controlled English for Knowledge Representation. In: Reasoning Web, 4th International Summer School 2008, Tutorial Lectures (2008)
Greenes, R.A., Peleg, M., Boxwala, A., Tu, S., Patel, V., Shortliffe, E.H.: Sharable Computer-Based Clinical Practice Guidelines: Rationale, Obstacles, Approaches, and Prospects. In: Medinfo. (2001)
Kuhn, T.: AceWiki: Collaborative Ontology Management in Controlled Natural Language. In: 3rd Semantic Wiki Workshop, CEUR Workshop Proceedings (2008)
Power, R., Scott, D., Evans, R.: What You See Is What You Meant: Direct Knowledge Editing with Natural Language Feedback. In: Proc. 13th European Conference on Artificial Intelligence, ECAI 1998 (1998)
Schwitter, R., Ljungberg, A., Hood, D.: ECOLE: A Look-ahead Editor for a Controlled Language. In: Proc. 8th European Association for Machine Translation and the 4th Controlled Language Applications Workshop, EAMT-CLAW 2003 (2003)
Shiffman, R.N., Michel, G., Essaihi, A., Thornquist, E.: Bridging the Guideline Implementation Gap: A Systematic, Document-centered Approach to Guideline Implementation. J. Am. Med. Informatics Assoc. 5, 418–426 (2004)
Sun, Y., van Wingerde, F.J., Homer, C.J.: The Challenges of Implementing a Real-Time Clinical Practice Guideline. Clin. Perform Quality Health Care (1999)
Detsky, A.S.: Regional variation in medical care. N. Engl. J. Med. (1995)
Wennberg, J.E., Gittelson, A.: Small-area variation in health care delivery. Science (1973)
Wennberg, J.E., Freeman, J.L., Culp, W.J.: Are hospital services rationed in New Haven or over-utilised in Boston. Lancet (1987)
Grilli, R., Magrini, N., Penna, A., Mura, G., Liberati, A.: Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet (2000)
Shaneyfelt, T.M., Mayo-Smith, M.F., Rothwangl, J.: Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA (1999)
AGREE Collaboration. AGREE Instrument. AGREE Collaboration (2001)
Shiffman, R.N., Shekelle, P., Overhage, J.M., Slutsky, J., Grimshaw, J., Deshpande, A.M.: Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann. Intern. Med. (2003)
Tierney, W.M., Overhage, J.M., Takesue, B.Y., Harris, L.E., Murray, M.D., Vargo, D.L.: Computerizing guidelines to improve care and patient outcomes: the example of heart failure. J. Am. Med. Inform. Assoc. (1995)
Codish, S., Shiffman, R.N.: A model of ambiguity and vagueness in clinical practice guideline recommendations. In: Friedman, C.P. (ed.) Proceedings of the Annual Meeting of the American Medical informatics Association 2005 (2005)
Shiffman, R.N., Dixon, J., Brandt, C., Essaihi, A., Hsiao, A., Michel, G.: The GuideLine Implementability Appraisal: development of an instrument to identify obstacles to guideline implementation (2004) (Submitted)
Guyatt, G., Gutterman, D., Baumann, M.H., Adrizzo-Harris, D., Hylek, E.M., Phillips, B.: Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest (2006)
Hussain, T., Michel, G., Shiffman, R.N.: The Yale guideline recommendation corpus: a representative sample of the knowledge content of guidelines. Int. J. Med. Informatics (2009)
Balas, E.R., Boren, S.A.: Managing clinical knolwledge for health care improvement. Yearbook of Medical informatics (2000)
Oxman, A.D., Thomson, M.A., Davis, D.A., Haynes, R.B.: No magic bullets: a systematic review of 102 trials of interventions to improve medical practice. Can. Med. Assoc. J. (1995)
Bero, L.A., Grilli, R., Grimshaw, J.M., Harvey, E., Oxman, A.D., Thomson, M.A.: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group (1998)
Berwick, D.M.: Disseminating innovations in health care. Jama (2003)
Merritt, T.A., Palmer, D., Bergman, D.A., Shiono, P.H.: Clinical practice guidelines in pediatric and newborn medicine: implications for their use in practice. Pediatrics (1997)
Grimshaw, J.M., Russell, I.T.: Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet (1993)
Ohno-Machado, L., Gennari, J.H., Murphy, S.N., Jain, N.L., Tu, S.W., Oliver, D.E.: The guideline interchange format: a model for representing guidelines. J. Am. Med. Informatics Assoc. (1998)
Patel, V.L., Allen, V.G., Arocha, J.F., Shortliffe, E.H.: Representing clinical guidelines in GLIF: individual and collaborative expertise. J. Am. Med. Informatics Assoc. (1998)
Lomotan, E.A., Michel, G., Lin, Z.Q., Shiffman, R.N.: How should we write guideline recommendations? Quality and Safety in Health Care (in press)
Jenders, R.A., Hripcsak, G., Sidelli, R.V., DuMouchel, W., Zhang, H., Cimino, J.J., Johnson, S.B., Sherman, E.H., Clayton, P.D.: Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center. In: Proc. Annu Symp. Comput. Appl. Med. Care (1995)
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Shiffman, R.N., Michel, G., Krauthammer, M., Fuchs, N.E., Kaljurand, K., Kuhn, T. (2010). Writing Clinical Practice Guidelines in Controlled Natural Language . In: Fuchs, N.E. (eds) Controlled Natural Language. CNL 2009. Lecture Notes in Computer Science(), vol 5972. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-14418-9_16
Download citation
DOI: https://doi.org/10.1007/978-3-642-14418-9_16
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-14417-2
Online ISBN: 978-3-642-14418-9
eBook Packages: Computer ScienceComputer Science (R0)