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J Am Med Inform Assoc. 2011 Dec;18 Suppl 1:i132-9. doi: 10.1136/amiajnl-2011-000334. Epub 2011 Nov 3.

A multi-layered framework for disseminating knowledge for computer-based decision support.

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  • 1Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California 92093-0728, USA. aboxwala@ucsd.edu

Abstract

BACKGROUND:

There are several challenges in encoding guideline knowledge in a form that is portable to different clinical sites, including the heterogeneity of clinical decision support (CDS) tools, of patient data representations, and of workflows.

METHODS:

We have developed a multi-layered knowledge representation framework for structuring guideline recommendations for implementation in a variety of CDS contexts. In this framework, guideline recommendations are increasingly structured through four layers, successively transforming a narrative text recommendation into input for a CDS system. We have used this framework to implement rules for a CDS service based on three guidelines. We also conducted a preliminary evaluation, where we asked CDS experts at four institutions to rate the implementability of six recommendations from the three guidelines.

CONCLUSION:

The experience in using the framework and the preliminary evaluation indicate that this approach has promise in creating structured knowledge, to implement in CDS systems, that is usable across organizations.

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