We have been developing the Hypertext Guideline Markup Language (HGML), the key component of a guideline delivery and evaluation system. HGML is an XML/XHTML specification for the identification of condition and recommendation elements within text guidelines. This markup process results in "machine operable" versions of text-based clinical practice guidelines, to automatically generate relevant recommendations given a particular case, and it allows clinicians to access the guideline using multiple views.

To ease the process of marking up guidelines we created a guideline markup editor that uses a point-and-click interface similar to the interface commonly used by word processors and HTML editors. We have also developed a Guideline Evaluation Engine that allows us to collect information about a patient (either from an Electronic Medical Record system, or directly from a clinician through a web-based interface), and return relevant recommendations to a web browser. The output from the system is linked to the related text in the original guideline, and to supporting evidence including references, related text, and survival curves from models evaluated by Decision Maker, a companion project developed and maintained by members of this Group.

Our most recent work includes

• Continued development of a markup editor to facilitate the streamlined encoding of guidelines. Our latest editor is based on the Mozilla/Firefox Annozilla Extension!
• Refinement of the HGML elements for increased flexibility and scope, making it easier it identify critical guideline components and their relationships
• Implementation of a guideline server, integrated with a prototype point-of-care delivery system, in which guideline recommendations relevant to a specific patient can be delivered (integrated with our current medical record system, Logician).
• Exploration of Semi-Automatic means for encoding clinical guidelines, using UMLS/MetaMap to identify clinical terms in the guidelines and infer possible encodings to assist in the markup process.

For more information, please see...

• HGML2.2 Elements Specification Overview
• Hagerty CG, Pickens D, Kulikowski CA, and Sonnenberg FA. HGML: A Hypertext Guideline Markup Language. Proceedings Annual Meeting of the AMIA 2000 Fall Symposium, American Medical Informatics Association, 2000:325-9. [Download PDF]
• A slide presentation [Download Powerpoint File]
• Hagerty CG, Chang J, Pickens DS, Kulikowski CA, and Sonnenberg FA. Semi-Automated Encoding of Guidelines. Medinfo. 2004;2004(CD):1625.
• The Medinfo 2004 Poster [Download PDF]

SimPal /
Decision
Maker

Web-based Model Presentation

UMaker