Guideline representation ontologies for evidencebased medicine practice

An ontology in the context of guideline representation is a specification of conceptualizations that constitutes evidence-based clinical practice guidelines. It represents the elements of a guideline by specifying its attributes and defining the relationships that hold among them. For example, a guideline representation ontology would define a set of medical decisions and actions (concepts), as well as a set of rules (relationships) that relate the evaluation of a decision criterion to further reasoning steps or to its associated actions. A rigorously defined computational ontology provides considerable promise of producing computable representations that can be visualized, edited, executed, and shared using computer-based systems. A widely acknowledged ontology, or standard representation schema, is the key to facilitating the dissemination of guidelines across computer systems and healthcare institutions. The first part of this chapter presents the evolution of ontology research in guideline representation. Several representative ontologies are reviewed and discussed, with in-depth analyses of two popular models: GLIF (Guideline Interchange Format) and PROforma. The second part of the chapter analyzes seven key elements constituting a guideline representation. It also discusses the criteria for evaluating competing ontologies and some known limitations in the existing models. At the end of this chapter, four key steps are outlined that converts a guideline into computerized representation, which can be then used in Clinical Decision Support Systems (CDSSs).