Approaches to formalisation of medical guidelines can be divided into model–centric and document–centric. While model–centric approaches dominate in the development of clinical decision support applications, document–centric, mark–up–based formalisation is suitable for application tasks requiring the ‘literal ’ content of the document to be transferred into the formal model. Examples of such tasks are logical verification of the document or compliance analysis of health records. The quality and efficiency of document–centric formalisation can be improved using a decomposition of the whole process into several explicit steps. We present a methodology and software tool supporting the step–by–step formalisation process. The knowledge elements can be marked up in the source text, refined to a tree structure with increasing level of detail, rearranged into an XML knowledge base, and, finally, exported into the operational representation. User–definable transformation rules enable to automate a large part of the process. The approach is being tested in the domain of cardiology. For parts of the WHO/ISH Guidelines for Hypertension, the process has been carried out through all the stages, to the form of executable application, generated automatically from the XML knowledge base. 1.

In order for clinical guidelines to be verified, they must first be acquired or at least translated into a format that can be treated formally. Most guidelines today either exist as plain text, tables, or flow-charts.

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Clinical protocols and guidelines are widely used in the medical domain to improve disease management techniques. Different software systems are in development to support the design and the execution of such guidelines. The bottleneck in the guideline software developing process is the transformation of the textbased clinical guidelines into a formal representation, which can be used by the execution software. This paper introduces a method and a tool that was designed to provide a solution for that bottleneck. The so-called Guideline Markup Tool (GMT) facilitates the translation of guidelines into a formal representation written in XML. This tool enables the protocol designer to create links between the original guideline and its formal representation and ease the editing of guidelines applying design patterns in the form of macros. The usefulness of our approach is illustrated using GMT to edit Asbru protocols. We performed a usability study with eight participants to examine the usefulness of the GMT and of the Asbru macros, which showed that the proposed approach is very appropriate to author and maintain clinical guidelines.

The Stepper tool was developed to assist a knowledge engineer in developing a computable version of narrative guidelines. The system is document--centric: it formalises the initial text in multiple user--definable steps corresponding to interactive XML transformations. In this paper, we report on experience obtained by applying the tool on a narrative guideline document addressing unstable angina pectoris. Possible role of the tool and associated methodology in developing a guideline--based application is also discussed.