Abstract Objective: An evaluation of the cognitive processes used in
the translation of a clinical guideline from text into an encoded form so that
it can be shared among medical institutions.
Design: A comparative study at three sites regarding the generation
of individual and collaborative representations of a guideline for the
management of encephalopathy using the GuideLine Interchange Format (GLIF)
developed by members of the InterMed Collaboratory.
Measurements: Using theories and methods of cognitive science, the
study involves a detailed analysis of the cognitive processes used in
generating representations in GLIF. The resulting process-outcome measures are
used to compare subjects with various types of computer science or clinical
expertise and from different institutions.
Results: Consistent with prior studies of text comprehension and
expertise, the variability in strategies was found to be dependent on the
degree of prior experience and knowledge of the domain. Differing both in
content and structure, the representations developed by physicians were found
to have additional information and organization not explicitly stated in the
guidelines, reflecting the physicians' understanding of the underlying
pathophysiology. The computer scientists developed more literal
representations of the guideline; additions were mostly limited to
specifications mandated by the logic of GLIF itself. Collaboration between
physicians and computer scientists resulted in consistent representations that
were more than the sum of the separate parts, in that both domain-specific
knowledge of medicine and generic knowledge of guideline structure were
Conclusion: Because of the variable construction of guideline
representations, understanding the processes and limitations involved in their
generation is important in developing strategies to construct shared
representations that are both accurate and efficient. The encoded guidelines
developed by teams that include both clinicians and experts in computer-based
representations are preferable to those developed by individuals of either
type working alone.