The GuideLine Interchange Format

Objective: To allow exchange of clinical practice guidelines among institutions and computer-based applications. Design: The GuideLine Interchange Format (GLIF) specification consists of the GLIF model and the GLIF syntax. The GLIF model is an object-oriented representation that consists of a set of classes for guideline entities, attributes for those classes, and data types for the attribute values. The GLIF syntax specifies the format of the test file that contains the encoding. Methods: Researchers from the InterMed Collaboratory at Columbia University, Harvard University (Brigham and Women's Hospital and Massachusetts General Hospital), and Stanford University analyzed four existing guideline systems to derive a set of requirements for guideline representation. The GLIF specification is a consensus representation developed through a brainstorming process. Four clinical guidelines were encoded in GLIF to assess its expressivity and to study the variability that occurs when two people from different sites encode the same guideline. Results: The encoders reported that GLIF was adequately expressive. A comparison of the encodings revealed substantial variability. Conclusion: GLIF was sufficient to model the guidelines for the four conditions that were examined. GLIF needs improvement in standard representation of medical concepts, criterion logic, temporal information, and uncertainty.

**研究目标**：实现临床实践指南（clinical practice guidelines）在各机构与计算机应用程序间的交互共享。

**研究设计**：指南交换格式（GuideLine Interchange Format, GLIF）规范由GLIF模型与GLIF语法两部分组成。GLIF模型为面向对象的表示形式，包含用于描述指南实体的类集合、对应类的属性，以及属性值的数据类型。GLIF语法则规定了承载编码内容的测试文件格式。

**研究方法**：来自哥伦比亚大学、哈佛大学（布里格姆妇女医院与麻省总医院）以及斯坦福大学的InterMed协作组研究人员，对4套现有指南系统开展分析，以此推导得到一套指南表示的需求规范。GLIF规范是通过头脑风暴流程形成的共识性表示方案。研究人员将4项临床实践指南以GLIF格式进行编码，以此评估其表达能力，并探究不同机构的两名编码人员对同一项指南进行编码时产生的差异。

**研究结果**：编码人员反馈GLIF具备足够的表达能力。对编码结果的对比分析显示出显著的编码差异。

**研究结论**：GLIF足以对本次研究涉及的4类病症相关指南进行建模。GLIF仍需在医学概念的标准表示、判据逻辑、时序信息以及不确定性处理等方面进行优化完善。