Guideline Workshop Position Paper Propositional Representation of Clinical Practice Guidelines

Clinical practice guidelines (CPGs) are aimed at physicians of various degrees of knowledge and experience. The expected result of the use of guidelines is the standardization and homogenization of clinical practice (i.e., that the same clinical problem be diagnosed, treated, or managed similarly by different physicians). However, CPGs can be semantically very complex. In fact, many CPGs are composed of elaborate collections of prescribed procedures, sometimes involving the embedding of procedures within procedures or complicated temporal or causal relations among the various steps in a procedure. Furthermore, interpretation of CPGs involves the generation of inferences that are needed for correctly implementing the procedure prescribed by the guideline. The fact that interpretation requires making inferences makes CPGs highly ambiguous and therefore prone to different interpretations by different physicians. To overcome the inherent ambiguity of CPGs, physicians make use of their domain-specific knowledge as well as their general world knowledge. This knowledge helps disambiguate procedural steps and temporal or causal relations among steps. Unfortunately, it is also the source of the differences in CPG interpretation that the CPGs are intended to equalize.