The structure of guideline recommendations: a synthesis.

We propose that recommendations in a clinical guideline can be structured either as collections of decisions that are to be applied in specific situations or as processes that specify activities that take place over time. We formalize them as "recommendation sets" consisting of either Activity Graphs that represent guideline-directed processes or Decision Maps that represent atemporal recommendations or recommendations involving decisions made at one time point. We model guideline processes as specializations of workflow processes and provide possible computational models for decision maps. We evaluate the proposed formalism by showing how various guideline-modeling methodologies, including GLIF, EON, PRODIGY3, and Medical Logic Modules can be mapped into the proposed structures. The generality of the formalism makes it a candidate for standardizing the structure of recommendations for computer-interpretable guidelines.