Patel V L, Allen V G, Arocha J F, Shortliffe E H
Centre for Medical Education, McGill University, Montreal, PQ, Canada.
J Am Med Inform Assoc. 1998 Sep-Oct;5(5):467-83. doi: 10.1136/jamia.1998.0050467.
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.
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.
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.
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 guidelines; addition 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 seamlessly integrated.
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.
评估将临床指南从文本形式转换为编码形式以便在医疗机构间共享时所使用的认知过程。
一项在三个地点进行的比较研究，内容是关于使用InterMed协作实验室成员开发的指南交换格式（GLIF）生成脑病管理指南的个体和协作表示。
该研究运用认知科学的理论和方法，详细分析了在生成GLIF表示过程中所使用的认知过程。所得的过程 - 结果测量用于比较具有不同类型计算机科学或临床专业知识且来自不同机构的受试者。
与先前关于文本理解和专业知识的研究一致，发现策略的变异性取决于该领域先前经验和知识的程度。医生所开发的表示在内容和结构上均有所不同，被发现具有指南中未明确表述的额外信息和组织方式，这反映了医生对潜在病理生理学的理解。计算机科学家开发的指南表示更为字面化；添加的内容大多局限于GLIF自身逻辑所要求的规范。医生与计算机科学家之间的协作产生了一致的表示，其效果大于各部分之和，因为医学领域特定知识和指南结构的通用知识都被无缝整合。
由于指南表示的构建存在差异，了解其生成过程及局限性对于制定构建准确且高效的共享表示的策略很重要。由临床医生和基于计算机表示的专家组成的团队所开发的编码指南优于由任何一种类型的个体单独开发的指南。
