A systematic process for converting text-based guidelines into a linear algorithm for electronic implementation

Clinical practice guidelines are increasingly important for improving the quality and the process of healthcare delivery. Unfortunately, most guidelines are available only in a text-based format, which is difficult to integrate into clinical practice. Computers can facilitate guideline integration into clinical practice; however, this migration to computers requires translating text into intermediary representations. One type of representation that is readily adaptable for computerization is a linear algorithm. This paper describes a systematic process to convert text-based clinical practice guidelines into a linear algorithm with structured content, as an intermediate step to electronic implementation. The process includes: 1) defining applicability criteria, 2) identifying entry points, 3) defining decision points, 4) defining actions, 5) creating a linear algorithm that links decision points and actions, and 6) adding supporting resources. This process has been used successfully to prepare more than two dozen guidelines for computerization. It has been tested by several physicians and informaticians and shown to be transferable to various user groups. The availability of a systematic process to convert text-based guidelines into a structured intermediary format for electronic implementation can facilitate the computerization of guidelines and can inform guideline content developers regarding the critical elements that need to be explicitly stated in guidelines to support electronic implementation.