A document engineering environment for clinical guidelines

In this paper, we present a document engineering environment for Clinical Guidelines (G-DEE), which are standardized medical documents developed to improve the quality of medical care. The computerization of Clinical Guidelines has attracted much interest in recent years, as it could support the knowledge-based process through which they are produced. Early work on guideline computerization has been based on document engineering techniques using mark-up languages to produce structured documents. We propose to extend the document-based approach by introducing some degree of automatic content processing, dedicated to the recognition of linguistic markers, signaling recommendations through the use of "deontic operators". Such operators are identified by shallow parsing using Finite-State Transition Networks, and are further used to automatically generate mark-up structuring the documents. We also show that several guidelines manipulation tasks can be formalized as XSL-based transformations of the original marked-up document. The automatic processing component, which underlies the marking-up process, has been evaluated using two complete clinical guidelines (corresponding to over 300 recommendations). As a result, precision of marker identification varied between 88 and 98% and recall between 81 and 99%.