A Preliminary Evaluation of Guideline Content Mark-up
Using GEM--An XML Guideline Elements Model

Bryant T. Karras, MD, Sujai Nath, MD, Richard N. Shiffman, MD, MCIS

Affiliation of the authors: Yale University, New Haven, Connecticut.

Objective: To describe application of GEM to analysis and categorization of guideline content.

Method: We examined the application of GEM constructs to the AAP guideline on neurodiagnostic evaluation of febrile seizures. Subjects at 4 sites marked-up the guideline content using a hierarchical template that includes branches for identity, developer, purpose, intended audience, method of development, knowledge components, testing, and review. The types of elements used were tabulated. Subjects were surveyed regarding the usability of the model.

Results:  Eight subjects analyzed the guideline, using between 46 and 149 elements to model its content. There was considerable variation in the application of elements. The number of elements used correlated with time to complete task. Subjects found application of GEM to be straightforward in 6 of 8 categories and sufficiently comprehensive to model the guideline’s information content.

Conclusions: Subjects found GEM was sufficiently comprehensive to model the content of the guideline. Improved editing tools will facilitate translation.