# Guideline execution engine

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A **guideline execution engine** is a [computer program](/source/Computer_program) which can interpret a [clinical guideline](/source/Clinical_guideline) represented in a computerized format and perform actions towards the user of an [electronic medical record](/source/Electronic_medical_record).

A guideline execution engine needs to communicate with a host [clinical information system](/source/Clinical_information_system). [Virtual Medical Record](/source/Virtual_Medical_Record) (vMR) is one possible interface which can be used.

The engine's main function is to manage instances of executed guidelines of individual patients.

## Architecture

The following modules are generally needed for any engine:

- interface to clinical information system
- new guidelines loading module
- guideline interpreter module
- clinical events parser
- alert/recommendations dispatch

## Guideline Interchange Format

The [Guideline Interchange Format](/source/Guideline_Interchange_Format) (GLIF) is a computer representation format for [clinical guidelines](/source/Clinical_guideline).[1] Represented guidelines can be executed using a guideline execution engine.

The format has several versions as it has been improved. In 2003 GLIF3 was introduced.

## Use of third party workflow engine as a guideline execution engine

Some commercial [electronic health record](/source/Electronic_health_record) systems use a [workflow engine](/source/Workflow_engine) to execute clinical guidelines. RetroGuide[2] and HealthFlow[3] are examples of such an approach.

## See also

- [Arden syntax](/source/Arden_syntax)
- [Medical algorithm](/source/Medical_algorithm)

## References

1. ["Guideline Representation Page: GLIF 2.0, 3.4, 3.5 Specifications"](http://mis.hevra.haifa.ac.il/~morpeleg/Intermed/). *Stanford University, School of Medicine, InterMed Collaboratory*

1. Huser, V.; Narus, S. P.; Rocha, R. A. (2010). "Evaluation of a flowchart-based EHR query system: A case study of RetroGuide". *Journal of Biomedical Informatics*. **43** (1): 41–50. [doi:10.1016/j.jbi.2009.06.001](https://doi.org/10.1016/j.jbi.2009.06.001). [PMC 2840619](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840619). [PMID 19560553](https://pubmed.ncbi.nlm.nih.gov/19560553)

1. Huser V, Rasmussen LV, Oberg R, Starren JB (2011), "Implementation of workflow engine technology to deliver basic clinical decision support functionality", *BMC Med Res Methodol*. **11**: 43, [doi:10.1186/1471-2288-11-43](https://doi.org/10.1186/1471-2288-11-43). [PMC 3079703](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079703). [PMID 21477364](https://pubmed.ncbi.nlm.nih.gov/21477364)

## Further reading

- Wang D, Peleg M, Tu SW, etal (October 2004). "Design and implementation of the GLIF3 guideline execution engine". *J Biomed Inform*. **37** (5): 305–18. [doi:10.1016/j.jbi.2004.06.002](https://doi.org/10.1016/j.jbi.2004.06.002). [PMID 15488745](https://pubmed.ncbi.nlm.nih.gov/15488745)
- Ram P, Berg D, Tu S, etal (2004). "Executing clinical practice guidelines using the SAGE execution engine". *Stud Health Technol Inform*. **107** (Pt 1): 251–5. [PMID 15360813](https://pubmed.ncbi.nlm.nih.gov/15360813)
- Tu SW, Campbell J, Musen MA (2003). "The structure of guideline recommendations: a synthesis". *AMIA Annu Symp Proc*. **2003**: 679–83. [PMC 1480008](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480008). [PMID 14728259](https://pubmed.ncbi.nlm.nih.gov/14728259) [(PDF)](https://web.archive.org/web/20110719200301/http://bmir.stanford.edu/file_asset/index.php/1511/BMIR-2003-0966.pdf)
- Tu SW, Musen MA (1999). "A flexible approach to guideline modeling". *Proc AMIA Symp*. [PMC 2232509](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2232509). [PMID 10566393](https://pubmed.ncbi.nlm.nih.gov/10566393) [(PDF)](https://web.archive.org/web/20100818051352/http://bmir.stanford.edu/file_asset/index.php/211/BMIR-1999-0789.pdf)

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