GLIF – GELLO – Archetypes Jared Davison Medical-Objects Australia

Key Points • GLIF and GELLO implementation using Lymphoma as the clinical example • Arden was considered but GELLO felt to be better fit – GELLO was Object-Oriented – Interface with data model – vMR rather than use curly braces – Closely related to Object Constraint Language (OCL)

Key Points • GLIF chosen as guideline representation language – Inspiration for GELLO – Specific lacking detail, specifically no structures to accommodate GELLO • GELLO specifications had not been implemented – Significant errors and lacked required features • eg no standard way of passing parameters to GELLO and no formal definitions of GELLO libraries

Key Points • Contact with GELLO authors and researchers – Raised issues for inclusion in second ballot of GELLO

Key Points • GELLO requires a VMR for access to patient data – Lack of specifications for vMR – Created abstraction of HL7 v2 model – Could be represented as v3 • Used Archetype Definition Language (ADL) to define data structures for user data-entry – Encoded in HL7 v2 OBX using an experimental technique – Enables re-use and re-editing of data – Also used for decision support

GLIF Guideline - Lymphoma

Archetype Editor with GELLO Events

GELLO Expressions

Lymphoma Archetype Example

Completed Archetype Example

Editing Lymphoma Type Codes

Editing Help Text (Didactics)

Editing Decision Logic (GELLO)

GELLO Compiler IDE

Setting up SNOMED-CT Codes

Lymphoma Scenario Jack Smith age 63, 5 visits/episodes in all for treatment cycles including registration and early data gathering *2 visits, Diffuse large B-cell lymphoma, increased FLIPI, responds to treatment, bulky stage II, work to guidelines, radiotherapy gets a letter, pathology radiology requests and reports, Rx rituximab, CHOP and radiotherapy, and ABCR notifications

Patient Registration

GLIF Guideline Execution

GLIF Guideline Execution

Record Reported Symptoms

Ordering Blood Tests

Clinical Staging Data

Patient Data Summary

Curative Intent Treatment Plan

Example of Supporting Evidence

Cancer Registry Notification