Table 1.

Definitions of Shiffman’s Steps⁵

Decision Category	Definition
Select Guidelines	Choice of specific guidelines and choice of specific recommendations within the selected guidelines to be implemented
Markup	Identification and tagging of guideline knowledge components relevant to operationalization
Atomize	The process of extracting and refining single concepts from the narrative text recommendations
Deabstract	The process of adjusting the level of generality at which a decision variable or action is described to permit operationalization
Disambiguate	The process of establishing a single semantic interpretation for a recommendation statement
Build Executable Statements	Arrangement of the atomized, de-abstracted, and disambiguated decision variables and actions into logical statements that can be translated readily into computable statements
Verify Completeness	The process to make sure that each recommendation provides guidance in all situations that a clinician is likely to face
Add Explanation	A facility to describe the reasoning behind recommendations
Identify Origin	Identifying a source or origin in the clinical environment for each decision variable
Insert Recommendations	Identifying an insertion point in the care process for each recommended action
Define Action Type	Categorizing guideline-recommended activities according to predefined action types
Define Associated Beneficial Services	Linking action types to associated beneficial services that offer design patterns for facilitating clinical care
Design User Interface	Selecting and grouping user interface elements to best deliver CDS output