Modelling clinical narrative as computable knowledge: The NICE computable implementation guidance project

Introduction: Translating narrative clinical guidelines to computable knowledge is a long‐standing challenge that has seen a diverse range of approaches. The UK National Institute for Health and Care Excellence (NICE) Content Advisory Board (CAB) aims ultimately to (1) guide clinical decision support and other software developers to increase traceability, fidelity and consistency in supporting clinical use of NICE recommendations, (2) guide local practice audit and intervention to reduce unwarranted variation, (3) provide feedback to NICE on how future recommendations should be developed. Objectives: The first phase of work was to explore a range of technical approaches to transition NICE toward the production of natively digital content. Methods: Following an initial ‘collaborathon’ in November 2022, the NICE Computable Implementation Guidance project (NCIG) was established. We held a series of workstream calls approximately fortnightly, focusing on (1) user stories and trigger events, (2) information model and definitions, (3) horizon‐scanning and output format. A second collaborathon was held in March 2023 to consolidate progress across the workstreams and agree residual actions to complete. Results: While we initially focussed on technical implementation standards, we decided that an intermediate logical model was a more achievable first step in the journey from narrative to fully computable representation. NCIG adopted the WHO Digital Adaptation Kit (DAK) as a technology‐agnostic method to model user scenarios, personae, processes and workflow, core data elements and decision‐support logic. Further work will address indicators, such as prescribing compliance, and implementation in document templates for primary care patient record systems. Conclusions: The project has shown that the WHO DAK, with some modification, is a promising approach to build technology‐neutral logical specifications of NICE recommendations. Implementation of concurrent computable modelling by multidisciplinary teams during guideline development poses methodological and cultural questions that are complex but tractable given suitable will and leadership

Architectural Paint Research and the Archaeology of Buildings

Architectural Paint Research (APR) is the archaeological study of interior and exterior applied decoration. Over time, applied layers of paint and other decorative finishes build-up on the surface of a built structure, encapsulating microscopic deposits of material evidence. This evidence can be used to inform the phase dating of a structure, or illuminate the historic function of a space. It can challenge preconceived ideas of how specific areas were decorated, and track the changes in aesthetics over time. It can identify when architects’ ideologies have been balanced by practical considerations. It can provide an insight into the intangible and ephemeral atmosphere that decoration gives to a room. Finally, it can examine the dirt trapped between layers of decoration and thus categorize the physical environmental conditions that surrounded a building at varying points in its history. Although used in the commercial heritage and conservation sectors, Architectural Paint Research is almost completely unknown to building archaeologists. This article aims to introduce APR to a new audience, and argues that is an invaluable tool in the archaeological interpretation of buildings