CC BY-NC-ND 4.0 · Appl Clin Inform 2021; 12(03): 495-506
DOI: 10.1055/s-0041-1731001
Research Article

A Comparison of Arden Syntax and Clinical Quality Language as Knowledge Representation Formalisms for Clinical Decision Support

Andrey Soares
1   Department of Medicine, University of Colorado, Aurora, Colorado, United States
Robert A. Jenders
2   Department of Medicine, University of California, Los Angeles, California, United States
Robert Harrison
3   University of Colorado Health (UCHealth), Aurora, Colorado, United States
Lisa M. Schilling
1   Department of Medicine, University of Colorado, Aurora, Colorado, United States
› Author Affiliations
Funding Dr. Jenders was supported by NIMHD grants U54MD007598 and S21MD000103 and NCATS grant UL1TR001881 from the National Institutes of Health (USA).


Objectives This article presents a comparative study of two Health Level Seven International (HL7) standards for clinical knowledge representation, the Arden Syntax and the Clinical Quality Language (CQL), regarding their expressiveness and utility to represent knowledge for clinical decision support (CDS) systems.

Methods We compiled a concatenated set of features from both languages and made descriptive comparisons of 27 categories covering areas of language characteristics, data, control statements, and operators.

Results Both Arden and CQL have similar constructs that can be used for representing CDS knowledge but also have unique constructs that could support distinct use cases. They have constructs that fully or partially address several of the categories used in the comparison, except for data models and terminologies in Arden and event triggering and iteration statements in CQL.

Conclusion These standards can facilitate the sharing, management, and reuse of computable knowledge, and permit knowledge to be represented with their languages and converted to a machine-friendly executable code that can be shared and reused by other systems. Having support for standard data models and terminologies will continue to be a differential for adoption of a language. The HL7 working groups responsible for developing these standards can direct future development to enhance the functions of the standard and address the gaps identified in this study.

Protection of Human and Animal Subjects

Human and animal subjects were not included in this project.

Publication History

Received: 15 January 2021

Accepted: 03 May 2021

Article published online:
30 June 2021

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