Fig. (2) Life Cycle of Rules Knowledge Refinement. Note that stage 3 is typically skipped by implementers, such as those deploying Arden MLMs. The Morningside Initiative seeks to make stage 3 explicit, as a means of capturing the experience of successful implementations and also as a means to formalize the range of setting-specific options needed to successfully embed CDS into operational settings. The Morningside Initiative is seeking to do this using open source tools and methods and a collaborative process wherever possible. Relationships to three concurrent projects involving Morningside Initiative participants, the DoD-based Knowledge Management Repository (KMR) project, the AHRQ-funded Structuring Clinical Recommendations for Clinical Decision Support (SCRCDS) project, and the ONC-funded SHARP-C subproject 2B are shown. Two AHRQ-funded initiatives, the Guidelines into Decision Support (GLIDES) and the Clinical Decision Support Consortium (CDSC), have similar goals of supporting the lifecycle shown in this figure, but are using different approaches. GLIDES is using the Guideline Element Markup (GEM) tools to refine guidelines into decision support implementation. CDSC is developing knowledge authoring, sharing, and execution tools and processes based on a formal model of intermediate knowledge artifacts.