Guideline-based decision support in medicine : modeling guidelines for the development and application of clinical decision support systems

Guideline-based Decision Support in Medicine Modeling Guidelines for the Development and Application of Clinical Decision Support Systems The number and use of decision support systems that incorporate guidelines with the goal of improving care is rapidly increasing. Although developing systems that are both effective in supporting clinicians and accepted by them has proven to be a difficult task, of the systems that were evaluated by a controlled trial, the majority showed impact. The work, described in this thesis, aims at developing a methodology and framework that facilitates all stages in the guideline development process, ranging from the definition of models that represent guidelines to the implementation of run-time systems that provide decision support, based on the guidelines that were developed during the previous stages. The framework consists of 1) a guideline representation formalism that uses the concepts of primitives, Problem-Solving Methods (PSMs) and ontologies to represent guidelines of various complexity and granularity and different application domains, 2) a guideline authoring environment that enables guideline authors to define guidelines, based on the newly developed guideline representation formalism, and 3) a guideline execution environment that translates defined guidelines into a more efficient symbol-level representation, which can be read in and processed by an execution-time engine. The described methodology and framework were used to develop and validate a number of guidelines and decision support systems in various clinical domains such as Intensive Care, Family Practice, Psychiatry and the areas of Diabetes and Hypertension control

Context-based task ontologies for clinical guidelines

Evidence-based medicine relies on the execution of clinical practice guidelines and protocols. A great deal of of effort has been invested in the development of various tools which automate the representation and execution of the recommendations contained within such guidelines and protocols by creating Computer Interpretable Guideline Models (CIGMs). Context-based task ontologies (CTOs), based on standard terminology systems like UMLS, form one of the core components of such a model. We have created DAML+OIL-based CTOs for the tasks mentioned in the WHO guideline for hypertension management, drawing comparisons also with other related guidelines. The advantages of CTOs include: contextualization of ontologies, providing ontologies tailored to specific aspects of the phenomena of interest, dividing the complexity involved in creating ontologies into different levels, providing a methodology by means of which the task recommendations contained within guidelines can be integrated into the clinical practices of a health care set-up

Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

Design of a goal ontology for medical decision-support

Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2005.Includes bibliographical references (leaves 34-36).Objectives: There are several ongoing efforts aimed at developing formal models of medical knowledge and reasoning to design decision-support systems. Until now, these efforts have focused primarily on representing content of clinical guidelines and their logical structure. The present study aims to develop a computable representation of health-care providers' intentions to be used as part of a framework for implementing clinical decision-support systems. Our goal is to create an ontology that supports retrieval of plans based on the intentions or goals of the clinician. Methods: We developed an ontological representation of medical goals, plans, clinical scenarios and other relevant entities in medical decision-making. We used the resulting ontology along with an external ontology inference engine to simulate selection of clinical recommendations based on goals. The ontology instances used in the simulation were modeled from two clinical guidelines. Testing the design: Thirty-two clinical recommendations were encoded in the experimental model. Nine test cases were created to verify the ability of the model to retrieve the plans. For all nine cases, plans were successfully retrieved. Conclusion: The ontological design we developed supported effective reasoning over a medical knowledge base.(cont.) The immediate extension of this approach to be fully developed in medical applications may be partially limited by the lack of available editing tools. Many efforts in this area are currently aiming to the development of needed technologies.by Davide Zacacagnini [i.e. Zaccagnini].S.M

A unified system for clinical guideline management and execution

There are several approaches to Computer-Interpretable Guidelines (CIG) representation and execution that offer the possibility of acquiring, executing and editing CPGs. Many CIG approaches aim to represent Clinical Practice Guidelines (CPGs) by computationally formalising the knowledge that they enclose, in order to be suitable for the integration in Clinical Decision Support Systems (CDSS). However, the current approaches for this purpose lack in providing a unified workflow for management and execution of CIGs. Besides characterising these limitations and identifying improvements to include in future tools, this work describes the unified architecture for CIG management and execution, a unified approach that allows the CIG acquisition, editing and execution.This work has been supported by COMPETE: POCI-01-0145-FEDER-0070 43 and FCT – Funda ̧c ̃aopara a Ciˆencia e Tecnologia within the Project Scope UID/CEC/ 00319/2013

A personal assistant for health care professionals based on clinical protocols

Current tools to operationalize Computer-Interpretable Guidelines focus mainly on displaying recommendations rather than assisting health care professionals in their daily activities. Furthermore, their underlying models have limitations at the level of temporal representation that hinder the accurate depiction of clinical protocols in a few specific situations. This work identifies such situations and proposes a comprehensive temporal model based on OntologyWeb Language (OWL), along with a web-based tool that provides an alternative way to deploy and view clinical protocols. This is evaluated through a case study featuring a clinical protocol for the treatment of colon cancer. It was possible to observe that the model was able to represent the majority of temporal patterns, specially those with periodic events and temporal restrictions about the state of a patient.This work has been supported by FCT Fundacao para a Ciencia e Tecnologia within the Project Scope UID/CEC/00319/2013. The work of Tiago Oliveira is supported by a FCT grant with the reference SFRH/BD/85291/2012.info:eu-repo/semantics/publishedVersio

Representing temporal patterns in computer-interpretable clinical Guidelines

Computer-interpretable Guidelines (CIGs) as machine-readable versions of clinical protocols have to provide appropriate constructs for the representation of different aspects of medical knowledge, namely administrative information, workflows of procedures, clinical constraints and temporal constraints. This work focuses on the latter, by aiming to develop a comprehensive representation of temporal constraints for machine readable formats of clinical protocols and provide a proper execution engine that deals with different time patterns and constraints placed on them. A model for the representation of time is presented for the CompGuide ontology in Ontology Web language (OWL) along with a comparison with the available formalisms in this field.This work is part-funded by ERDF - European Regional Development Fund through the COMPETE Programme (operational programme for competitiveness) and by National Funds through the FCT - Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project FCOMP-01-0124-FEDER-028980 and project Scope UID/CEC/00319/2013.The work of Tiago Oliveira is supported by a FCT grant with the reference SFRH/BD/85291/2012.info:eu-repo/semantics/publishedVersio

Thirty years of artificial intelligence in medicine (AIME) conferences: A review of research themes

Over the past 30 years, the international conference on Artificial Intelligence in MEdicine (AIME) has been organized at different venues across Europe every 2 years, establishing a forum for scientific exchange and creating an active research community. The Artificial Intelligence in Medicine journal has published theme issues with extended versions of selected AIME papers since 1998