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

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

IUPC: Identification and Unification of Process Constraints

Business Process Compliance (BPC) has gained significant momentum in research and practice during the last years. Although many approaches address BPC, they mostly assume the existence of some kind of unified base of process constraints and focus on their verification over the business processes. However, it remains unclear how such an inte- grated process constraint base can be built up, even though this con- stitutes the essential prerequisite for all further compliance checks. In addition, the heterogeneity of process constraints has been neglected so far. Without identification and separation of process constraints from domain rules as well as unification of process constraints, the success- ful IT support of BPC will not be possible. In this technical report we introduce a unified representation framework that enables the identifica- tion of process constraints from domain rules and their later unification within a process constraint base. Separating process constraints from domain rules can lead to significant reduction of compliance checking effort. Unification enables consistency checks and optimizations as well as maintenance and evolution of the constraint base on the other side.Comment: 13 pages, 4 figures, technical repor

A Generic Approach to Supporting the Management of Computerised Clinical Guidelines and Protocols

Clinical guidelines or protocols (CGPs) are statements that are systematically developed for the purpose of guiding the clinician and the patient in making decisions about appropriate healthcare for specific clinical problems. Using CGPs is one of the most effective and proven ways to attaining improved quality, optimised resource utilisation, cost containment and reduced variation in healthcare practice. CGPs exist mainly as paper-based natural language statements, but are increasingly being computerised. Supporting computerised CGPs in a healthcare environment so that they are incorporated into the routine used daily by clinicians is complex and presents major information management challenges. This thesis contends that the management of computerised CGPs should incorporate their manipulation (operations and queries), in addition to their specification and execution, as part of a single unified management framework. The thesis applies modern advanced database technology to the task of managing computerised CGPs. The event-condition-action (ECA) rule paradigm is recognised to have a huge potential in supporting computerised CGPs. In this thesis, a unified generic framework, called SpEM and an approach, called MonCooS, were developed for enabling computerised CGPs, to be specified by using a specification language, called PLAN, which follows the ECA rule paradigm; executed by using a software mechanism based on the ECA mechanism within a modern database system, and manipulated by using a manipulation language, called TOPSQL. The MonCooS approach focuses on providing clinicians with assistance in monitoring and coordinating clinical interventions while leaving the reasoning task to domain experts. A proof-of-concepts system, TOPS, was developed to show that CGP management can be easily attained, within the SpEM framework, by using the MonCooS approach. TOPS is used to evaluate the framework and approach in a case study to manage a microalbuminuria protocol for diabetic patients. SpEM and MonCooS were found to be promising in supporting the full-scale management of information and knowledge for the computerised clinical protocol. Active capability within modern DBMS is still experiencing significant limitations in supporting some requirements of this application domain. These limitations lead to pointers for further improvements in database management system (DBMS) functionality for ECA rule support. The main contributions of this thesis are: a generic and unified framework for the management of CGPs; a general platform and an advanced software mechanism for the manipulation of information and knowledge in computerised CGPs; a requirement for further development of the active functionality within modern DBMS; and a case study for the computer-based management of microalbuminuria in diabetes patients

Fuzzy Logic in Clinical Practice Decision Support Systems

Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. This paper discusses sources of fuzziness in clinical practice guidelines. We consider how fuzzy logic can be applied and give a set of heuristics for the clinical guideline knowledge engineer for addressing uncertainty in practice guidelines. We describe the specific applicability of fuzzy logic to the decision support behavior of Care Plan On-Line, an intranet-based chronic care planning system for General Practitioners

Development and implementation of clinical guidelines : an artificial intelligence perspective

Clinical practice guidelines in paper format are still the preferred form of delivery of medical knowledge and recommendations to healthcare professionals. Their current support and development process have well identified limitations to which the healthcare community has been continuously searching solutions. Artificial intelligence may create the conditions and provide the tools to address many, if not all, of these limitations.. This paper presents a comprehensive and up to date review of computer-interpretable guideline approaches, namely Arden Syntax, GLIF, PROforma, Asbru, GLARE and SAGE. It also provides an assessment of how well these approaches respond to the challenges posed by paper-based guidelines and addresses topics of Artificial intelligence that could provide a solution to the shortcomings of clinical guidelines. Among the topics addressed by this paper are expert systems, case-based reasoning, medical ontologies and reasoning under uncertainty, with a special focus on methodologies for assessing quality of information when managing incomplete information. Finally, an analysis is made of the fundamental requirements of a guideline model and the importance that standard terminologies and models for clinical data have in the semantic and syntactic interoperability between a guideline execution engine and the software tools used in clinical settings. It is also proposed a line of research that includes the development of an ontology for clinical practice guidelines and a decision model for a guideline-based expert system that manages non-compliance with clinical guidelines and uncertainty.This work is funded by national funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project PEst-OE/EEI/UI0752/2011"