A Scalable Architecture for Incremental Specification and Maintenance of Procedural and Declarative Clinical Decision-Support Knowledge

Clinical guidelines have been shown to improve the quality of medical care and to reduce its costs. However, most guidelines exist in a free-text representation and, without automation, are not sufficiently accessible to clinicians at the point of care. A prerequisite for automated guideline application is a machine-comprehensible representation of the guidelines. In this study, we designed and implemented a scalable architecture to support medical experts and knowledge engineers in specifying and maintaining the procedural and declarative aspects of clinical guideline knowledge, resulting in a machine comprehensible representation. The new framework significantly extends our previous work on the Digital electronic Guidelines Library (DeGeL) The current study designed and implemented a graphical framework for specification of declarative and procedural clinical knowledge, Gesher. We performed three different experiments to evaluate the functionality and usability of the major aspects of the new framework: Specification of procedural clinical knowledge, specification of declarative clinical knowledge, and exploration of a given clinical guideline. The subjects included clinicians and knowledge engineers (overall, 27 participants). The evaluations indicated high levels of completeness and correctness of the guideline specification process by both the clinicians and the knowledge engineers, although the best results, in the case of declarative-knowledge specification, were achieved by teams including a clinician and a knowledge engineer. The usability scores were high as well, although the clinicians’ assessment was significantly lower than the assessment of the knowledge engineers

An Ontology And Constraint-Based Approach For Dynamic Personalised Planning In Healthcare[QA75].

Para doktor atau pakar kesihatan semestinya mengambil berat berkenaan pengemaskinian rekod atau profil pesakit mereka, dan perancangan rawatan yang sesuai untuk pesakit mereka, untuk mendapatkan hasil perkhidmatan kesihatan yang berkesan. Healthcare service providers are undoubtedly concerned about updating their patients’ health records or profiles, and the planning of their patients’ treatments to support the effective delivery of healthcare services

Digital clinical guidelines modelling

Oliveira T., Costa A., Neves J., Novais P., Digital Clinical Guidelines Modelling, Modelling and Simulation 2011, Novais P., Machado J., Analide C., Abelha A., (Eds.) (ESM’2011 – The 2011 European Simulation and Modelling Conference, Guimarães, Portugal) EUROSIS Publisher, ISBN: 978-9077381-66-3, pp 392-398, 2011.Healthcare environments are very demanding, because practitioners are required to consult many patients in a short period of time, increasing the levels of stress which usually harms the outcome of healthcare processes. The short time practitioners have with their patients does not facilitate informed decision making and checking all possibilities. A possible solution is the use of guideline-based applications, because they have the potential of being an effective means of both changing the process of healthcare and improving its outcomes. However, current Clinical Guidelines are available in text format as long documents, which render them difficult to consult and to integrate in clinical Decision Support Systems. With this paper we present a new model for guideline interpretation, in order to facilitate de development of guideline-based Decision Support Systems and to increase the availability of Clinical Guidelines at the moment of the clinical process. This model will also provide mechanisms to comply with cases where incomplete and uncertain information is present. The development and implementation of this model will be presented in the following pages

OWL-based acquisition and editing of computer-interpretable guidelines with the CompGuide editor

Computer-Interpretable Guidelines (CIGs) are the dominant medium for the delivery of clinical decision support, given the evidence-based nature of their source material. Therefore, these machine-readable versions have the ability to improve practitioner performance and conformance to standards, with availability at the point and time of care. The formalisation of Clinical Practice Guideline knowledge in a machine-readable format is a crucial task to make it suitable for the integration in Clinical Decision Support Systems. However, the current tools for this purpose reveal shortcomings with respect to their ease of use and the support offered during CIG acquisition and editing. In this work, we characterise the current landscape of CIG acquisition tools based on the properties of guideline visualisation, organisation, simplicity, automation, manipulation of knowledge elements, and guideline storage and dissemination. Additionally, we describe the CompGuide Editor, a tool for the acquisition of CIGs in the CompGuide model for Clinical Practice Guidelines that also allows the editing of previously encoded guidelines. The Editor guides the users throughout the process of guideline encoding and does not require proficiency in any programming language. The features of the CIG encoding process are revealed through a comparison with already established tools for CIG acquisition.COMPETE, Grant/Award Number: POCI-01-0145-FEDER-007043; FCT - Fundacao para a Ciencia e Tecnologia, Grant/Award Number: UID/CEC/00319/201

Conflict resolution in clinical treatments

Dissertação de mestrado integrado em Engenharia InformáticaCurrently, in the health area, there is a need for systems that provide support for the decision of health professionals through specific recommendations for each patient based on Clinical Practice Guidelines (CPGs) for automatic interpretation. CPGs are documents that have enormous importance in the daily life of health professionals, playing a key role in reducing variations in medical practice, improving the quality of health care, and reducing health care costs. These documents reflect knowledge about how best to diagnose and treat diseases in the form of a list of clinical recommendations. However, there may be conflicts and interactions in the application of these clinical recommendations, that which in their maximum exponent may impair the patient’s clinical condition. These conflicts are transported to decision support systems, creating the need to develop computational methods to solve these same conflicts. In the case of multimorbid patients, this resolution of conflicts can be very problematic because these patients suffer from several pathologies at the same time, and that the use of a drug for one particular pathology may have a detrimental effect on the application of another drug in another pathology. Therefore, the objective of this dissertation topic is the determination of conflicts and interactions between drugs and the determination of these same alternatives.Atualmente na área da saúde, existe uma necessidade de existirem sistemas que forneçam apoio à decisão dos profissionais de saúde através de recomendações específicas para cada paciente com base em protocolos clínicos para interpretação automática. Os protocolos clínicos são documentos que têm enorme importância no dia-a-dia dos profissionais de saúde, desempenhando um papel fundamental na redução das variações na prática médica, na melhoria da qualidade dos cuidados de saúde e na redução dos custos de saúde. Estes documentos reflectem o conhecimento sobre a melhor forma de diagnosticar e tratar doenças na forma de uma lista de recomendações clínicas. Contudo, podem existir conflitos e interações na aplicação destas recomendações clínicas, que no seu expoente máximo poderão levar a um agravamento do estado clínico do paciente, nomeadamente no caso da aplicação de diferentes fármacos. Estes conflitos são transportados para os sistemas de apoio à decisão, criando a necessidade de desenvolver métodos computacionais de resolução destes mesmos conflitos. No caso dos pacientes multimórbidos esta resolução de conflitos pode ser bastante problemática devido ao facto destes pacientes sofrerem de várias patologias ao mesmo tempo, e que a utilização de um fármaco para uma determinada patologia possa vir a ter um efeito nocivo na aplicação de outro fármaco noutra patologia. Sendo assim, o objetivo deste tema de dissertação é a determinação dos conflitos e interações entre fármacos e a determinação dessas mesmas alternativas

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