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

Compguide: Acquisition and editing of computer-interpretable guidelines

The formalization of Clinical Practice Guidelines (CPGs) as Computer-Interpretable Guidelines (CIGs) has the potential to positively influence the behaviour of health practitioners by being available at the point and time of care. Existing tools for acquiring and editing CIGs for automatic interpretation present limitations in their ease of use and the support they offer to a CIG encoder. Besides characterizing these limitations and identifying improvements to include in future tools, this work describes the CompGuide Editor, a Protégé tool for the management of CIGs that guides a user throughout the several steps of CIG encoding, without requiring the user to have programming knowledge, and through the use of interfaces that are simple and intuitive.FCT - Fuel Cell Technologies Program (SFRH/BD/85291/2012)info:eu-repo/semantics/publishedVersio

Implementing clinical guidelines in an organizational setup

Outcomes research in healthcare has been a topic much addressed in recent years. Efforts in this direction have been supplemented by work in the areas of guidelines for clinical practice and computer-interpretable workflow and careflow models.In what follows we present the outlines of a framework for understanding the relations between organizations, guidelines, individual patients and patient-related functions. The derived framework provides a means to extract the knowledge contained in the guideline text at different granularities, in ways that can help us to assign tasks within the healthcare organization and to assess clinical performance in realizing the guideline. It does this in a way that preserves the flexibility of the organization in the adoption of the guidelines

The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions : a review

Clinical practice guidelines (CPGs) document evidence-based information and recommendations on treatment and management of conditions. CPGs usually focus on management of a single condition; however, in many cases a patient will be at the centre of multiple health conditions (multimorbidity). Multiple CPGs need to be followed in parallel, each managing a separate condition, which often results in instructions that may interact with each other, such as conflicts in medication. Furthermore, the impetus to deliver customised care based on patient-specific information, results in the need to be able to offer guidelines in an integrated manner, identifying and managing their interactions. In recent years, CPGs have been formatted as computer-interpretable guidelines (CIGs). This enables developing CIG-driven clinical decision support systems (CDSSs), which allow the development of IT applications that contribute to the systematic and reliable management of multiple guidelines. This study focuses on understanding the use of CIG-based CDSSs, in order to manage care complexities of patients with multimorbidity. The literature between 2011 and 2017 is reviewed, which covers: (a) the challenges and barriers in the care of multimorbid patients, (b) the role of CIGs in CDSS augmented delivery of care, and (c) the approaches to alleviating care complexities of multimorbid patients. Generating integrated care plans, detecting and resolving adverse interactions between treatments and medications, dealing with temporal constraints in care steps, supporting patient-caregiver shared decision making and maintaining the continuity of care are some of the approaches that are enabled using a CIG-based CDSS

Computer-interpretable guidelines using GLIF with Windows workflow foundation

Modern medicine is increasingly using evidence based medicine (EBM). EBM has become an integral part of medical training and ultimately on practice. Davis et al. [6] describe the “clinical care gap” where actual day-to-day clinical practice differs from EBC, leading to poor outcomes. This thesis researches the GLIF specification and implements the foundation for a GLIF based guideline system using Windows Workflow Foundation 4.0. There exists no public domain computer implementable guideline system. The guideline system developed allows a guideline implementer to create a guideline visually using certain medical related tasks, and to test and debug them before implementation. Chapter 5 of this thesis shows how to implement a guideline called Group A Streptococcal Disease Surveillance Protocol for Ontario Hospitals which is of fundamental importance for Ontario hospitals. The workflow approach allows developers to create custom tasks should the need arise. The Workflow Foundation provides a powerful set of base classes to implement clinical guidelines.Master's These

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

A web platform and a decision model for computer-interpretable guidelines

Situations of medical error and defensive medicine are com- mon in healthcare environments and have repercussions in the quality of care under o er. The occurrence of adverse events and the increase of healthcare expenses are some of the consequences of medical malpractice. Indeed, these situations may be prevented by encouraging the compli- ance with Clinical Guidelines (CGs). However, the current format of CGs proved to be disadvantageous for real-time application, i.e., they may not provide recommendations to healthcare professionals when required, and on time. The introduction of Computer-Interpretable Guidelines (CIGs) may provide a solution to this problem, however they are not widely implemented and there are some issues that need to be contemplated. Indeed, in this paper it is presented the CompGuide project for guideline representation and sharing, combined with the handling of incomplete information in that context

Webifying the computerized execution of Clinical Practice Guidelines

The means through which Clinical Practice Guidelines are dissemi-nated and become accessible are a crucial factor in their later adoption by health care professionals. Making these guidelines available in Clinical Decision Sup-port Systems renders their application more personal and thus acceptable at the moment of care. Web technologies may play an important role in increasing the reach and dissemination of guidelines, but this promise remains largely unful-filled. There is a need for a guideline computer model that can accommodate a wide variety of medical knowledge along with a platform for its execution that can be easily used in mobile devices. This work presents the CompGuide frame-work, a web-based and service-oriented platform for the execution of Computer-Interpretable Guidelines. Its architecture comprises different modules whose in-teraction enables the interpretation of clinical tasks and the verification of clinical constraints and temporal restrictions of guidelines represented in OWL. It allows remote guideline execution with data centralization, more suitable for a work en-vironment where physicians are mobile and not bound to a machine. The solution presented in this paper encompasses a computer-interpretable guideline model, a web-based framework for guideline execution and an Application Programming Interface for the development of other guideline execution systems.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 (PTDC/EEI-SII/1386/2012). The work of Tiago Oliveira is supported by doctoral grant by FCT (SFRH/BD/85291/2012)

Process Model Metrics for Quality Assessment of Computer-Interpretable Guidelines in PROform

Background: Clinical Practice Guidelines (CPGs) include recommendations to optimize patient care and thus have the potential to improve the quality and outcomes of healthcare. To achieve this, CPG recommendations are usually formalized in terms of Computer-Interpretable Guideline (CIG) languages. However, a clear understanding of CIG models may prove complicated, due to the inherent complexity of CPGs and the specificities of CIG languages. Drawing a parallel with the Business Process Management (BPM) and the Software Engineering fields, understandability and modifiability of CIG models can be regarded as primary quality attributes, in order to facilitate their validation, as well as their adaptation to accommodate evolving clinical evidence, by modelers (typically teams made up of clinical and IT experts). This constitutes a novel approach in this area of CIG development, where understandability and modifiability aspects have not been considered to date. Objective: In this paper, we define a comprehensive set of process model metrics for CIGs described in the PROforma CIG language, with the main objective of providing tools for quality assessment of CIG models in this language. Methods: To this end, we first reinterpret a set of metrics from the BPM field in terms of PROforma and then we define new metrics to capture the singularities of PROforma models. Additionally, we report on a set of experiments to assess the relationship between the structural and logical properties of CIG models, as measured by the proposed metrics, and their understandability and modifiability from the point of view of modelers, both clinicians and IT staff. For the analysis of the experiment results, we perform statistical analysis based on a generalized linear mixed model with binary logistic regression. Results: Our contribution includes the definition of a comprehensive set of metrics that allow measuring model quality aspects of PROforma CIG models, the implementation of tools and algorithms to assess the metrics for PROforma models, and the empirical validation of the proposed metrics as quality indicators. Conclusions: In light of the results, we conclude that the proposed metrics can be of great value, as they capture the PROforma-specific features in addition to those inspired by the general-purpose BPM metrics in the literature. In particular, the newly defined metrics for PROforma prevail as statistically significant when the whole CIG model is considered, which means that they better characterize its complexity. Consequently, the proposed metrics can be used as quality indicators of the understandability, and thereby maintainability, of PROforma CIGs

Computer-interpretable guidelines driven clinical decision support systems : an approach to the treatment personalisation routes of patients with multi-diseases

Clinical Decision Support Systems help the delivery of care by supplementing generic clinical guidelines with decision support. This is achieved by encompassing patient specific recommendations that support the implementation of the computer-interpretable guidelines (CIGs). CIG implementation involves understanding the risks and outcomes of a treatment, which may show diversifications between patients with multiple diseases and those without. The objective of this study is to present a state-of-the-art approach for CIG based treatment personalisation routes and stages for patients with multiple diseases