Creating hospital-specific customized clinical pathways by applying semantic reasoning to clinical data

AbstractObjectiveClinical pathways (CPs) are widely studied methods to standardize clinical intervention and improve medical quality. However, standard care plans defined in current CPs are too general to execute in a practical healthcare environment. The purpose of this study was to create hospital-specific personalized CPs by explicitly expressing and replenishing the general knowledge of CPs by applying semantic analysis and reasoning to historical clinical data.MethodsA semantic data model was constructed to semantically store clinical data. After querying semantic clinical data, treatment procedures were extracted. Four properties were self-defined for local ontology construction and semantic transformation, and three Jena rules were proposed to achieve error correction and pathway order recognition. Semantic reasoning was utilized to establish the relationship between data orders and pathway orders.ResultsA clinical pathway for deviated nasal septum was used as an example to illustrate how to combine standard care plans and practical treatment procedures. A group of 224 patients with 11,473 orders was transformed to a semantic data model, which was stored in RDF format. Long term order processing and error correction made the treatment procedures more consistent with clinical practice. The percentage of each pathway order with different probabilities was calculated to declare the commonality between the standard care plans and practical treatment procedures. Detailed treatment procedures with pathway orders, deduced pathway orders, and orders with probability greater than 80% were provided to efficiently customize the CPs.ConclusionsThis study contributes to the practical application of pathway specifications recommended by the Ministry of Health of China and provides a generic framework for the hospital-specific customization of standard care plans defined by CPs or clinical guidelines

Medical Big Data Analysis in Hospital Information System

The rapidly increasing medical data generated from hospital information system (HIS) signifies the era of Big Data in the healthcare domain. These data hold great value to the workflow management, patient care and treatment, scientific research, and education in the healthcare industry. However, the complex, distributed, and highly interdisciplinary nature of medical data has underscored the limitations of traditional data analysis capabilities of data accessing, storage, processing, analyzing, distributing, and sharing. New and efficient technologies are becoming necessary to obtain the wealth of information and knowledge underlying medical Big Data. This chapter discusses medical Big Data analysis in HIS, including an introduction to the fundamental concepts, related platforms and technologies of medical Big Data processing, and advanced Big Data processing technologies

Knowledge-based Biomedical Data Science 2019

Knowledge-based biomedical data science (KBDS) involves the design and implementation of computer systems that act as if they knew about biomedicine. Such systems depend on formally represented knowledge in computer systems, often in the form of knowledge graphs. Here we survey the progress in the last year in systems that use formally represented knowledge to address data science problems in both clinical and biological domains, as well as on approaches for creating knowledge graphs. Major themes include the relationships between knowledge graphs and machine learning, the use of natural language processing, and the expansion of knowledge-based approaches to novel domains, such as Chinese Traditional Medicine and biodiversity.Comment: Manuscript 43 pages with 3 tables; Supplemental material 43 pages with 3 table

Knowledge-driven delivery of home care services

The version of record is available online at: http://dx.doi.org/10.1007/s10844-010-0145-0Home Care (HC) assistance is emerging as an effective and efficient alternative to institutionalized care, especially for the case of senior patients that present multiple co-morbidities and require life long treatments under continuous supervision. The care of such patients requires the definition of specially tailored treatments and their delivery involves the coordination of a team of professionals from different institutions, requiring the management of many kinds of knowledge (medical, organizational, social and procedural). The K4Care project aims to assist the HC of elderly patients by proposing a standard HC model and implementing it in a knowledge-driven e-health platform aimed to support the provision of HC services.Peer ReviewedPostprint (author's final draft

Ontologies Applied in Clinical Decision Support System Rules:Systematic Review

BackgroundClinical decision support systems (CDSSs) are important for the quality and safety of health care delivery. Although CDSS rules guide CDSS behavior, they are not routinely shared and reused. ObjectiveOntologies have the potential to promote the reuse of CDSS rules. Therefore, we systematically screened the literature to elaborate on the current status of ontologies applied in CDSS rules, such as rule management, which uses captured CDSS rule usage data and user feedback data to tailor CDSS services to be more accurate, and maintenance, which updates CDSS rules. Through this systematic literature review, we aim to identify the frontiers of ontologies used in CDSS rules. MethodsThe literature search was focused on the intersection of ontologies; clinical decision support; and rules in PubMed, the Association for Computing Machinery (ACM) Digital Library, and the Nursing & Allied Health Database. Grounded theory and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines were followed. One author initiated the screening and literature review, while 2 authors validated the processes and results independently. The inclusion and exclusion criteria were developed and refined iteratively. ResultsCDSSs were primarily used to manage chronic conditions, alerts for medication prescriptions, reminders for immunizations and preventive services, diagnoses, and treatment recommendations among 81 included publications. The CDSS rules were presented in Semantic Web Rule Language, Jess, or Jena formats. Despite the fact that ontologies have been used to provide medical knowledge, CDSS rules, and terminologies, they have not been used in CDSS rule management or to facilitate the reuse of CDSS rules. ConclusionsOntologies have been used to organize and represent medical knowledge, controlled vocabularies, and the content of CDSS rules. So far, there has been little reuse of CDSS rules. More work is needed to improve the reusability and interoperability of CDSS rules. This review identified and described the ontologies that, despite their limitations, enable Semantic Web technologies and their applications in CDSS rules

AIMS: An Automatic Semantic Machine Learning Microservice Framework to Support Biomedical and Bioengineering Research

The fusion of machine learning and biomedical research offers novel ways to understand, diagnose, and treat various health conditions. However, the complexities of biomedical data, coupled with the intricate process of developing and deploying machine learning solutions, often pose significant challenges to researchers in these fields. Our pivotal achievement in this research is the introduction of the Automatic Semantic Machine Learning Microservice Framework (AIMS). AIMS addresses these challenges by automating various stages of the machine learning pipeline, with a particular emphasis on the ontology of machine learning services tailored for the biomedical domain. This ontology encompasses everything from task representation, service modeling, and knowledge acquisition to knowledge reasoning and the establishment of a self-supervised learning policy. Our framework has been crafted to prioritize model interpretability, integrate domain knowledge effortlessly, and handle biomedical data with efficiency. Additionally, AIMS boasts a distinctive feature: it leverages self-supervised knowledge learning through reinforcement learning techniques, paired with an ontology-based policy recording schema. This enables it to autonomously generate, fine-tune, and continually adapt to machine learning models, especially when faced with new tasks and data. Our work has two standout contributions of demonstrating that machine learning processes in the biomedical domain can be automated, while integrating a rich domain knowledge base and providing a way for machines to have a self-learning ability, ensuring they handle new tasks effectively. To showcase AIMS in action, we've highlighted its prowess in three case studies from biomedical tasks. These examples emphasize how our framework can simplify research routines, uplift the caliber of scientific exploration, and set the stage for notable advances

DETECTION AND HANDLING EXCEPTIONS IN BUSINESS PROCESS MANAGEMENT SYSTEMS USING ACTIVE SEMANTIC MODEL

Although business process management systems (BPM) have been used over the years, their performance in unpredicted situations has not been adequately solved. In these cases, it is common to request user assistance or invoke predefined procedures. In this paper, we propose using the Active Semantic Model (ASM) to detect and handle exceptions. This is a specifically developed semantic network model for modeling of semantic features of the business processes. ASM is capable of classifying new situations based on their similarities with existing ones. Within BPM systems this is then used to classify new situations as exceptions and to handle the exceptions by changing the process based on ASM’s previous experience. This enables automatic detection and handling of exceptions which significantly improves the performance of bpm systems

PharmacyGPT: The AI Pharmacist

In this study, we introduce PharmacyGPT, a novel framework to assess the capabilities of large language models (LLMs) such as ChatGPT and GPT-4 in emulating the role of clinical pharmacists. Our methodology encompasses the utilization of LLMs to generate comprehensible patient clusters, formulate medication plans, and forecast patient outcomes. We conduct our investigation using real data acquired from the intensive care unit (ICU) at the University of North Carolina Chapel Hill (UNC) Hospital. Our analysis offers valuable insights into the potential applications and limitations of LLMs in the field of clinical pharmacy, with implications for both patient care and the development of future AI-driven healthcare solutions. By evaluating the performance of PharmacyGPT, we aim to contribute to the ongoing discourse surrounding the integration of artificial intelligence in healthcare settings, ultimately promoting the responsible and efficacious use of such technologies

Semantic Inference on Clinical Documents: Combining Machine Learning Algorithms With an Inference Engine for Effective Clinical Diagnosis and Treatment

Clinical practice calls for reliable diagnosis and optimized treatment. However, human errors in health care remain a severe issue even in industrialized countries. The application of clinical decision support systems (CDSS) casts light on this problem. However, given the great improvement in CDSS over the past several years, challenges to their wide-scale application are still present, including: 1) decision making of CDSS is complicated by the complexity of the data regarding human physiology and pathology, which could render the whole process more time-consuming by loading big data related to patients; and 2) information incompatibility among different health information systems (HIS) makes CDSS an information island, i.e., additional input work on patient information might be required, which would further increase the burden on clinicians. One popular strategy is the integration of CDSS in HIS to directly read electronic health records (EHRs) for analysis. However, gathering data from EHRs could constitute another problem, because EHR document standards are not unified. In addition, HIS could use different default clinical terminologies to define input data, which could cause additional misinterpretation. Several proposals have been published thus far to allow CDSS access to EHRs via the redefinition of data terminologies according to the standards used by the recipients of the data flow, but they mostly aim at specific versions of CDSS guidelines. This paper views these problems in a different way. Compared with conventional approaches, we suggest more fundamental changes; specifically, uniform and updatable clinical terminology and document syntax should be used by EHRs, HIS, and their integrated CDSS. Facilitated data exchange will increase the overall data loading efficacy, enabling CDSS to read more information for analysis at a given time. Furthermore, a proposed CDSS should be based on self-learning, which dynamically updates a knowledge model according to the data-stream-based upcoming data set. The experiment results show that our system increases the accuracy of the diagnosis and treatment strategy designs

SUPPORTING ENGINEERING DESIGN OF ADDITIVELY MANUFACTURED MEDICAL DEVICES WITH KNOWLEDGE MANAGEMENT THROUGH ONTOLOGIES

Medical environments pose a substantial challenge for engineering designers. They combine significant knowledge demands with large investment for new product development and severe consequences in the case of design failure. Engineering designers must contend with an often-chaotic environment to which they have limited access and familiarity, a user base that is difficult to engage and highly diverse in many attributes, and a market structure that often pits stakeholders against one another. As medical care in general moves towards personalized models and surgical tools towards less invasive options emerging manufacturing technologies in additive manufacturing offer significant potential for the design of highly innovative medical devices. At the same time however these same technologies also introduce yet more challenges to the design process. This dissertation presents a knowledge-based approach to addressing the existing and emerging challenges of medical device design. The approach aims to address these challenges using knowledge captured in a suite of modular ontologies modeling knowledge domains that must be considered in medical device design. These include ontologies for understanding clinical context, human factors, regulation, enterprise, and manufacturability. Together these ontologies support design ideation, knowledge capture, and design verification. These ontologies are subsequently used to formulate a comprehensive knowledge framework for medical device design, and to enable an innovative design process. Case studies analyzing the design of surgical tools in several medical specialties are used to assess the capabilities of this approach