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

A unified view of data-intensive flows in business intelligence systems : a survey

Data-intensive flows are central processes in today’s business intelligence (BI) systems, deploying different technologies to deliver data, from a multitude of data sources, in user-preferred and analysis-ready formats. To meet complex requirements of next generation BI systems, we often need an effective combination of the traditionally batched extract-transform-load (ETL) processes that populate a data warehouse (DW) from integrated data sources, and more real-time and operational data flows that integrate source data at runtime. Both academia and industry thus must have a clear understanding of the foundations of data-intensive flows and the challenges of moving towards next generation BI environments. In this paper we present a survey of today’s research on data-intensive flows and the related fundamental fields of database theory. The study is based on a proposed set of dimensions describing the important challenges of data-intensive flows in the next generation BI setting. As a result of this survey, we envision an architecture of a system for managing the lifecycle of data-intensive flows. The results further provide a comprehensive understanding of data-intensive flows, recognizing challenges that still are to be addressed, and how the current solutions can be applied for addressing these challenges.Peer ReviewedPostprint (author's final draft

Are decision trees a feasible knowledge representation to guide extraction of critical information from randomized controlled trial reports?

<p>Abstract</p> <p>Background</p> <p>This paper proposes the use of decision trees as the basis for automatically extracting information from published randomized controlled trial (RCT) reports. An exploratory analysis of RCT abstracts is undertaken to investigate the feasibility of using decision trees as a semantic structure. Quality-of-paper measures are also examined.</p> <p>Methods</p> <p>A subset of 455 abstracts (randomly selected from a set of 7620 retrieved from Medline from 1998 – 2006) are examined for the quality of RCT reporting, the identifiability of RCTs from abstracts, and the completeness and complexity of RCT abstracts with respect to key decision tree elements. Abstracts were manually assigned to 6 sub-groups distinguishing whether they were primary RCTs versus other design types. For primary RCT studies, we analyzed and annotated the reporting of intervention comparison, population assignment and outcome values. To measure completeness, the frequencies by which complete intervention, population and outcome information are reported in abstracts were measured. A qualitative examination of the reporting language was conducted.</p> <p>Results</p> <p>Decision tree elements are manually identifiable in the majority of primary RCT abstracts. 73.8% of a random subset was primary studies with a single population assigned to two or more interventions. 68% of these primary RCT abstracts were structured. 63% contained pharmaceutical interventions. 84% reported the total number of study subjects. In a subset of 21 abstracts examined, 71% reported numerical outcome values.</p> <p>Conclusion</p> <p>The manual identifiability of decision tree elements in the abstract suggests that decision trees could be a suitable construct to guide machine summarisation of RCTs. The presence of decision tree elements could also act as an indicator for RCT report quality in terms of completeness and uniformity.</p

Leveraging workflow control patterns in the domain of clinical practice guidelines

Background: Clinical practice guidelines (CPGs) include recommendations describing appropriate care for the management of patients with a specific clinical condition. A number of representation languages have been developed to support executable CPGs, with associated authoring/editing tools. Even with tool assistance, authoring of CPG models is a labor-intensive task. We aim at facilitating the early stages of CPG modeling task. In this context, we propose to support the authoring of CPG models based on a set of suitable procedural patterns described in an implementation-independent notation that can be then semi-automatically transformed into one of the alternative executable CPG languages. Methods: We have started with the workflow control patterns which have been identified in the fields of workflow systems and business process management. We have analyzed the suitability of these patterns by means of a qualitative analysis of CPG texts. Following our analysis we have implemented a selection of workflow patterns in the Asbru and PROforma CPG languages. As implementation-independent notation for the description of patterns we have chosen BPMN 2.0. Finally, we have developed XSLT transformations to convert the BPMN 2.0 version of the patterns into the Asbru and PROforma languages. Results: We showed that although a significant number of workflow control patterns are suitable to describe CPG procedural knowledge, not all of them are applicable in the context of CPGs due to their focus on single-patient care. Moreover, CPGs may require additional patterns not included in the set of workflow control patterns. We also showed that nearly all the CPG-suitable patterns can be conveniently implemented in the Asbru and PROforma languages. Finally, we demonstrated that individual patterns can be semi-automatically transformed from a process specification in BPMN 2.0 to executable implementations in these languages. Conclusions: We propose a pattern and transformation-based approach for the development of CPG models. Such an approach can form the basis of a valid framework for the authoring of CPG models. The identification of adequate patterns and the implementation of transformations to convert patterns from a process specification into different executable implementations are the first necessary steps for our approach.This research has been supported by: 1) Austrian Science Fund (FWF) through project TRP71-N23. 2) Spanish Ministry of Education through grant PR2010-0279, and by Universitat Jaume I through project P11B2009-38

MOG 2007:Workshop on Multimodal Output Generation: CTIT Proceedings

This volume brings together presents a wide variety of work offering different perspectives on multimodal generation. Two different strands of work can be distinguished: half of the gathered papers present current work on embodied conversational agents (ECA’s), while the other half presents current work on multimedia applications. Two general research questions are shared by all: what output modalities are most suitable in which situation, and how should different output modalities be combined

Generating Abstract Arguments: a Natural Language Approach

International audienceMany argumentation tools have been proposed nowadays to support the users in on-line social discussions. However, the main drawback of these tools is that they do not cope with the automatic generation of the arguments from the natural language discussions of the users. In this paper, we propose to use a technique from computational linguistics, namely textual entailment, to generate in an automatic way the abstract arguments from the dialogues. The abstract arguments as well as their relationships are then structured in an argumentation graph to evaluate the dialogue as a whole. The success criteria of the proposed approach is that it is able to represent the dynamics of the dialogues among users allowing to find the use of argumentation natural enough to be really adopted

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

Relation Classification with Limited Supervision

Large reams of unstructured data, for instance in form textual document collections containing entities and relations, exist in many domains. The process of deriving valuable domain insights and intelligence from such documents collections usually involves the extraction of information such as the relations between the entities in such collections. Relation classification is the task of detecting relations between entities. Supervised machine learning models, which have become the tool of choice for relation classification, require substantial quantities of annotated data for each relation in order to perform optimally. For many domains, such quantities of annotated data for relations may not be readily available, and manually curating such annotations may not be practical due to time and cost constraints. In this work, we develop both model-specific and model-agnostic approaches for relation classification with limited supervision. We start by proposing an approach for learning embeddings for contextual surface patterns, which are the set of surface patterns associated with entity pairs across a text corpus, to provide additional supervision signals for relation classification with limited supervision. We find that this approach improves classification performance on relations with limited supervision instances. However, this initial approach assumes the availability of at least one annotated instance per relation during training. In order to address this limitation, we propose an approach which formulates the task of relation classification as that of textual entailment. This reformulation allows us to use the textual descriptions of relations to classify their instances. It also allows us to utilize existing textual entailment datasets and models to classify relations with zero supervision instances. The two methods proposed previously rely on the use of specific model architectures for relation classification. Since a wide variety of models have been proposed for relation classification in the literature, a more general approach is thus desirable. We subsequently propose our first model-agnostic meta-learning algorithm for relation classification with limited supervision. This algorithm is applicable to any gradient-optimized relation classification model. We show that the proposed approach improves the predictive performance of two existing relation classification models when supervision for relations is limited. Next, because all the approaches we have proposed so far assume the availability of all supervision needed for classifying relations prior to model training, they are unable to handle the case when new supervision for relations becomes available after training. Such new supervision may need to be incorporated into the model to enable it classify new relations or to improve its performance on existing relations. Our last approach addresses this short-coming. We propose a model-agnostic algorithm which enables relation classification models to learn continually from new supervision as it becomes available, while doing so in a data-efficient manner and without forgetting knowledge of previous relations