Modelling clinical goals: a corpus of examples and a tentative ontology

Knowledge of clinical goals and the means to achieve them are either not represented in most current guideline representation systems or are encoded procedurally (e.g. as clinical algorithms, condition-action rules). There would be a number of major benefits if guideline enactment systems could reason explicitly about clinical objectives (e.g. whether a goal has been successfully achieved or not, whether it is consistent with prevailing conditions, or how the system should adapt to circumstances where a recommended action has failed to achieve the intended result). Our own guideline specification language, PROforma, includes a simple goal construct to address this need, but the interpretation is unsatisfactory in current enactment engines, and goals have yet to be included in the language semantics. This paper discusses some of the challenges involved in developing an explicit, declarative formalism for goals. As part of this, we report on a study we have undertaken which has identified over 200 goals in the routine management of breast cancer, and outline a tentative formal structure for this corpus

Guideline-based decision support in medicine : modeling guidelines for the development and application of clinical decision support systems

Guideline-based Decision Support in Medicine Modeling Guidelines for the Development and Application of Clinical Decision Support Systems The number and use of decision support systems that incorporate guidelines with the goal of improving care is rapidly increasing. Although developing systems that are both effective in supporting clinicians and accepted by them has proven to be a difficult task, of the systems that were evaluated by a controlled trial, the majority showed impact. The work, described in this thesis, aims at developing a methodology and framework that facilitates all stages in the guideline development process, ranging from the definition of models that represent guidelines to the implementation of run-time systems that provide decision support, based on the guidelines that were developed during the previous stages. The framework consists of 1) a guideline representation formalism that uses the concepts of primitives, Problem-Solving Methods (PSMs) and ontologies to represent guidelines of various complexity and granularity and different application domains, 2) a guideline authoring environment that enables guideline authors to define guidelines, based on the newly developed guideline representation formalism, and 3) a guideline execution environment that translates defined guidelines into a more efficient symbol-level representation, which can be read in and processed by an execution-time engine. The described methodology and framework were used to develop and validate a number of guidelines and decision support systems in various clinical domains such as Intensive Care, Family Practice, Psychiatry and the areas of Diabetes and Hypertension control

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

Healthcare Process Support: Achievements, Challenges, Current Research

Healthcare organizations are facing the challenge of delivering high-quality services to their patients at affordable costs. To tackle this challenge, the Medical Informatics community targets at formalisms for developing decision-support systems (DSSs) based on clinical guidelines. At the same time, business process management (BPM) enables IT support for healthcare processes, e.g., based on workflow technology. By integrating aspects from these two fields, promising perspectives for achieving better healthcare process support arise. The perspectives and limitations of IT support for healthcare processes provided the focus of three Workshops on Process-oriented Information Systems (ProHealth). These were held in conjunction with the International Conference on Business Process Management in 2007-2009. The ProHealth workshops provided a forum wherein challenges, paradigms, and tools for optimized process support in healthcare were debated. Following the success of these workshops, this special issue on process support in healthcare provides extended papers by research groups who contributed multiple times to the ProHealth workshop series. These works address issues pertaining to healthcare process modeling, process-aware healthcare information system, workflow management in healthcare, IT support for guideline implementation and medical decision support, flexibility in healthcare processes, process interoperability in healthcare and healthcare standards, clinical semantics of healthcare processes, healthcare process patterns, best practices for designing healthcare processes, and healthcare process validation, verification, and evaluation

Design of a goal ontology for medical decision-support

Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2005.Includes bibliographical references (leaves 34-36).Objectives: There are several ongoing efforts aimed at developing formal models of medical knowledge and reasoning to design decision-support systems. Until now, these efforts have focused primarily on representing content of clinical guidelines and their logical structure. The present study aims to develop a computable representation of health-care providers' intentions to be used as part of a framework for implementing clinical decision-support systems. Our goal is to create an ontology that supports retrieval of plans based on the intentions or goals of the clinician. Methods: We developed an ontological representation of medical goals, plans, clinical scenarios and other relevant entities in medical decision-making. We used the resulting ontology along with an external ontology inference engine to simulate selection of clinical recommendations based on goals. The ontology instances used in the simulation were modeled from two clinical guidelines. Testing the design: Thirty-two clinical recommendations were encoded in the experimental model. Nine test cases were created to verify the ability of the model to retrieve the plans. For all nine cases, plans were successfully retrieved. Conclusion: The ontological design we developed supported effective reasoning over a medical knowledge base.(cont.) The immediate extension of this approach to be fully developed in medical applications may be partially limited by the lack of available editing tools. Many efforts in this area are currently aiming to the development of needed technologies.by Davide Zacacagnini [i.e. Zaccagnini].S.M