Development and implementation of clinical guidelines : an artificial intelligence perspective

Clinical practice guidelines in paper format are still the preferred form of delivery of medical knowledge and recommendations to healthcare professionals. Their current support and development process have well identified limitations to which the healthcare community has been continuously searching solutions. Artificial intelligence may create the conditions and provide the tools to address many, if not all, of these limitations.. This paper presents a comprehensive and up to date review of computer-interpretable guideline approaches, namely Arden Syntax, GLIF, PROforma, Asbru, GLARE and SAGE. It also provides an assessment of how well these approaches respond to the challenges posed by paper-based guidelines and addresses topics of Artificial intelligence that could provide a solution to the shortcomings of clinical guidelines. Among the topics addressed by this paper are expert systems, case-based reasoning, medical ontologies and reasoning under uncertainty, with a special focus on methodologies for assessing quality of information when managing incomplete information. Finally, an analysis is made of the fundamental requirements of a guideline model and the importance that standard terminologies and models for clinical data have in the semantic and syntactic interoperability between a guideline execution engine and the software tools used in clinical settings. It is also proposed a line of research that includes the development of an ontology for clinical practice guidelines and a decision model for a guideline-based expert system that manages non-compliance with clinical guidelines and uncertainty.This work is funded by national funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project PEst-OE/EEI/UI0752/2011"

A semantics and a logic for Fuzzy Arden Syntax

Fuzzy programming languages, such as the Fuzzy Arden Syntax (FAS), are used to describe behaviours which evolve in a fuzzy way and thus cannot be characterized neither by a Boolean outcome nor by a probability distribution. This paper introduces a semantics for FAS, focusing on the weighted parallel interpretation of its conditional statement. The proposed construction is based on the notion of a fuzzy multirelation which associates with each state in a program a fuzzy set of weighted possible evolutions. The latter is parametric on a residuated lattice which models the underlying semantic ‘truth space’. Finally, a family of dynamic logics, equally parametric on the residuated lattice, is introduced to reason about FAS programsThis work was founded by the ERDF — European Regional Development Fund through the Operational Programme for Competitiveness and Internationalisation — COMPETE 2020 Pro gramme and by National Funds through the Portuguese funding agency, FCT — Fundação para a Ciência e a Tecnologia, within projects POCI-01-0145-FEDER-030947and POCI-01-0145-FEDER-02994

Declarative Guideline Conformance Checking of Clinical Treatments: A Case Study

Conformance checking is a process mining technique that allows verifying the conformance of process instances to a given model. Thus, this technique is predestined to be used in the medical context for the comparison of treatment cases with clinical guidelines. However, medical processes are highly variable, highly dynamic, and complex. This makes the use of imperative conformance checking approaches in the medical domain difficult. Studies show that declarative approaches can better address these characteristics. However, none of the approaches has yet gained practical acceptance. Another challenge are alignments, which usually do not add any value from a medical point of view. For this reason, we investigate in a case study the usability of the HL7 standard Arden Syntax for declarative, rule-based conformance checking and the use of manually modeled alignments. Using the approach, it was possible to check the conformance of treatment cases and create medically meaningful alignments for large parts of a medical guideline

Processing Gradual Information with Fuzzy Arden Syntax

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Fuzzy Logic in Clinical Practice Decision Support Systems

Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. This paper discusses sources of fuzziness in clinical practice guidelines. We consider how fuzzy logic can be applied and give a set of heuristics for the clinical guideline knowledge engineer for addressing uncertainty in practice guidelines. We describe the specific applicability of fuzzy logic to the decision support behavior of Care Plan On-Line, an intranet-based chronic care planning system for General Practitioners

An overview of decision table literature.

The present report contains an overview of the literature on decision tables since its origin. The goal is to analyze the dissemination of decision tables in different areas of knowledge, countries and languages, especially showing these that present the most interest on decision table use. In the first part a description of the scope of the overview is given. Next, the classification results by topic are explained. An abstract and some keywords are included for each reference, normally provided by the authors. In some cases own comments are added. The purpose of these comments is to show where, how and why decision tables are used. Other examined topics are the theoretical or practical feature of each document, as well as its origin country and language. Finally, the main body of the paper consists of the ordered list of publications with abstract, classification and comments.

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

An extended HD Fluent Analysis of Temporal knowledge in OWL-based clinical Guideline System

The Web Ontology Language (OWL) based clinical guideline system is a kind of clinical decision support system which is often used to assist health professionals to find clinical recommendations from the guidelines and check clinical compliance issues in terms of the guideline recommendations. However, due to some limitations of the current OWL language constructs, temporal knowledge contained in various knowledge domains cannot be directly represented in OWL. As a result, the representation, query and reasoning of temporal knowledge are largely ignored in many OWL-based clinical guideline ontology systems. The aim of this research is to investigate a temporal knowledge modelling method namely “4D fluent” and extend it to represent the temporal constraints contained in clinical guideline recommendations within OWL language constructs. The extended 4D fluent method can model temporal constraints including valid calendar time, interval, duration, repetitive or cyclical temporal constraints and temporal relations such that it can enable reasoning over these temporal constraints in the OWL-based clinical guideline ontology system and overcome the shortcoming of the traditional OWL-based clinical guideline system to an extent

Generalising KAT to verify weighted computations

Kleene algebra with tests (KAT) was introduced as an algebraic structure to model and reason about classic imperative programs, i.e. sequences of discrete transitions guarded by Boolean tests. This paper introduces two generalisations of this structure able to express programs as weighted transitions and tests with outcomes in non necessarily bivalent truth spaces: graded Kleene algebra with tests (GKAT) and a variant where tests are also idempotent (I-GKAT). In this context, and in analogy to Kozen's encoding of Propositional Hoare Logic (PHL) in KAT we discuss the encoding of a graded PHL in I-GKAT and of its while-free fragment in GKAT. Moreover, to establish semantics for these structures four new algebras are de ned: FSET (T ), FREL(K; T ) and FLANG(K; T ) over complete residuated lattices K and T , and M(n;A) over a GKAT or I-GKAT A. As a nal exercise, the paper discusses some program equivalence proofs in a graded context.POCI-01-0145-FEDER-03094, NORTE-01-0145-FEDER-000037. ERDF – European Regional Development Fund through the Operational Programme for Competitiveness and Internationalisation - COMPETE 2020 Programme and by National Funds through the Portuguese funding agency, FCT - Fundação para a Ciência e a Tecnologia, within project POCI-01-0145-FEDER-030947. This paper is also a result of the project SmartEGOV, NORTE-01-0145-FEDER-000037. The second author is supported in the scope of the framework contract foreseen in the numbers 4, 5 and 6 of the article 23, of the Decree-Law 57/2016, of August 29, changed by Portuguese Law 57/2017, of July 19, at CIDMA (Centro de Investigação e Desenvolvimento em Matemática e Aplicações) UID/MAT/04106/2019