Clinical guidelines as plans: An ontological theory

Clinical guidelines are special types of plans realized by collective agents. We provide an ontological theory of such plans that is designed to support the construction of a framework in which guideline-based information systems can be employed in the management of workflow in health care organizations. The framework we propose allows us to represent in formal terms how clinical guidelines are realized through the actions of are realized through the actions of individuals organized into teams. We provide various levels of implementation representing different levels of conformity on the part of health care organizations. Implementations built in conformity with our framework are marked by two dimensions of flexibility that are designed to make them more likely to be accepted by health care professionals than standard guideline-based management systems. They do justice to the fact 1) that responsibilities within a health care organization are widely shared, and 2) that health care professionals may on different occasions be non-compliant with guidelines for a variety of well justified reasons. The advantage of the framework lies in its built-in flexibility, its sensitivity to clinical context, and its ability to use inference tools based on a robust ontology. One disadvantage lies in its complicated implementation

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

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

A unified framework for building ontological theories with application and testing in the field of clinical trials

The objective of this research programme is to contribute to the establishment of the emerging science of Formal Ontology in Information Systems via a collaborative project involving researchers from a range of disciplines including philosophy, logic, computer science, linguistics, and the medical sciences. The re­searchers will work together on the construction of a unified formal ontology, which means: a general framework for the construction of ontological theories in specific domains. The framework will be constructed using the axiomatic-deductive method of modern formal ontology. It will be tested via a series of applications relating to on-going work in Leipzig on medical taxonomies and data dictionaries in the context of clinical trials. This will lead to the production of a domain-specific ontology which is designed to serve as a basis for applications in the medical field

Using ontology in query answering systems: Scenarios, requirements and challenges

Equipped with the ultimate query answering system, computers would finally be in a position to address all our information needs in a natural way. In this paper, we describe how Language and Computing nv (L&C), a developer of ontology-based natural language understanding systems for the healthcare domain, is working towards the ultimate Question Answering (QA) System for healthcare workers. L&C’s company strategy in this area is to design in a step-by-step fashion the essential components of such a system, each component being designed to solve some one part of the total problem and at the same time reflect well-defined needs on the prat of our customers. We compare our strategy with the research roadmap proposed by the Question Answering Committee of the National Institute of Standards and Technology (NIST), paying special attention to the role of ontology

Referent tracking for corporate memories

For corporate memory and enterprise ontology systems to be maximally useful, they must be freed from certain barriers placed around them by traditional knowledge management paradigms. This means, above all, that they must mirror more faithfully those portions of reality which are salient to the workings of the enterprise, including the changes that occur with the passage of time. The purpose of this chapter is to demonstrate how theories based on philosophical realism can contribute to this objective. We discuss how realism-based ontologies (capturing what is generic) combined with referent tracking (capturing what is specific) can play a key role in building the robust and useful corporate memories of the future

An Aboriginal English Ontology Framework for Patient-Practitioner Interview Encounters

Current diagnosis, treatment and healthcare delivery processes in Australia are dominated by long established westernized clinically driven methods of patient-practitioner interaction. Consequently this dominant healthcare provider influence contributes to risk of miscommunication, misinformation in patient records and reciprocal misunderstandings that go unrecognised as such. For Indigenous communities, inadequate health literacy (HL) and a pervasive semantic disconnect are major barriers. Overcoming these barriers in the primary care setting presents opportunities to deliver appropriate timely and more effective care. We propose an e-health framework that enhances the Patient-Practitioner Interview Encounter (PPIE) through the use of a patient-centric linguistic interface using semantic mappings between Aboriginal English (AE) and Standard Australian English (SAE). This will ameliorate communications and interactions, so meeting the needs of all stakeholders (Patients, Physicians, Nurses, Allied Health Professionals and their Non-Critical Carers) engaged in Indigenous patient-centric primary care. It provides healthcare practitioners and their Indigenous T2DM patients with a new platform for two-way educative sharing and knowledge exchange that will increase mutually productive treatment, care and management expectations

Barry Smith an sich

Festschrift in Honor of Barry Smith on the occasion of his 65th Birthday. Published as issue 4:4 of the journal Cosmos + Taxis: Studies in Emergent Order and Organization. Includes contributions by Wolfgang Grassl, Nicola Guarino, John T. Kearns, Rudolf Lüthe, Luc Schneider, Peter Simons, Wojciech Żełaniec, and Jan Woleński

An Ontology-Based Interpretable Fuzzy Decision Support System for Diabetes Diagnosis

Diabetes is a serious chronic disease. The importance of clinical decision support systems (CDSSs) to diagnose diabetes has led to extensive research efforts to improve the accuracy, applicability, interpretability, and interoperability of these systems. However, this problem continues to require optimization. Fuzzy rule-based systems are suitable for the medical domain, where interpretability is a main concern. The medical domain is data-intensive, and using electronic health record data to build the FRBS knowledge base and fuzzy sets is critical. Multiple variables are frequently required to determine a correct and personalized diagnosis, which usually makes it difficult to arrive at accurate and timely decisions. In this paper, we propose and implement a new semantically interpretable FRBS framework for diabetes diagnosis. The framework uses multiple aspects of knowledge-fuzzy inference, ontology reasoning, and a fuzzy analytical hierarchy process (FAHP) to provide a more intuitive and accurate design. First, we build a two-layered hierarchical and interpretable FRBS; then, we improve this by integrating an ontology reasoning process based on SNOMED CT standard ontology. We incorporate FAHP to determine the relative medical importance of each sub-FRBS. The proposed system offers numerous unique and critical improvements regarding the implementation of an accurate, dynamic, semantically intelligent, and interpretable CDSS. The designed system considers the ontology semantic similarity of diabetes complications and symptoms concepts in the fuzzy rules' evaluation process. The framework was tested using a real data set, and the results indicate how the proposed system helps physicians and patients to accurately diagnose diabetes mellitusThis work was supported by National Research Foundation of Korea-Grant funded by the Korean Government (Ministry of Science, ICT and Future Planning)-NRF-2017R1A2B2012337)S