St-Modeler : a clinical guidelines development and verification environment

Orientador: Jacques WainerDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de ComputaçãoResumo: Um guia de conduta médica é um documento formado por um conjunto de recomendações sistematicamente desenvolvidas para auxiliar nas decisões de praticantes e pacientes sobre cuidados de saúde em circunstâncias específicas. Desde que sejam bem elaborados, comprovadamente melhoram a qualidade média do atendimento médico. Frequentemente médicos não estão acostumados com guias práticos escritos em papel e não os aplicam adequadamente. Implementados em sistemas computacionais podem melhorar significativamente a qualidade do atendimento médico diretamente no local da assistência. Este trabalho está ligado ao projeto ST-Guide, uma iniciativa surgida no Instituto de Computação da Universidade Estadual de Campinas (IC-UNICAMP) para resolver o problema de formalização e implementação de guias clínicos práticos. As contribuições realizadas foram: (a) reestruturação do projeto em outras tecnologias; (b) estabelecimento e implementação de uma arquitetura extensível para suportar modelagem e implementação de guias; (c) realização de alterações conceituais para facilitar o processo de modelagem; (d) criação de novo algoritmo para verificação lógica de incompletude e ambiguidade; e (e) criação de um ambiente gráfico de desenvolvimento de guias associado a um verificador lógico que atua em tempo real, isto é, à medida em que ocorre a modelagem. Experimentos baseados em guias clínicos para assistência pré-natal e hipertensão são apresentados e o texto é concluído com uma discussão do que foi realizado e sugestão de trabalhos futuros.Abstract: Clinical guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Since well elaborated, they provenly improve medical assistance quality. Oftenly clinicians aren't used to paper written guidelines and don't apply them adequately. Implemented in computer systems guidelines can significantly improve medical care quality directly at the point-of-care. This work is related to ST-Guide project, an initiative arisen at the Institute of Computing of State University of Campinas (IC-UNICAMP) to solve the practice guideline formalization and implementation problems. The contributions done were: (a) project restructuring on other technologies; (b) extensible architecture specification and implementation to support guideline modelling and implementation; (c) conceptual changes to ease modelling; (d) new incompletude and ambiguity logical verification algorithm; and (e) guideline graphical development environment coupled with a real time logical verifier. Experiments based on pre-natal assistence and hypertension clinical guidelines are presented and the text is concluded with a discussion of what was done and future work suggestions.MestradoMestre em Computaçã

Technical Report on Interpretation of the Electrocardiogram (ECG) Signal using Formal Methods

Today an evidence-based medicine has given number of medical practice clinical guidelines and protocols. Clinical guidelines systematically assist practitioners with providing appropriate health care for specific clinical circumstances. However, a significant number of guidelines and protocols are lacking in quality. Indeed, ambiguity and incompleteness are more likely anomalies in medical practices. From last few years, many researchers have tried to address the problem of protocol improvement in clinical guidelines, but results are not sufficient since they believe on informal processes and notations. Our objective is to find anomalies and to improve the quality of medical protocols using well known formal techniques, such as Event B. In this report, we use the Event B modeling language to capture guidelines for their validation. We have established a classification of possible properties to be verified in a guideline. Our approach is illustrated with a guideline which published by the National Guideline Clearing House (NGC) and AHA/ACC Society. Our main contribution is to evaluate real-life medical protocols using refinement based formal method like Event B for improving quality of the protocols. Refinement based formalisation is very easy to handle any complex medical protocols. For this evaluation we have selected a real-life reference protocol (ECG Interpretation) which covers a wide variety of protocol characteristics related to the several heart diseases. We formalise the given reference protocol, verify a set of interesting properties of the protocol and finally determine anomalies. Our main results are: to formalise an ECG interpretation protocol for diagnosing the ECG signal in optimal way; to discover an hierarchical structure for the ECG interpretation efficiently using incremental refinement approach; a set of properties which should be satisfied by medical protocol; verification proofs for the protocol and properties according to the medical experts; and perspectives of the potentials of this approach. Finally, we have shown the feasibility of our approach for analysing medical protocols

A verification of medical guidelines by model checking -a case study

Abstract. This paper presents a case study on how to apply formal modeling and verification in the context of quality improvement in medical healthcare. The aim is to verify quality requirements of medical guidelines and clinical treatment protocols that are used to standardize patient care both for general practitioners and hospitals. This research is supported by the European Commission’s IST program and brings together experts from computer science, artificial intelligence in medicine, hospitals, and the Dutch Institute for Healthcare Improvement (CBO). We present the process of formal modeling and verification of guidelines using the modeling language Asbru, temporal logic for expressing the quality requirements, and model checking for proof and error detection. The approach is illustrated with a case study on a guideline from the American Association for Pediatrics on “Jaundice in health