Assessing an ontology for the representation of clinical protocols in decision support systems

In order to assess the expressiveness of the CompGuide ontology for Clinical Practice Guidelines, a study was conducted with fourteen students of the Integrated Masters in Biomedical Engineering from the University of Minho in Portugal to whom it was proposed the representation of multiple guidelines according to the ontology. They were then asked to evaluate the ontology through a questionnaire and written reports. Although the results seem promising, there is the need for significant improvements mainly in: the representation of medication prescriptions, the tasks used to retrieve information from the patient, the diversity of actions offered by the ontology, the expressiveness of conditions regarding the state of a patient, and temporal constraints.FCT - Fundação para a Ciência e a Tecnologiainfo:eu-repo/semantics/publishedVersio

Acceptability and usage patterns of an image analysis workstation.

Critical to the successful deployment and use ofnew computer systems is the acceptance of the system by the users, i.e., the clinicians. We describe a study which evaluated, in an experimental setting, the potential acceptability of an image analysis workstation for radiation therapy. The acceptability and usage patterns were measured using semistructured questionnaires and maintaining logs of user interactions. The results ofthe study showed that the radiation oncologists, who were the subjects for the study, perceived the workstation as acceptable. The results also suggested several areas for improvement of workstation that could increase its acceptance in the clinical setting

A system for the management of clinical tasks throughout the clinical process with notification features

Computer-Interpretable Guidelines have been associated with a higher integration of standard practices in the daily context of health care institutions. The Clinical Decision Support Systems that deliver these machine-interpretable recommendations usually follow a Q & A style of communication, retrieving information from the user or a clinical repository and performing reasoning upon it, based on the rules from Clinical Practice Guidelines. However, these systems are limited in the reach they are capable of achieving as they were initially conceived for use in very specific moments of the clinical process, namely in physician appointments. The purpose of this work is thus to present a system that, in addition to Q & A reasoning, is equipped with other functionalities such as the scheduling and temporal management of clinical tasks, the mapping of these tasks onto an agenda of activities to allow an easy consultation by health care professionals, and notifications that let health care professionals know of task enactment times and information collection times. In this way, the system ensures the delivery of procedures. The main components of the system, which reflect a different perspective on the delivery of CIG advice that we call guideline as a service, are disclosed, and they include a health care Personal Assistant Web Application, a health care assistant mobile application, and the integration with the private calendar services of the user.(POCI-01-0145-)info:eu-repo/semantics/publishedVersio

Semantic Correctness in Adaptive Process Management Systems

Abstract. Adaptivity in Process Management Systems (PMS) is key to their successful applicability in pratice. Approaches have already been de-veloped to ensure the system correctness after arbitrary process changes at the syntactical level. However, still errors may be caused at the se-mantical level. Therefore, the integration of application knowledge will flag a milestone in the development of process management technology. In this paper, we introduce a framework for defining semantic constraints over processes in such a way that they can express real-world applica-tion knowledge. On the other hand, these constraints are still manageable concerning the effort for maintenance and semantic process verification. This can be used, for example, to detect semantic conflicts when ap-plying process changes (e.g., drug incompatibilities). In order to enable the PMS to deal with such semantic conflicts we also introduce a notion of semantic correctness and discuss how to (efficiently) verify semantic correctness in the context of process changes

Standards for Scalable Clinical Decision Support: Need, Current and Emerging Standards, Gaps, and Proposal for Progress

Despite their potential to significantly improve health care, advanced clinical decision support (CDS) capabilities are not widely available in the clinical setting. An important reason for this limited availability of CDS capabilities is the application-specific and institution-specific nature of most current CDS implementations. Thus, a critical need for enabling CDS capabilities on a much larger scale is the development and adoption of standards that enable current and emerging CDS resources to be more effectively leveraged across multiple applications and care settings. Standards required for such effective scaling of CDS include (i) standard terminologies and information models to represent and communicate about health care data; (ii) standard approaches to representing clinical knowledge in both human-readable and machine-executable formats; and (iii) standard approaches for leveraging these knowledge resources to provide CDS capabilities across various applications and care settings. A number of standards do exist or are under development to meet these needs. However, many gaps and challenges remain, including the excessive complexity of many standards; the limited availability of easily accessible knowledge resources implemented using standard approaches; and the lack of tooling and other practical resources to enable the efficient adoption of existing standards. Thus, the future development and widespread adoption of current CDS standards will depend critically on the availability of tooling, knowledge bases, and other resources that make the adoption of CDS standards not only the right approach to take, but the cost-effective path to follow given the alternative of using a traditional, ad hoc approach to implementing CDS

A Scalable Architecture for Incremental Specification and Maintenance of Procedural and Declarative Clinical Decision-Support Knowledge

Clinical guidelines have been shown to improve the quality of medical care and to reduce its costs. However, most guidelines exist in a free-text representation and, without automation, are not sufficiently accessible to clinicians at the point of care. A prerequisite for automated guideline application is a machine-comprehensible representation of the guidelines. In this study, we designed and implemented a scalable architecture to support medical experts and knowledge engineers in specifying and maintaining the procedural and declarative aspects of clinical guideline knowledge, resulting in a machine comprehensible representation. The new framework significantly extends our previous work on the Digital electronic Guidelines Library (DeGeL) The current study designed and implemented a graphical framework for specification of declarative and procedural clinical knowledge, Gesher. We performed three different experiments to evaluate the functionality and usability of the major aspects of the new framework: Specification of procedural clinical knowledge, specification of declarative clinical knowledge, and exploration of a given clinical guideline. The subjects included clinicians and knowledge engineers (overall, 27 participants). The evaluations indicated high levels of completeness and correctness of the guideline specification process by both the clinicians and the knowledge engineers, although the best results, in the case of declarative-knowledge specification, were achieved by teams including a clinician and a knowledge engineer. The usability scores were high as well, although the clinicians’ assessment was significantly lower than the assessment of the knowledge engineers

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"

ProDoc: An electronic patient record to foster processoriented practices

Abstract. The paper presents PRODOC, an Electronic Document System that allows users to navigate documental artifacts according to predefined process maps. In fact in PRODOC, process models are to be considered as maps that users willingly take as guide for their decisions and actions, rather than scripts prescribed from above. The main tenet of this research is that, by integrating documents and processes, documental practices and related work practices could better align to intended models of action. The underlying concept is the result of a long empirical research in the healthcare domain, where we have deployed PRODOC as an innovative and process-oriented Electronic Patient Record. The user participation in the phase of document definition and clinical processes modeling is central in our approach and it is illustrated in three scenarios of the software informal validation that we present in this paper. 1 Health records: a challenging domain The healthcare domain is the marketing target of many vendors that propose systems of various kinds to support different phases or activities of the healthcare process. Some of these systems receive a good acceptance since they mainly deal with administrativ