Supporting the Refinement of Clinical Process Models to Computer-Interpretable Guideline Models

Clinical guidelines contain recommendations on the appropriate management of patients with specific clinical conditions. A prerequisite for using clinical guidelines in information systems is to encode them in a Computer-Interpretable Guideline (CIG) language. However, this is a difficult and demanding task, usually done by IT staff. The goal of the paper is to facilitate the encoding of clinical guidelines in CIG languages, while increasing the involvement of clinicians. To achieve this, it is proposed to support the refinement of guideline processes from a preliminary specification in a business process language to a detailed implementation in one of the available CIG languages. The approach relies on the use of the Business Process Model and Notation (BPMN) for the specification level, a CIG language for the implementation level, and on algorithms to semi-automatically transform guideline models in BPMN into the CIG language of choice. As a first step towards the implementation of the approach, in this work algorithms are implemented to transform a BPMN specification of clinical processes into the PROforma CIG language, and are successfully applied to several clinical guidelines

A model-driven transformation approach for the modelling of processes in clinical practice guidelines

Clinical Practice Guidelines (CPGs) include recommendations aimed at optimising patient care, informed by a review of the available clinical evidence. To achieve their potential benefits, CPG should be readily available at the point of care. This can be done by translating CPG recommendations into one of the languages for Computer-Interpretable Guidelines (CIGs). This is a difficult task for which the collaboration of clinical and technical staff is crucial. However, in general CIG languages are not accessible to non-technical staff. We propose to support the modelling of CPG processes (and hence the authoring of CIGs) based on a transformation, from a preliminary specification in a more accessible language into an implementation in a CIG language. In this paper, we approach this transformation following the Model-Driven Development (MDD) paradigm, in which models and transformations are key elements for software development. To demonstrate the approach, we implemented and tested an algorithm for the transformation from the BPMN language for business processes to the PROforma CIG language. This implementation uses transformations defined in the ATLAS Transformation Language. Additionally, we conducted a small experiment to assess the hypothesis that a language such as BPMN can facilitate the modelling of CPG processes by clinical and technical staff.Funding for open access charge: CRUE-Universitat Jaume

Process Model Metrics for Quality Assessment of Computer-Interpretable Guidelines in PROform

Background: Clinical Practice Guidelines (CPGs) include recommendations to optimize patient care and thus have the potential to improve the quality and outcomes of healthcare. To achieve this, CPG recommendations are usually formalized in terms of Computer-Interpretable Guideline (CIG) languages. However, a clear understanding of CIG models may prove complicated, due to the inherent complexity of CPGs and the specificities of CIG languages. Drawing a parallel with the Business Process Management (BPM) and the Software Engineering fields, understandability and modifiability of CIG models can be regarded as primary quality attributes, in order to facilitate their validation, as well as their adaptation to accommodate evolving clinical evidence, by modelers (typically teams made up of clinical and IT experts). This constitutes a novel approach in this area of CIG development, where understandability and modifiability aspects have not been considered to date. Objective: In this paper, we define a comprehensive set of process model metrics for CIGs described in the PROforma CIG language, with the main objective of providing tools for quality assessment of CIG models in this language. Methods: To this end, we first reinterpret a set of metrics from the BPM field in terms of PROforma and then we define new metrics to capture the singularities of PROforma models. Additionally, we report on a set of experiments to assess the relationship between the structural and logical properties of CIG models, as measured by the proposed metrics, and their understandability and modifiability from the point of view of modelers, both clinicians and IT staff. For the analysis of the experiment results, we perform statistical analysis based on a generalized linear mixed model with binary logistic regression. Results: Our contribution includes the definition of a comprehensive set of metrics that allow measuring model quality aspects of PROforma CIG models, the implementation of tools and algorithms to assess the metrics for PROforma models, and the empirical validation of the proposed metrics as quality indicators. Conclusions: In light of the results, we conclude that the proposed metrics can be of great value, as they capture the PROforma-specific features in addition to those inspired by the general-purpose BPM metrics in the literature. In particular, the newly defined metrics for PROforma prevail as statistically significant when the whole CIG model is considered, which means that they better characterize its complexity. Consequently, the proposed metrics can be used as quality indicators of the understandability, and thereby maintainability, of PROforma CIGs

Towards the semantic enrichment of Computer Interpretable Guidelines: a method for the identification of relevant ontological terms

Ponència presentada a 2018 The American Medical Informatics Association Annual Symposium (AMIA 2018) celebrat a San Francisco, Estats Units de l'Amèrica del Nord, el 3 de novembre de 2018Clinical Practice Guidelines (CPGs) contain recommendations intended to optimize patient care, produced based on a systematic review of evidence. In turn, Computer-Interpretable Guidelines (CIGs) are formalized versions of CPGs for use as decision-support systems. We consider the enrichment of the CIG by means of an OWL ontology that describes the clinical domain of the CIG, which could be exploited e.g. for the interoperability with the Electronic Health Record (EHR). As a first step, in this paper we describe a method to support the development of such an ontology starting from a CIG. The method uses an alignment algorithm for the automated identification of ontological terms relevant to the clinical domain of the CIG, as well as a web platform to manually review the alignments and select the appropriate ones. Finally, we present the results of the application of the method to a small corpus of CIGs