Skip to main content

Challenges in Delivering Decision Support Systems: The MATE Experience

  • Conference paper
Knowledge Representation for Health-Care. Data, Processes and Guidelines (KR4HC 2009)

Part of the book series: Lecture Notes in Computer Science ((LNAI,volume 5943))

Included in the following conference series:

Abstract

Cancer Multidisciplinary Meeting (MDM) is a widely endorsed mechanism for ensuring high quality evidence-based health care. However, there are shortcomings that could ultimately result in unintended patient harm. On the other hand, clinical guidelines and clinical decision support systems (DSS) have been shown to improve decision-making in various measures. Nevertheless, their clinical use requires seamlessly interoperation with the existing electronic health record (EHR) platform to avoid the detrimental effects that duplication of data and work has in the quality of care. The aim of this work is to propose a computational framework to provide a clinical guideline-based DSS for breast cancer MDM. We discuss a range of design and implementation issues related to knowledge representation and clinical service delivery of the system, and propose a service oriented architecture based on the HL7 EHR functional model. The main result is the DSS named MATE (Multidisciplinary Assistant and Treatment sElector), which demonstrates that decision support can be effectively deployed in a real clinical setting and suggest that the technology could be generalised to other cancer MDMs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Sutton, D.R., Fox, J.: The syntax and semantics of the PROforma guideline modeling language. Journal of the American Medical Informatics Association 10(5), 433–443 (2003)

    Article  Google Scholar 

  2. OpenClinical: Methods and tools for the development of computer-interpretable guidelines: PROforma (2006), http://www.openclinical.org/gmm_proforma.html (accessed 15 October 2009)

  3. Sutton, D.R., Taylor, P., Earle, K.: Evaluation of PROforma as a language for implementing medical guidelines in a practical context. BMC Medical Informatics and Decision Making 6(20) (April 2006), doi:10.1186/1472-6947-6-20

    Google Scholar 

  4. Patkar, V., et al.: Breast cancer referral guidelines (2008), http://www.cossac.org/projects/credo/applications#guidelines (accessed 15 October 2009)

  5. Golbeck, J., Fragoso, G., Hartel, F., et al.: The national cancer institutes thésaurus and ontology. Web Semantics: Science, Services and Agents on the World Wide Web 1(1), 75–80 (2003)

    Article  Google Scholar 

  6. Guyatt, G., Gutterman, D., Baumann, M.H., et al.: Grading strength of recommendations and quality of evidence in clinical guidelines. Chest 129(1), 174–181 (2006)

    Article  Google Scholar 

  7. Ravdin, P.M., Siminoff, L.A., Davis, G.J., et al.: Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. Journal of Clinical Oncology 19(4), 980–991 (2001)

    Google Scholar 

  8. Van Zee, K.J., Manasseh, D.M., Bevilacqua, J.L., et al.: A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Annals of surgical oncology 10(10), 1140–1151 (2003)

    Article  Google Scholar 

  9. Patkar, V., Fox, J.: Clinical guidelines and care pathways: A case study applying proforma decision support technology to the breast cancer care pathway. In: Ten Teije, A., Miksch, S., Lucas, P. (eds.) Computer-based Medical Guidelines and Protocols: A Primer and Current Trends. Studies in Health Technology and Informatics, vol. 139, pp. 233–242. IOS Press, Amsterdam, doi:10.3233/978-1-58603-873-1-233

    Google Scholar 

  10. Groot, P., Hommersom, A., Lucas, P., et al.: Using model checking for critiquing based on clinical guidelines. Artificial Intelligence in Medicine 46, 19–36 (2009)

    Article  Google Scholar 

  11. Perez, B., Porres, I.: Verification of clinical guidelines by model checking. In: 21st IEEE International Symposium on Computer-Based Medical Systems, pp. 114–119. IEEE CS Press, Los Alamitos (2008)

    Chapter  Google Scholar 

  12. Reenskaug, T.M.H.: The original MVC reports. Technical report, Xerox PARC (December 1979), http://heim.ifi.uio.no/~trygver/2007/MVC_Originals.pdf (accessed 15 October 2009)

  13. HL7: Electronic health record functional model (2008), http://www.hl7.org/EHR/ (accessed 15 October 2009)

  14. Séroussi, B., Bouaud, J., Gligorov, J., Uzan, S.: Supporting multidisciplinary staff meetings for guideline-based breast cancer management: a study with oncodoc2. In: AMIA Annual Symposium Proceedings, pp. 656–660 (2007)

    Google Scholar 

  15. Séroussi, B., Bouaud, J., Antoine, E.C.: Oncodoc: a successful experiment of computer-supported guideline development and implementation in the treatment of breast cancer. Artificial Intelligence in Medicine 22, 43–64 (2001)

    Article  Google Scholar 

  16. Maviglia, S.M., Zielstorff, R.D., Paterno, M., et al.: Automating complex guidelines for chronic disease: Lessons learned. Journal of the American Medical Informatics Association 10(2), 154–165 (2003)

    Article  Google Scholar 

  17. Boxwala, A.A., Peleg, M., Tu, S., et al.: Glif3: a representation format for sharable computer-interpretable clinical practice guidelines. Journal of Biomedical Informatics 37, 147–161 (2004)

    Article  Google Scholar 

  18. Laleci, G.B., Dogac, A.: A semantically enriched clinical guideline model enabling deployment in heterogeneous healthcare environments. IEEE Transactions on Information Technology in Biomedicine 13(2), 263–273 (2009)

    Article  Google Scholar 

  19. Hrabak, K.M., Campbell, J.R., Tu, S.W., et al.: Creating interoperable guidelines: Requirements of vocabulary standards in immunization decision support. In: Klaus, A., Kuhn, J.R., Warren, T.Y.L. (eds.) MEDINFO 2007 - Proceedings of the 12th World Congress on Health (Medical) Informatics Building Sustainable Health Systems. Studies in Health Technology and Informatics, vol. 129, pp. 930–934 (2007)

    Google Scholar 

  20. Tu, S.W., Campbell, J.R., Glasgow, J., et al.: The sage guideline model: Achievements and overview. Journal of the American Medical Informatics Association 14(5), 589–598 (2007)

    Article  Google Scholar 

  21. Kazemzadeh, R.S., Sartipi, K.: Interoperability of data and knowledge in distributed health care systems. In: Proceedings of the 13th IEEE International Workshop on Software Technology and Engineering Practice, pp. 230–240. IEEE Computer Society, Los Alamitos (2005)

    Google Scholar 

  22. Johnson, P.D., Tu, S.W., Musen, M.A., Purves, I.: A virtual medical record for guideline-based decision support. In: AMIA Annual Symposium Proceedings, pp. 294–298 (2001)

    Google Scholar 

  23. Schadow, G., Russler, D.C., Mead, C.N., McDonald, C.J.: Integrating medical information and knowledge in the hl7 rim. In: AMIA Annual Symposium Proceedings, pp. 764–768 (2000)

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Acosta, D., Patkar, V., Keshtgar, M., Fox, J. (2010). Challenges in Delivering Decision Support Systems: The MATE Experience. In: Riaño, D., ten Teije, A., Miksch, S., Peleg, M. (eds) Knowledge Representation for Health-Care. Data, Processes and Guidelines. KR4HC 2009. Lecture Notes in Computer Science(), vol 5943. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11808-1_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-11808-1_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11807-4

  • Online ISBN: 978-3-642-11808-1

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics