Skip to main content

The “Human Cli-Knowme” Project: Building a Universal, Formal, Procedural and Declarative Clinical Knowledge Base, for the Automation of Therapy and Research

  • Conference paper

Part of the book series: Lecture Notes in Computer Science ((LNAI,volume 6924))

Abstract

Currently, most clinical knowledge is in free text and is not easily accessible to clinicians and medical researchers. A major grand challenge for medical informatics is the creation of a distributed, universal, formal, sharable, reusable, and computationally accessible medical knowledge base. The required knowledge consists of both procedural knowledge, such as clinical guidelines, and declarative knowledge, such as context-sensitive interpretations of longitudinal patterns of raw clinical data accumulating from several sources.

In this position paper, I first demonstrate the feasibility of such an enterprise, and explain in detail the overall lifecycle of a clinical guideline, by reviewing the main current components and their respective evaluations of one such comprehensive architecture for management of clinical guidelines: The Digital Electronic Guideline Library (DeGeL), a Web-based, modular, distributed architecture that facilitates gradual conversion of clinical guidelines from text to a formal representation in chosen target guideline ontology. The architecture supports guideline classification, semantic markup, context-sensitive search, browsing, run-time application to a specific patient at the point of care, and retrospective quality assessment. The DeGeL architecture operates closely with a declarative-knowledge temporal-abstraction architecture, IDAN.

Thus, there is significant evidence that building a distributed, multiple-ontology architecture that caters for the full life cycle of a significant portion of current clinical procedural and declarative knowledge, which I refer to as “the Human Clin-knowme Project,” has become a feasible task for a joint, coordinated, international effort involving clinicians and medical informaticians.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   69.99
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

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Quaglini, S., Ciccarese, P., Micieli, G., Cavallini, A.: Non-compliance with guidelines: motivations and consequences in a case study. In: Proceedings of Symposium on Computerized Guidelines and Protocols (CGP 2004), Studies in Health Technology and Informatics Prague, Czech Republic, vol. 101, pp. 75–87. IOS Press (2004)

    Google Scholar 

  2. Peleg, M., Tu, S.W., Bury, J., Ciccarese, P., Fox, J., Greenes, R.A., Hall, R., Johnson, P.D., Jones, N., Kumar, A., Miksch, S., Quaglini, S., Seyfang, A., Shortliffe, E.H., Stefanelli, M.: Comparing Computer-Interpretable Guideline Models: A Case-Study Approach. JAMIA 10(1), 52–68 (2002)

    Google Scholar 

  3. De Clercq, P.A., Blom, J.A., Korsten, H.H., Hasman, A.: Approaches for creating computer-interpretable guidelines that facilitate decision support. J. Artif. Intell. Med. 31(1), 1–27 (2004)

    Article  Google Scholar 

  4. Isern, D., Moreno, A.: Computer-based execution of clinical guidelines: a review. Int. J. Med. Inform. 77(12), 787–808 (2008)

    Article  Google Scholar 

  5. Latoszek-Berendsen, A., Tange, H., van den Herik, H.J., Hasman, A.: From clinical practice guidelines to computer-interpretable guidelines. A literature overview. J. Methods Inf. Med. 49(6), 550–570 (2010)

    Article  Google Scholar 

  6. Shahar, Y.: The Need for a Human Clinome Project. In: Altman, R.B., Balling, R., Brinkley, J.F., et al. (eds.) Commentaries on “Informatics and Medicine: From Molecules to Populations” (An invited multiple-author editorial on Kuhn et al’s paper). Methods of Information in Medicine, vol. 47(4), pp. 296–317 (2008)

    Google Scholar 

  7. Shahar, Y., Young, O., Shalom, E., Galperin, M., Mayaffit, A., Moskovitch, R., Hessing, A.: A framework for a distributed, hybrid, multiple-ontology clinical-guideline library and automated guideline-support tools. J. Biomed. Inform. 37(5), 325–344 (2004)

    Article  Google Scholar 

  8. Boaz, D., Shahar, Y.: A framework for distributed mediation of temporal-abstraction queries to clinical databases. Artificial Intelligence in Medicine 34(1), 3–24 (2005)

    Article  Google Scholar 

  9. Fox, J., Glasspool, D., Grecu, D., Modgil, S., South, M., Patkar, V.: Argumentation-Based Inference and Decision Making - A Medical Perspective. IEEE Intelligent Systems 22, 34–41 (2007)

    Article  Google Scholar 

  10. Shahar, Y., Miksch, S., Johnson, P.: The Asgaard project: A task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artif. Intell. Med. (14), 29–51(1998)

    Google Scholar 

  11. Shalom, E., Shahar, Y., Taieb-Maimon, M., Bar, G., Young, O., Martins, B.S., Vaszar, L., Liel, Y., Leibowitz, A., Marom, T., Lunenfeld, E.: A Quantitative Evaluation of a Methodology for Collaborative Specification of Clinical Guidelines at Multiple Representation Levels. Journal of Biomedical Informatics 41(6) (2008)

    Google Scholar 

  12. Shalom, E., Shahar, Y., Taieb-Maimon, M., Martins, S.B., Vaszar, L.T., Goldstein, G.L., Lunenfeld, E.: Ability of expert physicians to structure clinical guidelines: Reality versus perception. Journal of Evaluation in Clinical Practice 15, 1043–1053 (2009)

    Article  Google Scholar 

  13. Hatsek, A., Shahar, Y., Taieb-Maimon, M., Shalom, E., Klimov, D., Lunenfeld, E.: A Scalable Architecture for Incremental Specification and Maintenance of Procedural and Declarative Clinical Decision-Support Knowledge. The Open Medical Informatics Journal 4, 255–277 (2010)

    Article  Google Scholar 

  14. Moskovitch, R., Shahar, Y.: Vaidurya: A multiple-ontology, concept-based, context-sensitive, clinical-guideline search engine. J. Biomed. Inform. 42(1), 11–21 (2009)

    Article  Google Scholar 

  15. Moskovitch, R., Martins, S.B., Behiri, E., Shahar, Y.: A comparative evaluation of full-text, concept-based, and context-sensitive search. JAMIA 14, 164–174 (2007); reprinted in: The IMIA Yearbook of Medical Informatics, F.K. Schattauer and The International Medical Informatics Association, Stuttgart (2008)

    Google Scholar 

  16. Shalom, E., Friedman, I., Shahar, Y., Hatsek, A., Lunenfeld, E.: Towards a realistic clinical-guidelines application framework: Desiderata, Applications, and lessons learned. In: Riaño, D., ten Teije, A., Miksch, S. (eds.) KR4HC 2011. LNCS (LNAI), vol. 6924. Springer, Heidelberg (2011)

    Google Scholar 

  17. Young, O., Shahar, Y., Liel, Y., Lunenfeld, E., Bar, G., Shalom, E., Martins, S.B., Vaszar, L.T., Marom, T., Goldstein, M.K.: Runtime application of Hybrid-Asbru clinical guidelines. J. Biomed. Inform. 40(5), 507–526 (2007)

    Article  Google Scholar 

  18. Shahar, Y.: A framework for knowledge-based temporal abstraction. Artificial Intelligence 90(1-2), 79–133 (1997)

    Article  MATH  Google Scholar 

  19. Kuilboer, M.M., Shahar, Y., Wilson, D.M., Musen, M.A.: Knowledge reuse: Temporal-abstraction mechanisms for the assessment of children’s growth. In: Proceedings of the Seventeenth Annual Symposium on Computer Applications in Medical Care, Washington, DC, pp. 449–453 (1993)

    Google Scholar 

  20. Shahar, Y., Das, A.K., Tu, S.W., Kraemer, F.B., Musen, M.A.: Knowledge-based temporal abstraction for diabetic monitoring. In: Proceedings of the Eighteenth Annual Symposium on Computer Applications in Medical Care, Washington, DC, pp. 697–701 (1994)

    Google Scholar 

  21. Shahar, Y., Musen, M.A.: Knowledge-based temporal abstraction in clinical domains. Artificial Intelligence in Medicine 8(3), 267–298 (1996)

    Article  Google Scholar 

  22. Shahar, Y., Cheng, C.: Model-based visualization of temporal abstractions. Computational Intelligence 16(2), 279–306 (2000)

    Article  Google Scholar 

  23. Shahar, Y., Goren-Bar, D., Boaz, D., Tahan, G.: Distributed, intelligent, interactive visualization and exploration of time-oriented clinical data. Artificial Intelligence in Medicine 38(2), 115–135 (2006)

    Article  Google Scholar 

  24. Martins, S.B., Shahar, Y., Goren-Bar, D., Galperin, M., Kaizer, H., Basso, L.V., McNaughton, D., Goldstein, M.K.: Evaluation of an architecture for intelligent query and exploration of time-oriented clinical data. Artificial Intelligence in Medicine 43, 17–34 (2008)

    Article  Google Scholar 

  25. Klimov, D., Shahar, Y., Taieb-Maimon, M.: Intelligent visualization of temporal associations for multiple time-oriented patient records. Methods of Information in Medicine 48(3), 254–262 (2009)

    Article  Google Scholar 

  26. Klimov, D., Shahar, Y., Taieb-Maimon, M.: Intelligent querying, visualization, and exploration of the time-oriented data of multiple patients. Artificial Intelligence in Medicine 49, 11–31 (2010)

    Article  Google Scholar 

  27. Klimov, D., Shahar, Y., Taieb-Maimon, M.: Intelligent selection and retrieval of multiple time-oriented records. The Journal of Intelligent Information Systems 35, 261–300 (2010)

    Article  Google Scholar 

  28. Chakravarty, S., Shahar, Y.: A constraint-based specification of periodic patterns in time-oriented data. Annals of Mathematics and Artificial Intelligence 30(1-4) (2000)

    Google Scholar 

  29. Chakravarty, S., Shahar, Y.: Specification and detection of periodicity in clinical data. Methods of Information in Medicine 40(5), 410–420 (2001); reprinted in: Haux, R., Kulikowski, C. (eds.) Yearbook of Medical Informatics, pp. 296–306. F.K. Schattauer and The International Medical Informatics Association, Stuttgart (2003)

    Google Scholar 

  30. Anselma, L., Terenziani, P., Montani, S., Bottrighi, A.: Towards a comprehensive treatment of repetitions, periodicity and temporal constraints in clinical guidelines. J. Artif. Intell. Med. 38(2), 171–195 (2006)

    Article  Google Scholar 

  31. Boaz, D., Shahar, Y.: A framework for distributed mediation of temporal-abstraction queries to clinical databases. Artificial Intelligence in Medicine 34(1), 3–24 (2005)

    Article  Google Scholar 

  32. German, E., Leibowitz, A., Shahar, Y.: An architecture for linking medical decision-support applications to clinical databases and its evaluation. J. Biomed. Inform. 42(2), 203–218 (2009)

    Article  Google Scholar 

  33. Shahar, Y., Shalom, E., Mayaffit, A., Young, O., Galperin, M., Martins, S.B., Goldstein, M.K.: A distributed, collaborative, structuring model for a clinical-guideline digital-library. In: Proceedings of the 2003 AMIA Annual Fall Symposium, Washington, DC (2003) (available on CD)

    Google Scholar 

  34. Riaño, D.: A Knowledge-Management Architecture to Integrate and to Share Medical and Clinical Data, Information, and Knowledge. In: Riaño, D., ten Teije, A., Miksch, S., Peleg, M. (eds.) KR4HC 2009. LNCS, vol. 5943, pp. 180–194. Springer, Heidelberg (2010)

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Shahar, Y. (2012). The “Human Cli-Knowme” Project: Building a Universal, Formal, Procedural and Declarative Clinical Knowledge Base, for the Automation of Therapy and Research. In: Riaño, D., ten Teije, A., Miksch, S. (eds) Knowledge Representation for Health-Care. KR4HC 2011. Lecture Notes in Computer Science(), vol 6924. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27697-2_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-27697-2_1

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-27696-5

  • Online ISBN: 978-3-642-27697-2

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics