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Towards a Realistic Clinical-Guidelines Application Framework: Desiderata, Applications, and Lessons Learned

  • Conference paper
Process Support and Knowledge Representation in Health Care (ProHealth 2012, KR4HC 2012)

Part of the book series: Lecture Notes in Computer Science ((LNAI,volume 7738))

Abstract

Clinicians can benefit from automated support to guideline (GL) application at the point of care. However, several conceptual dimensions should be considered for a realistic application: 1) The representation of the knowledge might be through structured text (semi-formal), or specified in a machine-comprehensible language (formal); 2) The availability of electronic patient data might be partial or full; 3) GL-based recommendations might be triggered by a human-initiated (synchronous) session, or data–driven (asynchronous). In addition, several requirements must be fulfilled, such as an evaluation of the GL application engine by a GL simulation engine. Finally, to apply multiple GLs, by multiple users, in multiple settings, the GL-application engine should be designed as an enterprise architecture that can plug into any Electronic Medical Record (EMR). We present an architecture fulfilling these desiderata, describe application examples with different conceptual dimensions and requirements, using our new GL-application engine, PICARD, discuss lessons learned, and briefly describe a clinical evaluation of the current framework in the domain of pre-eclampsia/toxemia of pregnancy.

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References

  1. Qualigini, 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. 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 

  6. 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 

  7. 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 

  8. Goud, R., Hasman, A., Peek, N.: Development of a guideline-based decision support system with explanation facilities for outpatient therapy. Comput. eMethods Programs Biomed. 91(2), 145–153 (2008)

    Article  Google Scholar 

  9. Peleg, M., Shachak, A., Wang, D., Karnieli, E.: Using multi-perspective methodologies to study users’ interactions with the prototype front end of a guideline-based decision support system for diabetic foot care. Int. J. Med. Inform. 78(7), 482–493 (2009)

    Article  Google Scholar 

  10. Wang, D., Peleg, M., Tu, S.W., Boxwala, A.A., Ogunyemi, O., Zeng, Q., Greenes, R.A., Patel, V.L., Shortliffe, E.H.: Design and implementation of the GLIF3 guideline execution engine. J. Biomed. Inform. 37(5), 305–318 (2004)

    Article  Google Scholar 

  11. 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 

  12. Chan, A.S., Coleman, R.W., Martins, S.B., Advani, A., Musen, M.A., Bosworth, H.B., Oddone, E.Z., Shlipak, M.G., Hoffman, B.B.: Evaluating provider adherence in a trial of a guideline-based decision support system for hypertension. Stud. Health Technol. Inform. 107(Pt 1), 125–129 (2007)

    Google Scholar 

  13. Fox, J., Patkar, V., Thomson, R.: Decision Support for Healthcare: the PROforma evidence base. Inf. Prim. Care 14(1), 49–54 (2006)

    Google Scholar 

  14. De Clercq, P.A., Hasman, A., Blom, J.A., Korsten, H.H.: Design and implementation of a framework to support the development of clinical guidelines. Int. J. Med. Inform. 64(2-3), 285–318 (2001)

    Article  Google Scholar 

  15. Tu, S.W., Campbell, J.R., Glasgow, J., et al.: The SAGE Guideline Model: Achievements and overview. J. Am. Med. Inform. Assoc. 14(5), 589–598 (2007)

    Article  Google Scholar 

  16. Seyfang, A., Paesold, M., Votruba, P., Miksch, S.: Improving the execution of clinical guidelines and temporal data abstraction high-frequency domains. Stud. Health Technol. Inform. 139, 263–272 (2008)

    Google Scholar 

  17. Eccher, C., Seyfang, A., Ferro, A., Miksch, S.: Embedding oncologic protocols into the provision of care: the Oncocure project. Stud. Health Technol. Inform. 150, 663–667 (2009)

    Google Scholar 

  18. Choi, J., Currie, L.M., Wang, D., Bakken, S.: Encoding a clinical practice guideline using guideline interchange format: a case study of a depression screening and management guideline. Int. J. Med. Inform. 76(suppl. 2), S302–S307 (2007)

    Google Scholar 

  19. Grando, A., Peleg, M., Glasspool, D.: A goal-oriented framework for specifying clinical guidelines and handling medical errors. J. Bio. Inform. 43(2), 287–299 (2010)

    Article  Google Scholar 

  20. Isern, D., Moreno, A., Sanchez, D., Hajnal, A., Pedone, G., Varga, L.Z.: Agent-based execution of personalised home care treatments. J. App. Intelligence 34, 155–180 (2011)

    Article  Google Scholar 

  21. Isern, D., Senchez, D., Moreno, A.: Ontology-driven execution of clinical guidelines. Comput. Meth. Prog. Biomed. (2011), doi:10.1016/j.cmpb.2011.06.006

    Google Scholar 

  22. 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 

  23. Microsoft Developer Network, http://msdn.microsoft.com/en-us/netframework/aa663324

  24. 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 

  25. 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 

  26. 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 

  27. 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 

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

    Google Scholar 

  29. Shalom, E.: A multi-dimensional framework for realistic application of clinical guidelines. Ph.D. Thesis Dissertation, Department of Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel (submitted, 2012)

    Google Scholar 

  30. Friedman, I., Shalom, E., Shahar, Y.: Evaluation of guideline-application engines by longitudinal simulation: A position paper. In: Proceedings of the 3rd International Workshop on Knowledge Representation for Health Care (KR4HC 2011), Bled, Slovenia (2011)

    Google Scholar 

  31. MobiGuide FP7 EU project (FP7-287811) (2012), http://www.mobiguide-project.eu

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Author information

Authors and Affiliations

  1. Medical Informatics Research Center, Department of Information Systems Engineering, Ben Gurion University of the Negev, Beer-Sheva, Israel

    Erez Shalom, Iliya Fridman, Yuval Shahar & Avner Hatsek

  2. Soroka Medical Center, Department of OB/GYN, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel

    Eitan Lunenfeld

Authors
  1. Erez Shalom
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  2. Iliya Fridman
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  3. Yuval Shahar
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  4. Avner Hatsek
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  5. Eitan Lunenfeld
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Editor information

Editors and Affiliations

  1. Dept. of Computer Science, Data Management, University of Erlangen and Nuremberg, Martensstr. 3, 91058, Erlangen, Germany

    Richard Lenz

  2. Institute of Software Technology and Interactive Systems, Information and Software Engineering Gruop, Vienna University of Technology, Favoritenstr. 9-11, 1040, Vienna, Austria

    Silvia Miksch

  3. Faculty of Social Sciences, Dept. of Information Systems, University of Haifa, Rabin Bldg., room 7049, 31905, Haifa, Israel

    Mor Peleg

  4. Institute of Databases and Information Systems, Ulm University, Building 027 # room 524, James-Tranck-Ring, 89069, Ulm, Germany

    Manfred Reichert

  5. Dept. d’Enginyeria Informàtica i Matimàtiques, Research Group on Artificial Intelligence, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Spain

    David Riaño

  6. Dept. of AI, Knowledge Representation and Reasoning Gruop, Vrije Universiteit Amsterdam, De Boelelaan 1081A, 1081HV, Amsterdam, The Netherlands

    Annette ten Teije

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Shalom, E., Fridman, I., Shahar, Y., Hatsek, A., Lunenfeld, E. (2013). Towards a Realistic Clinical-Guidelines Application Framework: Desiderata, Applications, and Lessons Learned. In: Lenz, R., Miksch, S., Peleg, M., Reichert, M., Riaño, D., ten Teije, A. (eds) Process Support and Knowledge Representation in Health Care. ProHealth KR4HC 2012 2012. Lecture Notes in Computer Science(), vol 7738. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36438-9_4

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  • DOI: https://doi.org/10.1007/978-3-642-36438-9_4

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-36437-2

  • Online ISBN: 978-3-642-36438-9

  • eBook Packages: Computer ScienceComputer Science (R0)

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