Article

Argumentation logic for the flexible enactment of goal-based medical guidelines

Division of Biomedical Informatics, School of Medicine, University of California San Diego, 9500 Gilman Drive #0728, La Jolla, CA 92093-0728, USA.
Journal of Biomedical Informatics (Impact Factor: 2.19). 03/2012; 45(5):938-49. DOI: 10.1016/j.jbi.2012.03.005
Source: PubMed

ABSTRACT

RESEARCH PURPOSE: We have designed a prototype clinical workflow system that allows the specification and enactment of medical guidelines in terms of clinical goals to be achieved, maintained or avoided depending on the patient's disease and treatment evolution. The prototype includes: (1) an argumentation-based decision support system which can be used both to represent medical decisions within guidelines, and to dynamically choose the most suitable plans to achieve clinical goals, and (2) mechanisms to specify a health organization's facilities and health workers skills and roles, which can be taken into account during the decision process in order to improve quality of care. RESULTS: The framework has been fully implemented in the COGENT formal modeling system. The prototype has been evaluated implementing a hypertension guideline. CONCLUSIONS: The framework has shown flexibility and adaptability in (1) advising and tailoring health care based on a health organization's resources and a patient's particular medical condition, (2) delegating health care, and (3) replanning when unexpected situations arise.

Full-text preview

Available from: sciencedirect.com
  • Source
    • "From our vision, the managed elements can be either the patient treatment or the healthcare resources and business process. Thus, the adaptation of patient-specific treatment refers to changing their life style [8] and advises about patient behaviour [7] or/and adjusting the pharmacological plan as presented in [5] [6] [8] [9] [10] [11] [13] [14]. The approaches presented in [5] [10] [12] are interested in the adaptation of the healthcare business process which mainly concerns the definition of tasks to be executed in the patient treatment workflow such as laboratory tests, ECG test, etc. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Emerging new technologies in healthcare has proven great promises for managing patient care. In recent years, the evolution of Information and Communication Technologies pushes many research studies to think about treatment plan adaptation in this area. The main goal is to accelerate the decision making by dynamically generating new treatment due to unexpected situations. This paper portrays the treatment adaptation from a new perspective inspired from the human nervous system named autonomic computing. Thus, the selected potential studies are classified according to the maturity levels of this paradigm. To guarantee optimal and accurate treatment adaptation, challenges related to medical knowledge and data are identified and future directions to be explored in healthcare systems are discussed.
    Full-text · Conference Paper · Aug 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical practice guidelines (CPGs) aim to improve the quality of care, reduce unjustified practice variations and reduce healthcare costs. In order for them to be effective, clinical guidelines need to be integrated with the care flow and provide patient-specific advice when and where needed. Hence, their formalization as computer-interpretable guidelines (CIGs) makes it possible to develop CIG-based decision-support systems (DSSs), which have a better chance of impacting clinician behavior than narrative guidelines. This paper reviews the literature on CIG-related methodologies since the inception of CIGs, while focusing and drawing themes for classifying CIG research from CIG-related publications in the Journal of Biomedical Informatics (JBI). The themes span the entire life-cycle of CIG development and include: knowledge acquisition and specification for improved CIG design, including (1) CIG modeling languages and (2) CIG acquisition and specification methodologies, (3) integration of CIGs with electronic health records (EHRs) and organizational workflow, (4) CIG validation and verification, (5) CIG execution engines and supportive tools, (6) exception handling in CIGs, (7) CIG maintenance, including analyzing clinician's compliance to CIG recommendations and CIG versioning and evolution, and finally (8) CIG sharing. I examine the temporal trends in CIG-related research and discuss additional themes that were not identified in JBI papers, including existing themes such as overcoming implementation barriers, modeling clinical goals, and temporal expressions, as well as futuristic themes, such as patient-centric CIGs and distributed CIGs.
    No preview · Article · Jun 2013 · Journal of Biomedical Informatics
  • [Show abstract] [Hide abstract]
    ABSTRACT: This position paper presents research work involving the development of a publicly available Realistic Synthetic Electronic Healthcare Record (RS-EHR). The paper presents PADARSER, a novel approach in which the real Electronic Healthcare Record (EHR) and neither authorization nor anonymisation are required in generating the synthetic EHR data sets. The GRiSER method is presented for use in PADARSER to allow the RS-EHR to be synthesized for statistically significant localised synthetic patients with statistically prevalent medical conditions based upon information found from publicly available data sources. In treating the synthetic patient within the GRiSER method, clinical workflow or careflows (Cfs) are derived from Clinical Practice Guidelines (CPGs) and the standard local practices of clinicians. The Cfs generated are used together with health statistics, CPGs, medical coding and terminology systems to generate coded synthetic RS-EHR entries from statistically significant observations, treatments, tests, and procedures. The RS-EHR is thus populated with a complete medical history describing the resulting events from treating the medical conditions. The strength of the PADARSER approach is its use of publicly available information. The strengths of the GRiSER method are that (1) it does not require the use of the real EHR for generating the coded RS-EHR entries; and (2) the generic components for obtaining careflow from CPGs and for generating coded RS-EHR entries are applicable in other areas such as knowledge transfer and EHR user interfaces respectively.
    No preview · Chapter · Jan 2014
Show more