META-GLARE: a shell for CIG systems

International Journal on Artificial Intelligence Tools, 2014

Nowadays medical software is tightly coupled with medical devices that perform patient state monitoring and lately even some basic treatment procedures. Medical guidelines (GLs) can be seen as specification of a medical system which requires their computerinterpretable representation of medical GLs. Until now most of the medical GLs are often represented in a textual format and therefore often suffer from such structural problems as incompleteness, inconsistencies, ambiguity and redundancy, which makes the translation process to the machine-interpretable language more complicated. Computer-based interpretation of GLs can improve the quality of protocols as well as the quality of medical service. Several GLs formal representation methods have been presented recently. Only some of them enable automatic formal verification by introducing an additional translation path to the existing model checking environments. However, if a verified property fails it is difficult to trace back the result needed to change the model. Moreover, these formalisms provide the notion of time mostly in terms of actions order. In this paper we preset the application of a well-know formal behaviour representation approach of embedded systems design domain to medical GLs interpretation. We use Timed Automata extended with Tasks (TAT) and TIMES toolbox to represent medical GLs as a system behaviour in a computer interpretable form. We discuss the verification issues with the help of the anticancer drug imatinib case study.

International Journal of Medical Informatics, 2002

Representation of clinical practice guidelines in a computer-interpretable format is a critical issue for guideline development, implementation and evaluation. We studied eleven types of guideline representation models that can be used to encode guidelines in computer-interpretable formats. We have consistently found in all reviewed models that primitives for representation of actions and decisions are necessary components of a guideline representation model. Patient states and execution states are important concepts that closely relate to each other. Scheduling constraints on representation primitives can be modeled as sequences, concurrences, alternatives, and loops in a guideline's application process. Nesting of guidelines provides multiple views to a guideline with different granularities. Integration of guidelines with electronic medical records can be facilitated by the introduction of a formal model for patient data. Data collection, decision, patient state, and intervention constitute four basic types of primitives in a guideline's logic flow.

Artificial Intelligence in Medicine, 2001

In this paper, we propose an approach for managing clinical guidelines. We outline a modular architecture, allowing us to separate two conceptually distinct aspects: the representation (and acquisition) of clinical guidelines and their execution. We propose an expressive formalism, which allows one to deal with the context-dependent character of clinical guidelines and also takes into account different temporal aspects. We also describe our tool for acquiring clinical guidelines, which provides a user-friendly interface to physicians, and automatically detects many forms of syntactic and semantic inconsistencies in the guidelines being acquired. In the second part of the paper, we describe a¯exible engine for executing clinical guidelines (e.g. for clinical decision support applications, for medical education, or for integrating guidelines into the clinical practice), focusing our attention on temporal issues.

International Journal of …, 2002

Representation of clinical practice guidelines in a computer-interpretable format is a critical issue for guideline development, implementation and evaluation. We studied eleven types of guideline representation models that can be used to encode guidelines in computer-interpretable formats. We have consistently found in all reviewed models that primitives for representation of actions and decisions are necessary components of a guideline representation model. Patient states and execution states are important concepts that closely relate to each other. Scheduling constraints on representation primitives can be modeled as sequences, concurrences, alternatives, and loops in a guideline's application process. Nesting of guidelines provides multiple views to a guideline with different granularities. Integration of guidelines with electronic medical records can be facilitated by the introduction of a formal model for patient data. Data collection, decision, patient state, and intervention constitute four basic types of primitives in a guideline's logic flow.

2003

We developed the Guideline Execution by Semantic Decomposition of Representation (GESDOR) model to share guidelines encoded in different formats at the execution level. For this purpose, we extracted a set of generalized guideline execution tasks from the existing guideline representation models. We then created the mappings between specific guideline representation models and the set of the common guideline execution tasks. Finally, we developed a generic task-scheduling model to harmonize the existing approaches to guideline task scheduling. The evaluation has shown that the GESDOR model can be used for the effective execution of guidelines encoded in different formats, and thus realizes guideline sharing at the execution level.

International Journal of Medical Engineering and Informatics, 2013

Computer-interpretable guidelines (CIGs) can be understood as an alternative to deal with the various limitations of paper-based clinical guidelines and to put forward new possibilities for healthcare improvements. The effort spent in evaluating and adapting recommendations described in CIGs can be reduced if formalisation and modularisation of domain knowledge are employed. The approach presented in this paper considers that the content of CIGs and the adaptation rules are two distinct elements that need to be associated at run-time. In a first step, we propose to formalise the recommendations that are presented to healthcare professionals, named here 'care actions', in order to produce the set of elements that need to be adapted. In a second step, we exploit the medical background, defining and applying adaptation rules to generate a personalised treatment plan for the patient. The approach was applied to 21 CIGs to identify the potential and limitations of the implemented prototypes.

Journal of Biomedical …, 2004

The Guideline Interchange Format (GLIF) is a model for representation of sharable computer-interpretable guidelines. The current version of GLIF (GLIF3) is a substantial update and enhancement of the model since the previous version (GLIF2). GLIF3 enables encoding of a guideline at three levels: a conceptual flowchart, a computable specification that can be verified for logical consistency and completeness, and an implementable specification that is intended to be incorporated into particular institutional information systems. The representation has been tested on a wide variety of guidelines that are typical of the range of guidelines in clinical use. It builds upon GLIF2 by adding several constructs that enable interpretation of encoded guidelines in computer-based decision-support systems. GLIF3 leverages standards being developed in Health Level 7 in order to allow integration of guidelines with clinical information systems. The GLIF3 specification consists of an extensible object-oriented model and a structured syntax based on the Resource Description Framework (RDF).

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