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Case-based reasoning for managing non-compliance with clinical guidelines
- Proc. Case-Based Reasoning in the Health Sciences Workshop, International Conference on Case Based Reasoning (ICCBR
, 2007
"... Despite the recognized advantages that can be obtained in clinical practice when following clinical guidelines (GL), situations of noncompliance with them may emerge. Keeping track of such deviations from the default GL execution, and documenting the physician's motivations, would clearly be a ..."
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Despite the recognized advantages that can be obtained in clinical practice when following clinical guidelines (GL), situations of noncompliance with them may emerge. Keeping track of such deviations from the default GL execution, and documenting the physician's motivations, would clearly be an added value. Moreover, repeated alterations of GL actions (or flow) may highlight the need for an adaptation of the GL itself to the local reality, or may even indicate an improper or weak initial GL definition. In this article, we propose an approach for managing noncompliance with GL, based on the case-based reasoning methodology. In front of a new noncompliance case, our tool allows the physician to retrieve past situations similar to the current one, and to decide whether to reapply the same GL modifications adopted in them. Moreover, the tool is able to learn indications from the ground noncompliance cases that can be deployed for local adaptation, and possibly, for suggesting more formal GL revisions to be carried out by a committee of expert physicians.
A UML Approach to Process Modelling of Clinical Practice Guidelines for Enactment
, 2003
"... Although clinical practice guidelines (CPGs) have been suggested as a means of encapsulating best practice in evidence-based medical treatment, their usage in clinical environments has been disappointing. Criticisms of guideline representations have been that they are predominantly narrative and ..."
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Cited by 4 (0 self)
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Although clinical practice guidelines (CPGs) have been suggested as a means of encapsulating best practice in evidence-based medical treatment, their usage in clinical environments has been disappointing. Criticisms of guideline representations have been that they are predominantly narrative and are difficult to incorporate into clinical information systems.
Distributed guideline-based health care system
- in Proceedings of 4th International Conference on Intelligent Systems Design and Applications, ISDA 2004, IEEE
, 2004
"... Abstract — This paper proposes to combine Medical Guidelines with Multi-Agent Systems in order to obtain a system that could be used in a real medical environment for improving the current use/management of the resources. We propose in this paper an agent-based architecture, which allows to represen ..."
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Abstract — This paper proposes to combine Medical Guidelines with Multi-Agent Systems in order to obtain a system that could be used in a real medical environment for improving the current use/management of the resources. We propose in this paper an agent-based architecture, which allows to represent different entities in a medical centre and the relationships between them. A medical guideline specifies sequences of actions that could be performed in front of a particular pathology. The proposed system allows doctors to follow these guidelines when performing medical visits, and to access the results of clinical tests stored in an electronic medical record. Several service agents are connected to the physical resources providing clinical data of patients, which is added automatically to the medical record. All agents (internal of the system and user’s personal agents) have their own knowledge and some roles to accomplish. This paper is focused on a healthcare domain, but this approach could be adapted to other domains. Moreover, another goal of this work is to illustrate that our system is flexible and scalable, and it could be improved with new services/features if required. I.
Planning Supporting and Optimizing Clinical Guidelines Execution
"... A crucial feature of computerized clinical guidelines (CGs) lies in the fact that they may be used not just as conventional documents (as if they were just free text) describing general procedures that users have to follow. In fact, computerized CGs, thanks to a description in some semiformal repres ..."
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Cited by 2 (0 self)
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A crucial feature of computerized clinical guidelines (CGs) lies in the fact that they may be used not just as conventional documents (as if they were just free text) describing general procedures that users have to follow. In fact, computerized CGs, thanks to a description in some semiformal representation language, can also take
P.: Modeling Clinical Guidelines through Petri Nets
- Proc. of the 12th Conf. on Artificial Intelligence in Medicine (AIME’09
, 2009
"... Abstract. Clinical guidelines (GLs) play an important role to standard-ize and organize clinical processes according to evidence-based medicine. Several computer-based GL representation languages have been defined, usually focusing on expressiveness and/or on user-friendliness. In many cases, the in ..."
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Abstract. Clinical guidelines (GLs) play an important role to standard-ize and organize clinical processes according to evidence-based medicine. Several computer-based GL representation languages have been defined, usually focusing on expressiveness and/or on user-friendliness. In many cases, the interpretation of some constructs in such languages is quite un-clear. Only recently researchers have started to provide a formal seman-tics for some of such languages, thus providing an unambiguous specifica-tion for implementers, and a formal ground in which different approaches can be compared, and verification techniques can be applied. Petri Nets are a natural candidate formalism to cope with GL semantics, since they are explicitly geared towards the representation of processes, and are paired with powerful verification mechanisms. We show how Petri Nets can cope with the semantics of GLs in a clear way, taking the system GLARE formalism as a case study.
ENABLING MEDICAL EXPERT CRITIQUING USING A BDI APPROACH
"... Expert critiquing systems were introduced to assist physicians in decision making, without forcing them to comply to a gold standard of care. Critiquing systems do this by providing critique on a physician’s decisions, rather than telling him/her exactly what to do. In order to perform this task, a ..."
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Expert critiquing systems were introduced to assist physicians in decision making, without forcing them to comply to a gold standard of care. Critiquing systems do this by providing critique on a physician’s decisions, rather than telling him/her exactly what to do. In order to perform this task, a critiquing system must have knowledge of the diagnosis and the treatment processes, and must be able to link the actions preformed by a physician to this knowledge. The development of formal languages for describing medical guidelines (protocols) and the nationwide introduction of electronic patient records (EPR) in the Netherlands, facilitates the development of a new generation of medical critiquing systems. Essential to the success of the new generation critiquing systems is the ability to match the actions prescribed in a medical guideline to the physician’s actions reported in the EPR. Some authors have claimed that such a matching process is infeasible. This paper will show, however, that a BDI (beliefs, desires and intentions) approach enables a highly successful matching process thereby enabling expert critiquing based on an EPR. 1
Enabling protocol-based medical critiquing
"... Abstract. This paper investigates the combination of expert critiquing systems and formal medical protocols. Medical protocols might serve as a suitable basis for an expert critiquing system because of the ongoing acceptance of medical protocols and the rise of both evidence-based practice and evide ..."
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Abstract. This paper investigates the combination of expert critiquing systems and formal medical protocols. Medical protocols might serve as a suitable basis for an expert critiquing system because of the ongoing acceptance of medical protocols and the rise of both evidence-based practice and evidence-based protocols. A
From Narrative Therapeutic Guidelines to Decision Support: Design for Production Efficiency and Safety
"... This paper reports on a research project aimed at optimising the print and electronic production process of therapeutic guidelines and making the data elements and underlying logic machine-readable. We first describe a re-engineered guideline production system, SISMO (Single Input Source, Multiple O ..."
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This paper reports on a research project aimed at optimising the print and electronic production process of therapeutic guidelines and making the data elements and underlying logic machine-readable. We first describe a re-engineered guideline production system, SISMO (Single Input Source, Multiple Output), which has been devised and is currently being introduced into a guidelines production process. SISMO allows narrative text to be developed in a traditional manner, however a variety of print and electronic outputs can then be produced through XML and XSLT files. We then describe an Algorithmic Decision Support (ADS) server. The ADS server allows the execution of the reasoning that is implicit within the narrative of the guidelines and is intended to interface either with a user or an external system according to standard communication protocols.
Glossary
, 2007
"... Supporting medication-related decision making with information model-based digital documents Thesis submitted in fulfilment of the requirements for the award of the degree of Doctor of Philosophy ..."
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Supporting medication-related decision making with information model-based digital documents Thesis submitted in fulfilment of the requirements for the award of the degree of Doctor of Philosophy
