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Medlock S, Ploegmakers KJ, Cornet R, Pang KW. Use of an open-source electronic health record to establish a "virtual hospital": A tale of two curricula. Int J Med Inform 2023; 169:104907. [PMID: 36347140 DOI: 10.1016/j.ijmedinf.2022.104907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The electronic health record (EHR) is central to medical informatics. Its use is also recognized as an important skill for future clinicians. Typically, medical students' first exposure to an EHR is when they start their clinical internships, and medical informatics students may or may not get experience with an EHR before graduation. We describe the process of implementing an open-source EHR in two curricula: Medicine and Medical informatics. For medical students, the primary goals were to allow students to practice analyzing information from the EHR, creating therapeutic plans, and communicating with their colleagues via the EHR before they start their first clinical rotations. For medical informatics students, the primary goal was to give students hands-on experience with creating decision support in an EHR. APPROACH We used the OpenMRS electronic health record with a custom decision support module based on Arden Syntax. Medical students needed a secure, stable environment to practice medical reasoning. Medical informatics students needed a more isolated system to experiment with the EHR's internal configuration. Both student groups needed synthetic patient cases that were realistic, but in different aspects. For medical students, it is essential that these cases are clinically consistent, and events unfold in a logical order. By contrast, synthetic data for medical informatics students should mimic the data quality problems found in real patient data. OUTCOMES Medical informatics students show more mature reasoning about data quality issues and workflow integration than prior to using the EHR. Comments on both course evaluations have been positive, including comments on how working with a real-world EHR provides a realistic experience. CONCLUSION The open-source EHR OpenMRS has proven to be a valuable addition to both the medicine and medical informatics curriculum. Both sets of students experience use of the EHR as giving them valuable, realistic learning experiences.
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Affiliation(s)
- Stephanie Medlock
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Kim J Ploegmakers
- Amsterdam UMC location University of Amsterdam, Teaching & Learning Centre (TLC) FdG-UvA, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ronald Cornet
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kim Win Pang
- Amsterdam UMC location University of Amsterdam, Teaching & Learning Centre (TLC) FdG-UvA, Meibergdreef 9, Amsterdam, the Netherlands
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Fortmann J, Lutz M, Spreckelsen C. System for Context-Specific Visualization of Clinical Practice Guidelines (GuLiNav): Concept and Software Implementation. JMIR Form Res 2022; 6:e28013. [PMID: 35731571 PMCID: PMC9260532 DOI: 10.2196/28013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/14/2021] [Accepted: 03/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Clinical decision support systems often adopt and operationalize existing clinical practice guidelines leading to higher guideline availability, increased guideline adherence, and data integration. Most of these systems use an internal state-based model of a clinical practice guideline to derive recommendations but do not provide the user with comprehensive insight into the model. Objective Here we present a novel approach based on dynamic guideline visualization that incorporates the individual patient’s current treatment context. Methods We derived multiple requirements to be fulfilled by such an enhanced guideline visualization. Using business process and model notation as the representation format for computer-interpretable guidelines, a combination of graph-based representation and logical inferences is adopted for guideline processing. A context-specific guideline visualization is inferred using a business rules engine. Results We implemented and piloted an algorithmic approach for guideline interpretation and processing. As a result of this interpretation, a context-specific guideline is derived and visualized. Our implementation can be used as a software library but also provides a representational state transfer interface. Spring, Camunda, and Drools served as the main frameworks for implementation. A formative usability evaluation of a demonstrator tool that uses the visualization yielded high acceptance among clinicians. Conclusions The novel guideline processing and visualization concept proved to be technically feasible. The approach addresses known problems of guideline-based clinical decision support systems. Further research is necessary to evaluate the applicability of the approach in specific medical use cases.
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Affiliation(s)
- Jonas Fortmann
- Institute of Medical Informatics, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
- Smart Medical Technology for Healthcare Consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Marlene Lutz
- Institute of Medical Informatics, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Cord Spreckelsen
- Smart Medical Technology for Healthcare Consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
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Maier C, Kapsner LA, Mate S, Prokosch HU, Kraus S. Patient Cohort Identification on Time Series Data Using the OMOP Common Data Model. Appl Clin Inform 2021; 12:57-64. [PMID: 33506478 DOI: 10.1055/s-0040-1721481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The identification of patient cohorts for recruiting patients into clinical trials requires an evaluation of study-specific inclusion and exclusion criteria. These criteria are specified depending on corresponding clinical facts. Some of these facts may not be present in the clinical source systems and need to be calculated either in advance or at cohort query runtime (so-called feasibility query). OBJECTIVES We use the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) as the repository for our clinical data. However, Atlas, the graphical user interface of OMOP, does not offer the functionality to perform calculations on facts data. Therefore, we were in search for a different approach. The objective of this study is to investigate whether the Arden Syntax can be used for feasibility queries on the OMOP CDM to enable on-the-fly calculations at query runtime, to eliminate the need to precalculate data elements that are involved with researchers' criteria specification. METHODS We implemented a service that reads the facts from the OMOP repository and provides it in a form which an Arden Syntax Medical Logic Module (MLM) can process. Then, we implemented an MLM that applies the eligibility criteria to every patient data set and outputs the list of eligible cases (i.e., performs the feasibility query). RESULTS The study resulted in an MLM-based feasibility query that identifies cases of overventilation as an example of how an on-the-fly calculation can be realized. The algorithm is split into two MLMs to provide the reusability of the approach. CONCLUSION We found that MLMs are a suitable technology for feasibility queries on the OMOP CDM. Our method of performing on-the-fly calculations can be employed with any OMOP instance and without touching existing infrastructure like the Extract, Transform and Load pipeline. Therefore, we think that it is a well-suited method to perform on-the-fly calculations on OMOP.
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Affiliation(s)
- Christian Maier
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bayern, Germany
| | - Lorenz A Kapsner
- Medical Center for Information and Communication Technology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Sebastian Mate
- Medical Center for Information and Communication Technology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bayern, Germany.,Medical Center for Information and Communication Technology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Stefan Kraus
- Department of Computer Science, Mannheim University of Applied Sciences, Mannheim, Baden-Württemberg, Germany
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Comprehensive analysis of rule formalisms to represent clinical guidelines: Selection criteria and case study on antibiotic clinical guidelines. Artif Intell Med 2020; 103:101741. [PMID: 31928849 DOI: 10.1016/j.artmed.2019.101741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The over-use of antibiotics in clinical domains is causing an alarming increase in bacterial resistance, thus endangering their effectiveness as regards the treatment of highly recurring severe infectious diseases. Whilst Clinical Guidelines (CGs) focus on the correct prescription of antibiotics in a narrative form, Clinical Decision Support Systems (CDSS) operationalize the knowledge contained in CGs in the form of rules at the point of care. Despite the efforts made to computerize CGs, there is still a gap between CGs and the myriad of rule technologies (based on different logic formalisms) that are available to implement CDSSs in real clinical settings. OBJECTIVE To helpCDSS designers to determine the most suitable rule-based technology (medical-oriented rules, production rules and semantic web rules) with which to model knowledge from CGs for the prescription of antibiotics. We propose a framework of criteria for this purpose that is extensible to more generic CGs. MATERIALS AND METHODS Our proposal is based on the identification of core technical requirements extracted from both literature and the analysis of CGs for antibiotics, establishing three dimensions for analysis: language expressivity, interoperability and industrial aspects. We present a case study regarding the John Hopkins Hospital (JHH) Antibiotic Guidelines for Urinary Tract Infection (UTI), a highly recurring hospital acquired infection. We have adopted our framework of criteria in order to analyse and implement these CGs using various rule technologies: HL7 Arden Syntax, general-purpose Production Rules System (Drools), HL7 standard Rule Interchange Format (RIF), Semantic Web Rule Language (SWRL) and SParql Inference Notation (SPIN) rule extensions (implementing our own ontology for UTI). RESULTS We have identified the main criteria required to attain a maintainable and cost-affordable computable knowledge representation for CGs. We have represented the JHH UTI CGs knowledge in a total of 12 Arden Syntax MLMs, 81 Drools rules and 154 ontology classes, properties and individuals. Our experiments confirm the relevance of the proposed set of criteria and show the level of compliance of the different rule technologies with the JHH UTI CGs knowledge representation. CONCLUSIONS The proposed framework of criteria may help clinical institutions to select the most suitable rule technology for the representation of CGs in general, and for the antibiotic prescription domain in particular, depicting the main aspects that lead to Computer Interpretable Guidelines (CIGs), such as Logic expressivity (Open/Closed World Assumption, Negation-As-Failure), Temporal Reasoning and Interoperability with existing HIS and clinical workflow. Future work will focus on providing clinicians with suggestions regarding new potential steps for CGs, considering process mining approaches and CGs Process Workflows, the use of HL7 FHIR for HIS interoperability and the representation of Knowledge-as- a-Service (KaaS).
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Transformation of Arden Syntax's medical logic modules into ArdenML for a business rules management system. Artif Intell Med 2018; 92:82-87. [DOI: 10.1016/j.artmed.2016.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/25/2016] [Accepted: 03/27/2016] [Indexed: 11/18/2022]
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Adlassnig KP, Haug P, Jenders RA. Arden Syntax: Then, now, and in the future. Artif Intell Med 2018; 92:1-6. [PMID: 30528060 DOI: 10.1016/j.artmed.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Klaus-Peter Adlassnig
- Section for Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria; Medexter Healthcare GmbH, Borschkegasse 7/5, A-1090 Vienna, Austria.
| | - Peter Haug
- Homer Warner Research Center, Intermountain Healthcare, 5171 South Cottonwood Street, Murray, UT 84107, USA; Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT 84108, USA
| | - Robert A Jenders
- Department of Medicine & Clinical and Translational Science Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA; Center for Biomedical Informatics, Charles Drew University, 1748 E 118th Street, LSRNE N238, Los Angeles, CA 90059, USA
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Kraus S, Rosenbauer M, Schröder L, Bürkle T, Adlassnig KP, Toddenroth D. A detailed analysis of the Arden Syntax expression grammar. J Biomed Inform 2018; 83:196-203. [PMID: 29775771 DOI: 10.1016/j.jbi.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/11/2018] [Accepted: 05/13/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Arden Syntax for Medical Logic Systems is a standard for encoding and sharing medical knowledge in the form of Medical Logic Modules. To improve accessibility for clinicians, the originators of the standard deliberately designed Arden Syntax expressions to resemble natural language, and parentheses around operands are not generally required. For certain patterns of nested expressions, however, the use of parentheses is mandatory, otherwise they are not accepted by an Arden Syntax environment. In this study, we refer to such patterns as anomalies. The purpose of this paper is to investigate the extent and the circumstances of such anomalies, and to outline a solution based on an alternative grammar encoding approach. METHODS To analyze the distribution of anomalies in nested expressions, we developed two custom-made complementary utilities. The first utility, termed parser, checks a single expression pattern against the specification-compliant grammar for syntactic correctness. The second utility, termed composer, automatically creates an extensive amount of expression patterns by permuting and nesting operators without the use of parentheses, and stores these together with the expected syntactic correctness. By means of these utilities we conducted a comprehensive analysis of anomalies by comparing the expected correctness with the actual correctness. Any detected anomalies are stored into a set of files, grouped by the respective top-level operator, for a subsequent analysis. RESULTS The composer utility nested 165 unary, binary, or ternary operators of Arden Syntax version 2.8 to a depth of two, resulting in a set of 76,533 expression patterns, of which 18,978 (24.8%) have been identified as anomalies. An automated assessment of their practical relevance for medical knowledge encoding is infeasible. Manual screening of selected samples indicated that only a small proportion of the detected anomalies would be relevant. The cause of the anomalies lies in the encoding of the grammar. A change of the basic encoding approach with some additional customizations eliminates the anomalies. A working expression parser is included in the supplementary material. CONCLUSION Arden Syntax expressions are affected by anomalies. Since only a small proportion of them have practical relevance and they cannot cause false calculations or clinical decisions, their practical impact is likely limited. However, they may be potential points of confusion for knowledge engineers. An alternative expression grammar, based on a different encoding approach, would not only eliminate the anomalies, but could considerably facilitate both maintenance and further development of the standard.
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Affiliation(s)
- Stefan Kraus
- Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen, Germany.
| | - Marc Rosenbauer
- Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen, Germany
| | - Lutz Schröder
- Department of Computer Science, Chair of Theoretical Computer Science, Friedrich-Alexander-University Erlangen-Nuremberg, Martensstrasse 3, 91058 Erlangen, Germany
| | - Thomas Bürkle
- Bern University of Applied Sciences, Institute for Medical Informatics, Höheweg 80, CH-2502 Biel, Switzerland
| | - Klaus-Peter Adlassnig
- Section for Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria; Medexter Healthcare GmbH, Borschkegasse 7/5, A-1090 Vienna, Austria
| | - Dennis Toddenroth
- Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen, Germany
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Wulff A, Haarbrandt B, Tute E, Marschollek M, Beerbaum P, Jack T. An interoperable clinical decision-support system for early detection of SIRS in pediatric intensive care using openEHR. Artif Intell Med 2018; 89:10-23. [PMID: 29753616 DOI: 10.1016/j.artmed.2018.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Clinical decision-support systems (CDSS) are designed to solve knowledge-intensive tasks for supporting decision-making processes. Although many approaches for designing CDSS have been proposed, due to high implementation costs, as well as the lack of interoperability features, current solutions are not well-established across different institutions. Recently, the use of standardized formalisms for knowledge representation as terminologies as well as the integration of semantically enriched clinical information models, as openEHR Archetypes, and their reuse within CDSS are theoretically considered as key factors for reusable CDSS. OBJECTIVE We aim at developing and evaluating an openEHR based approach to achieve interoperability in CDSS by designing and implementing an exemplary system for automated systemic inflammatory response syndrome (SIRS) detection in pediatric intensive care. METHODS We designed an interoperable concept, which enables an easy integration of the CDSS across different institutions, by using openEHR Archetypes, terminology bindings and the Archetype Query Language (AQL). The practicability of the approach was tested by (1) implementing a prototype, which is based on an openEHR based data repository of the Hannover Medical School (HaMSTR), and (2) conducting a first pilot study. RESULTS We successfully designed and implemented a CDSS with interoperable knowledge bases and interfaces by reusing internationally agreed-upon Archetypes, incorporating LOINC terminology and creating AQL queries, which allowed retrieving dynamic facts in a standardized and unambiguous form. The technical capabilities of the system were evaluated by testing the prototype on 16 randomly selected patients with 129 days of stay, and comparing the results with the assessment of clinical experts (leading to a sensitivity of 1.00, a specificity of 0.94 and a Cohen's kappa of 0.92). CONCLUSIONS We found the use of openEHR Archetypes and AQL a feasible approach to bridge the interoperability gap between local infrastructures and CDSS. The designed concept was successfully transferred into a clinically evaluated openEHR based CDSS. To the authors' knowledge, this is the first openEHR based CDSS, which is technically reliable and capable in a real context, and facilitates clinical decision-support for a complex task. Further activities will comprise enrichments of the knowledge base, the reasoning processes and cross-institutional evaluations.
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Affiliation(s)
- Antje Wulff
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School, Hannover, Germany.
| | - Birger Haarbrandt
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School, Hannover, Germany
| | - Erik Tute
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Germany
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von Bargen T, Kohlmann M, Marschollek M, Schwartze J, Song B, Wagner M, Wolf KH, Haux R, Gietzelt M. Home-centered Health-enabling Technologies and Regional Health Information Systems. Methods Inf Med 2018; 53:160-6. [DOI: 10.3414/me13-02-0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 11/06/2013] [Indexed: 11/09/2022]
Abstract
SummaryIntroduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records”.Objectives: In this paper, we present a prototype of a Home-Centered Health- Enabling Technology (HET-HC), which is able to capture, store, merge and process data from various sensor systems at people’s home. In addition, we present an architecture designed to integrate HET-HC into an exem -plary regional Health Information System (rHIS).Methods: rHIS are traditionally document-based to fit to the needs in a clinical context. However, HET-HC are producing continuous data streams for which documents might be an inappropriate representation. Therefore, the HET-HC could register placeholder-documents at rHIS. These placeholder-documents are assembled upon user-authenticated request by the HET-HC and are always up-to-date. Moreover, it is not trivial to find a clinical coding system for continuous sensor data and to make the data machine-readable in order to enhance the interoperability of such systems. Therefore, we propose the use of SNOCAP-HET, which is a nomenclature to describe the context of sensor-based measurements in health-enabling technologies.Results: We present an architectural approach to integrate HET-HC into rHIS. Our solution is the centralized registration of placeholder-documents with rHIS and the decentralized data storage at people’s home.Conclusions: We concluded that the pre -sented architecture of integrating HET-HC into rHIS might fit well to the traditional approach of document-based data storage. Data security and privacy issues are also duly considered.
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Ali T, Hussain M, Ali Khan W, Afzal M, Hussain J, Ali R, Hassan W, Jamshed A, Kang BH, Lee S. Multi-model-based interactive authoring environment for creating shareable medical knowledge. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 150:41-72. [PMID: 28859829 DOI: 10.1016/j.cmpb.2017.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Technologically integrated healthcare environments can be realized if physicians are encouraged to use smart systems for the creation and sharing of knowledge used in clinical decision support systems (CDSS). While CDSSs are heading toward smart environments, they lack support for abstraction of technology-oriented knowledge from physicians. Therefore, abstraction in the form of a user-friendly and flexible authoring environment is required in order for physicians to create shareable and interoperable knowledge for CDSS workflows. Our proposed system provides a user-friendly authoring environment to create Arden Syntax MLM (Medical Logic Module) as shareable knowledge rules for intelligent decision-making by CDSS. METHODS AND MATERIALS Existing systems are not physician friendly and lack interoperability and shareability of knowledge. In this paper, we proposed Intelligent-Knowledge Authoring Tool (I-KAT), a knowledge authoring environment that overcomes the above mentioned limitations. Shareability is achieved by creating a knowledge base from MLMs using Arden Syntax. Interoperability is enhanced using standard data models and terminologies. However, creation of shareable and interoperable knowledge using Arden Syntax without abstraction increases complexity, which ultimately makes it difficult for physicians to use the authoring environment. Therefore, physician friendliness is provided by abstraction at the application layer to reduce complexity. This abstraction is regulated by mappings created between legacy system concepts, which are modeled as domain clinical model (DCM) and decision support standards such as virtual medical record (vMR) and Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). We represent these mappings with a semantic reconciliation model (SRM). RESULTS The objective of the study is the creation of shareable and interoperable knowledge using a user-friendly and flexible I-KAT. Therefore we evaluated our system using completeness and user satisfaction criteria, which we assessed through the system- and user-centric evaluation processes. For system-centric evaluation, we compared the implementation of clinical information modelling system requirements in our proposed system and in existing systems. The results suggested that 82.05% of the requirements were fully supported, 7.69% were partially supported, and 10.25% were not supported by our system. In the existing systems, 35.89% of requirements were fully supported, 28.20% were partially supported, and 35.89% were not supported. For user-centric evaluation, the assessment criterion was 'ease of use'. Our proposed system showed 15 times better results with respect to MLM creation time than the existing systems. Moreover, on average, the participants made only one error in MLM creation using our proposed system, but 13 errors per MLM using the existing systems. CONCLUSION We provide a user-friendly authoring environment for creation of shareable and interoperable knowledge for CDSS to overcome knowledge acquisition complexity. The authoring environment uses state-of-the-art decision support-related clinical standards with increased ease of use.
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Affiliation(s)
- Taqdir Ali
- Department of Computer Science and Engineering, Kyung Hee University, Seocheon-dong, Giheung-gu, Yongin-si 446-701, Gyeonggi-do, Republic of Korea.
| | - Maqbool Hussain
- Department of Computer Science and Engineering, Kyung Hee University, Seocheon-dong, Giheung-gu, Yongin-si 446-701, Gyeonggi-do, Republic of Korea; College of Electronics and Information Engineering, Sejong University, Seoul, South Korea.
| | - Wajahat Ali Khan
- Department of Computer Science and Engineering, Kyung Hee University, Seocheon-dong, Giheung-gu, Yongin-si 446-701, Gyeonggi-do, Republic of Korea.
| | - Muhammad Afzal
- Department of Computer Science and Engineering, Kyung Hee University, Seocheon-dong, Giheung-gu, Yongin-si 446-701, Gyeonggi-do, Republic of Korea; College of Electronics and Information Engineering, Sejong University, Seoul, South Korea.
| | - Jamil Hussain
- Department of Computer Science and Engineering, Kyung Hee University, Seocheon-dong, Giheung-gu, Yongin-si 446-701, Gyeonggi-do, Republic of Korea.
| | - Rahman Ali
- Department of Computer Science and Engineering, Kyung Hee University, Seocheon-dong, Giheung-gu, Yongin-si 446-701, Gyeonggi-do, Republic of Korea.
| | - Waseem Hassan
- Department of Computer Science and Engineering, Kyung Hee University, Seocheon-dong, Giheung-gu, Yongin-si 446-701, Gyeonggi-do, Republic of Korea.
| | - Arif Jamshed
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore 54782, Pakistan.
| | - Byeong Ho Kang
- Computing and Information Systems, University of Tasmania, Hobart 7001, Tasmania, Australia.
| | - Sungyoung Lee
- Department of Computer Science and Engineering, Kyung Hee University, Seocheon-dong, Giheung-gu, Yongin-si 446-701, Gyeonggi-do, Republic of Korea.
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Schuh C, de Bruin JS, Seeling W. Clinical decision support systems at the Vienna General Hospital using Arden Syntax: Design, implementation, and integration. Artif Intell Med 2015; 92:24-33. [PMID: 26706047 DOI: 10.1016/j.artmed.2015.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/05/2015] [Accepted: 11/08/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Allgemeines Krankenhaus Informations Management (AKIM) project was started at the Vienna General Hospital (VGH) several years ago. This led to the introduction of a new hospital information system (HIS), and the installation of the expert system platform (EXP) for the integration of Arden-Syntax-based clinical decision support systems (CDSSs). In this report we take a look at the milestones achieved and the challenges faced in the creation and modification of CDSSs, and their integration into the HIS over the last three years. MATERIALS AND METHODS We introduce a three-stage development method, which is followed in nearly all CDSS projects at the Medical University of Vienna and the VGH. Stage one comprises requirements engineering and system conception. Stage two focuses on the implementation and testing of the system. Finally, stage three describes the deployment and integration of the system in the VGH HIS. The HIS provides a clinical work environment for healthcare specialists using customizable graphical interfaces known as parametric medical documents. Multiple Arden Syntax servers are employed to host and execute the CDSS knowledge bases: two embedded in the EXP for production and development, and a further three in clinical routine for production, development, and quality assurance. RESULTS Three systems are discussed; the systems serve different purposes in different clinical areas, but are all implemented with Arden Syntax. MONI-ICU is an automated surveillance system for monitoring healthcare-associated infections in the intensive care setting. TSM-CDS is a CDSS used for risk prediction in the formation of cutaneous melanoma metastases. Finally, TacroDS is a CDSS for the manipulation of dosages for tacrolimus, an immunosuppressive agent used after kidney transplantation. Problems in development and integration were related to data quality or availability, although organizational difficulties also caused delays in development and integration. DISCUSSION AND CONCLUSION Since the inception of the AKIM project at the VGH and its ability to support standards such as Arden Syntax and integrate CDSSs into clinical routine, the clinicians' interest in, and demand for, decision support has increased substantially. The use of Arden Syntax as a standard for CDSSs played a substantial role in the ability to rapidly create high-quality CDSS systems, whereas the ability to integrate these systems into the HIS made CDSSs more popular among physicians. Despite these successes, challenges such as lack of (consistent and high-quality) electronic data, social acceptance among healthcare personnel, and legislative issues remain. These have to be addressed effectively before CDSSs can be more widely accepted and adopted.
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Affiliation(s)
- Christian Schuh
- Section for Medical Expert and Knowledge-Based Systems, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria; IT Systems & Communications, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Jeroen S de Bruin
- Section for Medical Expert and Knowledge-Based Systems, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria.
| | - Walter Seeling
- Section for Medical Expert and Knowledge-Based Systems, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria; IT Systems & Communications, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
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Using Arden Syntax for the creation of a multi-patient surveillance dashboard. Artif Intell Med 2015; 92:88-94. [PMID: 26603750 DOI: 10.1016/j.artmed.2015.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 09/20/2015] [Accepted: 09/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Most practically deployed Arden-Syntax-based clinical decision support (CDS) modules process data from individual patients. The specification of Arden Syntax, however, would in principle also support multi-patient CDS. The patient data management system (PDMS) at our local intensive care units does not natively support patient overviews from customizable CDS routines, but local physicians indicated a demand for multi-patient tabular overviews of important clinical parameters such as key laboratory measurements. As our PDMS installation provides Arden Syntax support, we set out to explore the capability of Arden Syntax for multi-patient CDS by implementing a prototypical dashboard for visualizing laboratory findings from patient sets. METHODS AND MATERIAL Our implementation leveraged the object data type, supported by later versions of Arden, which turned out to be serviceable for representing complex input data from several patients. For our prototype, we designed a modularized architecture that separates the definition of technical operations, in particular the control of the patient context, from the actual clinical knowledge. Individual Medical Logic Modules (MLMs) for processing single patient attributes could then be developed according to well-tried Arden Syntax conventions. RESULTS We successfully implemented a working dashboard prototype entirely in Arden Syntax. The architecture consists of a controller MLM to handle the patient context, a presenter MLM to generate a dashboard view, and a set of traditional MLMs containing the clinical decision logic. Our prototype could be integrated into the graphical user interface of the local PDMS. We observed that with realistic input data the average execution time of about 200ms for generating dashboard views attained applicable performance. CONCLUSION Our study demonstrated the general feasibility of creating multi-patient CDS routines in Arden Syntax. We believe that our prototypical dashboard also suggests that such implementations can be relatively easy, and may simultaneously hold promise for sharing dashboards between institutions and reusing elementary components for additional dashboards.
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Accessing complex patient data from Arden Syntax Medical Logic Modules. Artif Intell Med 2015; 92:95-102. [PMID: 26409750 DOI: 10.1016/j.artmed.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Arden Syntax is a standard for representing and sharing medical knowledge in form of independent modules and looks back on a history of 25 years. Its traditional field of application is the monitoring of clinical events such as generating an alert in case of occurrence of a critical laboratory result. Arden Syntax Medical Logic Modules must be able to retrieve patient data from the electronic medical record in order to enable automated decision making. For patient data with a simple structure, for instance a list of laboratory results, or, in a broader view, any patient data with a list or table structure, this mapping process is straightforward. Nevertheless, if patient data are of a complex nested structure the mapping process may become tedious. Two clinical requirements - to process complex microbiology data and to decrease the time between a critical laboratory event and its alerting by monitoring Health Level 7 (HL7) communication - have triggered the investigation of approaches for providing complex patient data from electronic medical records inside Arden Syntax Medical Logic Modules. METHODS AND MATERIALS The data mapping capabilities of current versions of the Arden Syntax standard as well as interfaces and data mapping capabilities of three different Arden Syntax environments have been analyzed. We found and implemented three different approaches to map a test sample of complex microbiology data for 22 patients and measured their execution times and memory usage. Based on one of these approaches, we mapped entire HL7 messages onto congruent Arden Syntax objects. RESULTS While current versions of Arden Syntax support the mapping of list and table structures, complex data structures are so far unsupported. We identified three different approaches to map complex data from electronic patient records onto Arden Syntax variables; each of these approaches successfully mapped a test sample of complex microbiology data. The first approach was implemented in Arden Syntax itself, the second one inside the interface component of one of the investigated Arden Syntax environments. The third one was based on deserialization of Extended Markup Language (XML) data. Mean execution times of the approaches to map the test sample were 497ms, 382ms, and 84ms. Peak memory usage amounted to 3MB, 3MB, and 6MB. CONCLUSION The most promising approach by far was to map arbitrary XML structures onto congruent complex data types of Arden Syntax through deserialization. This approach is generic insofar as a data mapper based on this approach can transform any patient data provided in appropriate XML format. Therefore it could help overcome a major obstacle for integrating clinical decision support functions into clinical information systems. Theoretically, the deserialization approach would even allow mapping entire patient records onto Arden Syntax objects in one single step. We recommend extending the Arden Syntax specification with an appropriate XML data format.
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Haux R, Hein A, Kolb G, Künemund H, Eichelberg M, Appell JE, Appelrath HJ, Bartsch C, Bauer JM, Becker M, Bente P, Bitzer J, Boll S, Büsching F, Dasenbrock L, Deparade R, Depner D, Elbers K, Fachinger U, Felber J, Feldwieser F, Forberg A, Gietzelt M, Goetze S, Gövercin M, Helmer A, Herzke T, Hesselmann T, Heuten W, Huber R, Hülsken-Giesler M, Jacobs G, Kalbe E, Kerling A, Klingeberg T, Költzsch Y, Lammel-Polchau C, Ludwig W, Marschollek M, Martens B, Meis M, Meyer EM, Meyer J, Meyer Zu Schwabedissen H, Moritz N, Müller H, Nebel W, Neyer FJ, Okken PK, Rahe J, Remmers H, Rölker-Denker L, Schilling M, Schöpke B, Schröder J, Schulze GC, Schulze M, Siltmann S, Song B, Spehr J, Steen EE, Steinhagen-Thiessen E, Tanschus NM, Tegtbur U, Thiel A, Thoben W, van Hengel P, Wabnik S, Wegel S, Wilken O, Winkelbach S, Wist T, Wolf KH, Wolf L, Zokoll-van der Laan M. Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies--outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL). Inform Health Soc Care 2015; 39:166-87. [PMID: 25148556 DOI: 10.3109/17538157.2014.931849] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human-machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific "GAL technology", providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL's highly inter- and multidisciplinary aspects, with respect to research into GAL's application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.
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Affiliation(s)
- Reinhold Haux
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School , Braunschweig , Germany
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Song B, Becker M, Gietzelt M, Haux R, Kohlmann M, Schulze M, Tegtbur U, Wolf KH, Marschollek M. Feasibility Study of a Sensor-Based Autonomous Load Control Exercise Training System for COPD Patients. J Med Syst 2014; 39:150. [DOI: 10.1007/s10916-014-0150-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022]
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Kraus S, Castellanos I, Toddenroth D, Prokosch HU, Bürkle T. Integrating Arden-Syntax-based clinical decision support with extended presentation formats into a commercial patient data management system. J Clin Monit Comput 2013; 28:465-73. [PMID: 23354988 DOI: 10.1007/s10877-013-9430-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to introduce clinical decision support (CDS) that exceeds conventional alerting at tertiary care intensive care units. We investigated physicians' functional CDS requirements in periodic interviews, and analyzed technical interfaces of the existing commercial patient data management system (PDMS). Building on these assessments, we adapted a platform that processes Arden Syntax medical logic modules (MLMs). Clinicians demanded data-driven, user-driven and time-driven execution of MLMs, as well as multiple presentation formats such as tables and graphics. The used PDMS represented a black box insofar as it did not provide standardized interfaces for event notification and external access to patient data; enabling CDS thus required periodically exporting datasets for making them accessible to the invoked Arden engine. A client-server-architecture with a simple browser-based viewer allows users to activate MLM execution and to access CDS results, while an MLM library generates hypertext for diverse presentation targets. The workaround that involves a periodic data replication entails a trade-off between the necessary computational resources and a delay of generated alert messages. Web technologies proved serviceable for reconciling Arden-based CDS functions with alternative presentation formats, including tables, text formatting, graphical outputs, as well as list-based overviews of data from several patients that the native PDMS did not support.
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Affiliation(s)
- Stefan Kraus
- Center for Communication and Information Technology, University Hospital Erlangen, Erlangen, Germany,
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Marschollek M. Decision support at home (DS@HOME)--system architectures and requirements. BMC Med Inform Decis Mak 2012; 12:43. [PMID: 22640470 PMCID: PMC3464181 DOI: 10.1186/1472-6947-12-43] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 05/28/2012] [Indexed: 12/02/2022] Open
Abstract
Background Demographic change with its consequences of an aging society and an increase in the demand for care in the home environment has triggered intensive research activities in sensor devices and smart home technologies. While many advanced technologies are already available, there is still a lack of decision support systems (DSS) for the interpretation of data generated in home environments. The aim of the research for this paper is to present the state-of-the-art in DSS for these data, to define characteristic properties of such systems, and to define the requirements for successful home care DSS implementations. Methods A literature review was performed along with the analysis of cross-references. Characteristic properties are proposed and requirements are derived from the available body of literature. Results 79 papers were identified and analyzed, of which 20 describe implementations of decision components. Most authors mention server-based decision support components, but only few papers provide details about the system architecture or the knowledge base. A list of requirements derived from the analysis is presented. Among the primary drawbacks of current systems are the missing integration of DSS in current health information system architectures including interfaces, the missing agreement among developers with regard to the formalization and customization of medical knowledge and a lack of intelligent algorithms to interpret data from multiple sources including clinical application systems. Conclusions Future research needs to address these issues in order to provide useful information – and not only large amounts of data – for both the patient and the caregiver. Furthermore, there is a need for outcome studies allowing for identifying successful implementation concepts.
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Affiliation(s)
- Michael Marschollek
- Hanover Medical School, Peter L, Reichertz Institute for Medical Informatics, Carl-Neuberg-Str 1, Hanover 30625, Germany.
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Haux R, Hein A, Eichelberg M. On designing new environments for ageing: an introduction to the special issue on the design of environments for ageing. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 106:67-69. [PMID: 22482750 DOI: 10.1016/j.cmpb.2012.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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