Guideline-based decision support in medicine : modeling guidelines for the development and application of clinical decision support system

Contents......Page 5
1. General introduction......Page 9
1 Guidelines in medicine......Page 10
2  Active guideline-based decision support systems......Page 11
3 Thesis overview......Page 12
3.2 Methods......Page 13
2. Approaches for creating computer-interpretable guidelines that facilitate decision support......Page 17
1.1 Overview......Page 18
2 Areas......Page 19
2.1  Guideline modeling and representation......Page 20
3.1 Introduction......Page 21
3.2.2  Maintenance and library Slots......Page 22
3.2.3 Knowledge slots......Page 24
4.1 Introduction......Page 25
4.2.1 Guideline steps......Page 26
4.2.2 Medical ontology......Page 28
4.2.3 Guideline representation......Page 30
4.2.4 Language......Page 31
4.2.5 Modeling tools......Page 32
4.3  Guideline acquisition, verification and testing......Page 33
5.2.1  The domino model......Page 34
5.2.2 The task ontology......Page 36
5.2.4 Language......Page 39
5.3 Guideline acquisition......Page 40
5.4  Guideline verification and testing......Page 41
5.5 Guideline execution......Page 42
6.2.1 The intention-based model......Page 44
6.2.2  Temporal patterns and time annotations......Page 46
6.2.3 Guideline representation......Page 47
6.2.4 Language......Page 48
6.3  Guideline acquisition, verification and testing......Page 49
7.1.1 Overview......Page 51
7.2.1  The Dharma guideline model......Page 52
7.2.2  The Patient data model......Page 54
7.2.5 Guideline representation......Page 55
7.2.6 Language......Page 56
7.3  Guideline acquisition, verification and testing......Page 57
7.4 Guideline execution......Page 58
8.1.2  Guideline Modeling and representation......Page 61
8.1.3 Guideline acquisition......Page 65
8.2.1 Overview......Page 66
8.2.2 Guideline Representation......Page 67
8.2.4  Guideline verification and testing......Page 69
8.3 Conclusions......Page 70
References......Page 71
3. The application of problem-solving methods and ontologies for the development of shareable guidelines......Page 75
1.2.1  Modeling in terms of primitives......Page 76
1.2.2  Modeling in terms of Problem-Solving methods......Page 77
1.2.4  Combining primitives and PSMs: a new approach......Page 78
2.1  Representing domain knowledge......Page 79
2.2.2 Primitives......Page 80
2.2.3 Problem Solving Methods......Page 81
3 The framework......Page 82
4.1.1  Representing Situation-Action Rules......Page 84
4.1.2  Authoring Situation-Action Rules......Page 86
4.1.3  Executing Situation-Action Rules......Page 87
4.2.1  Representing Event-Based Modular Tasks......Page 88
4.2.2  Authoring Event-Based Modular Tasks......Page 90
4.2.3  Executing Event-Based Modular Tasks......Page 91
4.3.2  Authoring complex temporal guidelines......Page 92
5 Results......Page 94
6.1  Characteristics of the ontological approach......Page 95
6.3  Comparing other formalisms......Page 96
References......Page 98
4. Design and implementation of a framework to support the development of clinical guidelines......Page 101
1 Introduction......Page 102
2.1.2 Guideline acquisition......Page 103
2.2.1 Guideline representation formalisms......Page 104
3.1 Overview......Page 106
3.2.1  Utilizing the OKBC model......Page 108
3.2.2 Domain ontologies......Page 109
3.2.3 Method ontologies......Page 113
 attribute specifies......Page 114
3.2.5 Specifying Problem-Solving Methods......Page 115
3.2.6 Specifying Guidelines......Page 117
3.3  Stage 2: developing method libraries......Page 118
 and......Page 120
3.4.2 Authoring primitives......Page 121
3.4.3 Authoring PSMs......Page 126
3.4.4  Implementation of the KA-Tool’s component architecture......Page 130
3.5  Stage 4: executing guidelines......Page 131
4 Results......Page 135
5 Discussion......Page 136
References......Page 139
5. A strategy for development of practice guidelines for the ICU using automated knowledge acquisition techniques......Page 143
2.1  The knowledge acquisition environment......Page 144
2.2  Creating and updating guidelines......Page 145
2.2.2 Inference Syntax......Page 146
2.3 Validating implemented guidelines......Page 149
3 Results......Page 151
4 Discussion......Page 154
5 Conclusions......Page 155
6. Experiences with the development, implementation and evaluation of automated decision support systems......Page 159
1 Introduction......Page 160
2.1 Introduction......Page 161
2.3.1 Environment......Page 162
2.3.2  Development and implementation......Page 163
2.4.3  Experiences with GRIF......Page 166
3.2.1 Environment......Page 167
3.2.2  Development and implementation......Page 168
3.3.1  Evaluation in daily practice......Page 172
3.3.2 User satisfaction with CritICIS......Page 175
4.1 Introduction......Page 177
4.2.1  Environment and System Overview......Page 178
4.3 Results......Page 182
5.1 Introduction......Page 183
5.2.1 Environment......Page 185
5.2.2  Development and implementation......Page 188
5.3.2  Experiences with the consumer health record......Page 189
6 Discussion......Page 191
References......Page 192
Usefulness......Page 195
7. General discussion and conclusions......Page 197
2.1  The frame-based formalism......Page 198
2.3 Domain-specific knowledge......Page 200
2.4 Local adaptation and communication......Page 201
3.2 Guideline verification......Page 205
3.3  Guideline execution tasks......Page 206
3.4  Interfacing external patient information systems......Page 207
4.2 Verification......Page 208
5 Conclusions......Page 209
References......Page 210
Summary......Page 211
Samenvatting......Page 215
Dankwoord......Page 219
Curriculum Vitae......Page 223