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Symposium: CPG 2004

Symposium report: Computerized Guidelines and Protocols, Prague, 13-14 April 2004

Co-chairs: Silvia Miksch, Vienna University of Technology; Samson Tu, Stanford Medical Informatics
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Topic areas &
presentations

 bullet  Invited Talks  bullet  Communication and Evaluation  bullet  Formal Models  bullet  Guideline Models and Systems, Integration with Resources  bullet  Temporal Representation and Reasoning, Analysis

 bullet  OpenClinical Panel Discussion: Diversity and standardization in the development of clinical guideline models
Context
In recent years, guidelines and protocols have gained support as the vehicles for promoting best practices in clinical medicine. They offer the possibilities of reducing unwarranted practice variations, of containing cost while maintaining quality of care, and of defining standards of care for quality assurance purposes. These promises have led to an explosion of guideline publications. Yet studies have shown that dissemination and effective use of guidelines in clinical care remain a major bottleneck.

A number of researchers have developed different technologies for delivering computerized guidelines in clinical care. These technologies range from alerts and reminders to knowledge-based systems, information-retrieval systems, and others. The tasks to which guidelines have been applied include classic clinical decision support, workflow management, quality assurance, and resource-requirement estimates. The research has spanned several communities (information retrieval, artificial intelligence, medical informatics, software engineering, clinical medicine), but unfortunately, there has been little cross fertilization between the communities working in this area.

Gunther Schadow Following the success of the first European Workshop on Computerized Guidelines and Protocols held in Leipzig, Germany, in 2000, this symposium sought to identify use cases for guideline-based applications in healthcare, computerized methods for supporting the guideline development process, and pressing issues and promising approaches for developing usable and maintainable vehicles for guideline delivery. Brigitte Seroussi It brought together researchers from different communities to examine cutting-edge approaches to guideline modeling and application development, to consider how different communities can leverage each other's strengths, and to discuss additional challenges brought by new application contexts.

The next symposium in this series, entitled "Workshop on AI techniques in healthcare: Evidence-based guidelines and protocols", was held in conjunction with ECAI-06 (European Conference on Artificial Intelligence) on 29 August 2006 in Riva del Garda, Italy.

Topic areas
Presentations

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Invited Talks

Schadow G.
Motivations and Effects of Different Guideline Conceptualizations on the HL7 Reference Information Model

 [Presentation ]

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Ollenschläger G, Rosenbrand K, Marshall C.
Bridging the gap between the medical guideline- and computer science worlds: will Future Guidelines be Living Guidelines ?

 [ Introduction to GIN: an International Guidelines Network
- Günter Ollenschläger 
 ]

 [ Evidence-based guideline development
- Kitty Rosenbrand  
]

 [ Guideline Implementation
- Catherine Marshall 
 ]

 [ Guideline appraisal - an international viewpoint: the AGREE instrument  ]

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Communication and Evaluation
Aigner W, Miksch S.
Communicating the Logic of a Treatment Plan Formulated in Asbru to Domain Experts

Abstract/summary: This paper presents an interactive visualization tool for medical treatment plans that are formulated in the plan representation language Asbru. ... The intention of this work is to ... communicate the logic of a computerized treatment plan to physicians, nursing-, and other medical personnel visually. The visualization is based on the idea of flow-chart algorithms, ... extended to meet Asbru's needs.

[ ]   [Presentation]   [Presentation ]

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Quaglini S, Ciccarese P, Micieli G, Cavallini A.
Non-Compliance with Guidelines: Motivations and Consequences in a case study

Abstract. [...] In this paper we summarize our experience in evaluating both the usability and the impact of a guideline for acute/subacute stroke management. A computerised version of the guideline has been implemented and linked to the electronic patient record. We collected data on 386 patients. Our analysis highlighted a number of non-compliances. Some of them can be easily justified, while others depend only on physician resistance to behavioural changes and on cultural biases. From our results, health outcomes and costs are related to guideline compliance: a unit increase in the number of non-compliance results in a 7% increase of mortality at six months [...]

[ ]   [Presentation]   [Presentation ]

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Séroussi B, Bouaud J.
Reminder-based or on-demand guideline-based decision support systems: a preliminary study in primary care with the management of hypertension

Abstract: ASTI is a guideline-based decision support system for therapeutic prescribing in primary care with two modes of interaction. The "critic mode" operates as a reminder system to detect non guideline-compliant physician drug orders, whereas the "guided mode" operates on demand and provides physician guidance to help her establishing best recommended drug prescriptions for the management of hypertension. A preliminary evaluation study was conducted with 10 GPs to test the complementary nature of both modes of decision support. Results tend to validate our assumption that reminder-based interaction is appropriate for simple cases and that physicians are willing to use on-demand systems as clinical situations become more complex.

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Svátek V, Ríha A, Peleška J, Rauch J.
Analysis of Guideline Compliance - a Data Mining Approach

Abstract: "While guideline-based decision support is safety-critical and typically requires human interaction, offline analysis of guideline compliance can be performed to large extent automatically. We examine the possibility of automatic detection of potential non-compliance followed up with (statistical) association mining. Only frequent associations of non-compliance patterns with various patient data are submitted to medical expert for interpretation. The initial experiment was carried out in the domain of hypertension management."

[ ]   [Presentation]   [Presentation ]

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Formal Models

d'Aquin M, Brachais S, Lieber J, Napoli A.
Decision Support and Knowledge Management in Oncology using Hierarchical Classification

Abstract: "This paper presents the Kasimir research project for the management of decision protocols in oncology. A decision protocol is a kind of decision tree implemented in an object-based representation formalism. A reasoner based on such a formalism and on hierarchical classification is coupled with a knowledge editor. This association provides support for editing and maintaining protocols, enabling the detection of errors and the comparison between versions of the protocol. In this way, management of protocols takes fully advantage of the underlying knowledge representation and reasoning tools. This straightforward use of the protocol may be insufficient in some situations. Then, the protocol may have to be adapted for these situations. A study of protocol adaptation is presented. In particular a reasoner based on a combination of hierarchical classification and fuzzy logic is introduced."

[]    [Presentation ]

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Balser M, Coltell O, van Croonenborg J, Duelli C, van Harmelen F, Jovell A, Lucas P, Marcos M, Miksch S, Reif W, Rosenbrand K, Seyfang A, ten Teije A.
Protocure: Integrating formal methods in the development process of medical guidelines and protocols

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Schulz S, Hahn U.
A Description Logic Approach to Clinical Guidelines and Protocols

Abstract: We are developing a formal framework by which clinical guidelines and protocols (CGPs) can be partially represented as a set of terminological concept definitions using standard description logics. There are two benefits in pursuing such an approach. First, it provides a foundation for logic-based CGP fusion and collision detection. Second, it allows for the checking of clinical treatment episodes from the EPR against CGPs.

[]   [Presentation ]

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Guideline Models and Systems, Integration with Resources
Fox J, Alabassi A, Black E, Hurt C, Rose T.
Modelling Clinical Goals: a Corpus of Examples and a Tentative Ontology

Abstract: Knowledge of clinical goals and the means to achieve them are either not represented in most current guideline representation systems or are encoded procedurally (e.g. as clinical algorithms, condition-action rules). There would be a number of major benefits if guideline enactment systems could reason explicitly about clinical objectives (e.g. whether a goal has been successfully achieved or not, whether it is consistent with prevailing conditions, or how the system should adapt to circumstances where a recommended action has failed to achieve the intended result). ... This presentation discusses some of the challenges involved in developing an explicit, declarative formalism for goals. As part of this, we report on a study we have undertaken which has identified over 200 goals in the routine management of breast cancer, and outline a tentative formal structure for this corpus.

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Heller B, Herre H, Lippoldt K, Loeffler M.
Standardized Terminology for Clinical Trial Protocols Based on Top-Level Ontological Categories

Abstract: This paper describes a new method for the ontologically-based standardization of concepts with regard to the quality assurance of clinical trial protocols. We developed a data dictionary for medical and trial-specific terms in which concepts and relations are defined context-dependently. The data dictionary is provided to different medical research networks by means of the software tool Onto-Builder via the internet. The data dictionary is based on domain-specific ontologies and the top-level ontology of GOL (General Ontological Language) is a formal framework for building ontologies. (GOL is being developed by the Onto-Med research group at the University of Leipzig). The concepts and relations described in the data dictionary are represented in natural language, semi-formally or formally according to their use.

[Paper - U. Leipzig]   [ ]    [ ]

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Correndo G, Terenziani P.
Towards a Flexible Integration of Clinical Guideline Systems with Medical Ontologies and Medical Information Systems

Abstract. The integration of a computer-based system dealing with clinical guidelines with a medical ontology can provide several advantages, including standardization and knowledge sharing. Furthermore, in order to operate in the clinical practice, guideline systems must also interact with the hospital databases to retrieve patients’ data. Unfortunately, currently there seems not to be any “standard” consensus model either for the medical ontology or for (the conceptual structure of) patient databases (even if several interesting proposals have been carried out). In this paper we show how we are extending the GLARE guideline manager in order to strictly interact with both a medical ontology and a patient Database, in such a way that GLARE is not committed to any specific ontology and database (i.e, different ontologies and/or databases can be used).

[ ]   [Presentation]   [Presentation ]

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Tu S.W, Campbell J, Musen M.A.
SAGE Guideline Modeling: Motivation and Methodology

Abstract: The SAGE (Standards-Based Sharable Active Guideline Environment) project is a collaboration among research groups at six institutions in the US. The ultimate goal of the project is to create an infrastructure that will allow execution of standards-based clinical practice guidelines across heterogeneous clinical information systems. This paper describes the design goals of the SAGE guideline model in the context of the technological infrastructure and guideline modeling methodology that the project is developing.

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Shiffman R.N, Michel G, Essaihi A, Marcy T.W.
Using a Guideline-Centered Approach for the Design of a Clinical Decision Support System To Promote Smoking Cessation

We describe application of the Guidelines Element Model (GEM) in the design of a DSS to promote smoking cessation. Following selection of relevant recommendations and markup of knowledge components with the GEM Cutter editor, the Extractor style sheet was used to create a list of decision variables and actions for further processing...

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Moskovitch R, Shahar Y
A Multiple-Ontology Customizable Search . Interface for Retrieval of Clinical Practice Guidelines

Summary: Discussion of the Vaidurya guideline search engine which forms part of the Digital electronic Guideline Library (DeGeL) framework under development at Ben Gurion University, Beer Sheva, Israel.

[ ]    [ ]    [Presentation ]

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Temporal Representation and Reasoning, Analysis
Seyfang A, Miksch S.
Advanced Temporal Data Abstraction for Guideline Execution

Temporal data abstraction bridges the gap between snap shot values delivered by monitoring devices and laboratory tests on one hand and high-level medical concepts used in guidelines and by medical professionals on the other. Within this field, the detection and abstraction of repeated patterns is a complex and important challenge. A repeated pattern is a combination of events or intervals which occur multiple times in a formally describable temporal relation. While there are many approaches to detect patterns in time series without prior definition of target concepts, we describe the application of temporal data abstraction in the context of guideline execution. Here, predefined concepts of temporal patterns must be compared with measurement series describing the patient state. We discuss the requirements from both high-frequency domains such as intensive care units and low-frequency domains such as diabetes monitoring, and show our solution based on a new version of the Asgaard data abstraction unit. It interfaces the dynamically changing patient state to the guideline execution unit and features abstraction modules ranging from simple calculations to statistical measures calculated for sliding time windows.

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Kaiser K, Miksch S.
TimeWrap - A Method for Automatic Transformation of Structured Guideline Components into Formal Process-Representations

Abstract: Guideline and protocol representation languages have reached a level of complexity where auxiliary methods are needed to support the authoring of protocols in the particular language. ... We present a three-step wrapper method, called TimeWrap, to extract information, in particular temporal issues, out of semi-structured data and integrate it in a formal representation. We illustrate our approach using the guideline-representation language Asbru and examples from guidelines to treat conjunctivitis.

[Paper - Vienna U. of Technology]   [Presentation]   [Presentation ]

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Terenziani P, Montani S, Bottrighi A, Torchio M, Molino G, Correndo G.
The GLARE Approach to Clinical Guidelines: Main Features

In this paper, we present GLARE, a domain-independent prototypical system for acquiring, representing and executing clinical guidelines ... GLARE is characterized by the adoption of advanced Artificial Intelligence (AI) techniques, to support medical decision making and to manage temporal knowledge.

[Paper - Universitŕ del Piemonte Orientale, Alessandria]   [Presentation ]

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Wang D. (presented by Mor Peleg)
Translating Arden MLMs into GLIF Guidelines - A Case Study of Hyperkalemia Patient Screening

Abstract. To re-examine the validity of the medical knowledge that are embedded in the legacy system, we translated a Medical Logic Module (MLM) for hyperkalemia patient screening into the GuideLine Interchange Format (GLIF). We used a set of guiding principles to direct the translation. In addition, we used the GLIF3 Guideline Execution Engine (GLEE) as a testing tool to validate the encoded GLIF guideline by applying it to 5 simulated patient cases. The result has shown that it is possible to translate Arden MLMs into GLIF guidelines. However, significant efforts are necessary to handle the problems arose during the translation process. Automatic translation could be a more generalizable approach for future work.

[Paper]   [Presentation ]

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Ružicka M, Svátek V.
Mark-up based Analysis of Narrative Guidelines with the Stepper Tool

Abstract: "The Stepper tool was developed to assist a knowledge engineer in developing a computable version of narrative guidelines. The system is document-centric: it formalises the initial text in multiple user-definable steps corresponding to interactive XML transformations. In this paper, we report on experience obtained by applying the tool on a narrative guideline document addressing unstable angina pectoris. Possible role of the tool and associated methodology in developing a guideline-based application is also discussed."

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Symposium Proceedings [IOS Press]

Eds. K. Kaiser, S. Miksch and S.W. Tu. Computer-based Support for Clinical Guidelines and Protocols. Proceedings of the Symposiom on Computerized Guidelines and Protocols (CGP 2004), Volume 101 Studies in Health Technology and Informatics, 2004, 196 pp, hardcover. ISBN: 1 58603 412

[IOS Press]  

" In recent years, guidelines and protocols have gained support as the vehicles for promoting best practices in clinical medicine. They offer the possibilities of reducing unwarranted practice variations, of containing cost while maintaining quality of care, and of defining standards of care for quality assurance purposes. These promises have led to an explosion of guideline publications. Yet studies have shown that dissemination and effective use of guidelines in clinical care remains a major bottleneck. A number of researchers have developed different technologies for delivering computerized guidelines in clinical care. These technologies range from alerts and reminders to knowledge-based systems, information-retrieval systems, and others. The tasks to which guidelines have been applied include classic clinical decision support, workflow management, quality assurance, and resource-requirement estimates. The research has spanned several communities (information retrieval, artificial intelligence, medical informatics, software engineering, clinical medicine), but unfortunately, there has been little cross-fertilization between the communities working in this area. This publication brings together researchers from different communities to examine cutting-edge approaches to guideline modeling and application development and to consider how different communities can leverage each other's strengths. "
page history
Entry in directory: June 01 2004
Last main update: September 03 2004
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