DISCLAIMER

The applications accessible from this site are for demonstration purposes only. They have not been validated for clinical use and must not be used for real patient encounters.


Demonstrations of clinical applications
LISA    England
Leukaemia Information System and Advice
Clinical information and decision support system for collaborative care in childhood acute lymphoblastic leukaemia

developed by clinical domains keywords
Cancer Research UK (the Children's Cancer Group at St Bartholomew's Hospital, Advanced Computation Laboratory and Information Systems). Cancer, childhood acute lymphoblastic leukaemia decision support system, dose adjustment advice, treatment, PROforma guideline development and enactment technology.
status access demonstrator
Advanced prototype. LISA is to enter clinical practice in six specialist cancer hospital departments in the UK. You will need to enter the following information to access the LISA demonstrator:

  • At the login screen: enter User ID your email address and password R3
  • At the patient search screen: enter any two initials (representing an imaginary patient) and the trial number R0001.

    Before you use the demonstrator, print out the LISA Quick Start Tutorial - this guide will help you use the system.

  • description

    LISA is a web-based patient information and decision support system designed to provide advice about dose adjustments in the treatment of acute childhood lymphoblastic leukaemia. LISA has been implemented using PROforma guideline development and enactment technology.

    The LISA demonstrator

    The decision support module of the demonstration version of LISA is the same as the one on the live version of the system. The only significant difference between the two versions is that the demonstrator is not connected to a patient database.

    LISA encapsulates the dose adjustment rules defined in the Medical Research Council (UK) Acute Lymphoblastic Leukaemia Trial ALL97 guideline (version 1.1 revised November 1999). These rules have been modelled in the PROforma language for specifying decisions, plans and other tasks that make up the components of clinical guidelines and protocols, and are enacted by the associated PROforma decision support engine.

    LISA is primarily designed to provide dosage decision support in the 2-3 year maintenance period of treatment for Acute Lymphoblastic Leukaemia (ALL). The LISA demonstrator allows the user to simulate making dose decisions whilst taking a patient through this maintenance phase.

    LISA Decision support

    During the maintenance phase of treatment for ALL, drug dose adjustments decisions have to be made weekly and the main treatment consists of regular administration of two oral chemotherapy agents: 6-mercaptopurine (MP) which is administered daily, and meth-otrexate (MTX) which is given weekly. Doses have to be continually monitored and adjusted as responses to these drugs vary significantly from patient to patient.

    The MRC protocol specifies eight separate "states" for categorising patients' treatment needs over the course of the maintenance phase. Each state represents a drug and dose combination of MP and MTX to be administered. The goal of the system is to recommend the most appropriate combination for each individual case at any time. The system therefore monitors transitions between states. The eight states are: 0% MP and 0% MTX ("omit oral chemotherapy"), 50% MP and 50% MTX, 75% MP and 75% MTX, 100% MP and 100% MTX, 125% MP and 100% MTX, 125% MP and 125% MTX, 150% MP and 125% MTX and 150% MP and 150% MTX. A ninth option is also allowed to enable a clinician to prescribe a drug combination not defined in the protocol.

    Drug dose combination decisions in LISA are based on five data inputs:

    1. current state
    2. current platelet count of the blood result on which the decision is being based
    3. absolute neutrophil count of the blood result on which the decision is being based
    4. number of weeks that the patient has been at the current state
    5. number of weeks that the patient has tolerated treatment.
    When these patient data have been entered in LISA, the PROforma decision engine evaluates the logical condition associated with each argument and then "aggregates" those arguments that are true in order to arrive at an overall measure of support for each candidate course of treatment. Each candidate is allocated a priority level so that if more than one is recommended, the one with the highest priority is given precedence. A caption is associated with each argument to enable the reasons justifying the most strongly recommended treatment option can be displayed.

    references
    Bury J, Hurt C, Roy A et al. A quantitative and qualitative evaluation of LISA, a decision support system for chemotherapy dosing in childhood Acute Lymphoblastic Leukaemia. Medinfo. 2004;2004:197-201.

    [PubMed]   [paper - CRUK]

    " Objectives: To assess the acceptability to clinicians of a webbased decision support system designed to assist with dosage adjustments during maintenance therapy for childhood Acute Lymphoblastic Leukaemia (ALL), and to evaluate the potential impact of the system on decision-making and dosage calculations. Design: Balanced-block crossover experiment with simulated cases; questionnaire study and semi-structured interviews. Participants: 36 clinicians with differing experience in the management of ALL. Interventions: Subjects were asked to decide on appropriate levels of chemotherapy dosing for 8 simulated cases, 4 using the LISA decision support system, 4 using conventional paper-based records and guidance. Main outcome measures: Number of protocol-consistent dosage decisions made; time taken to manage each case; accuracy of dosage calculations; subjects’ opinions as to whether or not they would use the system in practice. Additional outcome measures: Functions subjects would like to see in an idealised system; subjects’ satisfaction with the implementation of the functions provided by LISA; qualitative data on issues subjects felt would impact upon the successful deployment of the system. "
    Hurt C, Fox J, Bury J, Saha V. Computerised advice on drug dosage decisions in childhood leukaemia: a method and a safety strategy. To appear in the proceedings of the 9th Conference on Artificial Intelligence in Medicine in Europe (AIME-03), Cyprus, 18 – 22 October.

    [Paper - CRUK/ACL]

    Abstract: " ... The trial protocol specifies that following initial treatment there is a 2-3 year maintenance period during which drug dosage decisions are made weekly according to a set of pre-defined rules. These rules are complex, and there is a significant frequency of error in clinical practice, which can lead to patient harm. We have built a web-based decision support system (called LISA) to address this problem. The dose alteration rules from the MRC protocol were for-malised in the PROforma guideline modeling language as a state transition problem, and dose adjustment recommendations are provided into the clinical setting by a PROforma enactment engine. The design and implementation of the decision support module, the safety issues raised and the strategy adopted for resolving them are discussed. System safety is very likely to become a major professional challenge for the medical AI community and it can be addressed, in this case, with relatively straightforward techniques. "
    J. P. Bury C. Hurt, C. Bateman et al. LISA: A Clinical Information and Decision Support System for Collaborative Care in Childhood Acute Lymphoblastic Leukaemia. Proceedings of the annual AMIA Annual Symposium, 2002.

    [Paper - CRUK/ACL]


    Abstract: " The treatment of a child with Acute Lymphoblastic Leukaemia (ALL) requires the collaboration of multiple providers across different organisations. We describe the implementation of a clinical information system for supporting collaborative care in the management of children with ALL. The system integrates the provision of patient data and clinical information with protocol-based, patient-specific decision support. The approach illustrated here should find applicability in the management of other diseases requiring collaborative care across institutions. "
    Medical Research Council. UK Acute Lymphoblastic Leukaemia Trial ALL97 (version 1.1 revised November 1999) (2000).

    [MRC ALL Guideline]


    The dose adjustment rules modelled in PROforma and implemented in LISA are defined in Appendix B of this MRC ALL trial protocol.
    contact links
    John Fox
    Advanced Computation Laboratory
    Cancer Research UK
    London
     bullet  Further information on LISA [OC AI systems archive]  bullet  PROforma guideline development and enactment technology [OC]
    acknowledgements
    Chris Hurt, Advanced Computation Lab. Cancer Research UK; Jonathan Bury, Academic Unit of Pathology, University of Sheffield Medical School; Vaskar Saha, Cancer Research UK Children's Cancer Group, St Bartholomew's Hospital, London.
    Entry on OpenClinical: 12 June 2003
    Last main update: 13 June 2003
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