capturing provenance, evolution and modification of...

42
Capturing Provenance, Evolution and Modification of Clinical Protocols via a Heterogeneous, Semantic Social Network Nick Portokallidis, George Drosatos and Eleni Kaldoudi School of Medicine, Democritus University of Thrace, Alexandroupoli, Greece This work was supported by eCP: Electronic Clinical Protocols project (MIS 375876), funded under the Greek National Programme Thales, co-funded by the European Commission. and FP7-ICT project CARRE (No. 611140), funded by the European Commission.

Upload: others

Post on 19-Jul-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Capturing Provenance, Evolution and Modification of Clinical Protocols via a

Heterogeneous, Semantic Social Network

Nick Portokallidis, George Drosatos and Eleni Kaldoudi

School of Medicine, Democritus University of Thrace,Alexandroupoli, Greece

This work was supported byeCP: Electronic Clinical Protocols project (MIS 375876),

funded under the Greek National Programme Thales, co-funded by the European Commission.and FP7-ICT project CARRE (No. 611140), funded by the European Commission.

Page 2: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Aim

A novel approach to describe, organize, manage, trace, use and reuseclinical protocols, based on a heterogeneous semantic social network

• The proposed approach allows

– Semantic tagging

– Semantic enrichment

• Main advantages

– Tracing protocol provenance, evolution and modifications

– Protocol meta-description, irrespective of protocol source format

– Interlinking to related scientific sources (e.g. scientific publications, PHR, etc.) and bodies (e.g. protocol issuing bodies, hospitals, etc.)

Page 3: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

BACKGROUND

Page 4: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Formal care plans

• Clinical guidelines

Systematically developed recommendations to address various clinical problems

• Clinical protocols

Detailed algorithms on how to address a particular clinical problem (based on guidelines)

• Care pathways

Care algorithms integrating multidisciplinary tasks for patient care in and outside the hospital (based on guidelines)

• Other, e.g. clinical trial protocols, clinical practice guidelines, …

Page 5: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Examples of formal care plans

Page 6: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

State of the art

• Protocol description languages

GLIF, EON, Asbru, GUIDE, PROforma, PLAN, …

• Protocol execution engines and management platforms

GLEE, SAGE, DeGeL, NewGuide, SpEM, Tallis, ArezzoTM, HeCaSe2, ...

• Current unmet needs

– Choose the right protocol

– Choose the right modification of a protocol (to meet local set-up)

– Trace protocol use and modification history

– Trace to protocol provenance, including medical evidence and issuing body

– Record outcomes of protocol clinical application (e.g. for protocol evaluation)

Page 7: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Our contribution

• Formal protocol meta-description

– eCP ontology

• Versatile protocol ‘meta-repository’

– Heterogeneous social network

Page 8: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

ECP ONTOLOGYKaldoudi, E., Drosatos, G., Portokallidis, N. and Third, A., 2016. An Ontology Based Scheme for Formal Care Plan Meta-Description. In XIV Mediterranean Conference on Medical and Biological Engineering and Computing 2016 (pp. 785-790). Springer International Publishing.

Page 9: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

Page 10: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

formal care plan

Page 11: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

formal care plan

title

genre type

related health issue

description

has

1…N

0…1

1g

ener

al

des

crip

tio

n

cla

ssif

ica

tio

n

has

Page 12: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

formal care plan

title

genre type

related health issue

description

has

1…N

0…1

1

issuing body evidence source

0…N

1

is issued by is endorsed by

1…Ng

ener

al

des

crip

tio

n

cla

ssif

ica

tio

n

has

Page 13: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

formal care plan

title

genre type

related health issue

description

quality of evidence

low

very low

is a value of

has

0…1

1…N

0…1

1

has

issuing body evidence source

0…N

1

is issued by is endorsed by

1…N

strength of recommendation

high

moderate

strong

weak

is a

va

lue

of

gen

era

ld

escr

ipti

on

cla

ssif

ica

tio

n

qu

alit

y &

leve

l of

reco

mm

end

ati

on

has

Page 14: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

formal care plan

title

genre type

related health issue

description

quality of evidence

low

very low

is a value of

observable

observable condition

is part of

1…N

initiated by

has

1…N0…1

1…N

0…1

1

has

issuing body evidence source

0…N

1

is issued by is endorsed by

1…N

strength of recommendation

high

moderate

strong

weak

is a

va

lue

of

gen

era

ld

escr

ipti

on

cla

ssif

ica

tio

n

qu

alit

y &

leve

l of

reco

mm

end

ati

on

has

Page 15: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

formal care plan

title

genre type

related health issue

description

quality of evidence

low

very low

is a value of

observable

observable condition

is part of

1…N

initiated by

has

1…N0…1

1…N

0…1

1

outcomes

has

1…N

issuing body evidence source

0…N

1

is issued by is endorsed by

1…N

strength of recommendation

high

moderate

strong

weak

is a

va

lue

of

resource

requires

0…N

gen

era

ld

escr

ipti

on

cla

ssif

ica

tio

n

qu

alit

y &

leve

l of

reco

mm

end

ati

on

has

has

Page 16: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

formal care plan

title

genre type

related health issue

description

quality of evidence

low

very low

is a value of

observable

observable condition

is part of

1…N

initiated by

source file

formatlocation

copyright

1…N

has

1…N0…1

1…N

0…1

1

outcomes

has

1…N

has

issuing body evidence source

0…N

1

is issued by is endorsed by

1…N

strength of recommendation

high

moderate

strong

weak

has

is a

va

lue

of

resource

requires

0…N

gen

era

ld

escr

ipti

on

cla

ssif

ica

tio

n

qu

alit

y &

leve

l of

reco

mm

end

ati

on

has

has

identifier

Page 17: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Conceptual model of care plan meta-description

formal care plan

title

genre type

related health issue

description

quality of evidence

low

very low

is a value of

observable

observable condition

is part of

1…N

initiated by

source file

formatlocation

copyright

1…N

has

1…N0…1

1…N

0…1

1

outcomes

has

1…N

has

issuing body evidence source

is a deviation of

0…N

1

is issued by is endorsed by

1…N

strength of recommendation

high

moderate

strong

weak

has

is a

va

lue

of

resource

requires

0…N

gen

era

ld

escr

ipti

on

cla

ssif

ica

tio

n

qu

alit

y &

leve

l of

reco

mm

end

ati

on

has

has

identifier

Page 18: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Ontology implementation

• Implemented with OWL2 using Protégé

• Integrated with commonly used standards and controlled vocabularies:

– ICD-10, SNOMED-CT, QUDT, UO, GRADE and UMLS

Page 19: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Ontology implementation

Available online in: http://purl.bioontology.org/ontology/ECP

Page 20: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-CLINPRO: CLINICAL PROTOCOL MANAGEMENT SYSTEM

Page 21: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Social networks

Connections and

relationships among

humans

Facebook

LinkedIn

CarePageson line digital content, resources, concepts…

Page 22: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Object centered social networks

People interacting on a

common social object

ResearchGate

Academia

PatientsLikeMeon line digital content, resources, concepts…

Page 23: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Heterogeneous social networks

Human and non-human

entities are all treated alike,

as actors

on line digital content, resources, concepts…

E. Kaldoudi, N. Dovrolis, and S. Dietze, Information Organization on the Internet based on Heterogeneous Social Networks, ACM SIGDOC’11: The 29th ACM International Conference on Design of Communication, Pisa, Italy, October 3-5, 2011 (pages: 107-114)

Page 24: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

patients formal care plans

medical evidence

health units

procedures

medical conditions

observables

infrastructure

people

medical practice

information

issuing bodies

e-ClinPro heterogeneous network

E. Kaldoudi, N. Dovrolis, Comorbidities Modeling for Supporting Integrated Care in Chronic Cardiorenal Disease, In the IFMBE Proceedings of MEDICON 2013, the 13th Mediterranean Conference on Medical and Biological Engineering and Computing, Sevilla, Spain, September 25-28, 2013, in Roa L.M.M (ed.), IFMBE Proceedings vol. 41, pp. 1362-1365, Springer International Publishing Switzerland, 2013.

Page 25: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Clinical protocol provenance, evolution and modification

• Provenance

– Issuing bodies

– Clinical practice guidelines

– Scientific evidence sources

• Evolution– Update of a previous version, e.g. due to new evidence

• Modification

– Infrastructure limitations, e.g. lack of a diagnostic equipment

– Clinical restrictions, e.g. due to concurrent clinical protocols

– Patient choices and objections, e.g. due to religion

– Insurance policy constraints, e.g. to firstly perform a lower cost procedure

– Adaptation to local settings, e.g. different language

– Restrictions due to comorbidities

Page 26: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Example of clinical protocols’ relationshipsin the semantic social network

Acute kidney injury

(Guideline)

Acute coronary syndrome (Pathway)

Blood pressure in CKD

(Guideline)

NICE

KDIGO

University General Hospital

of Alexandroupolis

School of Medicine (DUTh)

Acute kidney injury(Protocol)

Issuing bodiesHealth units

Care plans

Hospital of Komotini"Sismanogleio"

Acute kidney injury (Protocol) - Greek

Page 27: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Semantic tagging and interlinking

• Profile of clinical protocol based on the eCP ontology1

• Entry point: observables and observable condition described via the CARRE ontology2

• Issuing bodies and healthcare units are described following the SWRC ontology3

• Semantic tagging of medical terms with external resources via ICD-10 and SNOMED

• Medical evidence description based on the Bibliographic Ontology (via PubMed identifier and DOI)

1Kaldoudi, E., Drosatos, G., Portokallidis, N. and Third, A., 2016. An Ontology Based Scheme for Formal Care Plan Meta-Description. In XIV Mediterranean Conference on Medical and Biological Engineering and Computing 2016 (pp. 785-790). Springer International Publishing.2Third, A., Kaldoudi, E., Gotsis, G., Roumeliotis, S., Pafili, K. and Domingue, J., 2015. Capturing scientific knowledge on medical risk factors. In K-CAP2015: 8th International Conference on Knowledge Capture. ACM.3Sure, Y., Bloehdorn, S., Haase, P., Hartmann, J. and Oberle, D., 2005. The SWRC ontology–semantic web for research communities. In Portuguese Conference on Artificial Intelligence (pp. 218-231). Springer Berlin Heidelberg.

Page 28: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Semantic tagging and interlinking

General Information

Evolution

Exit Points

Clinical Care Plan

Technical Information

eCP

Entry Point

CARRE

Issuing body

SWRC

Health Unit

observables conditions

resources

ICD10, SNOMED-CT

Evidence Source

Bibliographic Ontology (PubMed ID & DOI)

Page 29: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-CLINPRO: IMPLEMENTATION

Page 30: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

e-ClinPro implementation

• Backend

– Server: NodeJS

– API: LoopBack framework

– Database: MongoDB

• Frontend

– Visual Interface: AngularJS

– Graph visualizations: Vis.JS

• Integration with

– NCBO BioPortal API

– PubMed API

• Available online in: http://iris.med.duth.gr/research/ecp

Page 31: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-ClinPro: Login

Page 32: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-ClinPro: Dashboard

Page 33: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-ClinPro: Visualizations

Page 34: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-ClinPro: Care plans list

Page 35: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-ClinPro: Care plan profile

Page 36: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-ClinPro: Edit care plan

Page 37: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

E-ClinPro: Initial condition builder

Page 38: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

CONCLUSION

Page 39: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Our contribution

• Formal protocol meta-description

– eCP ontology

• Versatile protocol ‘meta-repository’

– Heterogeneous social network

Page 40: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Work in progress

• Extensive ontology and system evaluation

Structured interviews and focus groups of different types of system users, including experts, nurses, residents, and medical students

• Support relationships between doctors, patients, and protocols for clinical protocol evaluation based on the assessment of

– The extent of clinical protocol use

– Type and number of clinical protocol modifications

– Outcomes of protocol clinical application

Page 41: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Acknowledgement

This work was financially supported by the projects

CARRE Project: Personalized patient empowerment and shareddecision support for cardiorenal disease and comorbidities, Grant no.611140, FP7-ICT (http://www.carre-project.eu/)

eCP: Development of electronic clinical protocols, (MIS 375876), theGreek National Programme Thales

both co-funded by the European Commission.

Page 42: Capturing Provenance, Evolution and Modification of ...iris.med.duth.gr/kaldoudi/wp-content/uploads/2015/... · An Ontology Based Scheme for Formal Care Plan Meta-Description. In

Contact

Eleni Kaldoudi

Associate Professor

School of Medicine

Democritus University of Thrace

Alexandroupoli, Greece

Email: [email protected]

http://iris.med.duth.gr/kaldoudi

Cite as

N. Portokallidis, G. Drosatos, E. Kaldoudi

Capturing Provenance, Evolution and

Modification of Clinical Protocols via a

Heterogeneous, Semantic Social Network

in W. Sermeus et al (Eds.), Nursing

Informatics, IMIA and IOS Press, 2016,

Stud Health Technol Inform. vol. 225, 592-

596, 2016