usability-focused clinical decision support with the help of semantic technologies
DESCRIPTION
Usability-focused Clinical Decision Support with the Help of Semantic Technologies. Braga S. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)TRANSCRIPT
Usability-Focused
Clinical Decision Support
with the Help of
SemanticTechnologies.
Dr Silviu Braga MD , Paolo Ciccarese PhD
Medicognos
Practicing Physicians Requirements
Usability=
Knowledge Based Workflow Support
=
“build in” Decision Support
Practicing Physicians USABILITY requirements
1. Clinical Workflow support
Reengineer the EHR into a clinical WfMS
2. Medical Knowledge support
Interface Terminology
Code once use multiple times: Interface Terminology with
transparent mapping to classifications and codifications
Design for decision support at the point of care
Multi-user, multilingual authoring by trained physicians
Quality assurance by design (semantically constraint
authoring + validation)
The known RIM- Terminology interaction problems
• The terminology binding “chaos” (A Rector)
• The semantic “grey zone” problem (Markwell report for NHS)
• The “system of coding vs system of meaning” problem ( A Rector )
The Challenge
The known semantic problems (B. Smith , A Rector , S. Schulz ,P. Elkin)
• Snomed CT
• HL7 v3-, OpenEHR- , EN 13606-, EN 13940 (ContSys) - RIMs
Timing problems
• Timing of Snomed redesign project (anatomy, organism, observable)
• Timing and capacities of ICD 11 ?
Unified Semantic Model
Ontology based RIM & Terminologies
1. Use of an Upper Ontology
2. Every aspect in the system is built on orthogonal “domain
ontologies” defined using a subset of OWL (proprietary
solution at runtime)
3. More expressive OWL for analysts (knowledge modeling, model
checking, maintenance, mining)
4. Reuse of existing ontologies such as FMA
Onthotypes®
1. Semantic data structures
2. Decoupling meaning from coding and presentation
3. Generate post-coordinated concepts through formal logical
expressions
4. Lexico-syntactic annotations
- Semantic User Interface Engine
- Natural Language Generation for the EHR notes
WF Engine Rules EngineInterface engine
EPR EHR NHRPHR
Clinical Knowledge Management Studio
Concept Builder
Template Builder
Workflow Builder
Drug KBBuilder
Queries &Rules Builder Clinical Domain Language
Executable Clinical Wf Care Plans KB
Executable Drug WfDrug Therapy Wf KB
Executable CDS logicRules KB
Terminology
“ontotypes” KB Templates
KB
Domain
Ontologies
Foundational layerTime/Space
Organisation
Process
Biomedical Clinical Situation
Care Plan
Care Organisation
BFOOBO
…
Knowledge & Workflow based Architecture
with build in CDS
Knowledge Management Studio
Build semantically constrained
data structures “Onthotypes”
Knowledge Management Studio
Knowledge based
Clinical Activity Templates
Knowledge Management Studio
Knowledge & Workflow based EHR
Workflow orientated
user interface
Knowledge & Workflow based EHR
Knowledge & Workflow based EHR
Contextual knowledge access
“pre-decision” support
Personalized
Activities
Knowledge & Workflow based EHR
Actionable DS inside the EPR Wf
The recommendations are linked
to the corresponding Activities
Knowledge & Workflow based EHR
Knowledge & Workflow based EHR
Customizing the content and the
workflow logic of the Actionable
Alerts
Knowledge & Workflow based EHR
Knowledge & Workflow based EHR
Actionable Alerts