Objectives: This survey analyses the latest literature contributions to clinical decision support systems (DSSs) on a two-year period (2017-2018), focusing on the approaches that adopt Artificial Intelligence (AI) techniques in a broad sense. The goal is to analyse the distribution of data-driven AI approaches with respect to “classical" knowledge-based ones, and to consider the issues raised and their possible solutions. Methods: We included PubMed and Web of ScienceTM publications, focusing on contributions describing clinical DSSs that adopted one or more AI methodologies. Results: We selected 75 papers, 49 of which describe approaches in the data-driven AI area, 20 present purely knowledge-based DSSs, and 6 adopt hybrid approaches relying on both formalized knowledge and data. Conclusions: Recent studies in the clinical DSS area demonstrate a prevalence of data-driven AI, which can be adopted autonomously in purely data-driven systems, or in cooperation with domain knowledge in hybrid systems. Such hybrid approaches, able to conjugate all available knowledge sources through proper knowledge integration steps, represent an interesting example of synergy between the two AI categories. This synergy can lead to the resolution of some existing issues, such as the need for transparency and explainability, nowadays recognized as central themes to be addressed by both AI and medical informatics research.

Many medical information systems record data about the executed process instances in the form of an event log. In this paper, we present a framework, able to convert actions in the event log into higher level concepts, at different levels of abstraction, on the basis of domain knowledge. Abstracted traces are then provided as an input to trace comparison and semantic process discovery. Our abstraction mechanism is able to manage non trivial situations, such as interleaved actions or delays between two actions that abstract to the same concept. Trace comparison resorts to a similarity metric able to take into account abstraction phase penalties, and to deal with quantitative and qualitative temporal constraints in abstracted traces. As for process discovery, we rely on classical algorithms embedded in the framework ProM, made semantic by the capability of abstracting the actions on the basis of their conceptual meaning. The approach has been tested in stroke care, where we adopted abstraction and trace comparison to cluster event logs of different stroke units, to highlight (in)correct behavior, abstracting from details. We also provide process discovery results, showing how the abstraction mechanism allows to obtain stroke process models more easily interpretable by neurologists.

Many information systems nowadays record data about the process instances executed at the organization in the form of traces in a log. In this paper we present a framework able to convert actions found in the traces into higher level concepts, on the basis of domain knowledge. Abstracted traces are then provided as an input to semantic process mining. The approach has been tested in the medical domain of stroke care, where we show how the abstraction mechanism allows the user to mine process models that are easier to interpret, since unnecessary details are hidden, but key behaviors are clearly visible.

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