Integrating Arden-Syntax-based clinical decision support with extended presentation formats into a commercial patient data management system

Abstract

The purpose of this study was to introduce clinical decision support (CDS) that exceeds conventional alerting at tertiary care intensive care units. We investigated physicians' functional CDS requirements in periodic interviews, and analyzed technical interfaces of the existing commercial patient data management system (PDMS). Building on these assessments, we adapted a platform that processes Arden Syntax medical logic modules (MLMs). Clinicians demanded data-driven, user-driven and time-driven execution of MLMs, as well as multiple presentation formats such as tables and graphics. The used PDMS represented a black box insofar as it did not provide standardized interfaces for event notification and external access to patient data; enabling CDS thus required periodically exporting datasets for making them accessible to the invoked Arden engine. A client-server-architecture with a simple browser-based viewer allows users to activate MLM execution and to access CDS results, while an MLM library generates hypertext for diverse presentation targets. The workaround that involves a periodic data replication entails a trade-off between the necessary computational resources and a delay of generated alert messages. Web technologies proved serviceable for reconciling Arden-based CDS functions with alternative presentation formats, including tables, text formatting, graphical outputs, as well as list-based overviews of data from several patients that the native PDMS did not support.

Mapping the Entire Record—An Alternative Approach to Data Access from Medical Logic Modules

“…This approach was successful, but also laborious and caused a substantial delay in data provision. 12 The CAI, in contrast, can be invoked from outside the PDMS. Our approach does, however, not fully eliminate data replication, as the CDS EMR buffer stores copies of patient data.…”

“…11 Thus, we integrated a commercial Arden Syntax processor with the PDMS. 12 With respect to EMR access from MLMs, we applied the conventional approach where each query retrieves a specific measurement. 13 In 2017, the availability of a new data interface for our PDMS prompted a redesign of our CDS integration.…”

The European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC): A special issue of full papers (Erlangen meeting 2011) and conference abstracts (Timisoara, meeting 2014)

“…These reflect the activities of ESCTAIC meeting participants spanning a wide range of interests from clinical workflow [4], data representation and management [5], application of data and models in decision support [6], to detailed analysis of individual continuous measurements [7]. Each of these papers illustrates novel technological contribution in the fields of anaesthesia and intensive care.…”

“…Four full papers [4][5][6][7] were accepted following peer review for publication in this issue. These reflect the activities of ESCTAIC meeting participants spanning a wide range of interests from clinical workflow [4], data representation and management [5], application of data and models in decision support [6], to detailed analysis of individual continuous measurements [7].…”

“…In this paper they simultaneously measured performance, physiological indicators of workload and distribution of visual attention in a simulator environment in 15 anaesthetists illustrating the potential benefits of such an experimental environment. Kraus et al [5] explore the integration of a language for encoding medical knowledge-the Arden syntax-into a commercially available PDMS system. The paper is largely technical, describing the platform for integrating the Medical Logic Modules (MLMs) of the Arden syntax, but also discusses the current status of clinical implementation with MLM's having been implemented for data-driven monitoring of laboratory values, and user driven decision support and these currently being applied an average of 442 times per day.…”