Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines:

Modern methods of process management at healthcare facilities

“…CGs are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" [21] and act as blueprints that guide the care delivery process and provide evidence-based recommendations. Consequently, many research groups have focused on computer-interpretable clinical guidelines (CIGs) and different languages have been proposed [49,42,61], which can be broadly classified as rule-based (e.g., Arden Syntax), logic-based (e.g., PROforma), network-based (e.g., EON) and workflow-based (e.g., Guide). Most of them follow a task-based paradigm where modeling primitives for representing actions, decisions and patient states are linked via scheduling and temporal constraints, often in a rigid flowchart-like structure, and many representation models are supported by sys-tems that allow the definition and enactment of CGs [27].…”

“…In the context of a CG, patient's clinical situation (referred to as patient state, scenario, or context [49]) is central and represent the shared knowledge that drives the decision making and evolves as a result of performed actions, made decisions and collected data. Conditions defined over patient state, along with temporal constraints, are typically used as entry/exit points for a guideline [61] and as eligibility criteria for specific actions [49]. During the collaboration-based patient management activities, clinicians have to react to internal (e.g., a change in patient's state) and external (e.g., availability of lab test results) events, that can occur in any sequence.…”

“…CGs could be seen as progressing through a set of stages, where each performed action, made decision or event occurrence is driven by (eligibility criteria mentioned before) and has an impact on patient state, as reflected in the underlying information model. The data-driven nature of the model facilitates the integration between process control knowledge and the patient-related and medical knowledge; in addition, the distinction between data attributes and status attributes can directly support an integrated and explicit representation of both patient and execution states, not provided by all CIG models [61,49]. Although artifact-centric models can open the way for a new generation of flexible and adaptive case management systems in healthcare, further investigation is needed to understand the contribution that these models can bring in solving well-known problems for CIGs; among them: (i) how to reconcile the decision-action nature of CGs with a declarative modeling approach than can be used and understood by clinicians and is able to represent the evidence-based knowledge contained in the CGs; (ii) how to define an information model that is able to capture all clinically relevant data and takes into account existing standards, models, and ontologies used in Electronic Medical Records (EMRs) for patient and medical data; (iii) to what extent clinical events and medical knowledge can be represented and encoded by rules and conditions; (iv) how can an artifact-centric model address the problems of guideline acquisition, verification, testing, tracing and evolution, and how to turn or customize abstract models in executable models that take into account additional information, such as resource availability, roles and local services, in a collaborative multi-user environment.…”

Supporting Physicians and Patients Through Recommendation: Guidelines and Beyond

“…It presents an assessment of the state of the art, as well as a collection of several recent approaches. Comprehensive surveys of the state-of-the-art about CIG have been already published [1,3,4,5,7,24].…”

Improving medical protocols by formal methods

“…Although we have used Asbru as protocol representation language in our case study, we believe that the same can be done with other languages like PROforma [22], EON [23] and others [24,25], provided that they are extended with a formal semantics (which most of these languages are currently lacking). In this sense, our proposal constitutes a general approach to the improvement of medical guidelines and protocols, and is independent of our specific choice for Asbru.…”