Transcription
Workbench and Wizard: MakingProtégé Usable as a Workbench forEncoding Clinical Practice GuidelinesSamson Tu, Ravi Shankar, Mark MusenStanford Medical Informatics(And SAGE Project partners: IDX, Nebraska, Mayo,Apelon, IHC)
OverviewClinical practice guidelines (CPG) and theiruse in clinical decision supportEnhancement to Protégé-2000 for encodingCPGs A knowledge-acquisition wizard A terminology plug-in Validation plug-insOutstanding issuesProtégé wish list
Decision Support For GuidelineBased CarePatient DataGuideline DecisionSupport SystemGuideline KnowledgeAcquisition ProcessConsider adding an ACEInhibitor because of acompelling indication(heart failure)
Guideline Resources(Terminology)SourceDocumentsAccess Model andResourcesConceptualizationValidation
Protégé-2000 As a Guideline KAWorkbenchAutomatic generation of model-specific userinterface forms allows rapid prototypingNo guidance for conceptualization andencoding of CPG in KBs Create ‘wizards’ to support KA tasksProtégé-2000 is component-based and hasan extensible architecture Access to external terminology through slot plug-in Validation through special tab plug-ins
OverviewClinical practice guidelines (CPG) and theiruse in clinical decision supportÂEnhancement to Protégé-2000 for encodingCPGs A knowledge-acquisition wizard A terminology plug-in Validation plug-insOutstanding issuesProtégé wish list
KA Wizard (1): Explicit Modelingof Guideline KA ProcessScripts define sequence of KA tasks
KA Wizard (2): Creation of AlternativeViews of Protégé FormsWork around Protégé’s 1-class/1-formrestriction
KA Wizard (3): Guiding a Userthrough KA TasksBased on specification of KA tasks and mapping of forms,the wizard presents a sequence of KA ted“recipe” of how-to(“Office paper-clip”metaphor)
Accessing External Resources:Terminology Plug-InA concept is represented as a terminological classA plug-in allows search and selection of terms from an externalterminology server (developed by Apelon colleagues) Invoked everywhere that a controlled term is needed “Cache” references to controlled terms in Protégé to support browsingin absence of terminology server
Validation of Guideline KBIntegrity constraints Local constraintsconstraints on slot values (e.g. type, cardinality)shown with red border in Protégé GUI Global constraintsconstraints that span across multiple slots, instances, orclassesencoded in Protégé’s PAL constraint languageOther types of validation (not done yet) Safety rules Conformance to guideline intentions Correctness of subsumption relationships
Local Constraints: ValidationThrough Facet-Constraint TabTab thatallowscheckingof selectclasses forinstanceswith that hasinstanceswith facetconstraintviolationsInstancewith facetconstraintviolationsSummaryof facetconstraintviolations
Global Constraints: ValidationUsing PAL Constraints
OverviewClinical practice guidelines (CPG) and theiruse in clinical decision supportEnhancement to Protégé-2000 for developingCPG knowledge bases A knowledge-acquisition wizard A terminology plug-in Validation plug-insÂOutstanding issuesProtégé wish list
Problems in Use of WizardsMapping and synchronization of guideline instancesand wizard instances Wizard creates and display wizard-specific forms and instancesfor mapped instances in guideline KB Easy to partition a guideline instance into multiple wizardinstances, difficult to aggregate multiple guideline instancesManagement and automation of domain-specificand book-keeping actionsSpecification of meaningful knowledge-acquisitionsubtasks
Problems in Use of TerminologyConstraints on allowed termsConcepts used in guidelines are not alwaysavailable as terms in existing terminology Primitive termse.g. haemophilus influenza type b conjugate vaccine Compositional termse.g. {Progressive neurological finding isa ‘Neurologicalfinding’ Associated course ‘Progressive’}e.g. {Respiratory problems excluding asthma}
Problems in Use of ConstraintsInsufficient facet constraints e.g. allowed values for Instance typeDifficulty in extending PAL Not easy to add new predicates to PALWeak constraint checking during editingprocess Facet constraints insufficient to specify allowed slotvalues PAL constraints not used for selecting slot values
Wish ListStandardized terminology and information models Express constraints on legal codes Facilitate definition of new codesA plug-in architecture for developing and using‘wizards’ to perform specific tasksA plug-in architecture for defining and usingalternative constraints in selecting and setting slotvalues A variety of constraint types A standardized way to invoke alternative constraint engines forchecking legal slot values
SAGE:“A word from our sponsor . . .”¾ The National Institute of Standards and Technology (NIST), an armof the U.S. Department of Commerce, funds “high risk” researchthrough its Advanced Technology Program (ATP).¾ The mission of the NIST/ATP program is “To accelerate thedevelopment of innovative technologies for broad national benefitthrough partnerships with the private sector”.¾ NIST/ATP projects must entail research that ‘leads to significantnational benefits.’The SAGE project is partially funded by NIST/ATP Cooperative Agreement Number 70NANB1H3049
CPG and Their Use in ClinicalDecision SupportClinical practice guidelines Statements to assist practitioner and patient in making decisionsabout appropriate health care in specific circumstances Traditionally published as monographs or journal papersMethods to change physician behavior Traditional diffusion modelExpects clinicians will change behavior on receipt of information Specific strategies rather than passive disseminationopinion leadersperformance feedbackcomputer-based decision-support at point of care
Decision Support For GuidelineBased CarePatient DataGuideline DecisionSupport SystemConsider adding an ACEInhibitor because of acompelling indication(heart failure)
Workbench Automatic generation of model-specific user-interface forms allows rapid prototyping No guidance for conceptualization and encoding of CPG in KBs Create 'wizards' to support KA tasks Protégé-2000 is component-based and has an extensible architecture Access to external terminology through slot plug-in
