Torres Silva Ever Augusto, Uribe Sebastian, Smith Jack, Luna Gomez Ivan Felipe, Florez-Arango Jose Fernando
Bioengineering Research Group, Universidad Pontificia Bolivariana, Medellin, Colombia.
Department of Microbial Pathogenesis and Immunology, Texas A&M Unversity, College Station, TX, United States.
JMIR Form Res. 2020 Oct 16;4(10):e17512. doi: 10.2196/17512.
Displeasure with the functionality of clinical decision support systems (CDSSs) is considered the primary challenge in CDSS development. A major difficulty in CDSS design is matching the functionality to the desired and actual clinical workflow. Computer-interpretable guidelines (CIGs) are used to formalize medical knowledge in clinical practice guidelines (CPGs) in a computable language. However, existing CIG frameworks require a specific interpreter for each CIG language, hindering the ease of implementation and interoperability.
This paper aims to describe a different approach to the representation of clinical knowledge and data. We intended to change the clinician's perception of a CDSS with sufficient expressivity of the representation while maintaining a small communication and software footprint for both a web application and a mobile app. This approach was originally intended to create a readable and minimal syntax for a web CDSS and future mobile app for antenatal care guidelines with improved human-computer interaction and enhanced usability by aligning the system behavior with clinical workflow.
We designed and implemented an architecture design for our CDSS, which uses the model-view-controller (MVC) architecture and a knowledge engine in the MVC architecture based on XML. The knowledge engine design also integrated the requirement of matching clinical care workflow that was desired in the CDSS. For this component of the design task, we used a work ontology analysis of the CPGs for antenatal care in our particular target clinical settings.
In comparison to other common CIGs used for CDSSs, our XML approach can be used to take advantage of the flexible format of XML to facilitate the electronic sharing of structured data. More importantly, we can take advantage of its flexibility to standardize CIG structure design in a low-level specification language that is ubiquitous, universal, computationally efficient, integrable with web technologies, and human readable.
Our knowledge representation framework incorporates fundamental elements of other CIGs used in CDSSs in medicine and proved adequate to encode a number of antenatal health care CPGs and their associated clinical workflows. The framework appears general enough to be used with other CPGs in medicine. XML proved to be a language expressive enough to describe planning problems in a computable form and restrictive and expressive enough to implement in a clinical system. It can also be effective for mobile apps, where intermittent communication requires a small footprint and an autonomous app. This approach can be used to incorporate overlapping capabilities of more specialized CIGs in medicine.
对临床决策支持系统（CDSS）功能的不满被认为是CDSS开发中的主要挑战。CDSS设计的一个主要困难是使功能与期望的和实际的临床工作流程相匹配。计算机可解释指南（CIG）用于以可计算语言将医学知识形式化到临床实践指南（CPG）中。然而，现有的CIG框架需要为每种CIG语言配备特定的解释器，这阻碍了实施的便利性和互操作性。
本文旨在描述一种表示临床知识和数据的不同方法。我们打算改变临床医生对具有足够表示能力的CDSS的看法，同时为Web应用程序和移动应用程序保持较小的通信和软件占用空间。这种方法最初旨在为基于Web的CDSS和未来的产前护理指南移动应用程序创建一种可读且语法简洁的语言，通过使系统行为与临床工作流程保持一致来改善人机交互并提高可用性。
我们为CDSS设计并实现了一种架构设计，该设计使用模型-视图-控制器（MVC）架构以及基于XML的MVC架构中的知识引擎。知识引擎设计还整合了CDSS中所需的与临床护理工作流程相匹配的要求。对于设计任务的这一组成部分，我们在特定目标临床环境中对产前护理的CPG进行了工作本体分析。
与用于CDSS的其他常见CIG相比，我们的XML方法可用于利用XML的灵活格式来促进结构化数据的电子共享。更重要的是，我们可以利用其灵活性，以一种无处不在、通用、计算高效、可与Web技术集成且人类可读的低级规范语言来标准化CIG结构设计。
我们的知识表示框架纳入了医学CDSS中使用的其他CIG的基本要素，并证明足以对一些产前保健CPG及其相关临床工作流程进行编码。该框架似乎具有足够的通用性，可用于医学中的其他CPG。事实证明，XML是一种表达能力足以以可计算形式描述规划问题、限制和表达能力足以在临床系统中实现的语言。它对于移动应用程序也可能有效，因为间歇性通信需要较小的占用空间和自主应用程序。这种方法可用于整合医学中更专业的CIG的重叠功能。
