Towards a systematic approach for argumentation, recommendation, and explanation in clinical decision support.

In clinical decision support, argumentation plays a key role while alternative reasons may be available to explain a given set of signs and symptoms, or alternative plans to treat a diagnosed disease. In literature, this key notion usually has closed boundary across approaches and lacks of openness and interoperability in Clinical Decision Support Systems (CDSSs) been built. In this paper, we propose a systematic approach for the representation of argumentation, their interpretation towards recommendation, and finally explanation in clinical decision support. A generic argumentation and recommendation scheme lays the foundation of the approach. On the basis of this, argumentation rules are represented using Resource Description Framework (RDF) for clinical guidelines, a rule engine developed for their interpretation, and recommendation rules represented using Semantic Web Rule Language (SWRL). A pair of proof knowledge graphs are made available in an integrated clinical decision environment to explain the argumentation and recommendation rationale, so that decision makers are informed of not just what are recommended but also why. A case study of triple assessment, a common procedure in the National Health Service of UK for women suspected of breast cancer, is used to demonstrate the feasibility of the approach. In conducting hypothesis testing, we evaluate the metrics of accuracy, variation, adherence, time, satisfaction, confidence, learning, and integration of the prototype CDSS developed for the case study in comparison with a conventional CDSS and also human clinicians without CDSS. The results are presented and discussed.