Musen M A, Tu S W, Das A K, Shahar Y
Section on Medical Informatics, Stanford University School of Medicine, CA 94305-5479, USA.
J Am Med Inform Assoc. 1996 Nov-Dec;3(6):367-88. doi: 10.1136/jamia.1996.97084511.
Provision of automated support for planning protocol-directed therapy requires a computer program to take as input clinical data stored in an electronic patient-record system and to generate as output recommendations for therapeutic interventions and laboratory testing that are defined by applicable protocols. This paper presents a synthesis of research carried out at Stanford University to model the therapy-planning task and to demonstrate a component-based architecture for building protocol-based decision-support systems. We have constructed general-purpose software components that (1) interpret abstract protocol specifications to construct appropriate patient-specific treatment plans; (2) infer from time-stamped patient data higher-level, interval-based, abstract concepts; (3) perform time-oriented queries on a time-oriented patient database; and (4) allow acquisition and maintenance of protocol knowledge in a manner that facilitates efficient processing both by humans and by computers. We have implemented these components in a computer system known as EON. Each of the components has been developed, evaluated, and reported independently. We have evaluated the integration of the components as a composite architecture by implementing T-HELPER, a computer-based patient-record system that uses EON to offer advice regarding the management of patients who are following clinical trial protocols for AIDS or HIV infection. A test of the reuse of the software components in a different clinical domain demonstrated rapid development of a prototype application to support protocol-based care of patients who have breast cancer.
为规划方案导向治疗提供自动化支持需要一个计算机程序,该程序将存储在电子病历系统中的临床数据作为输入,并生成由适用方案定义的治疗干预和实验室检测的建议作为输出。本文介绍了斯坦福大学开展的一项研究综述,该研究旨在对治疗规划任务进行建模,并展示一种用于构建基于方案的决策支持系统的基于组件的架构。我们构建了通用软件组件,这些组件能够:(1) 解释抽象的方案规范以构建适当的针对特定患者的治疗计划;(2) 从带时间戳的患者数据中推断出更高级别的、基于时间间隔的抽象概念;(3) 在面向时间的患者数据库上执行面向时间的查询;(4) 以一种便于人类和计算机高效处理的方式获取和维护方案知识。我们已在一个名为EON的计算机系统中实现了这些组件。每个组件都已独立开发、评估并报告。我们通过实现T-HELPER(一个基于计算机的病历系统,它使用EON为遵循艾滋病或HIV感染临床试验方案的患者提供管理建议)来评估这些组件作为复合架构的集成情况。在不同临床领域对软件组件的重用测试表明,能够快速开发出一个原型应用程序,以支持对乳腺癌患者进行基于方案的护理。