Adaptable Clinical Pathway (ACP) Reseach Framework
Objectives
To investigate characteristics of adaptable clinical pathway
To prove the hypothesis that complex workflows in healthcare domain can
be best represented and executed using semantic technology
To demonstrate that large scale (real size) medical knowledge and other
relevant domain knowledge can be expressed explicitly and
quantitatively
To prove that different domain knowledge can be linked via semantic web
technology and can be effectively used in solving real problems in
healthcare
To prove that the interoperable and scalable workflow in healthcare can
be achievable via semantic web technology
To improve quality of healthcare services by using knowledge-mediated
and evidence-based information systems
Key Elements in ACP Framework
Milestones
An explicitly expressed and connected knowledge base
- patient record (medical history, genetic and environmental information)
- medical knowledge (treatment guidelines, pharmaceutical guidelines)
- evidence about the effect of prior treatments, temporal reasoning
A declarative way that can produce step-wise clinical pathways
- conform to guidelines and best practices
- adaptable to patient’s medical condition
A highly integrated and webized system that provides required services utilizing the optimum workflow technology
terminology services
- service description and discovery
Medical Knowledge in Natural Form – Facts, Actions and Consequences
Peripheral Nerve Stimulation (PNS) is a method to objectively monitor the degree of neuromuscular blockade.
PNS helps to decrease avoidable side effects such as unwanted movement, prolonged paralysis, and delayed recovery from drug and/or metabolite accumulation.
There are several methods of monitoring neuromuscular blockade. The Train of Four (TOF) is an easy and suitable method for routine monitoring.
Traditional Pathways – Heart Failure
Traditional Pathways – Fracture Femur Head
Clinical Pathway in Semantic Web – ACP Ontology
Clinical Problem
Pathway
Pathway Element
Stage
Outcome
Patient State
Element Prescription
Resource Description
Patient Group
Time Reference Point
Clinical Pathway in Semantic Web – Pathway Elements
Clinical Pathway in Semantic Web – Element Groups
Clinical Pathway - Rules
Rules to select plan types
- patient clinical problem
- medical intervention stage
- patient states
Rules to select elements for a plan
- element description
- time interval, repeative cycles, duration
Rules to change patient state
- change of patient condition
- outcome from execution of pathway elements
Rules to validate plan
- adverse effects such as drug interaction
- optimization, i.e eliminate identical elements, combine steps
- enssure certain sequence of activities
Rules - Example
# rules to derive pathway element according to patient group
{?Y pcontext:hasProblem ?P;
pcontext:hasIntention ?Q.
?X cpath:hasClinicalProblem ?P;
cpath:hasStage ?Q.
?O pcontext:hasScenario ?A.
?A :member ?Y }
=>
{?O :needsPathway ?X}.
{?O :needsPathway ?X.
?X cpath:hasPrescriptionOf ?E.
?E cpath:isElementPrescriptionFor ?G;
cpath:hasPatientGroup ?B.
?O :patientType ?B. }
=>
{?O :needsAction (?E ?G)}.
|
Clinical Pathway – Up-To-Date
Issues in Adaptable Pathways
Inconsistencies
- Pathway ontologies are built without the knowledge of other pathways. Contradictions may exist when combined.
- Differences in Semantics, example of “Audi” as a car and “Audi” as a brand.
Unforeseeable Side effects
- Duplicate examinations
- Bad sequence
- Wrong conclusions
Trust
- When an external ontology is about to be merged the source must be trustworthy
Duplicate Steps
Solution
By adding extra rules this can be solved.
“If the outcome of an examination is valid for x days than any duplicate examination within that period can be canceled”
These are “rules about rules” or “policies”
Bad sequences
Solution
Extra rule
- “Examination X cannot be performed within x days after the administration of contrast medium Y”
Policy
- Rules can be abstracted further into policies:
- “All examinations must be checked against exclusion criteria”
Wrong Conclusion
Test Case 1: Merging Pathways
patient had femur head surgery, suffering heart faifure after operation
all steps from post-op care plan in femur head replacement pathway and steps from heart failure pathways
Test Case 2: Patient Context Aware Elements
measuring weight and height, frequency of the action changes according to patient type
extra steps to ensure non-pregnancy before a woman of productive age to undertake radiation investigation
drug prescription different according to patient age
Test Case 3: Duplication of resources
blood tests that require same type of sampling technique
similar actions such as vital sign measurement
duplication of resources (X-Ray)
Test Case 4: Adverse Drug Interaction
conflicting drug prescription orginated from different pathways
drug prescription without full consideration of patient history
drug conflicts with current patient states
Thanks!