Representation of medical guidelines using a classification-based system

ABSTRACT

Medical guidelines play an increasing role in selecting diagnostic and therapeutic steps under the aspects of effectiveness, invasiveness, and costs. To work directly on patient data already available in electronic form, they should be integrated into a medical information system. In order to develop a “medical guideline module” (MGM) managing and applying guidelines to patients, a “knowledge level” representation of guidelines is necessary which reflects the structure of medical knowledge and matches medical processes. Furthermore, a direct transformation to the “symbol level” is needed. We use a nested, frame-like structure on the knowledge level and show that a classification-based knowledge representation system (CBKRS) is principally well suited for the symbol level. To facilitate the usage and to be independent of a particular CBKRS, we introduce an intermediate level called “intelligent object system” (IOS). It is developed by augmenting a simple data model for describing complex objects with prototypes and implications as a means to classify objects and to draw inferences based on this classification. Finally, the transformation of guidelines to prototypes and implications is described.

REFERENCES

• 1: Carole A. Goble , Andrzej J. Glowinski , W. A. Nowlan , Alan L. Rector, A Descriptive Semantic Formalism for Medicine, Proceedings of the Ninth International Conference on Data Engineering, p.624-631, April 19-23, 1993
• 2: K. E. Campbell, M. A. Musen. "Representation of Clinical Data Using SNOMED III and Conceptual Graphs" in Proc. 16th Annual Symposium on Computer Applicatzons in Medical Care. M. g. Frisse (ed.), McGraw-Hill, November 1992, 354-358.
• 3: R. H. Baud, A.-M. Rassinoux, J.-R. Scherrer. "Natural Language Processing and Semantical Representation of Medical Texts" Methods of Information in Medzczne 3I (2) June 1992, 117-125.
• 4: J. J. Cimino, G. Hripcsak, S. B. Johnson, P. D. Clayton. "Designing an Introspective, Multipurpose, Controlled Medical Vocabulary" in Proc. 13th Annual Symposium on Computer A pphcatzons zn Medical Care. L. C. Kingsland (ed.), IEEE Computer Society Press, November 1989, 513-518.
• 5: R. MacGregor. "The Evolving Technology of Classification-Based Knowledge Representation Systems" in Prznczples of Semantic Networks. Exploratzons in the Representation of Knowledge. 3. F. Sowa (ed.), Morgan Kaufmann Publishers, 1991, 385-400.
• 6: D. Brill. Loom Re/erence Manual (Version 2.0). Information Sciences Institute, University of Southern California, December 1993.
• 7: L. A. Resnick, A. Borgida, R. J. Brachman, D. L. McGuinness, P. F. Patel-Schneider, K. C. Zalondek. CLASSIC Descr#ptzon and Reference Manual for the COMMON LISP Implementatzon (Verszon 2.1). AT&T Bell Laboratories. Murray Hill, N J. May 1993.
• 8: J. Heinsohn, D. Kudenko, B. Nebel, H.-J. Profiflich. An Empzmcal Analyszs of Term#nologzcal Representatzon Systems. RR-92-16, German Research Center for Artificial Intelligence (DFKI), Saarbrficken, Germany, 1992.
• 9: J. F. Sowa, Conceptual structures: information processing in mind and machine, Addison-Wesley Longman Publishing Co., Inc., Boston, MA, 1984
• 10: Richard Fikes , Tom Kehler, The role of frame-based representation in reasoning, Communications of the ACM, v.28 n.9, p.904-920, Sept. 1985 [doi>10.1145/4284.4285]
• 11: W. Swartout, R. Neches. "The Shifting Terminological Space: An Impediment to Evolvability" in Proc. Natzonal Conference on Artzficial Intelhgence. American Association for Artificial Intelligence, 1986, 936-941.
• 12: J. Yen , R. Neches , R. MacGregor, CLASP: Integrating Term Subsumption Systems and Production Systems, IEEE Transactions on Knowledge and Data Engineering, v.3 n.1, p.25-32, March 1991 [doi>10.1109/69.75885 ]
• 13: Howard W. Beck , Sunit K. Gala , Shamkant B. Navathe, Classification as a Query Processing Technique in the CANDIDE Semantic Data Model, Proceedings of the Fifth International Conference on Data Engineering, p.572-581, February 06-10, 1989
• 14: David Ungar , Randall B. Smith, Self: The power of simplicity, Conference proceedings on Object-oriented programming systems, languages and applications, p.227-242, October 04-08, 1987, Orlando, Florida, United States
• 15: C. Chambers , D. Ungar , E. Lee, An efficient implementation of SELF a dynamically-typed object-oriented language based on prototypes, Conference proceedings on Object-oriented programming systems, languages and applications, p.49-70, October 02-06, 1989, New Orleans, Louisiana, United States
• 16: G. Blaschek. "Type-Safe Object-Oriented Programming with Prototypes. The Concepts of Omega" Structured Programmzng 12 (4) 1991, 217-225.
• 17: R. d. Brachman, D. L. McGuinness, P. F. Patel- Schneider, L. A. Resnick. "Living with CLASSIC: When and How to Use a KL-ONE-Like Language" in Prznczples of Semantic Networks. Exploratzons zn the Representat2on of Knowledge. J. F. Sowa (ed.), Morgan Kaufmann Publishers, 1991, 401-456.
• 18: G. Hripcsak, P. D. Clayton, T. A. Pryor, P. Haug, O. B. Wigertz, J. Van der Lei. "The Arden Syntax for Medical Logic Modules" in Proc. 14th Annual Symposzum on Computer A pplicatzons zn Medical Care. R. A. Miller (ed.), IEEE Computer Society Press, November 1990, 200-204.

INDEX TERMS

Primary Classification:
  J. Computer Applications

Additional Classification:
  I. Computing Methodologies
  I.2 ARTIFICIAL INTELLIGENCE

General Terms:
Theory