BMC Med Inform Decis Mak - Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines.

Tópicos

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Resumo

CKGROUND: Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs.The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase.METHODS: A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA).RESULTS: The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows.CONCLUSIONS: The framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline.

Resumo Limpo

ckground computer icus reli softwar servic convey medic condit patient well assist staff take treatment decis servic use follow clinic guidelin quick accur howev develop servic often timeconsum errorpron consequ mani carerel activ still conduct base manual construct guidelin often ambigu lead unnecessari variat treatment coststh goal paper present semiautomat verif translat framework capabl turn manual construct diagram readytous program framework combin strength manual serviceori approach decreas disadvantag aim close gap communic medic domain lead less timeconsum errorpron develop phase shorter clinic evalu phasemethod framework propos semiautomat translat clinic guidelin express xmlbase flow chart drool rule flow employ semant technolog ontolog swrl overview architectur given technolog choic thorough motiv final shown framework can integr serviceori architectur soaresult applic drool rule languag express clinic guidelin evalu translat exampl guidelin name sedat protocol use anaesthet patient drool rule flow execut deploy rulebas applic part soa result show perform drool compar technolog web servic increas number decis node present rule flow delay introduc load rule flowsconclus framework effect solut computer clinic guidelin allow quick develop evalu humanread visual rule good perform monitor paramet patient automat detect except situat problem notifi medic staff task need perform computer sedat guidelin improv execut guidelin

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