PDF(Pubmed)
Abstract：
UNASSIGNED: Clinical decision support (CDS) systems (CDSSs) that integrate clinical guidelines need to reflect real-world co-morbidity. In patient-specific clinical contexts, transparent recommendations that allow for contraindications and other conflicts arising from co-morbidity are a requirement. In this work, we develop and evaluate a non-proprietary, standards-based approach to the deployment of computable guidelines with explainable argumentation, integrated with a commercial electronic health record (EHR) system in Serbia, a middle-income country in West Balkans.
UNASSIGNED: We used an ontological framework, the Transition-based Medical Recommendation (TMR) model, to represent, and reason about, guideline concepts, and chose the 2017 International global initiative for chronic obstructive lung disease (GOLD) guideline and a Serbian hospital as the deployment and evaluation site, respectively. To mitigate potential guideline conflicts, we used a TMR-based implementation of the Assumptions-Based Argumentation framework extended with preferences and Goals (ABA+G). Remote EHR integration of computable guidelines was via a microservice architecture based on HL7 FHIR and CDS Hooks. A prototype integration was developed to manage chronic obstructive pulmonary disease (COPD) with comorbid cardiovascular or chronic kidney diseases, and a mixed-methods evaluation was conducted with 20 simulated cases and five pulmonologists.
UNASSIGNED: Pulmonologists agreed 97% of the time with the GOLD-based COPD symptom severity assessment assigned to each patient by the CDSS, and 98% of the time with one of the proposed COPD care plans. Comments were favourable on the principles of explainable argumentation; inclusion of additional co-morbidities was suggested in the future along with customisation of the level of explanation with expertise.
UNASSIGNED: An ontological model provided a flexible means of providing argumentation and explainable artificial intelligence for a long-term condition. Extension to other guidelines and multiple co-morbidities is needed to test the approach further.
UNASSIGNED: We used an ontological framework, the Transition-based Medical Recommendation (TMR) model, to represent, and reason about, guideline concepts, and chose the 2017 International global initiative for chronic obstructive lung disease (GOLD) guideline and a Serbian hospital as the deployment and evaluation site, respectively. To mitigate potential guideline conflicts, we used a TMR-based implementation of the Assumptions-Based Argumentation framework extended with preferences and Goals (ABA+G). Remote EHR integration of computable guidelines was via a microservice architecture based on HL7 FHIR and CDS Hooks. A prototype integration was developed to manage chronic obstructive pulmonary disease (COPD) with comorbid cardiovascular or chronic kidney diseases, and a mixed-methods evaluation was conducted with 20 simulated cases and five pulmonologists.
UNASSIGNED: Pulmonologists agreed 97% of the time with the GOLD-based COPD symptom severity assessment assigned to each patient by the CDSS, and 98% of the time with one of the proposed COPD care plans. Comments were favourable on the principles of explainable argumentation; inclusion of additional co-morbidities was suggested in the future along with customisation of the level of explanation with expertise.
UNASSIGNED: An ontological model provided a flexible means of providing argumentation and explainable artificial intelligence for a long-term condition. Extension to other guidelines and multiple co-morbidities is needed to test the approach further.
摘要：
■整合临床指南的临床决策支持（CDS）系统（CDS）需要反映现实世界的合并症。在特定于患者的临床环境中，允许禁忌症和因合并症引起的其他冲突的透明建议是一项要求。在这项工作中,我们开发和评估一个非专有的，基于标准的方法来部署具有可解释论证的可计算指南，与塞尔维亚的商业电子健康记录（EHR）系统集成，西巴尔干的一个中等收入国家。
■我们使用了一个本体论框架，基于过渡的医学推荐(TMR)模型，代表，和原因，指导方针概念，并选择了2017年国际慢性阻塞性肺疾病全球倡议（GOLD）指南和塞尔维亚医院作为部署和评估地点，分别。为了缓解潜在的指导方针冲突，我们使用了基于TMR的基于假设的论证框架，扩展了偏好和目标（ABAG）。可计算指南的远程EHR集成是通过基于HL7FHIR和CDSHooks的微服务架构实现的。开发了一种原型集成来管理慢性阻塞性肺疾病（COPD）合并心血管或慢性肾脏疾病，并对20例模拟病例和5名肺科医师进行了混合方法评估。
■肺科医师在97%的时间内同意CDSS为每位患者分配的基于GOLD的COPD症状严重程度评估，和98%的时间与拟议的COPD护理计划之一。对可解释的论证原则的评论是有利的；建议在将来纳入其他合并症，并通过专业知识定制解释水平。
■本体论模型提供了一种灵活的手段，可以为长期条件提供论证和可解释的人工智能。需要扩展到其他指南和多种合并症来进一步测试该方法。
■我们使用了一个本体论框架，基于过渡的医学推荐(TMR)模型，代表，和原因，指导方针概念，并选择了2017年国际慢性阻塞性肺疾病全球倡议（GOLD）指南和塞尔维亚医院作为部署和评估地点，分别。为了缓解潜在的指导方针冲突，我们使用了基于TMR的基于假设的论证框架，扩展了偏好和目标（ABAG）。可计算指南的远程EHR集成是通过基于HL7FHIR和CDSHooks的微服务架构实现的。开发了一种原型集成来管理慢性阻塞性肺疾病（COPD）合并心血管或慢性肾脏疾病，并对20例模拟病例和5名肺科医师进行了混合方法评估。
■肺科医师在97%的时间内同意CDSS为每位患者分配的基于GOLD的COPD症状严重程度评估，和98%的时间与拟议的COPD护理计划之一。对可解释的论证原则的评论是有利的；建议在将来纳入其他合并症，并通过专业知识定制解释水平。
■本体论模型提供了一种灵活的手段，可以为长期条件提供论证和可解释的人工智能。需要扩展到其他指南和多种合并症来进一步测试该方法。
