背景:通过临床实践指南和医院特定的标准操作程序(SOP)提供知识在医学背景和黑色素瘤患者的治疗中无处不在。然而,这些知识源只能以非结构化文本形式提供,并且没有任何与真实患者数据的上下文链接。我们项目的目的是根据患者的实际数据和位置为下一个治疗步骤提供建模的决策支持。
方法:首先,我们从黑色素瘤的SOP中确定了在护理点必要的合格决策的段落.因此,并行考虑决策点的患者特定情境参考数据,并由FHIR(FastHealthcareInteroperabilityResource)资源代表.然后使用具有FHIR注释的BPMN建模来形式化决策算法。由医学专家提供验证,埃森大学医院的皮肤肿瘤学家。
结果:这里给出了所得到的BPMN模型,其中前哨淋巴结切除的诊断程序作为来自整个算法的示例片段。每个决策点都使用FHIR资源进行编辑,涵盖患者数据并准备模型的上下文敏感性。
结论:将基于指南的信息建模为决策算法,该算法可以在上下文参考的情况下在护理点呈现,可能有可能支持患者特定的临床决策。对于来自特定状态的患者,如在转移设置模型中,变得高度适合特定的患者病例,替代和个性化治疗选择。
BACKGROUND: The provision of knowledge through clinical practice
guidelines and hospital-specific standard operating procedures (SOPs) is ubiquitous in the medical context and in the treatment of melanoma patients. However, these knowledge sources are only available in unstructured text form and without any contextual link to real patient data. The aim of our project is to give a modeled decision support for the next treatment step based on the actual data and position of a patient.
METHODS: First, we identified passages for qualified decision-making necessary at the point of care from the SOP for melanoma. Thereby, the patient-specific contextual reference data at decision points was considered in parallel and represented by FHIR (Fast Healthcare Interoperability Resource) resources. The decision algorithm was then formalized using BPMN modeling with FHIR annotations. Validation was provided by medical experts, dermatooncologists from University Hospital Essen.
RESULTS: The resulting BPMN model is presented here with the diagnostic procedure of sentinel lymph node excision as the example snippet from the whole algorithm. Each decision point is edited with FHIR resources covering the patient data and preparing the context sensitivity of the model.
CONCLUSIONS: Modeling
guideline-based information into a decision algorithm that can be presented at the point of care with contextual reference, may have the potential to support patient-specific clinical decision-making. For patients from a certain status like in the metastatic setting modeling becomes highly tailored to specific patient cases, alternative and individualized treatment options.