抗生素在临床领域的过度使用正在导致细菌耐药性的惊人增加,从而危及其在治疗高度复发的严重传染病方面的有效性。虽然临床指南(CGs)以叙事形式关注抗生素的正确处方,临床决策支持系统(CDSS)在护理点以规则的形式操作CG中包含的知识。尽管努力将CG计算机化,CG与可用于在真实临床环境中实施CDS的无数规则技术(基于不同的逻辑形式)之间仍然存在差距.
为了帮助CDSS设计人员确定最合适的基于规则的技术(面向医学的规则,生产规则和语义网络规则),用于对来自CG的抗生素处方知识进行建模。我们为此提出了一个标准框架,该框架可扩展到更通用的CG。
我们的建议是基于从文献中提取的核心技术要求的识别和抗生素的CGs分析,建立三个维度进行分析:语言表达,互操作性和工业方面。我们提出了一个关于约翰·霍普金斯医院(JHH)尿路感染(UTI)抗生素指南的案例研究,高度复发的医院获得性感染。我们采用了我们的标准框架,以便使用各种规则技术分析和实施这些CG:HL7Arden语法,通用生产规则系统(Drools),HL7标准规则交换格式(RIF),语义Web规则语言(SWRL)和SParql推理符号(SPIN)规则扩展(实现我们自己的UTI本体)。
我们已经确定了为CG获得可维护且成本可承受的可计算知识表示所需的主要标准。我们在总共12个Arden语法MLM中代表了JHHUTICG知识,81个Drools规则和154个本体类,属性和个人。我们的实验证实了所提出的标准集的相关性,并显示了不同规则技术与JHHUTICG知识表示的合规性水平。
拟议的标准框架可能有助于临床机构选择最合适的规则技术来表示一般的CG,特别是抗生素处方领域,描绘导致计算机可解释指南(CIG)的主要方面,如逻辑表现力(开放/封闭世界假设,否定即失败),与现有HIS和临床工作流程的时间推理和互操作性。未来的工作将集中于为临床医生提供关于CG新的潜在步骤的建议。考虑流程挖掘方法和CG流程工作流,HL7FHIR用于HIS互操作性和服务知识(KaaS)的表示。
The over-use of antibiotics in clinical domains is causing an alarming increase in bacterial resistance, thus endangering their effectiveness as regards the treatment of highly recurring severe infectious diseases. Whilst Clinical Guidelines (CGs) focus on the correct prescription of antibiotics in a narrative form, Clinical Decision Support Systems (CDSS) operationalize the knowledge contained in CGs in the form of rules at the point of care. Despite the efforts made to computerize CGs, there is still a gap between CGs and the myriad of rule technologies (based on different logic formalisms) that are available to implement CDSSs in real clinical settings.
To helpCDSS designers to determine the most suitable rule-based technology (medical-oriented rules, production rules and semantic web rules) with which to model knowledge from CGs for the prescription of antibiotics. We propose a framework of criteria for this purpose that is extensible to more generic CGs.
Our proposal is based on the identification of core technical requirements extracted from both literature and the analysis of CGs for antibiotics, establishing three dimensions for analysis: language expressivity, interoperability and industrial aspects. We present a case study regarding the John Hopkins Hospital (JHH) Antibiotic Guidelines for Urinary Tract Infection (UTI), a highly recurring hospital acquired infection. We have adopted our framework of criteria in order to analyse and implement these CGs using various rule technologies: HL7 Arden Syntax, general-purpose Production Rules System (Drools), HL7 standard Rule Interchange Format (RIF), Semantic Web Rule Language (SWRL) and SParql Inference Notation (SPIN) rule extensions (implementing our own ontology for UTI).
We have identified the main criteria required to attain a maintainable and cost-affordable computable knowledge representation for CGs. We have represented the JHH UTI CGs knowledge in a total of 12 Arden Syntax MLMs, 81 Drools rules and 154 ontology classes, properties and individuals. Our experiments confirm the relevance of the proposed set of criteria and show the level of compliance of the different rule technologies with the JHH UTI CGs knowledge representation.
The proposed framework of criteria may help clinical institutions to select the most suitable rule technology for the representation of CGs in general, and for the antibiotic prescription domain in particular, depicting the main aspects that lead to Computer Interpretable Guidelines (CIGs), such as Logic expressivity (Open/Closed World Assumption, Negation-As-Failure), Temporal Reasoning and Interoperability with existing HIS and clinical workflow. Future work will focus on providing clinicians with suggestions regarding new potential steps for CGs, considering process mining approaches and CGs Process Workflows, the use of HL7 FHIR for HIS interoperability and the representation of Knowledge-as- a-Service (KaaS).