Clinical Guidelines and the Granularity of Plans

 

Anand Kumar, Barry Smith, Mario Stefanelli, Silvana Quaglinia and Matteo Piazza, “Implementing Clinical Guidelines in an Organizational Setup”, Proceedings of the Workshop on Model-Based and Qualitiative Reasoning in Biomedicine, AIME 2003, 39–44.

Outcomes research in healthcare has been a topic much addressed in recent years. Efforts in this direction have been supplemented by work in the areas of guidelines for clinical practice and computer-interpretable workflow and careflow models.In what follows we present the outlines of a framework for understanding the relations between organizations, guidelines, individual patients and patient-related functions. The derived framework provides a means to extract the knowledge contained in the guideline text at different granularities, in ways that can help us to assign tasks within the healthcare organization and to assess clinical performance in realizing the guideline. It does this in a way that preserves the flexibility of the organization in the adoption of the guidelines.

 

Anand Kumar, Matteo Piazza, Silvana Quaglini, Mario Stefanelli "Formalizing UMLS Relations using Semantic Partitions in the context of task-based Clinical Guidelines Model", Manuscript, 2003.

Objectives: To formalize the relations between the different Semantic Types in the Semantic Network of the Unified Medical Language System (UMLS) in the context of computer interpretable task-based clinical guidelines model. Design: We used the Semantic Type Collections as our basis in the formalization. We defined some operators based on the relations which we considered were applicable to all the Semantic Types in the Collection. Measurement: We separated the relations dealing with the Semantic Types Diagnostic Procedure, Laboratory Procedure and Therapeutic or Preventive Procedure. We calculated the ratio of the total relations in UMLS Semantic Network to the adjacent relations of these Semantic Types and also the percentage of Semantic Types who have an adjacent relations with these Semantic Types. Result: Without the consideration of Semantic Type Collection, the total adjacent relations for these three Semantic Types was 6.87% of the total and these covered almost half of the total Semantic Types on an average. With the consideration of Semantic Type Collection, we were able to represent these relations and also cover the whole UMLS Semantic Network. Conclusion: With the formalization of the mapping operators for the adjacent Semantic Types with respect to the three Semantic Types, the next step would be to map the non-adjacent ones to those three Semantic Types following a path with least distance.

 

Anand Kumar, Paolo Ciccarese, Barry Smith and Matteo Piazza, “Context-Based Task Ontologies for Clinical Guidelines”, in D. M. Pisanelli (ed.), Ontologies in Medicine: Proceedings of the Workshop on Medical Ontologies, Rome October 2003 (Studies in Health and Technology Informatics, 102 (2004)), Amsterdam: IOS Press, 2004, 81–94.

Evidence-based medicine relies on the execution of clinical practice guidelines and protocols. A great deal of of effort has been invested in the development of various tools which automate the representation and execution of the recommendations contained within such guidelines and protocols by creating Computer Interpretable Guideline Models (CIGMs). Context-based task ontologies (CTOs), based on standard terminology systems like UMLS, form one of the core components of such a model. We have created DAML+OIL-based CTOs for the tasks mentioned in the WHO guideline for hypertension management, drawing comparisons also with other related guidelines. The advantages of CTOs include: contextualization of ontologies, providing ontologies tailored to specific aspects of the phenomena of interest, dividing the complexity involved in creating ontologies into different levels, providing a methodology by means of which the task recommendations contained within guidelines can be integrated into the clinical practices of a health care set-up.

 

Anand Kumar, Barry Smith, Domenico M. Pisanelli, Aldo Gangemi and Mario Stefanelli, “An Ontological Framework for the Implementation of Clinical Guidelines in Health Care Organizations,” in D. M. Pisanelli (ed.), Ontologies in Medicine: Proceedings of the Workshop on Medical Ontologies (Rome October 2003), Amsterdam: IOS Press, 2004, 95–107.

The paper presents the outlines of an ontology of plans and guidelines, which is then used as the basis for a framework for implementing guideline-based systems for the management of workflow in health care organizations. The framework has a number of special features, above all in that it enables us to represent in formal terms assignments of work-items both to individuals and to teams and to tailor guideline to specific contexts of application in health care organizations. It is designed also to enable implementations to do justice to the fact that the processes carried out in health care organizations may deviate in different ways from the norms set forth in corresponding guideline definitions. This means that implementations built in conformity with the framework will be marked by a type of flexibility that might make them more likely to be accepted by healthcare professionals than are standard guideline-based management systems.

 

Anand Kumar, Barry Smith, Domenica Pisanelli, Aldo Gangemi and Mario Stefanelli, “Clinical Guidelines as Plans: An Ontological Theory”, Methods of Information in Medicine, 45 (2), 2006, 204-210.

Objective: Clinical guidelines are special types of plans realized by collective agents. We provide an ontological theory of such plans that is designed to support the construction of a framework in which guideline-based information systems can be employed in the management of workflow in health care organizations. Method: The framework we propose allows us to represent in formal terms how clinical guidelines are realized through the actions of individuals organized into teams. We provide various levels of implementation representing different levels of conformity on the part of health care organizations. Result: Implementations built in conformity with our framework are marked by two dimensions of flexibility that are designed to make them more likely to be accepted by health care professionals than are standard guideline-based management systems. They do justice to the fact (1) that responsibilities within a health care organization are widely shared, and (2) that health care professionals may on different occasions be noncompliant with guidelines for a variety of well justified reasons. Conclusion: The advantage of the framework lies in its built-in flexibility, its sensitivity to clinical context, and its ability to use inference tools based on a robust ontology. One disadvantage lies in the complication of its implementation.

 

Thomas Bittner and Barry Smith, “A Taxonomy of Granular Partitions”, Daniel Montello (ed.), Spatial Information Theory. Foundations of Geographic Information Science, Proceedings of COSIT 2001, Morro Bay, California, September 2001 (Lecture Notes in Computer Science 2205), Berlin/New York: Springer, 28–43.

In this paper we propose a formal theory of partitions (ways of dividing up or sorting or mapping reality) and we show how the theory can be applied in the geospatial domain. We characterize partitions at two levels: as systems of cells (theory A), and in terms of their projective relation to reality (theory B). We lay down conditions of well-formedness for partitions and we define what it means for partitions to project truly onto reality. We continue by classifying well-formed partitions along three axes: (a) degree of correspondence between partition cells and objects in reality; (b) degree to which a partition represents the mereological structure of the domain it is projected onto; and (c) degree of completeness and exhaustiveness with which a partition represents reality. This classification is used to characterize three types of partitions that play an important role in spatial information science: cadastral partitions, categorical coverages, and the partitions involved in folk categorizations of the geospatial domain.

Anand Kumar and Barry Smith “Ontology for Task-Based Clinical Guidelines and the Theory of Granular Partitions”, Proceedings of the 9th Conference on Artificial Intelligence in Medicine (Lecture Notes on Artificial Intelligence 2780), Berlin: Springer, 2003, 71–75.

The theory of granular partitions (TGP) is a new approach to the understanding of ontologies and other classificatory systems. The paper explores the use of this new theory in the treatment of task-based clinical guidelines as a means for better understanding the relations between different clinical tasks, both within the framework of a single guideline and between related guidelines. We used as our starting point a DAML+OIL-based ontology for the WHO guideline for hypertension management, comparing this with related guidelines and attempting to show that TGP provides a flexible and highly expressive basis for the manipulation of ontologies of a sort which might be useful in providing more adequate Computer Interpretable Guideline Models (CIGMs) in the future.