This is one of the possible Use Cases.
1. Abstract
Recommendations for Chronic Diseases, Type 2 Diabetes Guidelines. Suggesting therapeutic recommendations requires to use knowledge issued from several sources, e.g., ontologies of drugs, of diseases, of food, rules describing guidelines, patient's data and history stored in patient's electronic medical records. Therapeutic recommendations in guidelines can be considered as rules composed of body and head [19]. For chronic diseases, body is usually expressed as combinations of clinical and therapeutic criteria. Therapeutic criteria include patient's past or ongoing treatments, i.e. earlier treatment that has been prescribed and its outcome in terms of efficacy and tolerance. Body are sets of therapeutic options, generally expressed in terms of therapeutic classes, but sometimes expressed otherwise, as a particular type or group of therapeutic agents.
Here some examples of rules:
Rule1. If oral monotherapy with maximal doses of sulfamide or metformin associated with lifestyle changes is not effective, then the monotherapy should be replaced by oral bitherapy.
Rule 2. If a drug may interact with patient's medication or other conditions e.g., contraindications do not prescribe this drug.
2. Status
Originally proposed by: Christine Golbreich (posted by IanHorrocks on her behalf)
3. Relationship to OWL/RDF Compatibility
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A rule extension to OWL DL
4. Benefits of Interchange
- Interoperability between ontologies through OWL standard is necessary to allow reasoning across domains (Drug, Food, Disease) plus rules
5. Requirements on the RIF
- Compatibility with OWL
- Reasoning with ontologies and rules
6. Breakdown
6.1. Actors and their Goals
- Patient - consults his doctor for controlling his diabetes and getting his treatment
- Doctor - wants to prescribe the treatment which is appropriate to the current situation
- Doctor - suggests a new treatment and checks its relevance from the Computer-interpretable guidelines (CIG) and patient's electronic medical records (EMR).
6.2. Main Sequence
A diabete treatment depends on the disease evolution and patient's past treatment history. It needs to be regularly controlled and updated according the very simplified strategy below (guidelines), depending on several factors (including the level of some varriable << HbA1 >>)
At each next visit, his doctor checks if his new prescription is consitent with the patient's data, the guidelines and ontologies knowledge
If he mistakes then he asks his system to provide him some suggestions
The same patient comes back later ...
Another patient consults ...
General prescription strategy :
First : non-drug treatment
- Diet
- Physical activity
Next : drug treatment
- First, monotherapy
- Else next, bitherapy
And finally, insuline
7. Narratives
Treatment of diabetic patients must be regularly updated: for example, 5 to 7% of type 2 diabetic patients will require, yearly, a change from oral monotherapy or bitherapy antidiabetic drugs to insulin treatment, in order to maintain a good glycaemic control.
Scenario:
Bob goes to his physician, Dr. Rosen for a regular control. Bob is a 54 years old patient having Diabete, diagnosed in March 2002. His blood pressure is 16/9. His doctor's goal is to maintain the HbA1c (*) under 6.5. At the beginning, his glycemy was controlled thanks to a food diet and some physical practice, of medium intensity. Then a treatment by Glucor (a inh apha-glucosidase), 50 mg 3 time per day has been prescribed from June 2003, because of a too high value of HbA1c. Four months later, this drug was replaced by Hemi-daonil (glibenclamide, a sulfamid) 1.25 mg 3 times per day, because of digestive troubles. It was well supported. But one year later it had to be replaced by Diamicron (a sulfamide) 80 mg 3 times, because the glycemy control was not satisfying. Now, the patient has a value of HbA1c > 7 for the second time since 2 months. What should his doctor prescribe him, according to the guidelines recommendations?
His doctor was about prescribing Stagid (metformine, a biguanide) 700 mg, 3 times. Fortunately, he double checked his prescription with his system based on interpretable guidelines, patient's electronic medical records, Drug, Food, Disease ontologies. The system informed him that he should have prescribed a bitherapy (sulfamides/metformine, or sulfamides/apha-glucosidases inhibitor, or metformine/alpha-glucosidases inhibitors) instead (because of Rule1 "If oral monotherapy with maximal doses of sulfamide or metformin associated with lifestyle changes is not effective, then the monotherapy should be replaced by oral bitherapy"). So, he changed his prescription for an association of two other drugs: metformine and Avandia (rosiglitazone, a glitazones). However, unfortunately he was mistaking again. From the data registered in the electronic record of the patient, and the Disease ontology, the system warned him that this patient diabetes was complicated by a nephropathy with mild renal insufficiency. Then, hopefully the system complained again, and sent an alert from the Drug ontology indicating that the prescribed drug metformine was contraindicated because of the nephropathy, and also warned to potentially drug interaction with Bob's current Conversion Enzyme Inhibitor used for his nephropathy!
(*) HbA1c is an indicator used to evaluate diabete stage of a patient
This technology could be made available to doctors, to double check their own knowledge and to patients who want to take a greater role in understanding their own health care.
8. Commentary
extracted from http://www.med.univ-rennes1.fr/~cgolb/RIF/OntologyWithRule-CG.pdf
[19] V. Ebrahiminia, C. Duclos, R. Cohen, A. Venot, Representing the Patient's Therapeutic History in Medical Records and in Guideline Recommendations for Chronic Diseases Using a Unique Model, MIE 2005