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Semantic Web in Adaptable Clinical Protocols and Pathways (ACPP) Task Group (Obsolete)
Use Scenario of Adapatable Clinical Protocols and Pathways
This story depicts how the healthcare information system manages
Clinical protocols are guidelines and recommendations for the execution and interpretation of healthcare diagnostic and therapeutic tasks, in the context of a clinical condition or therapeutic process. Clinical pathway herein refers to the personalized multi-disciplinary execution plan that is generated by a team of clinical professionals, based upon one or more goals and includes diagnostic and therapeutic interventions. Traditionally, clinical protocols and pathways are specific for a single condition-, i.e. per disease, or medical condition. They are designed for to be applied to all members of the group of patients with that associated condition.
The current clinical pathway modeling and implementations have been mostly “static”, in the sense that a clinical pathway is a set of pre-determined steps. It does not adequately accommodate the changes of individual patient conditions, or the heterogeneity of patient conditions.
Adaptable Clinical Protocols and Pathways (ACPP) accommodate both patient heterogeneity and evolving clinical context through adaptive mechanisms that enable them to accommodate multiple simultaneous contexts and to dynamically adjust to changes in these contexts. They have the potential to eliminate both waste and error in healthcare delivery through the monitoring and orchestration of clinical services. Similar solutions have yielded significant benefit in other industries, such as Banking, Manufacturing, Retail and Transportation. However their adoption within Healthcare has been quite limited.
Such ACPP assimilate patient classification and clinical knowledge, together with knowledge regarding task performance. There currently are no existing universal standards for the expression of clinical protocols and pathways, creating a barrier to their widespread dissemination and adoption.
The ACPP Group is proposed to address the above challenges. We believe that the Semantic Web has great potential in meaningfully connecting a broad range of salient medical knowledge with individual patient medical information, and driving process management technology to orchestrate medical research discovery, and clinical best practices.
There are currently a number of approaches to the programmatic specification of protocols and pathways. The first is the prospective enumeration of sequential steps, with boolean branch points based upon axiomatic logic applied to state variables. The second specifies tasks, and the antecedent conditions necessary for their activation, and dynamically allocates tasks when the appropriate requisite conditions met. A third specifies a goal, with the necessary conditions, information requirements and needed activities to achieve the goal, together with the necessary milestones to measure the performance of the process.
Further, these technologies can be applied both to the sequence of logical steps in a decision sequence (often by a single individual, for example, according to medical knowledge of disease mangement), and to the sequence of process execution steps that occur during healthcare service provision (often by multiple individuals, for example, concerning scheduling and resource management).
The ACPP Group will endeavor to investigate the semantics to support approaches to process specification and process execution.
Limitation of Scope
Any care plan recommended to or performed on a patient mandates serious consideration. The adaptability of clinical pathways, either in the form of merging multiple clinical pathways, or changing a pre-defined step, could create the potential for adverse events. This group is chartered to address technical issues, and will not extend its discussion to legal or regulatory implications of adaptable clinical pathways.
More specifically, the following aspects of clinical pathways are considered out of scope for this ACPP group:
- Trust or Rating of Medical Knowledge. Issues included in this category are
- Expression of trust for medical knowledge
- Verification of protocols, and rating of the effectiveness of a treatment plan
- Implication of FDA regulation in validating or approving treatment plan
- Implications for the business model of a hospital
The ACPP Group is chartered to design a framework that consists of the following components:
- A descriptive mechanism that expresses the tasks involved in both approaches to protocol and process definition, including the instantiation, performance, and evaluation of these steps.
- A collection of core vocabulary that express pre-defined logical connections between steps, including conditionality, sequence, process branching and synchronization
- A set of generic mechanisms that govern the selection of clinical pathways and protocols in any given contexts
- A mechanism for specifying clinical indications and contra-indications for inferred pathway steps, sufficiently generic enough portable across different pathway invocations
- A mechanism that discerns and documents the possible adverse effects when merging clinical pathways or detecting inter process collisions.
- A mechanism that records and handles execution variances from clinical pathways
- If feasible the group will try to differentiate between medical oriented concepts and generic workflow concepts, leaving open the possibility to connect with existing or emerging generic workflow ontologies.
The group plans to examine and wherever feasible, integrate with other standards for nomenclature, reference information models, workflow and rules specifications including the HL7 Reference Information Model.
Sam Brabdt, Alfredo Morales, Davide Zaccagnini, Tonya Hongsermeier, Chimezie Ogbuji, Helen Chen
A flow-chart diagram illustrates how a stroke episode is managed.
The expected duration of the ACPP Working Group is two years. The major deliverable is the ACPP Ontology 1.0, with test cases. A set of technical notes documenting important discussions, issues and group consensus are also considered as deliverables.
- 1st Deliverable
- use cases and major category of constructs for ACPP ontology
- 2nd Deliverable
- ACPP Ontology draft
- test workbench demo proposal
Tools and Services
- Ontology Editor : Protege-OWL, SWOOP
- Semantic Web Reasoners : cwm, euler pellet owl reasoner, racer owl reasoner
- Clinical Terminology services :
Timeline for Task Completion
- Stage 1 (3 month goals)
- Identify use cases and scenarios for ACPP
- Identify scope and major category of interest for ACPP Ontology
- Stage 2 (6 months goals)
- ACPP Ontology draft
- Test workbench Demo: design and functionality proposal