Usability-focused Clinical Decision Support with the Help of Semantic Technologies. Braga S. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Usability-Focused
Clinical Decision Support
with the Help of
SemanticTechnologies.
Dr Silviu Braga MD , Paolo Ciccarese PhD
Medicognos

2. Practicing Physicians Requirements
Usability
=
Knowledge Based Workflow Support
=
“build in” Decision Support

3. Practicing Physicians USABILITY requirements
1. Clinical Workflow support
 Reengineer the EHR into a clinical WfMS
2. Medical Knowledge support
 Interface Terminology
 Code once use multiple times: Interface Terminology with
transparent mapping to classifications and codifications
 Design for decision support at the point of care
 Multi-user, multilingual authoring by trained physicians
 Quality assurance by design (semantically constraint
authoring + validation)

4. The Challenge
The known semantic problems (B. Smith , A Rector , S. Schulz ,P. Elkin)
• Snomed CT
• HL7 v3-, OpenEHR- , EN 13606-, EN 13940 (ContSys) - RIMs
The known RIM- Terminology interaction problems
• The terminology binding “chaos” (A Rector)
• The semantic “grey zone” problem (Markwell report for NHS)
• The “system of coding vs system of meaning” problem ( A Rector )
Timing problems
• Timing of Snomed redesign project (anatomy, organism, observable)
• Timing and capacities of ICD 11 ?

5. Unified Semantic Model

6. Ontology based RIM & Terminologies
1. Use of an Upper Ontology
2. Every aspect in the system is built on orthogonal “domain
ontologies” defined using a subset of OWL (proprietary
solution at runtime)
3. More expressive OWL for analysts (knowledge modeling, model
checking, maintenance, mining)
4. Reuse of existing ontologies such as FMA

7. Onthotypes®
1. Semantic data structures
2. Decoupling meaning from coding and presentation
3. Generate post-coordinated concepts through formal logical
expressions
4. Lexico-syntactic annotations
- Semantic User Interface Engine
- Natural Language Generation for the EHR notes

8. Knowledge & Workflow based Architecture
with build in CDS
EPR EHR PHR NHR …
Interface engine WF Engine Rules Engine
Terminology Templates Executable Clinical Wf Executable Drug Wf Executable CDS logic
“ontotypes” KB KB Care Plans KB Drug Therapy Wf KB Rules KB
Concept Template Workflow Drug KB Queries &Rules Builder
Builder Builder Builder Builder Clinical Domain Language
Clinical Knowledge Management Studio
Domain Clinical Situation Care Organisation
Biomedical
Care Plan
Ontologies OBO
BFO Organisation
Time/Space Process
Foundational layer

9. Knowledge Management Studio
Build semantically constrained
data structures “Onthotypes”

10. Knowledge Management Studio

11. Knowledge Management Studio
Knowledge based
Clinical Activity Templates

12. Knowledge & Workflow based EHR

13. Knowledge & Workflow based EHR
Workflow orientated
user interface

14. Knowledge & Workflow based EHR
Contextual knowledge access
“pre-decision” support

15. Knowledge & Workflow based EHR
Personalized
Activities

16. Knowledge & Workflow based EHR
Actionable DS inside the EPR Wf
The recommendations are linked
to the corresponding Activities

17. Knowledge & Workflow based EHR

18. Knowledge & Workflow based EHR
Customizing the content and the
workflow logic of the Actionable
Alerts

19. Knowledge & Workflow based EHR
Actionable Alerts