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Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

Femke Ongenae (UGent) , Femke De Backere (UGent) , Kristof Steurbaut (UGent) , Kirsten Colpaert (UGent) , Wannes Kerckhove (UGent) , Johan Decruyenaere (UGent) and Filip De Turck (UGent)
Author
Organization
Abstract
Background: Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods: A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA). Results: The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows. Conclusions: The framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline.
Keywords
ONTOLOGY, EXAMPLE, REPRESENTATION, DECISION-SUPPORT-SYSTEMS, VENTILATOR-ASSOCIATED PNEUMONIA, UNIT, OUTCOMES, MODEL

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Chicago
Ongenae, Femke, Femke De Backere, Kristof Steurbaut, Kirsten Colpaert, Wannes Kerckhove, Johan Decruyenaere, and Filip De Turck. 2010. “Towards Computerizing Intensive Care Sedation Guidelines: Design of a Rule-based Architecture for Automated Execution of Clinical Guidelines.” Bmc Medical Informatics and Decision Making 10.
APA
Ongenae, F., De Backere, F., Steurbaut, K., Colpaert, K., Kerckhove, W., Decruyenaere, J., & De Turck, F. (2010). Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines. BMC MEDICAL INFORMATICS AND DECISION MAKING, 10.
Vancouver
1.
Ongenae F, De Backere F, Steurbaut K, Colpaert K, Kerckhove W, Decruyenaere J, et al. Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines. BMC MEDICAL INFORMATICS AND DECISION MAKING. 2010;10.
MLA
Ongenae, Femke et al. “Towards Computerizing Intensive Care Sedation Guidelines: Design of a Rule-based Architecture for Automated Execution of Clinical Guidelines.” BMC MEDICAL INFORMATICS AND DECISION MAKING 10 (2010): n. pag. Print.
@article{986862,
  abstract     = {Background: Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase.
Methods: A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA).
Results: The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows.
Conclusions: The framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline.},
  articleno    = {3},
  author       = {Ongenae, Femke and De Backere, Femke and Steurbaut, Kristof and Colpaert, Kirsten and Kerckhove, Wannes and Decruyenaere, Johan and De Turck, Filip},
  issn         = {1472-6947},
  journal      = {BMC MEDICAL INFORMATICS AND DECISION MAKING},
  keywords     = {ONTOLOGY,EXAMPLE,REPRESENTATION,DECISION-SUPPORT-SYSTEMS,VENTILATOR-ASSOCIATED PNEUMONIA,UNIT,OUTCOMES,MODEL},
  language     = {eng},
  pages        = {22},
  title        = {Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines},
  url          = {http://dx.doi.org/10.1186/1472-6947-10-3},
  volume       = {10},
  year         = {2010},
}

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