Usability-Focused

Clinical Decision Support

with the Help of

SemanticTechnologies.

Dr Silviu Braga MD , Paolo Ciccarese PhD

Medicognos

Practicing Physicians Requirements

Usability=

Knowledge Based Workflow Support

=

“build in” Decision Support

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)

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 )

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

Timing problems

• Timing of Snomed redesign project (anatomy, organism, observable)

• Timing and capacities of ICD 11 ?

Unified Semantic Model

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

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

WF Engine Rules EngineInterface engine

EPR EHR NHRPHR

Clinical Knowledge Management Studio

Concept Builder

Template Builder

Workflow Builder

Drug KBBuilder

Queries &Rules Builder Clinical Domain Language

Executable Clinical Wf Care Plans KB

Executable Drug WfDrug Therapy Wf KB

Executable CDS logicRules KB

Terminology

“ontotypes” KB Templates

KB

Domain

Ontologies

Foundational layerTime/Space

Organisation

Process

Biomedical Clinical Situation

Care Plan

Care Organisation

BFOOBO

…

Knowledge & Workflow based Architecture

with build in CDS

Knowledge Management Studio

Build semantically constrained

data structures “Onthotypes”

Knowledge Management Studio

Knowledge based

Clinical Activity Templates

Knowledge Management Studio

Knowledge & Workflow based EHR

Workflow orientated

user interface

Knowledge & Workflow based EHR

Knowledge & Workflow based EHR

Contextual knowledge access

“pre-decision” support

Personalized

Activities

Knowledge & Workflow based EHR

Actionable DS inside the EPR Wf

The recommendations are linked

to the corresponding Activities

Knowledge & Workflow based EHR

Knowledge & Workflow based EHR

Customizing the content and the

workflow logic of the Actionable

Alerts

Knowledge & Workflow based EHR

Knowledge & Workflow based EHR

Actionable Alerts