Augmenting Guideline-based CDSS with Experts’ Knowledge

Nekane Larburu, Naiara Muro, Iván Macía, Eider Sánchez, Hui Wang, John Winder, Jacques Boaud, Brigitte Séroussi

Abstract

Over the past years, clinical guidelines have increasingly become part of the clinical daily practice in order to provide best available Evidence-Based-Medicine services. Hence, their formalization as computer interpretable guidelines (CIG) and their implementation in clinical decision support systems (CDSSs) are emerging to support clinicians in their decision making process and potentially improve medical outcomes. However, guideline compliancy in the clinical daily practice is still “low”. Some of the reasons for such low compliance rate are (i) lack of a complete guideline to cover special clinical cases (e.g. oncogeriatric cases), (ii) absence of parameters that current guidelines do not consider (e.g. lifestyle) and (iii) absence of up-to-date guidelines due to lengthy validation procedures. In this paper we present a novel method to build a CDSS that, besides integrating CIGs, stores experts’ knowledge to enrich the CDSS and provide best support to clinicians. The knowledge includes new evidence collected over time by the systematic usage of CDSSs.

References

  1. Adegboyega, T.O., Landercasper, J., Linebarger, J.H., Johnson, J.M., Andersen, J.J., Dietrich, L.L., Driscoll, C.D., Raghavendra, M., Madadi, A.R., Al-Hamadani, M., Vang, C.A., Marcou, K.A., Hudak, J., Go, R.S., 2015. Institutional review of compliance with NCCN guidelines for breast cancer: lessons learned from realtime multidimensional synoptic reporting. J. Natl. Compr. Cancer Netw. JNCCN 13, 177-183.
  2. Beeler, P.E., Bates, D.W., Hug, B.L., 2014. Clinical decision support systems. Swiss Med. Wkly. 144, w14073.
  3. Bouaud, J., Séroussi, B., 2011. Revisiting the EBM decision model to formalize non-compliance with computerized CPGs: results in the management of breast cancer with OncoDoc2. AMIA. Annu. Symp. Proc. 2011, 125-134.
  4. Cabana MD, Rand CS, Powe NR, et al, 1999. Why don't physicians follow clinical practice guidelines?: A framework for improvement. JAMA 282, 1458-1465.
  5. Chéreau, E., Coutant, C., Gligorov, J., Lesieur, B., Antoine, M., Daraï, E., Uzan, S., Rouzier, R., 2011. Discordance with local guidelines for adjuvant chemotherapy in breast cancer: reasons and effect on survival. Clin. Breast Cancer 11, 46-51.
  6. Colantonio, S., Conforti, D., Martinelli, M., Moroni, D., Perticone, F., Salvetti, O., Sciacqua, A., 2008. An intelligent and integrated platform for supporting the management of chronic heart failure patients, in: 2008 Computers in Cardiology. Presented at the 2008 Computers in Cardiology, pp. 897-900.
  7. Ferlay, J., Steliarova-Foucher, E., Lortet-Tieulent, J., Rosso, S., Coebergh, J.W.W., Comber, H., Forman, D., Bray, F., 2013. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur. J. Cancer 49, 1374-1403.
  8. Flottorp, S.A., Oxman, A.D., Krause, J., Musila, N.R., Wensing, M., Godycki-Cwirko, M., Baker, R., Eccles, M.P., 2013. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement. Sci. IS 8, 35.
  9. Fox, J., Patkar, V., Chronakis, I., Begent, R., 2009. From practice guidelines to clinical decision support: closing the loop. J. R. Soc. Med. 102, 464-473.
  10. Grimshaw, J.M., Russell, I.T., 1994. Achieving health gain through clinical guidelines II: Ensuring guidelines change medical practice. Qual. Health Care 3, 45-52.
  11. Hussain, S., Abidi, S.R., Abidi, S.S.R., 2007. Semantic Web Framework for Knowledge-Centric Clinical Decision Support Systems, in: Artificial Intelligence in Medicine. Presented at the Conference on Artificial Intelligence in Medicine in Europe, Springer, Berlin, Heidelberg, pp. 451-455.
  12. ICHOM - International Consortium for Health Outcomes Measurement [WWW Document], n.d. URL http://www.ichom.org/ (accessed 1.3.17).
  13. Landercasper, J., Dietrich, L.L., Johnson, J.M., 2006. A Breast Center review of compliance with National Comprehensive Cancer Network Breast Cancer guidelines. Am. J. Surg. 192, 525-527.
  14. Larburu, N., Schooten, B. van, Shalom, E., Fung, N., Sinderen, M. van, Hermens, H., Jones, V., 2015. A Quality-of-Data Aware Mobile Decision Support System for Patients with Chronic Illnesses, in Knowledge Representation for Health Care, Lecture Notes in Computer Science. Springer International Publishing, pp. 126-139.
  15. Lebeau, M., Mathoulin-Pélissier, S., Bellera, C., Tunon-deLara, C., Daban, A., Lipinski, F., Jaubert, D., Ingrand, P., Migeot, V., REPERES Group, 2011. Breast cancer care compared with clinical Guidelines: an observational study in France. BMC Public Health 11, 45.
  16. Leonard, R., Ballinger, R., Cameron, D., Ellis, P., Fallowfield, L., Gosney, M., Johnson, L., Kilburn, L.S., Makris, A., Mansi, J., Reed, M., Ring, A., Robinson, A., Simmonds, P., Thomas, G., Bliss, J.M., 2011. Adjuvant chemotherapy in older women (ACTION) study - what did we learn from the pilot phase? Br. J. Cancer 105, 1260-1266.
  17. McGlynn, E.A., Asch, S.M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., Kerr, E.A., 2003. The Quality of Health Care Delivered to Adults in the United States. N. Engl. J. Med. 348, 2635-2645.
  18. Mercuri, M., Gafni, A., 2011. Medical practice variations: what the literature tells us (or does not) about what are warranted and unwarranted variations. J. Eval. Clin. Pract. 17, 671-677.
  19. Miranda-Mena, T.G., Benítez U., S.L., Ochoa, J.L., Martínez-Béjar, R., Fernández-Breis, J.T., Salinas, J., 2006. A knowledge-based approach to assign breast cancer treatments in oncology units. Expert Syst. Appl. 31, 451-457.
  20. Parks, R.M., Lakshmanan, R., Winterbottom, L., AL Morgan, D., Cox, K., Cheung, K.-L., 2012. Comprehensive geriatric assessment for older women with early breast cancer - a systematic review of literature. World J. Surg. Oncol. 10, 88.
  21. Roshanov, P.S., Fernandes, N., Wilczynski, J.M., Hemens, B.J., You, J.J., Handler, S.M., Nieuwlaat, R., Souza, N.M., Beyene, J., Van Spall, H.G.C., Garg, A.X., Haynes, R.B., 2013. Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. BMJ 346, f657.
  22. Sacchi, L., Larizza, C., Combi, C., Bellazzi, R., 2007. Data mining with Temporal Abstractions: learning rules from time series. Data Min. Knowl. Discov. 15, 217- 247.
  23. Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., Richardson, W.S., 1996. Evidence based medicine: what it is and what it isn't. BMJ 312, 71-72.
  24. Schnitt, S.J., 1998. Microinvasive carcinoma of the breast: a diagnosis in search of a definition. Adv. Anat. Pathol. 5, 367-372.
  25. Séroussi, B., Laouénan, C., Gligorov, J., Uzan, S., Mentré, F., Bouaud, J., 2013. Which breast cancer decisions remain non-compliant with guidelines despite the use of computerised decision support? Br. J. Cancer 109, 1147-1156.
  26. Séroussi, B., Laouénan, C., Gligorov, J., Uzan, S., Mentré, F., Bouaud, J., 2013. Which breast cancer decisions remain non-compliant with guidelines despite the use of computerised decision support? Br. J. Cancer 109, 1147-1156.
  27. Wöckel, A., Kurzeder, C., Geyer, V., Novasphenny, I., Wolters, R., Wischnewsky, M., Kreienberg, R., Varga, D., 2010. Effects of guideline adherence in primary breast cancer--a 5-year multi-center cohort study of 3976 patients. Breast Edinb. Scotl. 19, 120-127.
Download


Paper Citation


in Harvard Style

Larburu N., Muro N., Macía I., Sánchez E., Wang H., Winder J., Boaud J. and Séroussi B. (2017). Augmenting Guideline-based CDSS with Experts’ Knowledge . In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2017) ISBN 978-989-758-213-4, pages 370-376. DOI: 10.5220/0006213903700376


in Bibtex Style

@conference{healthinf17,
author={Nekane Larburu and Naiara Muro and Iván Macía and Eider Sánchez and Hui Wang and John Winder and Jacques Boaud and Brigitte Séroussi},
title={Augmenting Guideline-based CDSS with Experts’ Knowledge},
booktitle={Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2017)},
year={2017},
pages={370-376},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0006213903700376},
isbn={978-989-758-213-4},
}


in EndNote Style

TY - CONF
JO - Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2017)
TI - Augmenting Guideline-based CDSS with Experts’ Knowledge
SN - 978-989-758-213-4
AU - Larburu N.
AU - Muro N.
AU - Macía I.
AU - Sánchez E.
AU - Wang H.
AU - Winder J.
AU - Boaud J.
AU - Séroussi B.
PY - 2017
SP - 370
EP - 376
DO - 10.5220/0006213903700376