Point of Care Healthcare

Clinical Guidelines are a major tool in improving the quality of medical care. However, most guidelines are in free text, not in a formal, executable format, and are not easily accessible to clinicians at the point of care. We have designed and implemented a Web-based, modular, distributed architecture, the Digital Electronic Guideline Library (DeGeL), which facilitates gradual conversion of clinical guidelines from text to a formal representation in chosen target guideline ontology. The architecture supports guideline classification, semantic markup, context-sensitive search, browsing, run-time application to a specific patient at the point of care, and retrospective quality assessment by a clinical organization. The DeGeL procedural-knowledge hybrid meta-ontology includes elements common to all guideline ontologies, such as semantic classification and domain knowledge; it also includes four content-representation formats: free text, semi-structured text, semi-formal representation, and a formal representation. These formats support increasingly sophisticated computational tasks. We have evaluated the accuracy and completeness of the specification of the semi-structured and semi-formal medical procedural knowledge by clinical editors, with encouraging results. Furthermore, the declarative knowledge embedded in the clinical guideline’s formal representation can also be exploited to support the tasks of interpretation, summarization, visualization, explanation, temporal …