Conformance analysis of the execution of clinical guidelines with basic medical knowledge and clinical terminology

Abstract

Clinical Guidelines (CGs) are developed for specifying the “best” clinical procedures for specific clinical circumstances. However, a CG is executed on a specific patient, with her peculiarities, and in a specific context, with its limitations and constraints. Physicians have to use Basic Medical Knowledge (BMK) in order to adapt the general CG to each specific case, even if the interplay between CGs and the BMK can be very complex, and the BMK should rely on medical terminological knowledge. In this paper, we focus on a posteriori analysis of conformance, intended as the adherence of an observed execution trace to CG and BMK knowledge. A CG description in the GLARE language is mapped to Answer Set Programming (ASP); the BMK and conformance rules are also represented in ASP. The BMK relies on the SNOMED CT terminology and additional (post-coordinated) concepts. Conformance analysis is performed in Answer Set Programming and identifies nonadherence situations to the CG and/or BMK, pointing out, in particular, discrepancies from one knowledge source that could be justified by another source, and discrepancies that cannot be justified.