A task-specific ontology for the application and critiquing of time-oriented clinical guidelines

Abstract

Clinical guidelines reuse existing clinical procedural knowledge while leaving room for flexibility by the care provider applying that knowledge. Guidelines can be viewed as generic skeletal-plan schemata that are instantiated and refined dynamically by the care provider over significant periods of time and in highly dynamic environments. In the Asgaard project, we are investigating a set of tasks that support the application of clinical guidelines by a care provider other than the guideline's designer. We are focusing on application of the guideline, recognition of care providers' intentions from their actions, and critique of care providers' actions given the guideline and the patient's medical record. We are developing methods that perform these tasks in multiple clinical domains, given an instance of a properly represented clinical guideline and an electronic medical patient record. In this paper, we point out the precise domain-specific knowledge required by each method, such as the explicit intentions of the guideline designer (represented as temporal patterns to be achieved or avoided). We present a machine-readable language, called Asbru, to represent and to annotate guidelines based on the taskspecific ontology. We also introduce an automated tool for acquisition of clinical guidelines based on the same ontology; the tool was developed using the PROTÉGÉ-II framework's suite of tools.