Richard Vdovjak

Tracebook: A Dynamic Checklist Support System

It has recently been demonstrated that checklists can enable significant improvements to patient safety. However, their clinical acceptance is significantly lower than expected. This is due to the lack of good support systems. Specifically, support systems are too static: this holds for paper-based support as well as for electronic systems that digitize paper-based support naively. Both approaches are independent from clinical process and clinical context. In this paper, we propose a process-oriented and context-aware dynamic checklist support system: Trace book. This system supports the execution of complex clinical processes and rules involving data from Electronic Medical Record systems. Workflow activities and forms are specific to individual patients based on clinical rules and they are dispatched to the right user automatically based on a process model. Besides describing the Trace book functionality in general, this paper demonstrates the support system specifically on an example application that we are preparing for a controlled clinical evaluation. At last we discuss the limitations of Trace book.

Identifying disease-centric subdomains in very large medical ontologies: a case-study on breast cancer concepts in SNOMED CT. or: Finding 2500 Out of 300.000

Modern medical vocabularies can contain up to hundreds of thousands of concepts. In any particular use-case only a small fraction of these will be needed. In this paper we first define two notions of a disease-centric subdomain of a large ontology. We then explore two methods for identifying disease-centric subdomains of such large medical vocabularies. The first method is based on lexically querying the ontology with an iteratively extended set of seed queries. The second method is based on manual mapping between concepts from a medical guideline document and ontology concepts. Both methods include concept-expansion over subsumption and equality relations. We use both methods to determine a breast-cancer-centric subdomain of the SNOMED CT ontology. Our experiments show that the two methods produce a considerable overlap, but they also yield a large degree of complementarity, with interesting differences between the sets of concepts that they return. Analysis of the results reveals strengths and weaknesses of the different methods.

Analyzing conformance to clinical protocols involving advanced synchronizations

Clinical protocols are a popular instrument to document how clinicians are expected to behave under specific conditions. Protocols are typically based on internationally peer reviewed clinical guidelines as well as on hospital-local agreements. Existing techniques for monitoring protocol adherence only support protocol descriptions involving simple sequences and local decision rules. As care and cure processes are becoming increasingly complex, the need for more advanced techniques naturally emerges. In this paper we present a novel approach to defining and monitoring complex clinical protocols. By using BPMN to document protocols we enable the concise specification of protocols that involve multiple stakeholders that operate in parallel and under uncertainty. Uncertainty relates to the fact that protocols may involve complex loops and choices. While this specification style was becoming increasingly popular in the literature and practice of hospital management and operations management in general, corresponding conformance analysis techniques were still lacking. This paper contributes the first such technique and evaluate it on a complex compliance pattern from the cardiology domain.

A meta-model for computer executable dynamic clinical safety checklists

BackgroundSafety checklist is a type of cognitive tool enforcing short term memory of medical workers with the purpose of reducing medical errors caused by overlook and ignorance. To facilitate the daily use of safety checklists, computerized systems embedded in the clinical workflow and adapted to patient-context are increasingly developed. However, the current hard-coded approach of implementing checklists in these systems increase the cognitive efforts of clinical experts and coding efforts for informaticists. This is due to the lack of a formal representation format that is both understandable by clinical experts and executable by computer programs.MethodsWe developed a dynamic checklist meta-model with a three-step approach. Dynamic checklist modeling requirements were extracted by performing a domain analysis. Then, existing modeling approaches and tools were investigated with the purpose of reusing these languages. Finally, the meta-model was developed by eliciting domain concepts and their hierarchies. The feasibility of using the meta-model was validated by two case studies. The meta-model was mapped to specific modeling languages according to the requirements of hospitals.ResultsUsing the proposed meta-model, a comprehensive coronary artery bypass graft peri-operative checklist set and a percutaneous coronary intervention peri-operative checklist set have been developed in a Dutch hospital and a Chinese hospital, respectively. The result shows that it is feasible to use the meta-model to facilitate the modeling and execution of dynamic checklists.ConclusionsWe proposed a novel meta-model for the dynamic checklist with the purpose of facilitating creating dynamic checklists. The meta-model is a framework of reusing existing modeling languages and tools to model dynamic checklists. The feasibility of using the meta-model is validated by implementing a use case in the system.

DCCSS: A meta-model for dynamic clinical checklist support systems

Clinical safety checklists receive much research attention since they can reduce medical errors and improve patient safety. Computerized checklist support systems are also being developed actively. Such systems should individualize checklists based on information from the patients medical record while also considering the context of the clinical workflows. Unfortunately, the form definitions, database queries and workflow definitions related to dynamic checklists are too often hard-coded in the source code of the support systems. This increases the cognitive effort for the clinical stakeholders in the design process, it complicates the sharing of dynamic checklist definitions as well as the interoperability with other information systems. In this paper, we address these issues by contributing the DCCSS meta-model which enables the model-based development of dynamic checklist support systems. DCCSS was designed as an incremental extension of standard meta-models, which enables the reuse of generic model editors in a novel setting. In particular, DCCSS integrates the Business Process Model and Notation (BPMN) and the Guideline Interchange Format (GLIF), which represent best of breed languages for clinical workflow modeling and clinical rule modeling respectively. We also demonstrate one of the use cases where DCCSS has already been applied in a clinical setting.