A Knowledge Authoring Tool for Clinical Decision Support

  • Dustin Dunsmuir
  • Jeremy Daniels
  • Christopher Brouse
  • Simon Ford
  • J. Mark AnserminoEmail author


Anesthesiologists in the operating room are unable to constantly monitor all data generated by physiological monitors. They are further distracted by clinical and educational tasks. An expert system would ideally provide assistance to the anesthesiologist in this data-rich environment. Clinical monitoring expert systems have not been widely adopted, as traditional methods of knowledge encoding require both expert medical and programming skills, making knowledge acquisition difficult. A software application was developed for use as a knowledge authoring tool for physiological monitoring. This application enables clinicians to create knowledge rules without the need of a knowledge engineer or programmer. These rules are designed to provide clinical diagnosis, explanations and treatment advice for optimal patient care to the clinician in real time. By intelligently combining data from physiological monitors and demographical data sources the expert system can use these rules to assist in monitoring the patient. The knowledge authoring process is simplified by limiting connective relationships between rules. The application is designed to allow open collaboration between communities of clinicians to build a library of rules for clinical use. This design provides clinicians with a system for parameter surveillance and expert advice with a transparent pathway of reasoning. A usability evaluation demonstrated that anesthesiologists can rapidly develop useful rules for use in a predefined clinical scenario.


Decision support Expert system Situation awareness Usability Anesthesia Monitoring Knowledge resources 



This project was supported by the Canadian Institutes of Health Research. We would like to thank all the experts who have assisted and advised us with developing this application. We would also like to thank the volunteers who participated in the usability evaluation for their ideas and feedback and Elizabeth Cheu for reviewing and editing the manuscript.


Bayesian Networks

A technique that is based on the relative probability of an event given the probabilities of associated events in the network; employs Bayes’ theorem.

Change point

A significant point of change in a physiological parameter found by using trend detection algorithms.

Decision support engine

An expert system that assists and potentially enhances a human’s ability to make decisions.

Drag and drop

In a computer graphical user interface, the process of clicking an object and then holding down and dragging it to another location before releasing.

Expert system

A software-based system that integrates a mass of information based on rules or processing performed within the software program to supply expert knowledge about a specific field.

Fuzzy logic

Reasoning methodology producing a definite conclusion based upon vague, ambiguous, imprecise, noisy or missing input information.

Graphical user interface (GUI)

A user interface (part of the program the user interacts with) which contains the graphic elements: icons, text, labels, buttons, etc.

Human reliability analysis

The study of the probability that a human will correctly perform a task and those factors related to this probability.


In terms of Java, a specific object of a Java class.


The ability to communicate and operate with different hardware and software systems.


An object-oriented programming language.

Knowledge base

The encoded knowledge for an expert system. In a rule-based expert system, a knowledge base incorporates definitions of attributes and rules along with control information; a store of factual and heuristic data.

Knowledge encoding

The process of building a knowledge base through encoding the human expert knowledge in the computer language being used.

Knowledge engineer

The person encoding the knowledge into the knowledge base.

Knowledge rule

A rule written in the language of the knowledge base, which is used by a decision support system or expert system to analyze data and make decisions.

Machine learning

A method of artificial intelligence in which patterns are found within the data to enable the application to slowly learn how different pieces of data are interconnected.

Neural network

A method of artificial intelligence which is used to solve tasks through a network of simple processing units, model similar to biological neuron networks.


Design methodology that breaks down problems into objects rather than procedures.

Open source

Any project whose source code is made available for use or modifications as users or developers see fit.

Standard deviation

The measure of the spread of a parameter’s values.

Static decision-making

Decision making that does not change. Given the same input, the same decision will always be made.

Static parameter

A parameter whose values remains known and unchanged throughout a process.


In computer programming, the conforming rules of the code, which must be followed for the code to be valid in the computer language used.

Trend detection algorithm

A computer process which identifies changing trends of the physiological parameters being monitored. Significant trend changes in a parameter are recorded as change points.

Ventilatory events

A change in patient’s ventilation, outside defined normal limits, within anesthesia.

Working Memory

This is where all the facts in the decision support engine are located.


A general purpose mark-up language used as the format for configuration files.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Dustin Dunsmuir
    • 1
  • Jeremy Daniels
    • 1
  • Christopher Brouse
    • 2
  • Simon Ford
    • 1
  • J. Mark Ansermino
    • 1
    • 3
    Email author
  1. 1.Department of Anesthesiology, Pharmacology and TherapeuticsThe University of British ColumbiaVancouverCanada
  2. 2.Electrical and Computer EngineeringThe University of British ColumbiaVancouverCanada
  3. 3.Department of Pediatric AnesthesiaBritish Columbia Children’s HospitalVancouverCanada

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