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Integrating Arden-Syntax-based clinical decision support with extended presentation formats into a commercial patient data management system

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Abstract

The purpose of this study was to introduce clinical decision support (CDS) that exceeds conventional alerting at tertiary care intensive care units. We investigated physicians’ functional CDS requirements in periodic interviews, and analyzed technical interfaces of the existing commercial patient data management system (PDMS). Building on these assessments, we adapted a platform that processes Arden Syntax medical logic modules (MLMs). Clinicians demanded data-driven, user-driven and time-driven execution of MLMs, as well as multiple presentation formats such as tables and graphics. The used PDMS represented a black box insofar as it did not provide standardized interfaces for event notification and external access to patient data; enabling CDS thus required periodically exporting datasets for making them accessible to the invoked Arden engine. A client–server-architecture with a simple browser-based viewer allows users to activate MLM execution and to access CDS results, while an MLM library generates hypertext for diverse presentation targets. The workaround that involves a periodic data replication entails a trade-off between the necessary computational resources and a delay of generated alert messages. Web technologies proved serviceable for reconciling Arden-based CDS functions with alternative presentation formats, including tables, text formatting, graphical outputs, as well as list-based overviews of data from several patients that the native PDMS did not support.

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References

  1. Pryor TA, Hripcsak G. The Arden Syntax for medical logic modules. Int J Clin Monit Comput. 1993;10(4):215–24.

    Article  PubMed  CAS  Google Scholar 

  2. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330(7494):765.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Randell R, Mitchell N, Dowding D, Cullum N, Thompson C. Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review. J Health Serv Res Policy. 2007;12(4):242–51.

    Article  PubMed  Google Scholar 

  4. Shojania KG, Jennings A, Mayhew A, Ramsay C, Eccles M, Grimshaw J. Effect of point-of-care computer reminders on physician behaviour: a systematic review. Can Med Assoc J. 2010;182(5):E216–25.

    Article  Google Scholar 

  5. Jaspers MWM, Smeulers M, Vermeulen H, Peute LW. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. J Am Med Inform Assoc. 2011;18(3):327.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux P, Beyene J, Sam J, Haynes RB. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes. JAMA. 2005;293(10):1223–38.

    Article  PubMed  CAS  Google Scholar 

  7. Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome: a critical appraisal of research. Ann Intern Med. 1994;120(2):135–42.

    Article  PubMed  CAS  Google Scholar 

  8. Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280(15):1339–46.

    Article  PubMed  CAS  Google Scholar 

  9. Hripcsak G, Ludemann P, Pryor TA, Wigertz OB, Clayton PD. Rationale for the Arden Syntax. Comput Biomed Res. 1994;27(4):291–324.

    Article  PubMed  CAS  Google Scholar 

  10. Hripcsak G. Writing Arden Syntax medical logic modules. Comput Biol Med. 1994;24(5):331–63.

    Article  PubMed  CAS  Google Scholar 

  11. Karadimas HC, Chailloleau C, Hemery F, Simonnet J, Lepage E. Arden/J: an architecture for MLM execution on the java platform. J Am Med Inform Assoc. 2002;9(4):359–68.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gietzelt M, Goltz U, Grunwald D, Lochau M, Marschollek M, Song B, Wolf KH. ARDEN2BYTECODE: a one-pass Arden Syntax compiler for service-oriented decision support systems based on the OSGi platform. Comput Methods Programs Biomed. 2012;106(2):114–25. doi:10.1016/j.cmpb.2011.11.003.

    Article  PubMed  Google Scholar 

  13. Fehre K, Mandl H, Adlassnig KP. Service-Oriented, Arden-Syntax-Based clinical decision support. In: Proceedings of eHealth2011. Austrian Computer Society; 2011. p. 123–8.

  14. Sojer R, Bürkle T, Criegee-Rieck M, Neubert A, Brune K, Prokosch HU. Knowledge modelling and knowledge representation in hospital information systems to improve drug safety. J Inf Technol Healthc. 2006;29.

  15. Gao X, Johansson B, Shahsavar N, Arkad K, Åhlfeldt H, Wigertz O. Pre-compiling medical logic modules into C++ in building medical decision support systems. Comput Methods Programs Biomed. 1993;41(2):107–19.

    Article  PubMed  CAS  Google Scholar 

  16. Kuhn RA, Reider RS. A C++ framework for developing medical logic modules and an Arden Syntax compiler. Comput Biol Med. 1994;24(5):365–70.

    Article  PubMed  CAS  Google Scholar 

  17. Tafazzoli AG, Altmann U, Wachter W, Katz FR, Holzer S, Dudeck J. Integrated knowledge-based functions in a hospital cancer registry–specific requirements for routine applicability. Proc Amia Symp; 1999. p. 410–4. http://www.ncbi.nlm.nih.gov/pubmed/10566391.

  18. Liang YC, Chang P. The development of variable MLM editor and TSQL translator based on Arden Syntax in Taiwan. In: Proceedings of AMIA annual symposium; 2003. p. 908.

  19. Kim S, Haug PJ, Rocha RA, Choi I. Modeling the Arden Syntax for medical decisions in XML. Int J Med Inf. 2008;77(10):650–6.

    Article  Google Scholar 

  20. Jung CY, Sward KA, Haug PJ. Executing medical logic modules expressed in ArdenML using drools. J Am Med Inform Assoc. 2012;19(4):533–6. doi:10.1136/amiajnl-2011-000512.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Oppenheim MI, Mintz RJ, Boyer AG, Frayer WW. Design of a clinical alert system to facilitate development, testing, maintenance, and user-specific notification. In: Proceedings of AMIA symposium; 2000. p. 630–4.

  22. Hripcsak G, Clayton PD, Jenders RA, Cimino JJ, Johnson SB. Design of a clinical event monitor. Comput Biomed Res. 1996;29(3):194–221.

    Article  PubMed  CAS  Google Scholar 

  23. Gietzelt M, Goltz U, Grunwald D, Lochau M, Marschollek M, Song B, Wolf KH. Arden2ByteCode: a one-pass Arden Syntax compiler for service-oriented decision support systems based on the OSGi platform. Comput Methods Programs Biomed; 2011.

  24. Greenes RA. Clinical decision support: the road ahead. Amsterdam: Academic Press; 2007.

    Google Scholar 

  25. Burkle T, Castellanos I, Tech H, Prokosch HU. Implementation of a patient data management system—an evaluation study of workflow alterations. Stud Health Technol Inform. 2010;160(Pt 2):1256–60.

    PubMed  Google Scholar 

  26. Nadkarni PM. Metadata-driven Software Systems in Biomedicine Designing Systems that can adapt to changing knowledge: health informatics. London: Springer-Verlag London Limited; 2011.

    Book  Google Scholar 

  27. Arkad K, Ahlfeldt H, Gao X, Shahsavar N, Wigertz O, Jean FC, Degoulet P. Integration of data driven decision support into the HELIOS environment. Int J Biomed Comput. 1994;34(1):195–205.

    Article  PubMed  CAS  Google Scholar 

  28. Johansson B, Bergqvist Y. Integrating decision support, based on the Arden Syntax, in a clinical laboratory environment. In: Proceedings of annual symposium on computers applied to medical care; 1993. p. 394–8. http://www.ncbi.nlm.nih.gov/pubmed/8130502.

  29. V2.5-2005 AHA. Health Level Seven Arden Syntax, Version 2.5 (revision of ANSI/HL7 Arden V2.1-2002). 2005.

  30. Karlsson D, Ekdahl C, Wigertz O, Shahsaver N, Gill H, Forsum U. Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique. Methods Inf Med. 1997;36(2):108–14.

    PubMed  CAS  Google Scholar 

  31. Jenders R, Huang H, Hripcsak G, Clayton P. Evolution of a knowledge base for a clinical decision support system encoded in the Arden Syntax. In: Proceedings of AMIA Symposium American Medical Informatics Association; 1998. p. 558–62.

  32. Wright A, Sittig DF. A four-phase model of the evolution of clinical decision support architectures. Int J Med Inf. 2008;77(10):641–9.

    Article  Google Scholar 

  33. Sailors RM, Bradshaw RL, East TD Moving Arden Syntax outside of the (Alert) box: a paradigm for supporting multi-step clinical protocols. In: Proceedings of AMIA Symposium; 1998. p. 1071.

  34. Sherman EH, Hripcsak G, Starren J, Jenders RA, Clayton P. Using intermediate states to improve the ability of the Arden Syntax to implement care plans and reuse knowledge. In: Proceedings of AMIA annual; 1995. p. 238–42.

  35. Starren J, Hripcsak G, Jordan D, Allen B, Weissman C, Clayton P. Encoding a post-operative coronary artery bypass surgery care plan in the Arden Syntax. Comput Biol Med. 1994;24(5):411–7.

    Article  PubMed  CAS  Google Scholar 

  36. Adlassnig KP, Rappelsberger A. Medical knowledge packages and their integration into health-care information systems and the World Wide Web. Stud Health Technol Inform. 2008;136:121–6.

    PubMed  Google Scholar 

  37. Koller W, Blacky A, Bauer C, Mandl H, Adlassnig KP. Electronic surveillance of healthcare-associated infections with MONI-ICU–a clinical breakthrough compared to conventional surveillance systems. Stud Health Technol Inform. 2010;160(Pt 1):432–6.

    PubMed  Google Scholar 

  38. Adlassnig KP, Blacky A, Koller W. Artificial-intelligence-based hospital-acquired infection control. Stud Health Technol Inform. 2009;149:103–10.

    PubMed  Google Scholar 

  39. Jenders RA, Corman R, Dasgupta B. Making the standard more standard: a data and query model for knowledge representation in the Arden syntax. In: Proceedings of AMIA annual symposium; 2003. p. 323–30.

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Authors and Affiliations

  1. Center for Communication and Information Technology, University Hospital Erlangen, Erlangen, Germany

    Stefan Kraus

  2. Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany

    Ixchel Castellanos

  3. Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany

    Dennis Toddenroth, Hans-Ulrich Prokosch & Thomas Bürkle

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  1. Stefan Kraus
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  2. Ixchel Castellanos
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  3. Dennis Toddenroth
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  4. Hans-Ulrich Prokosch
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  5. Thomas Bürkle
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Correspondence to Stefan Kraus.

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Kraus, S., Castellanos, I., Toddenroth, D. et al. Integrating Arden-Syntax-based clinical decision support with extended presentation formats into a commercial patient data management system. J Clin Monit Comput 28, 465–473 (2014). https://doi.org/10.1007/s10877-013-9430-0

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  • DOI: https://doi.org/10.1007/s10877-013-9430-0

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