URUZ3: A formal-specification tool for acquisition and maintenance of clinical guidelines

Department of Information Systems EngineeringFaculty of Engineering

Ben-Gurion University of the Negev

Student :Erez ShalomAdvisor : Prof.Yuval Shachar

• The task of authoring the Knowledge will include a two-phase process:-first phase (typically performed by a medical expert) supports semantic mark-up and structuring of free-text guidelines-second phase (typically performed by a knowledge engineer)

converts the semi-structured guideline into a formal guideline-specification language , ASBRU.

• Current work on URUZ has graphical and other limitations , therefore, the structuring is performed until the semi-structured only, in cumbersome ,not intuitive way.

a

b

Semantic markup(semi-Structuring)

Adding a machine-comprihensible f ormat

Free-text guideline

Web-basedguideline library

-Eligibility & applicability determination-Runtime application-Retrospective Quality assessment

Context-sensitiveWeb-based Search,retrieval, andBrowsing interf ace

URUZ

Background

URUZ3 requirements

• Graphical and intuitive WinForm tool for guideline structuring

• Enable structuring for semi and formal language• every element in the formal-language will have

special graphical representation , emphasizing its special characteristics(e.g plan-body builder,condition builder)

• Support multi-ontology for mark-up• Part of DeGeL’s framework• the tool will also involve interaction with other

tools (IDAN’s frame work)

URUZ3 & IDAN framework

Physician Knowledgeengineer

URUZ3

DeGeL

IndexiGuide Vaidurya

Search for Gl,GlDoc to Edit

Index a SelectedGlDoc

IDAN

KnowledgeBase

QueryBuilder(IDAN Language)

Vocabularyserver

Define the term “Hypertension”in the KB

Search for standard term“hemoglobin” in ICD-9 anddefine it in the kb

Build the query“patients with Hypertension andhemoglobin less then 9.5 gr/dl” inIDAN language

Gudeline text example:“This guideline is forpatients withHypertension andhemoglobin less then9.5 gr/dl”

Starting URUZ3

When starting URUZ3 ,before creating a GLDoc ,one can choose the ontology to based on.

Current supported ontologies are Asbru,GEM

GL Source documentationand modules(e.g add source)

Open IndexiguideOpen the KB to Define

Knowledge

Current Ontologies tocreate GLDoc from

URUZ3 main interface:

About the Structure-level Views tree:There is view for each structure-level. Thus, when expert structure a GLDoc, she can choose a view of structuring level.the tree composed from relevant knowledge roles of the current structuring level(e.g. knowledge roles as “returns” and “arguments” will be shown just in Full-Asbru view –see slide 8).The expert push the button for each view. the most right button is hybrid view. See more explanation in the comments part

Here ,an expert dragged the “filter-precondition” knowledge role to the edit area.

because the current structuring level is “text”, an html editor tab control generated, enables drag& drop of text portions from the GL source ( “Diagnosis and management of hypertension”).

Free text and modifications can be done using the editor tool -bar

View area

Edit area

Text View(Default view)

SST View

Full structuredView

All levels -hybrid View

Tag for every sourceof the GL

Structure-levelsViews tree

Drop aknowledge role

here to edit

PB tree

Drag &Drop

Click to addComments

C

Specify here the structure of Sst-(filter condition)

Prompt the use every-time the plan proceeding the next step

Override the value of the condition in run-time by the user

...

Construct your condition(condition builder )

Specify a time for this condition to be hold

...

Drag &Drop

SST level of theknowledge role

SST viewselected

Control for “filter condition” isgenerated with SST semantics

Open the “conditionbuilder ” for furtherstructuring of thecondition

Open GUI for “time-annotation” structuring

Asbru semantics

Is the patientnot regnant?

And

Is thepatientadult?

SST view-”filter precondition” example :

Note that because the structure level view is SST,every knowledge role which belongs to this level (e.g not “arguments”) has an “SST” node (and icon) enabling further structuring in SST.Here ,an expert dragged the Text “filter-precondition” to the view area and the “SST” knowledge role to the edit area ; then he can open the condition builder for the semi-formal structuring.

Specify here the Full structure of -(filter condition)

Full structure level ofthe knowledge role

Full structureview selected

Drag &Drop

Construct your condition in IDAN language ...

Open the query builder ofIDAN language to Full-structure of the condition

Full structured view-”filter precondition” example :

In the Full structure view every knowledge role which is belong to this level (e.g “arguments”,”value def”) have “Full” node(and simbolic image) enabling further structuring in Full Asbru. Here ,an expert dragged the Text “filter-precondition” to the view area and the “Full” knowledge role to the edit area –then he can constarct the condition in IDAN language ,thus the condition is represented in his formal structure.

Drag &Drop

SST level of theknowledge role

SST viewselected

Specify here the Sst structure of -(Deafults)

...Select a plan to activate when current plan is suspended

Select a plan to activate when current plan is Aborted

Sepcify a deafult time this plan can be activated

Specify a typical duration for current plan

...

...

...

Asbrusemantics

SST view-”deafults” example :

The expert dragged the “SST” node of “deafults “ knowledge role to the editing area.Thus the generated tab is according to Asbru semantics in the context of that knowledge role. when pressing the buttons a different GUI is generated for each attribute, enable further structuring of the element .for example,a control for specifing time –annotation or duration can be generated according to the user action.

Specify here the Sst structure of -(Deafults)

...

Open the Plan-Body Builder for specify Medical tasks hierarchy

Open the PB builder ,forfurther structuring -seeslide 13

Drag &Drop

SST viewselected

SST view-”Plan-Body” example :

From the SST level of Plan-body ,the expert can open the Plan-body builder (explain in detail in slid 12-17).Thus, the expert can create hierarchy of plans for the current plan.

Drag &Drop

Full structureslevel of the

knowledge role

Hybrid viewselected

Sst level of theknowledge role

HL StateBP Level

Specify here the Sst structure of -(Obtain values)

The list of Obtain values from current plan

HL State1BP Level1Deagnosis

Specify here the Full structure of -(Returns)

The list of Return values from current plan

Hybrid view-”deafults” example :

Note that the tree includes all the knowledge roles from all the levels.

Here ,the SST level of the “obtain values” knowledge role used for structuring the FULL level of “Returns” knowledge role. By selecting a plan in the PB tree (we have plans specification after we used the PB builder), we can structure a knowledge role in context of the selected GL.

Plan-Body builder :Expressing the Procedural Knowledge

• This task will be perform in several steps, guiding the physician, step by step, to structure the guideline’s procedural knowledge

• In the beginning of the process ,the medical tasks hierarchy will be defined and afterwards the order between the them.

• Thus, when the general concept of the plan is discovered, the physician can continue with defining the less intuitive characteristics of the procedural knowledge.

• In this primary prototype the first two steps were implemented

Semantic Types

Reference Types

Control Types

Parent Text Child Text

Order Between Plans

Plans Tree

Plans Tab

Drag And Drop Plans

Root Text (Source in this case) Free Text for selected Plan

selected Plan

Generated Tree of plans

Check if mandatory plan

Parallel Order selected

Dragged text to child plan from Parent text

Renamed Plan

New tab for expanded plan

Every new level has at least 2 general plans

Condition Type

Previous Child Text become Parent text in this level

Generated tree

Convert to semantic type mechanism

Converted plan

Condition Property – Opne

Expression Builder

Condition Text

Expression Bulider open to specify a condition base (or not) on the text

Double Click Expand the (plan (has dash boredr

Convert the general into drug type

The Expression

Choises

Default

Drag a Choice

and add to the cases collection

Back to Parent Level

Reference Types