Executing medical logic modules expressed in ArdenML using Drools

The Arden Syntax is an HL7 standard language for representing medical knowledge as logic statements. Despite nearly 2 decades of availability, Arden Syntax has not been widely used. This has been attributed to the lack of a generally available compiler to implement the logic, to Arden's complex syntax, to the challenges of mapping local data to data references in the Medical Logic Modules (MLMs), or, more globally, to the general absence of decision support in healthcare computing. An XML representation (ArdenML) may partially address the technical challenges. MLMs created in ArdenML can be converted into executable files using standard transforms written in the Extensible Stylesheet Language Transformation (XSLT) language. As an example, we have demonstrated an approach to executing MLMs written in ArdenML using the Drools business rule management system. Extensions to ArdenML make it possible to generate a user interface through which an MLM developer can test for logical errors.

[1]  Paul Browne,et al.  JBoss Drools Business Rules , 2009 .

[2]  R A Kuhn,et al.  A C++ framework for developing Medical Logic Modules and an Arden Syntax compiler. , 1994, Computers in biology and medicine.

[3]  Omar Bouhaddou,et al.  Knowledge Engineering in Health Informatics , 1997, Computers and Medicine.

[4]  M. Musen.  Scalable Software Architectures for Decision Support , 1999, Methods of Information in Medicine.

[5]  Charles L. Forgy,et al.  Rete: a fast algorithm for the many pattern/many object pattern match problem , 1991 .

[6]  Éric Lepage,et al.  Application of Information Technology: Arden/J: An Architecture for MLM Execution on the Java Platform , 2002, J. Am. Medical Informatics Assoc..

[7]  I Clark,et al.  Incorporation of the Arden Syntax within the reimplementation of a closed-loop decision support system. , 1996, Computers and biomedical research, an international journal.

[8]  Guilherme Del Fiol,et al.  Standards in Clinical Decision Support: Activities in Health Level Seven and Beyond , 2013, MedInfo.

[9]  Tonya Hongsermeier,et al.  The Morningside Initiative: Collaborative Development of a Knowledge Repository to Accelerate Adoption of Clinical Decision Support , 2010, The open medical informatics journal.

[10]  Robert A. Jenders,et al.  Challenges in implementing a knowledge editor for the Arden Syntax: knowledge base maintenance and standardization of database linkages , 2002, AMIA.

[11]  Richard N. Shiffman,et al.  Using GEM-encoded guidelines to generate medical logic modules , 2001, AMIA.

[12]  R. Matthew Sailors.  ArdenML: The Arden Syntax Markup Language (or Arden Syntax: It's Not Just Text Any More!) , 2001, AMIA.

[13]  R. Matthew Sailors,et al.  Structuring Healthcare Knowledge Bases: An Analysis of Explicit and Implicit Structures in Arden Syntax and An XML Schema Representation of Arden Syntax , 2003, AMIA.

[14]  T A Pryor,et al.  Sharing MLM's: an experiment between Columbia-Presbyterian and LDS Hospital. , 1993, Proceedings. Symposium on Computer Applications in Medical Care.

[15]  Roberto A. Rocha,et al.  Modeling the Arden Syntax for medical decisions in XML , 2008, Int. J. Medical Informatics.

[16]  George Hripcsak,et al.  Evolution of a knowledge base for a clinical decision support system encoded in the Arden Syntax , 1998, AMIA.

[17]  Filip De Turck,et al.  Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines , 2010, BMC Medical Informatics Decis. Mak..

[18]  T A Pryor,et al.  The use of medical logic modules at LDS hospital. , 1994, Computers in biology and medicine.

[19]  Eneida A. Mendonça,et al.  Adapting Current Arden Syntax Knowledge for an Object Oriented Event Monitor , 2003, AMIA.

[20]  G Hripcsak,et al.  The Columbia-Presbyterian Medical Center decision-support system as a model for implementing the Arden Syntax. , 1991, Proceedings. Symposium on Computer Applications in Medical Care.

[21]  P Ludemann.  Mid-term report on the Arden Syntax in a clinical event monitor. , 1994, Computers in biology and medicine.

[22]  Robert A. Jenders,et al.  Towards improved knowledge sharing: assessment of the HL7 Reference Information Model to support medical logic module queries , 1997, AMIA.

[23]  O B Wigertz,et al.  An object oriented approach to interpret medical knowledge based on the Arden syntax. , 1992, Proceedings. Symposium on Computer Applications in Medical Care.

[24]  Robert A. Greenes,et al.  Clinical Decision Support: The Road Ahead , 2006 .

[25]  T A Pryor,et al.  The arden syntax for medical logic modules , 1990, International journal of clinical monitoring and computing.

[26]  H Ahlfeldt,et al.  Pre-compiling medical logic modules into C++ in building medical decision support systems. , 1993, Computer methods and programs in biomedicine.