Knowledge engineering for adverse drug event prevention: On the design and development of a uniform, contextualized and sustainable knowledge-based framework

The primary aim of this work was the development of a uniform, contextualized and sustainable knowledge-based framework to support adverse drug event (ADE) prevention via Clinical Decision Support Systems (CDSSs). In this regard, the employed methodology involved first the systematic analysis and formalization of the knowledge sources elaborated in the scope of this work, through which an application-specific knowledge model has been defined. The entire framework architecture has been then specified and implemented by adopting Computer Interpretable Guidelines (CIGs) as the knowledge engineering formalism for its construction. The framework integrates diverse and dynamic knowledge sources in the form of rule-based ADE signals, all under a uniform Knowledge Base (KB) structure, according to the defined knowledge model. Equally important, it employs the means to contextualize the encapsulated knowledge, in order to provide appropriate support considering the specific local environment (hospital, medical department, language, etc.), as well as the mechanisms for knowledge querying, inference, sharing, and management. In this paper, we present thoroughly the establishment of the proposed knowledge framework by presenting the employed methodology and the results obtained as regards implementation, performance and validation aspects that highlight its applicability and virtue in medication safety.

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

[2]  Arie Hasman,et al.  Design and implementation of a framework to support the development of clinical guidelines , 2001, Int. J. Medical Informatics.

[3]  Arie Hasman,et al.  With good intentions , 2007, Int. J. Medical Informatics.

[4]  David Glasspool,et al.  A goal-oriented framework for specifying clinical guidelines and handling medical errors , 2010, J. Biomed. Informatics.

[5]  Elpida T. Keravnou,et al.  Temporal representation and reasoning in medicine: Research directions and challenges , 2006, Artif. Intell. Medicine.

[6]  D. Bates,et al.  Adverse drug events and medication errors: detection and classification methods , 2004, Quality and Safety in Health Care.

[7]  P A De Clercq,et al.  Development of a computerised alert system, ADEAS, to identify patients at risk for an adverse drug event , 2010, Quality and Safety in Health Care.

[8]  Susie Stephens,et al.  Applying semantic Web technologies to drug safety determination , 2006, IEEE Intelligent Systems.

[9]  Jonathan M. Teich,et al.  Research Paper: Identifying Adverse Drug Events: Development of a Computer-based Monitor and Comparison with Chart Review and Stimulated Voluntary Report , 1998, J. Am. Medical Informatics Assoc..

[10]  Radja Messai,et al.  Implementation of a taxonomy aiming to support the design of a contextualised clinical decision support system. , 2011, Studies in health technology and informatics.

[11]  Alan L. Rector,et al.  Frames and OWL Side by Side , 2006 .

[12]  Arie Hasman,et al.  Three-Layer Model for the design of a Protocol Support System , 2005, Int. J. Medical Informatics.

[13]  George Hripcsak,et al.  Detecting adverse events for patient safety research: a review of current methodologies , 2003, J. Biomed. Informatics.

[14]  Frank van Harmelen,et al.  Handbook of Knowledge Representation , 2008, Handbook of Knowledge Representation.

[15]  John Fox,et al.  Comparing computer-interpretable guideline models: a case-study approach. , 2003, Journal of the American Medical Informatics Association : JAMIA.

[16]  Katharina Kaiser,et al.  Computer-interpretable Guideline Formalisms , 2008, Computer-based Medical Guidelines and Protocols.

[17]  D. Littler,et al.  Where are we and where are we going , 2005 .

[18]  David W. Bates,et al.  A computerized method for identifying incidents associated with adverse drug events in outpatients , 2001, Int. J. Medical Informatics.

[19]  Dieter Fensel,et al.  Knowledge Engineering: Principles and Methods , 1998, Data Knowl. Eng..

[20]  Romaric Marcilly,et al.  Medication related computerized decision support system (CDSS): make it a clinicians' partner! , 2011, Studies in health technology and informatics.

[21]  Frank van Harmelen,et al.  Editorial: Evaluating knowledge engineering techniques , 1999, Int. J. Hum. Comput. Stud..

[22]  F A Sonnenberg,et al.  Computer-Interpretable Clinical Practice Guidelines , 2006, Yearbook of Medical Informatics.

[23]  Thomas H. Payne,et al.  Review Paper: Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review , 2007, J. Am. Medical Informatics Assoc..

[24]  P. Aspden,et al.  Preventing Medication Errors , 2007 .

[25]  Syed Sibte Raza Abidi,et al.  A knowledge creation info-structure to acquire and crystallize the tacit knowledge of health-care experts , 2005, IEEE Transactions on Information Technology in Biomedicine.

[26]  Marc Berg,et al.  Understanding handling of drug safety alerts: a simulation study , 2010, Int. J. Medical Informatics.

[27]  John Yen,et al.  A distributed adverse drug reaction detection system using intelligent agents with a fuzzy recognition‐primed decision model , 2007, Int. J. Intell. Syst..

[28]  Régis Beuscart,et al.  Adverse drug events prevention rules: multi-site evaluation of rules from various sources. , 2009, Studies in health technology and informatics.

[29]  Régis Beuscart,et al.  Patient safety through intelligent procedures in medication: the PSIP project. , 2009, Studies in health technology and informatics.

[30]  Richard Platt,et al.  Early adverse drug event signal detection within population‐based health networks using sequential methods: key methodologic considerations , 2009, Pharmacoepidemiology and drug safety.

[31]  E. Shortliffe Clinical decision-support systems , 1990 .

[32]  Jeffrey K Aronson,et al.  Medication errors: definitions and classification. , 2009, British journal of clinical pharmacology.

[33]  Arie Hasman,et al.  Approaches for creating computer-interpretable guidelines that facilitate decision support , 2004, Artif. Intell. Medicine.

[34]  Lawrence M. Fagan,et al.  Medical informatics: computer applications in health care and biomedicine (Health informatics) , 2003 .

[35]  Aziz A. Boxwala,et al.  Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines: : A literature review of guideline representation models , 2002, Int. J. Medical Informatics.

[36]  René Amalberti,et al.  Adverse events in medicine: Easy to count, complicated to understand, and complex to prevent , 2011, J. Biomed. Informatics.

[37]  Charlene R. Weir,et al.  Developing a taxonomy for research in adverse drug events: potholes and signposts , 2002, AMIA.

[38]  R. Beuscart,et al.  Detection of adverse drug events: proposal of a data model. , 2009, Studies in health technology and informatics.

[39]  David W. Bates,et al.  Incidence of Adverse Drug Events and Medication Errors in Japan: the JADE Study , 2010, Journal of General Internal Medicine.

[40]  Vassilis Koutkias,et al.  Information contextualization in decision support modules for adverse drug event prevention. , 2011, Studies in health technology and informatics.

[41]  Antoni Ligęza,et al.  Logical Foundations for Rule-Based Systems , 2006 .

[42]  John K. Debenham Knowledge Engineering , 1998, Encyclopedia of Social Network Analysis and Mining.

[43]  Velma L. Payne,et al.  Hospital care watch (HCW): an ontology and rule-based intelligent patient management assistant , 2005, 18th IEEE Symposium on Computer-Based Medical Systems (CBMS'05).

[44]  John Debenham,et al.  Knowledge Engineering , 1998, Artificial Intelligence.

[45]  N. Maglaveras,et al.  Constructing Clinical Decision Support Systems for Adverse Drug Event Prevention: A Knowledge-based Approach. , 2010, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[46]  Patrice Degoulet,et al.  Implementation of automated signal generation in pharmacovigilance using a knowledge-based approach , 2005, Int. J. Medical Informatics.

[47]  Régis Beuscart,et al.  Data Mining to Generate Adverse Drug Events Detection Rules , 2011, IEEE Transactions on Information Technology in Biomedicine.

[48]  Michael Schachter,et al.  The epidemiology of medication errors: how many, how serious? , 2009, British journal of clinical pharmacology.

[49]  Elske Ammenwerth,et al.  Validation of completeness, correctness, relevance and understandability of the PSIP CDSS for medication safety. , 2011, Studies in health technology and informatics.

[50]  Antoni Ligeza,et al.  Logical Foundations for Rule-Based Systems (Studies in Computational Intelligence) (Studies in Computational Intelligence) , 2006 .

[51]  M Stefanelli,et al.  Clinical guidelines as plans--an ontological theory. , 2006, Methods of information in medicine.

[52]  Guilherme Del Fiol,et al.  Modeling a decision support system to prevent adverse drug events , 2000, Proceedings 13th IEEE Symposium on Computer-Based Medical Systems. CBMS 2000.

[53]  Ruth Ellen Bulger,et al.  The Institute of Medicine , 1992, JAMA.

[54]  Cédric Bousquet,et al.  Mining for Adverse Drug Events with Formal Concept Analysis , 2009, MIE.

[55]  A. Pariente,et al.  Data mining on electronic health record databases for signal detection in pharmacovigilance: which events to monitor? , 2009, Pharmacoepidemiology and drug safety.

[56]  Katharina Kaiser,et al.  Modelling Clinical Guidelines and Protocols for the Prevention of Risks Against Patient Safety , 2009, MIE.

[57]  Vassilis Koutkias,et al.  Three different cases of exploiting decision support services for adverse drug event prevention. , 2011, Studies in health technology and informatics.