Supporting clinical guidelines using DL-temporal reasoning

The algorithmic character of many clinical guidelines promoted their formal representation and use in decision support systems for giving advice in daily clinical routine. However, their typical formalization as workflow graphs restricts supervised care to a fixed set of treatment paths incapable to react on unforeseen events. Medication, for instance, constitutes a workflow on its own as an iterated process having restrictions on its duration, on the total amount of drugs to take, or the condition to stop it prematurely. Multi-morbidity gives rise to treatments following different guidelines but resulting in the need for alignment of the suggested care. Sometimes, a treatment has to deviate from the official guidelines because, for instance, the patient either refuses a designated intervention or gets an allergic reaction. Nonetheless, the remaining care should follow the guideline as close as possible. Rather than a fixed set of treatments paths encoded in a workflow graph, there is a need for a more flexible approach to react to the characteristics and needs of the individual cases. In this paper we present a new approach in which we consider care as an orchestration of various processes which altogether have to follow given clinical guidelines. The approach is based on the use of formal logics to specify the world as well as actions and processes operating in it. Workflows or other requested activities, which are encoded in clinical guidelines, are represented as temporal logical formulas. Activated as monitors they compare the actual development against the specified behavior and report once the specified behavior has been observed or the world has entered a state which violates the specification. In either case the system can actively react on such a new situation by starting new processes that deal with the occurred new situation. We illustrate our approach with the help of clinical guidelines to treat an acute coronary syndrome.