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A study of applying
knowledge modelling to
evidence-based guidelines
M. Taboada, J. Des, D. Martínez and J. Mira
University of Santiago de Compostela, Spain
The 17th European Conference on Artificial Intelligence
OUTLINE
•
Introduction
•
Stages in the construction of a KM
1. Identify knowledge pieces
2. Transform textual knowledge into knowledge
components
3. Validate knowledge
•
Results
The 17th European Conference on Artificial Intelligence
Introduction
•
Many Knowledge Engineering (KE)
methodologies and representation languages
– have been proposed and
– successfully applied to the medical domain
• CommonKADS (CK):
¾ A general KE methodology
¾ Knowledge model (KM)
The 17th European Conference on Artificial Intelligence
Introduction
• Asbru, EON, GLIF, Guide, Prodigy,
PROForma
– Languages to formally represent clinical
practice guidelines
– The codification of a clinical guideline is an
arduous and complex task
– The final resulting model is illegible for
medical specialists
The 17th European Conference on Artificial Intelligence
Introduction
• Two types of solutions:
1. Describing guidelines in a higher level of
abstraction (Clercq et al., Vollebregt et al.)
¾ By combining components of a KM with
primitives of a representation language
2. Reducing the gap between natural
language and formal guideline
representation (Svatek et al., Votruba et al.)
¾ By keeping traces of the transformation
process The 17th European Conference on Artificial Intelligence
Introduction
• Our proposal:
¾ Combining the two types of mentioned
solutions
1. CK provides a KM with all types of knowledge
existing in the guideline
2. The resulting KM will be incomplete; CK helps
us to identify the omissions
3. CK oriented to obtain a compact model; need
of reconstructing the process of KM
construction.
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
• Our proposal:
¾An extension of the construction process of
CK
¾Case-study: the KM on medical diagnosis in
Conjunctivitis using the textual guideline
• http://www.aao.org/aao/education/library/ppp
¾ We provide a set of methodological
strategies that systematize the KM on
medical diagnosis
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
1. Identify knowledge patterns
• Isolated nouns and nouns with adjectives
¾ Diagnosis, cause, visual function, discharge
• Vague expressions
¾ Decrease of the visual acuity, rapid development of
severe hyperpurulent conjunctivitis
• Generic linguistics expressions: Verbs
describing
¾ Structures or parts: The patient population includes
individuals of all ages …
¾ Medical actions: Establish the diagnosis of
conjunctivitis …
¾ Decisions or causalities:
patient history may elicit
The 17th European Conference on Artificial Intelligence
….
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
1. Identify knowledge components to be reused
• Benjamins’ library
¾ Problem solving methods (PSMs) in the domain of
diagnosis
• The UMLS Metathesaurus
¾ Controlled vocabulary in the medical domain
• The UMLS Semantic Network
¾ An ontology in the medical domain
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
ENTITY
Conjunctivitis (ICD-9 #372.0 - 372.3)
.....
PURPOSE
The purpose of diagnosing and managing patients with conjunctivitis is to undertake the following:
- Preserve visual function
- Minimize the spread of infectious disease
- Reduce or eliminate conjunctival inflammation and its complications
...
GOALS
- Establish the diagnosis of conjunctivitis, differentiating it from other causes of red eye
- Identify the cause of conjunctivitis
- Establish appropriate therapy
- Relieve discomfort and pain
- Prevent complications
- Prevent the spread of communicable diseases
- Educate and engage the patient in the management of the disease
Group
Group
........
PREVENTION AND EARLY DETECTION
......
The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic conjunc
tivitis,
primarily by educating the patient and family about proper hygiene. Infected individuals should be
counseled to wash hands frequently and use separate towels, and to avoid close contact with others
during the period of contagion. Avoiding contact with others is especially important for individua
ls
in professions with high potential for transmission, such as health care workers and child care providers.
While the exact length of the period of infectivity is variable, many consider 7 days from the onse
t of
symptoms as the contagious period, because the recovery of virus from infected cases drops off er
aft
7 days of infection.11 However, other studies....
........
CARE PROCESS
PATIENT OUTCOME CRITERIA
Outcome criteria for treating conjunctivitis include the following:
- Eliminating or reducing signs and symptoms of conjunctivitis
- Restoring or maintaining normal visual function
The
17th European
Conference
on applicable
Artificial
underlying
systemic disease
process when
- Detecting and treating the
Group
Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
2. Transform generic expressions into knowledge
components
Verbs describing
structures or parts
Transformed into
Relationships
The initial eye examination includes measurement of visual acuity, external
examination and slit-lamp biomicroscopy
Transformed into
Measurement of visual acuity
Ocular exploration
External examination
‘Part-of’
Slit-lamp biomicroscopy
The 17th European Conference on Artificial Intelligence
2. Transform generic expressions into knowledge
components
Verbs describing
actions
Transformed into
Tasks, PSMs or
Inferences
Establish the diagnosis of conjunctivitis, differentiating it from other causes of red eye
Differential diagnosis
(CUI: C0011906)
Transformed into
Diagnosis Task
Prime diagnostic method
Symptom detection
Hypothesis generation
Hypothesis discrimination
The 17th European Conference on Artificial Intelligence
2. Transform generic expressions into knowledge
components
Transformed into
Verbs describing
Cuasalities
Tasks, PSMs or
Inferences
The external examination should be include the following elements: ….
Transformed into
Assesment Task
Generate data
to be collected
Obtain data
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
Stages in the construction of a KM
Simulate
test
cases
Establish
correspondences
Transform
textual
terms
Validate
knowledge
Detect
gaps
Transform
standard
terms
Identify
patterns
Transform
simple
expressions
Identify
components
Transform
generic
expressions
Transform
knowledge
Identify
knowledge pieces
The 17th European Conference on Artificial Intelligence
Some results
• Initially, experts divided the text into three parts:
¾ General objectives
¾ Disease model
¾ Treatment model
The 17th European Conference on Artificial Intelligence
Some results
¾ General objectives
¾ Described by generic linguistic expressions:
¾Two flat list
¾ Purpose: 4 expressions
¾ Goals: 7 expressions
¾One flat list
¾ Orientation part: 3 expressions
¾Expressions embedded in isolated paragrahs
¾ 3 expressions
The 17th European Conference on Artificial Intelligence
Some results
1. The UMLS Metathesaurus includes many of the
objectives
The 17th European Conference on Artificial Intelligence
Some results
2. The UMLS Metathesaurus provides a means of
disambiguating linguistic expressions
The 17th European Conference on Artificial Intelligence
Some results
3. The UMLS Semantic Network provides a structured
organization of the objectives
Occupational Activity
Health Care Activity
Laboratory Procedure
Diagnostic Procedure
Differential Diagnosis
Early Diagnosis
Therapeutic or Preventive Procedure
Minimize opportunities ...
Therapeutic Procedure
Management procedure
Referral to specialist
Reporting
Identify individuals or patient populations
who would benefit from case management
Educational Activity
Educate the patient
The 17th European Conference on Artificial Intelligence
Conclusions
• We have proposed methodological strategies that
systematize the acquisition process and knowledge
modeling on medical diagnosis
¾ Extending the KM construction of CK
¾ Establishing explicit mappings between the original
medical texts and the resulting KM
¾ With the aim of detecting and documenting all the
transformations
¾ Providing a limited number of transformations in
each stage
The 17th European Conference on Artificial Intelligence