Clinical Knowledge Hub - Conceptual Integration of Rules, Data Sets, and Queries

描述(由申请人提供)： 该项目旨在共享已在实践中证明的临床决策支持(CDS)知识。CDS知识交换标准与临床数据交换标准一样存在(约20年)，但可计算、可操作的知识在实践中的共享极其有限。在高度创新的CDS研究领域，分歧力量比比皆是，所开发的方法和内容是完全不相容的，即使每一条都可能在实践中得到验证。该项目将从根本上改变目前的CDS知识共享僵局，方法是创建、验证和改进一种方法，通过系统地应用大量经过实际验证但互不兼容的高价值资源，对CDS知识进行概念性整合。最初，建立了一个基于网络的临床知识库，它的内容和整合程度将会增长。内容包括(I)Regenstrief研究所的数据词典和完整的CDS知识库；(Ii)已出版的哥伦比亚大学医学中心的Arden语法医学逻辑模块(MLM)；(Iii)通过计算机自动化(CHICA)系统改善儿童健康的MLMS；(Iv)FDA/NLM发布的结构化产品标签(SPL)增强了退伍军人管理局的NDF-RT药物知识库，(V)由美国、荷兰、英国NHS、澳大利亚的各种连续性护理项目发布的临床数据集和模板，(Vi)急诊科、临床LOINC小组和其他详细临床模型的CDC数据元素，(Vii)癌症数据协议(例如，美国病理学会癌症方案)。还将分发编辑和改编内容的应用程序和工具，以及在各种系统上实施的应用程序和工具。内容的整合将达到各个层面：(1)词汇整合，即所有特殊代码到标准术语的映射；(2)跨不同表示语言的句法整合，包括Arden语法医学逻辑模块(MLM)和Regenstrief CARE和G-CARE语言；(3)语义整合，包括将程序性知识(例如CARE和MLMS)转换为陈述性知识(例如G-CARE)；以及最后(4)跨不同知识形态的实用集成，包括(A)CDS提醒规则，(B)声明性CDS知识表示(例如，药物相互作用表)，(C)计算的观察规则的定义(例如，肾小球滤过率估计)，(D)临床数据集、模板和评估工具，(E)保健质量测量，以及(F)针对个人和人群数据的临床研究查询。因此，广泛有用的CDS知识将从其具体的表示、概念化和应用中解锁出来，而通过开放源码合作开发和发布的软件将简化适应和采用。

DESCRIPTION (provided by applicant): This project aims at sharing clinical decision support (CDS) knowledge that has been proven in practice. CDS knowledge interchange standards have existed for as long as clinical data interchange standards (about 2 decades), yet sharing of computable, actionable knowledge in practice is extremely limited. Diverging forces abound in the highly innovative CDS research field and developed methods and content are deeply incompatible even though each piece may have been validated in practice. This project will impact the present CDS knowledge sharing impasse at its roots by creating, validating and refining a methodology for conceptual integration of CDS knowledge through systematic application on a large body of high value, practically validated, but incompatible resources. Initially a web-based Clinical Knowledge Library is established that will grow in contents and in its degree of integration. The contents include (i) the Regenstrief Institute's data dictionaries and complete CDS knowledge base; (ii) the published Columbia University Medical Center' Arden Syntax Medical Logic Modules (MLM), (iii) MLMs of the Child Health Improvement through Computer Automation (CHICA) system; (iv) FDA/NLM published Structured Product Labels (SPL) enhanced with the VA's NDF-RT medication knowledge base, (v) Clinical data sets and templates published by various continuity of care projects in the U.S., Netherlands, U.K. NHS, Australia, (vi) The CDC Data Elements for Emergency Departments, clinical LOINC panels, and other detailed clinical models, (vii) Cancer data protocols (e.g., College of American Pathology Cancer Protocols). Applications and tools for editing and adapting the content, as well as for implementation on a diverse set of systems will also be disseminated. The integration of content will reach all levels: (1) lexical integration, i.e., mapping of all idiosyncratic codes to standard terminologies; (2) syntactic integration across different representation languages including Arden Syntax Medical Logic Modules (MLM) and Regenstrief CARE and G-CARE languages; (3) semantic integration, including the transformation procedural knowledge (e.g., CARE and MLMs) into declarative ones (e.g., G- CARE); and finally (4) pragmatic integration across different knowledge modalities including (a) CDS reminder rules, (b) declarative CDS knowledge representations (e.g., drug-interaction tables), (c) definitions of calculated observation rules (e.g., glomerular filtration rate estimate), (d) clinical data sets, templates and assessment instruments, (e) healthcare quality measures, and (f) clinical research queries for both individual and population data. Thus widely useful CDS knowledge will be unlocked from its concrete representations, conceptualizations and applications, and adaptation and adoption will be simplified by the software developed and released in open source collaborations.