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Achievements and Challenges for the New Decade
Knowledge is becoming increasingly recognized as a valuable resource. Given its importance it is surprising that expert systems technology has not become a more common means of utilizing knowledge. In this chapter we review some of the history of expert systems, the shortcomings of first generation expert systems, current approaches and future decisions. In particular we consider a knowledge acquisition and representation technique known as Ripple Down Rules (RDR) that avoids many of the limitations of earlier systems by providing a simple, user-driven knowledge acquisition approach based on the combined use of rules and cases and which support online validation and easy maintenance. RDR has found particular commercial success as a clinical decision support system and we review what features of RDR make it so suited to this domain.
Artificial Intelligence in Medicine
Ripple down rules: Turning knowledge acquisition into knowledge maintenance1992 •
International Journal of Knowledge-Based Organizations
Supporting Knowledge-Based Decision Making in the Medical Context2011 •
Knowledge-based clinical decision making is one of the most challenging activities of physicians. Clinical Practice Guidelines are commonly recognized as a useful tool to help physicians in such activities by encoding the indications provided by evidence-based medicine. Computer-based approaches can provide useful facilities to put guidelines into practice and to support physicians in decision-making. Specifically, GLARE (GuideLine Acquisition, Representation and Execution) is a domain-independent prototypical tool providing advanced Artificial Intelligence techniques to support medical decision making, including what-if analysis, temporal reasoning, and decision theory analysis. The paper describes such facilities considering a real-world running example and focusing on the treatment of therapeutic decisions.
2012 IEEE 14th International Conference on e-Health Networking, Applications and Services (Healthcom)
Developing a rule-driven clinical decision support system with an extensive and adaptative architecture2012 •
Studies in health technology and informatics
Modeling decision support rule interactions in a clinical setting2013 •
Traditionally, rule interactions are handled at implementation time through rule task properties that control the order in which rules are executed. By doing so, knowledge about the behavior and interactions of decision rules is not captured at modeling time. We argue that this is important knowledge that should be integrated in the modeling phase. In this project, we build upon current work on a conceptual schema to represent clinical knowledge for decision support in the form of if <formula></formula> then rules. This schema currently captures provenance of the clinical content, context where such content is actionable (i.e. constraints) and the logic of the rule itself. For this project, we borrowed concepts from both the Semantic Web (i.e., Ontologies) and Complex Adaptive Systems (CAS), to explore a conceptual approach for modeling rule interactions in an enterprise-wide clinical setting. We expect that a more comprehensive modeling will facilitate knowledge authori...
Health and Technology
A systematic review of technologies and standards used in the development of rule-based clinical decision support systemsA Clinical Decision Support System (CDSS) is a technology platform that uses medical knowledge with clinical data to provide customised advice for an individual patient's care. CDSSs use rules to encapsulate expert knowledge and rules engines to infer logic by evaluating rules according to a patient's specific information and related medical facts. However, CDSSs are by nature complex with a plethora of different technologies, standards and methods used to implement them and it can be difficult for practitioners to determine an appropriate solution for a specific scenario. This study's main goal is to provide a better understanding of different technical aspects of a CDSS, identify gaps in CDSS development and ultimately provide some guidelines to assist their translation into practice. We focus on issues related to knowledge representation including use of clinical ontologies, interoperability with EHRs, technology standards, CDSS architecture and mobile/cloud access.Th...
2016 International Conference on Big Data and Smart Computing (BigComp)
Constructing an initial knowledge base for medical domain expert system using induct RDR2016 •
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
Evaluation of a commercial rule engine as a basis for a clinical decision support service2006 •
Current implementation techniques constrain our ability to rapidly deploy and augment clinical decision support systems at Partners Healthcare Systems. We report on the use of a commercially-available rule engine system-iLog Rules-as the basis for a series of prototypes typifying Partners decision support applications. For three prototypical systems, we successfully decoupled the decision support component from application and support logic, and reimplemented that component using iLog. We found that the rule engine itself provides high-performance execution for the small rulesets we evaluated, and that overall application performance was found to be generally acceptable. We note that the major bottleneck to application performance is the ability to rapidly deliver patient data to the rule engine for execution. Future investigation will focus on abstracting features from each of the prototypes and incorporating them into a scalable and reusable decision support service architecture.
Studies in health technology and informatics
Creating an ontology driven rules base for an expert system for medical diagnosis2011 •
Expert systems of the 1980s have failed on the difficulties of maintaining large rule bases. The current work proposes a method to achieve and maintain rule bases grounded on ontologies (like NCIT). The process described here for an expert system on plasma cell disorder encompasses extraction of a sub-ontology and automatic and comprehensive generation of production rules. The creation of rules is not based directly on classes, but on individuals (instances). Instances can be considered as prototypes of diseases formally defined by "destrictions" in the ontology. Thus, it is possible to use this process to make diagnoses of diseases. The perspectives of this work are considered: the process described with an ontology formalized in OWL1 can be extended by using an ontology in OWL2 and allow reasoning about numerical data in addition to symbolic data.
International Journal of Medical Informatics
Developing healthcare rule-based expert systems: Case study of a heart failure telemonitoring system2012 •
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Revue d'histoire de l'Amérique française
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Antimicrobial Agents and Chemotherapy
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Rising trends of caesarean section: a retrospective study2019 •
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