Journal
JOURNAL OF BIOMEDICAL INFORMATICS
Volume 41, Issue 6, Pages 889-903Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.jbi.2008.04.009
Keywords
Clinical decision support systems; Clinical guidelines; Ontologies; Knowledge acquisition; Knowledge bases; Evaluation; Mark-up; Structuring; Completeness; Correctness
Funding
- NIH [R01-LM-06806]
- IBM faculty fellowship
- Ben-Gurion University of the Negev
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We introduce a three-phase, nine-step methodology for specification of clinical guidelines (GLs) by expert physicians, clinical editors, and knowledge engineers and for quantitative evaluation of the specification's quality. We applied this methodology to a particular framework for incremental GL structuring (mark-up) and to GLs in three clinical domains. A gold-standard mark-up was created, including 196 plans and subplans, and 326 instances of ontological knowledge roles (KRs). A completeness measure of the acquired knowledge revealed that 97% of the plans and 91% of the KR instances of the GLs were recreated by the clinical editors. A correctness measure often revealed high variability within clinical editor pairs structuring each GL, but for all GLs and clinical editors the specification quality was significantly higher than random (p < 0.01). Procedural KRs were more difficult to mark-up than declarative KRs. We conclude that given an ontology-specific consensus. clinical editors with mark-up training can structure CL knowledge with high completeness, whereas the main demand for correct structuring is training in the ontology's semantics. (c) 2008 Elsevier Inc. All rights reserved.
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