Using clinical reasoning ontologies to make smarter clinical decision support systems: a systematic review and data synthesis

Objective: The study sought to describe the literature describing clinical reasoning ontology (CRO)-based clinical decision support systems (CDSSs) and identify and classify the medical knowledge and reasoning concepts and their properties within these ontologies to guide future research. Methods: MEDLINE, Scopus, and Google Scholar were searched through January 30, 2019, for studies describing CRO-based CDSSs. Articles that explored the development or application of CROs or terminology were selected. Eligible articles were assessed for quality features of both CDSSs and CROs to determine the current practices. We then compiled concepts and properties used within the articles. Results: We included 38 CRO-based CDSSs for the analysis. Diversity of the purpose and scope of their ontologies was seen, with a variety of knowledge sources were used for ontology development. We found 126 unique medical knowledge concepts, 38 unique reasoning concepts, and 240 unique properties (137 relationships and 103 attributes). Although there is a great diversity among the terms used across CROs, there is a significant overlap based on their descriptions. Only 5 studies described high quality assessment. Conclusion: We identified current practices used in CRO development and provided lists of medical knowledge concepts, reasoning concepts, and properties (relationships and attributes) used by CRO-based CDSSs. CRO developers reason that the inclusion of concepts used by clinicians' during medical decision making has the potential to improve CDSS performance. However, at present, few CROs have been used for CDSSs, and highquality studies describing CROs are sparse. Further research is required in developing high-quality CDSSs based on CROs.