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1 The Medical Informatics Research Center, Ben Gurion University, Beer Sheva, Israel

The Importance of Creating an Ontology-Specific Consensus Before a Markup-Based Specification of Clinical Guidelines.

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1 The Medical Informatics Research Center, Ben Gurion University, Beer Sheva, Israel

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  1. The Importance of Creating an Ontology-Specific Consensus Before a Markup-Based Specification of Clinical Guidelines Erez Shalom1,Yuval Shahar1Eitan Lunenfeld2, Meirav Taieb-Maimon1, Ohad Young1, Guy Bar2, Susana B.Martins3, Laszlo Vaszar3, Yair Liel2, Avi Yarkoni2,Mary K.Goldstein3, Akiva Leibowitz2, and Tal Marom4 1 The Medical Informatics Research Center, Ben Gurion University, Beer Sheva, Israel 2 Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel3 Veterans Administration Palo Alto Heath Care System, Palo Alto,CA 4 E.Wolfson Medical Center, Holon, Israel

  2. The Required Infrastructure to support automation of GLs

  3. What are the essential steps for the overall guideline specification process?

  4. A Methodology for GL Specification& for its Evaluation 1. • The methodology is embedded within the Digital Guideline Library (DeGeL) architecture • Creating an Ontology-Specific Consensus (OSC)is a crucial, mandatory step before markup

  5. The Importance of an Ontology-Specific Consensus (OSC) • An OSC is a document that describes the core objectives and means of the GL • Refers to the knowledge roles of the chosen (target) specification ontology • Enhances accuracy of the mark-up • Decreases variability during mark-up and during application of the GL

  6. The Consensus-Creation Methodology 1 Clinical consensus – the pathway of the GL KE +EP add procedural knowledge semantics to the pathway (e.g parallel order between the regimens) 2 KE+EPadd declarative knowledge to the pathway (e.g filter condition to the main root of the GL) 3 4 Ontology-Specific Consensus

  7. The second stage in forming an Ontological consensus

  8. The third stage in forming an Ontological consensus

  9. Results (I): Procedural Complexity of the GLs

  10. Results (II): Quality of markups • EPs can perform markup! • High completeness: 91% of the plans and 97% of the KRs were recreated, compared to Gold Standard markup • Variable correctness, but proportion of perfect scores significantly high (P<0.05) • Several clusters of KRs can be formed by level of difficulty to structure • Creating an OSC is crucial for achieving high quality

  11. Results (III): Types of errors The differences in the total numbers of errors between the three GLs were highly significant in a proportion test (P<0.001)

  12. Conclusions • Markup is feasible by EPs! • The more detailed and structured the OSC was, the lower the total number of errors committed by the EPs for each KR • The need for a graphical OSC-forming graphical tool

  13. Summary • The need for gradual GL specification • Creating an ontology-specific consensus as a first step • Using a well defined methodology for the overall process to increase the quality of the markups • For more information: erezsh@bgu.ac.il http://medinfo.ise.bgu.ac.il/medlab

  14. Questions?

  15. The second stage in forming an Ontological consensus

  16. Creation of OSC – example:Textual Source in the PID Guideline

  17. The first stage in forming an Ontology-Specific consensus

  18. Results (III): Procedural Complexity of the GLs The Subjective Qualitative Ranking

  19. Results (I): The Guidelines • Pelvic Inflammatory Disease (PID) • Chronic Obstructive Pulmonary Disease (COPD) • Hypothyroidism(HypoThyrd)

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