Role of Semantic Web Technologies in Managing Knowledge Change and Provenance

Vipul Kashyap1, Alfredo Morales2

vkashyap1@partners.org ; alfredo.morales@cerebra.com 1Clinical Informatics R&D, Partners Healthcare System

2 Cerebra, Inc.

HCLSIG Face to Face Meeting, Cambridge MAJanuary 25, 2006

Outline

• Some definitions

• The Business Problem:— Structured Clinical Documentation in HealthCare

• Example

• Semantics-based approach for Clinical Documentation

• Dependency Propagation and Management

• Conclusions

What does it mean to manage Knowledge Change and Provenance

• There is a close interrelationship between knowledge change and provenance

— What has changed? – Change— Why did it change? – Provenance

• Did someone change it? – Provenance• Did its components change? – Change

— Who changed it? – Provenance

• Significance:— Rapid Knowledge Discovery and Evolution in Healthcare and

Life Sciences

The Business Problem• Difficulty of identifying targeted templates for particular

conditions and diseases

• Inflexibility for documenting unforeseen findings

• Lack of consistency and maintenance of documentation templates as clinical knowledge and content evolves over time.

• Inefficiency, complexity and slow pace of navigating through user interfaces

— leads to decreased overall efficiency for generating complex documents

Example:

Example Instrument

1. Do you know if there any contraindications to fibric acid for this patient? __ Yes __ No

2. Does this patient suffer from gallstones?__ Yes__ No

3. What is the AST Value for this patient? ______ mg/ml?

4. Which of the following range of values does the AST values for this patient apply to? _ < 10 _ [10,20] _ [20,40]

5. Are the liver panel values more than the normal values for this patient? __ Yes __ No

6. If the answer to Question 5 is Yes, then the liver panel values are: __ 2 x Normal __ 3 x Normal

Documentation Ontology

• A Data Collection Item consists of: - A domain (Patient) - A question - An attribute (has_contraindication_to) - A value

• A Data Collection Item can depend on the results of other data collection items

Domain Ontology

Suppose AST values change from 0 AST 40 to 20 AST 40

Bridge – Composition Ontology

Knowledge Change and Provenance

• At each stage, Knowledge Engineer gets notified of:— What has changed?

• The definition of Fibric Acid Contraindication

— Why did it change? • Fibric Acid Contraindication Patient with Abnormal Liver Panel

Abnormal Liver Panel Abnormal AST Change in AST Values

— Who was responsible for the change?• Knowledge Engineer who entered the changed AST values?

• Change in a Clinical Guideline?

The Value Proposition of Semantics

• Managing change and provenance is a very difficult problem

• Semantics can play a crucial role in it:— A reasoner can navigate a semantic model of knowledge

and propagate change

— One can declaratively change the model at any time…

— The reasoner will compute the new changes!

• Configuration v/s coding…. Could lead to huge ROI!