Shahar Y, Miksch S and Johnson P, "The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines", Artif Intell Med., 1998 Sep-Oct, 14 (1-2):29-51.  Home/Search   Document Details and Download   Summary   Related Articles   Check

....These guidelines are used by a wide variety of medical professionals: medical specialists, family doctors, hospital nurses. The interest in medical guidelines has resulted in the development of a number of special purpose knowledge representation languages intended for modelling guidelines [3, 7, 9]. They provide the opportunity to formalise informal guidelines into more formal objects. However formalisation of a guideline turns out to be a very time consuming task, resulting in a formal guideline that is much more complex than the original version and even more importantly the relation ....

....some open issues and future work. 2 The case study This study has been carried out within the Protocure project (www.protocure.org) a European project which aims to evaluate the use of formal methods for quality improvement of medical guidelines. The guidelines selected and formalised in Asbru [9] within the Protocure project have been used as a starting point. The definition of the relations between the original and formal guideline has been done with the Guideline Markup Tool [10] The selected guidelines The guidelines that have been used in this study are the American Academy of ....

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Y. Shahar, S. Miksch, and P. Johnson. The asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. AIM, 14:29--51, 1998.

....formal and detailed enough language since only precise descriptions will allow us to uncover anomalies in the protocols. Although the trend is changing lately, many of the protocol languages in the literature (e.g. GLIF [8] are not formal enough. Exceptions to this are PROforma [5] and Asbru [11]. In this work we have chosen Asbru, firstly because it is more precise in the description of various medical aspects, and secondly because Asbru protocols are more declarative, and thus they are more amenable to formal analysis. Concerning the protocols object of our study, we have tried to ....

....and improvement of these protocols, and report on the findings of our casestudy. Finally, we end with some conclusions and future work ideas. II. THE ASBRU PROTOCOL REPRESENTATION LANGUAGE Asbru is a semi formal language intended to support the tasks necessary for protocol based care [11]. It is a semiformal language because its semantics, although more precise than in other protocol representation languages, is not defined in a formal way 1 . This semi formal feature makes Asbru suitable for an initial analysis but not for a systematic verification of protocols. Finally, Asbru ....

Y. Shahar, S. Miksch, and P. Johnson. The Asgaard project: a task-specific framework for the application and critiquing of timeoriented clinical guidelines. Artificial Intelligence in Medicine, 14:29--51, 1998.

....different degrees. Since we aim at a formal verification, we have chosen the logic of a theorem prover KIV [5] as target formalism. Prior to the KIV formalisation step, we have carried out a modelling step using a specific purpose knowledge representation language for medical protocols Asbru [6]. This gradual formalisation strategy has made the formalisation task feasible, which in turn has enabled us to use theorem proving. The structure of this paper roughly follows the Asbru modelling KIV formalisationKIV verification process that the protocol has undergone. First section 2 ....

....these actions [9] However, although the trend is changing lately, many of the protocol representation languages in the literature are not formal enough. For instance, they often incorporate many free text elements which do not have clear semantics. Exceptions to this are PROforma [10] and Asbru [6]. In this work we have used Asbru, mainly because it is more precise in the description of a variety of medical aspects. 3.1 Asbru: a knowledge representation language for protocols The main aspects of Asbru are: i) in Asbru a medical protocol is considered as a plan skeleton with sub plans in ....

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Shahar, Y., Miksch, S., Johnson, P.: The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. AI in Medicine 14 (1998) 29--51

....testing of an evolving knowledge base. Several encoding tools have been developed, and they vary in their architectural flexibility and feature support. Some are dedicated authoring environments for specific guideline models (e.g. Arezzo for PROforma s guideline model and AsbruView for Asbru [3]) Protg 2000 [4] on the other hand, is the latest in a series of completely general purpose programs that help users build knowledge acquisition systems. Pro tg 2000 s extensible component based architecture and configurable GUI greatly facilitate customizing knowledge acquisition for given ....

Shahar Y, Miksch S, Johnson P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artificial Intelligence in Medicine . 1998; 14:29-51.

.... system developed at Duke University (hereafter referred to as Siegfried model) 28] the GLIF model developed by the InterMed Collaboratory [18, 29] the Asbru model originally developed at Stanford University and currently maintained by Vienna University of Technology and Ben Gurion University [30], the GUIDE PatMan model developed at the University of Pavia [31] the PRODIGY model developed at the University of Newcastle [32] the guideline representation model in the GASTON framework developed at the University of Maastricht (hereafter referred to as GASTON model) 33] and the guideline ....

.... For example, DILEMMA PRESTIGE represents guidelines as a set of protocols that can be refined further into subprotocols [23] A similar approach is taken by Asbru, in which plans are recursively decomposed until they become atomic plans that can be directly executed for specific clinical purposes [30]. Actions can be classified into three categories, i.e. clinical interventions, data collections, and wait actions. Clinical interventions are the actions that deal directly with the management and treatment of patients, such as prescriptions and operations. Data collections, on the other hand, ....

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Shahar Y, Miksch S, Johnson P. The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artif Intell Med. 1998;14(1-2):29-51.

....guidelines. In recent years, various computer based technologies have been developed to facilitate clinical practice guidelines development. Most of these efforts, however, focus on supporting guideline representation, editing, and delivery, instead of information integration and interpretation [1][2] This paper introduces a decision analytic artificial intelligence architecture based on the DynaMoL family of tools [3] which center on a dynamic decision modeling language, to automate clinical practice guideline development in critical care management. The proposed architecture ....

Y. Shahar, S. Miksch, and P. Johnson. The Asgaard project: A task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artif Intell Med. 14:29-51,1998.

.... patient record model EON [14,15] scenario, activity state no flowchart subguideline EMR ontology PROforma [16] enquiry n a task state constraints satisfaction graph plan n a GLIF [17,18] action step patient state no flowchart subguideline three layer domain ontology Asbru [19] condition, preference plan temporal patterns plan state plan body plan n a GUIDE [20] decision task, wait, monitor (implicit) n a flowchart task relational PRODIGY [21] scenario n a state transition diagram subguideline EMR ontology n a: information not available from the ....

....actions are encoded. In DILEMMA, execution states are represented as procedure states and decisions are represented as state transitions [13] A similar approach is used in Asbru, which has conditions and preferences for decisions, plans for actions, as well as plan states for execution states [19]. EON distinguishes an activity, which is a continuous process, from an action, which is an instantaneous process [14,15] Consequently, it offers both a patient scenario, which is used to describe the patient state with regard to decisions made and actions completed, and an activity state, which ....

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Shahar Y, Miksch S, Johnson P. The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artif Intell Med 1998;14(1-2):29-51.

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Shahar Y, Miksch S, Johnson P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artif Intell Med. 1998;14:29-51.

....of time oriented, hierarchical treatment schemata. Diagnosis is modelled as conditions under which treatment steps are performed. Asbru is part of the Asgaard project in which a set of task specific problem solving methods for the design, execution, and critiquing of treatment plans are developed [3]. An Asbru plan library is built on skeletal plans which are plan schemata at various levels of detail, capturing the essence of the procedure, but leaving enough room for execution time flexibility in the achievement of particular goals [4] Thus, they are usually reusable in various contexts. ....

Shahar Y, Miksch S, Johnson P. The Asgaard project: a taskspecific framework for the application and critiquing of time-oriented clinical guidelines. Art Intel Med, 1998:14, pp. 29-51.

....in Artificial Intelligence in Medicine, 2002. 3 1 Introduction The computerization of clinical practice guidelines and the variety of tasks associated with this objective have been the subject of numerous research projects performed over the last decade in the medical informatics community [5, 9, 18, 19, 24, 25]. In comparison with the extensive research efforts invested in this subject, few guidelines have actually been employed in an automated version in clinical practice. One frequently reported factor that complicates the implementation of such applications is the existence of deficiencies within ....

....[10] The time delay statement may consequently be used to specify minimum duration constraints between individual MLMs. An approach that emphasizes efficient handling of temporal expressions within guideline knowledge is the Asbru language [15] which was created as part of the Asgaard project [24]. Asbru provides the most powerful functionality in specifying temporal scheduling constraints in comparison with the above mentioned approaches. As we will demonstrate in greater detail in section 3.2.1, Asbru allows uncertain specification of a guideline activity s duration and its starting and ....

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Y. Shahar, S. Miksch and P. Johnson, The Asgaard project: A task-specific framework for the application and critiquing of time-oriented clinical guidelines, Artificial Intelligence in Medicine 14 (1998) 29-51.

....allows the user to tell it the outcome of treatment steps he or she has performed. It must also be possible to simulate patient parameters for testing treatment plans prior to actual clinical trials. We present a user interface, called AsbrUI, that meets these criteria. 1 Introduction Asbru [7] is a plan specification language for defining clinical protocols. A clinical protocol is usually translated into many Asbru plans that contain small units of the treatment and information about how they work together. This knowledge acquisition and translation is supported by a visual tool named ....

....the medical sta# has performed, and their outcome. The user interface for the execution unit is called AsbrUI, and is described in this paper. Because we are still in the design phase of AsbrUI, all images presented in this paper are mock ups. An in depth description of the details of Asbru [6, 7] is beyond the scope of this paper. Some features of Asbru are covered in the sections that describe the corresponding AsbrUI components. Section 3 describes the AsbrUI components that handle the acquisition of patient data; components concerned with controlling the execution of plans are ....

Yuval Shahar, Silvia Miksch, and Peter Johnson. The Asgaard project: A taskspecific framework for the application and critiquing of time-oriented clinical guidelines. Artificial Intelligence in Medicine, 14:29--51, 1998.

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Shahar Y, Miksch S, Johnson P. The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artificial Intelligence in Medicine 1998; 14:29-51.

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Shahar Y, Miksch S, Johnson P. The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artif Intell Med. 1998;14:29-51.

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Shahar Y, Miksch S, Johnson P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artificial Intelligence in Medicine 1998; 14:29-51.

....actions by an intelligent system. 6. Temporal abstractions are a useful representation for the process and outcome intentions of designers of clinical guidelines, and enable real time and retrospective critiquing and quality assessment of the application of these guidelines by care providers [5]. 7. Domain specific, meaningful, interval based characterizations of time oriented medical data are a prerequisite for effective visualization and dynamic exploration of these data by care providers [6] Visualization and exploration of information in general, and of large amounts of ....

....use the Common Object Request Broker Architecture (CORBA) as a communication protocol (Figure 4) All temporal queries and assertions in the EON architecture are mediated through the Tzolkin mediator. 5. 2 Automated Quality Assessment of Guideline Based Therapy: The Asgaard The Asgaard project [5] is a general framework for the representation, application, and critiquing of clinical guidelines. The Asgaard project uses the Asbru guidelinespecification language, which enables the representation of both the prescribed actions of time oriented therapy guidelines and their underlying process ....

Shahar, Y., Miksch, S., and Johnson, P.: The Asgaard project: A task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artificial Intelligence in Medicine 14 (1998) 29-51.

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Shahar Y, Miksch S, Johnson P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artif Intell Med. 1998;14:29-51.

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Shahar Y, Miksch S and Johnson P, "The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines", Artif Intell Med., 1998 Sep-Oct, 14 (1-2):29-51.

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Shahar Y, Miksch S, Johnson P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artif Intell Med. 1998;14:29-51.

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Y. Shahar, S. Miksch, P. Johnson, The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines, In: Artificial Intelligence in Medicine, 14(1-2), 29-51,1998.

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Shahar, Y., Miksch, S., Johnson, P.: The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artificial Intelligence in Medicine 14 (1998) 29--51

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Shahar Y, Miksch S, Johnson P. The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artificial Intelligence in Medicine 1998; 14:29-51.

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Shahar Y, Miksch S, Johnson P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artificial Intelligence in Medicine 1998;14:29-51.

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Shahar, Y., Miksch, S., Johnson, P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artificial Intelligence in Medicine 1998;14:29--51.

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Shahar Y, Miksch S, Johnson P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artificial Intelligence in Medicine 1998;14:2951.

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Shahar, Y., Miksch, S., Johnson, P. The Asgaard Project: A Task-Specific Framework for the Application and Critiquing of Time-Oriented Clinical Guidelines. Artificial Intelligence in Medicine 1998;14:29--51.

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