临床指南模型构建中医学知识的规范化表达方法

Representation of Medical Concepts in Computer-interpretable Guideline Modeling

目的:探索和研究计算机化临床指南模型构建中医学知识规范化表达的方法,为基于疾病防治指南的计算机决策支持(CDS)系统及其在个人健康管理中的应用提供借鉴。方法:以高血压为例,分析防治指南文本,构建规则、提炼出节点和医学概念;形成类的层次结构;利用protege进行本体建模,参考openEHR原型表达医学概念。结果:建立了高血压评估诊疗管理全过程的流程图。以"测量血压"为例,描述了"行为"节点类的属性;以"医学概念"中的"血压"类为例,定义其描述结构和内容;通过"行为"类的属性将实例"测量血压"关联至概念类中定义的"血压"。结论:疾病防治过程中涉及的医学概念能以结构化的形式嵌入指南模型,在此基础上构建CDS有助于减少理解分歧导致的诊疗行为变异,促进慢性病管理中各参与方的知识共享。

Objective： To develop a method for representing medical concepts in computer-interpretable guideline modeling for the purpose of building computer-based clinical decision support （CDS） systems and enabling personal health management. Methods： Taking hypertension guideline as an example, we extracted business rules, working flow nodes and medical concepts as three super classes. The hierarchies, slots and relationships of classes were defined as an ontology by prot e g e. Medical concepts in the guideline model were described by referring to openEHR archetypes. Results： A flow chart for healthcare of hypertension was created. For blood pressure measurement, which is a component of the flow chart, and, also an instance of act node, its properties 4were defined. For blood pressure, which is a class of medical concept, its structured definition was produced as slots of the class. Trough the property of act, blood pressure measurement could be linked to blood pressure, that means a approach was created to connect act node with medical concepts. Conclusion： Structured medical concepts can be embedded in computerized guideline models. Implementing CDS systems based on such model might be helpful to reduce practice variations and to promote knowledge sharing among multiple participants in chronic disease management.