An Ontology-based Mediator of Clinical Information for Decision Support Systems A Prototype of a Clinical Alert System for Prescriptions

Objective: We have been developing a decision support system that uses electronic clinical data and provides alerts to clinicians. However, the inference rules for such a system are difficult to write in terms of representing domain concepts and temporal reasoning. To address this problem, we have developed an ontology-based mediator of clinical information for the decision support system. Methods: Our approach consists of three steps: 1) development of an ontology-based mediator that represents domain concepts and temporal information; 2) mopping of clinical data to corresponding concepts in the mediator; 3) temporal abstraction that creates high-level, interval-based concepts from time-stamped clinical data. As a result, we can write a concept-based rule expression that is available for use in domain concepts and interval-based temporal information. The proposed approach was applied to a prototype of clinical alert system, and the rules for adverse drug events were executed on data gathered over a 3-month period. Results: The system generated 615 alerts. 346 cases (56%) were considered appropriate and 269 cases (44%) were inappropriate. Of the false alerts, 192 cases were due to data inaccuracy and 77 cases were due to insufficiency of the temporal abstraction. Conclusion: Our approach enabled to represent a concept-based rule expression that was available for the prototype of a clinical alert system. We believe our approach will contribute to narrow the gaps of information model between domain concepts and clinical data repositories.