Int.J.TechnologyManagement,Vol.X,No.X,xxxx1Copyright©2004InderscienceEnterprisesLtd.KnowledgeRepresentationIssuesinOntology-basedClinicalKnowledgeManagementSystemsJuan-JoséSiciliaHospitalClínicoSanCarlosProfesorMartínLagoss/n–28040Madrid,SPAINE-mail:juanjosicilia@gmail.comMiguel-AngelSiciliaComputerScienceDepartment,UniversityofAlcalá,Ctra.Barcelona,km.33.6–28871AlcaládeHenares(Madrid),SPAINE-mail:msicilia@uah.esSalvadorSánchez-AlonsoComputerScienceDepartment,UniversityofAlcalá,Ctra.Barcelona,km.33.6–28871AlcaládeHenares(Madrid),SPAINE-mail:salvador.sanchez@uah.esElenaGarcía-BarriocanalComputerScienceDepartment,UniversityofAlcalá,Ctra.Barcelona,km.33.6–28871AlcaládeHenares(Madrid),SPAINE-mail:elena.garciab@uah.esMariaPontikakiUniversityofPiraieus119Marathonodromonstreet,tk11525,Athens,GREECEE-mail:mariapontikaki@yahoo.comAbstract:KnowledgeManagementinhealthcarecoversanumberofdiversepracticeactivityareasthatrangefromadmissionandaccountingtopreventivehealthprogrammes.Fromamongtheseareas,clinicalknowledgemanagementrepresentsaspecificcategorythatposesdifferentiatedproblemsandrequiresspecificmanagementsupport.Clinicalknowledgeaspracticedtodaymixesformallyassessedscientificknowledgewithaperson-cultureinwhichtheexpertiseoftheclinicianisthekeyelement.WhenconsideringstandardKnowledgeManagementlifecycles,thisentailsthattherequiredprocessesofcreation,assessmentanddisseminationofclinicalknowledgeassetsdivergefromotherkindofactivitiesinhowdifferentkindsofknowledgearehandled.Further,theInformationTechnologysupportrequiredforclinicalknowledgeassetsiscomplexandmulti-perspective,thusrequiringschemasthatintegrateformallygatheredevidenceandsubjectivepracticalknowledge.ThispaperSiciliadealswiththosedifferencesfromtheviewpointofformalontologyasatooltomodelthespecificitiesofclinicalknowledge.Anepistemologicalaccountofsuchknowledgeisfirstprovided,whichservestodelineatehowclinicalprocessesandclinicalknowledgemanagementcouldbealigned.Theproblemsofclaimevaluationandrepresentationarethenapproachedfromthatframework,resultinginarealisticintegratedsetofdesignguidelinesforclinicalknowledgemanagementpreparedforuseinontology-basedInformationSystems.Keywords:Healthcaresystems,KnowledgeManagement,clinicalknowledge,ontologies.1IntroductionKnowledgeManagement(KM)inhealthcaresystemsencompassesthetechniquesforthecreation,development,disseminationandutilisationofavarietyoffacetsthatcomprise“healthcareknowledgeassets”(RazaAbidi,2001).Healthcaresystemsstoremassiveamountsofdataofdiversekinds,includingpatientrecords,admissioninformationandadministrativedata,andthesedataareconsequentlyhandledbyavarietyofprofessionals.Thiscallsbothforspecificmanagementmethodsandalsofortoolsthatextractinformationfromthesedatabases.Asamatteroffact,thereexistproposalsfortheimplementationofKMtechniquesinthespecificenvironmentofhealthcareorganizations(RazaAbidi,2001;Bose,2003),anddataminingtoolshavebeenappliedtolargepatientdatasetsasameantodiscovernovelclinicaldiseaseassociations,e.g.(Mullinsetal.,2006).However,clinicalknowledgerequiresaspecificapproachtoKMthatdiffersfromthatusedforotherkindsofknowledgeassetsasthoserelatedtoadministrationorbenchmarking.ClinicalKMisconcernedwithclinical-basedactivities(involvinghealth-careprofessionalsandtheirdirectinteractionwithpatients)whilehealthcareKMinabroadsensecoversalsothemanagementoftheknowledgeinthewholeorganization,includingsuchaspectsashealthcaremanagementandclinicalgovernance.ThespecificityofclinicalKMcomesfromthefactthatclinicalknowledgeisnowadaysconsideredasatwo-facedphenomenon.Ontheonehand,itcomprisestheapplicationofsoundscientifictheoryandevidencesthatareevaluatedthroughtheconventionalscientificpublicationprocessandthemethodologicalnormsregulatingclinicaltrials.Butontheotherhand,clinicalKMisalsosomethingtiedandspecifictotheexperienceofthephysician,orinsomecases,togroupsofprofessionalsinconcretehealthcareinstitutions.This“personculture”–inthewordsofMarshall(1997)–isstillanimportantingredientofeveryday’sclinicalpractice,whoserootscanbefoundinthateachindividualdoctorhasherown,idiosyncraticmodeofdiagnosticreasoning,andinsomecases,suchmodeisnotexplicit(Sadegh-Zadeh,2000).Ifthisdualityistakenforgranted,thedynamicsofKMactivitiesmustaccountforbothfacetsofclinicalknowledgeandintegratethemintoacoherentsystem.Thisresultsinbothepistemologicalissuesandproblemsofpracticalknowledgerepresentationthatrequirespecificconsideration.OntologybasedKMinclinicalsettingsEpistemologicalissuesareinherenttophysiciansashealthcareprofessionals,andtheevolutionofepistemologicalthinkingisaprocessthatdoctoreducationaddressesinsomeway(KnightandMattick,2006).Thecurrentepistemologicaldebateinclinicalaspectsismostlycentredintheevidence-basedmedicine(EBM)approachtomedicalpractice,oftendefinedas“theconscientious,explicitandjudicioususeofcurrentbestevidenceinmakingdecisionsaboutthecareofindividualpatients”.AcentralissueinseveralEBMapproachesisclassifyingmedicalevidenceinseverallevels,withdatacomingfromrandomizedcontrolledtrialsconsideredusuallyasthatofbestquality,a
本文标题:Knowledge Representation Issues in Ontology-based
链接地址:https://www.777doc.com/doc-3382573 .html