This Is A Gap In Digital Health Capability That Should Have Been Filled Long Since. Seems It Is Very Hard!

This appeared last week.

Clinical Decision Logic Fun

Posted on 22/10/2020 by wolandscat

How close can we get to making a clinical decision logic language look like the published guidelines which it is used to encode?

Below is an openEHR Decision Logic Module (DLM) example, in the current form of the openEHR Decision Language specification currently under development. Why another language? Well I’ll answer that with: show me a language that does this, and we’ll use it instead (e.g. why not ProForma, Arden, GLIF etc?).

Of course this language doesn’t yet solve all the problems, but we are taking two particular challenges seriously:

• the problem of ‘subject variables’ (aka ‘curly braces’ or data access problem);
• getting the cognitive level of the language as close as possible to the cognitive level of the source materials and authors’ thinking.

As background, our conceptual basics here.

The following logic module is the logic part of the RCHOPS21 guideline published by the NHS Thames Valley Cancer Network. Our encoding of this into Task Plan + DLM is shown here; below is the DLM, colourised in a way that future tools will hopefully support.

If you look closely at the DLM below, you will see various syntax tricks. I won’t explain them here (some of them come from the openEHR Expression Language), the idea is that a clinical professional and any other guideline-knowledgeable person will guess the meaning. We would be very interested in what such people think of the example below (along with any others who care to comment).

If you wish to comment, you may of course do so here on the blog post but you might also consider this discussion thread on the openEHR Discourse site (or feel free to raise a new topic in that category).

Lots more code here:

https://wolandscat.net/2020/10/22/clinical-decision-logic-fun/

Thomas Beale is a really smart guy and if he says there is a problem there is a high probability he is right. I also know that producing computable, updateable clinical guidelines of the sort that understand the meaning of what the authors of those guidelines has been well beyond the wit of most men!

If Tom has added a small brick to the wall, all power to his arm I reckon!

David.