一种面向诊疗协议的知识表达及转化方法

doi:10.3969/j.issn.0258-8021. 2014. 02.002

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摘要基于最佳循证依据来规范医疗行为，能够有效提高医疗质量和保障医疗安全。而各类循证医学诊疗协议（如标准医嘱集和临床路径），在临床实践中并未得到普遍认可和广泛利用，其中一个重要原因是诊疗协议在临床信息环境中被简化为套餐式的医嘱集，缺乏对于个体的适应性和复杂知识的执行力，因此被临床工作者称为“菜谱医疗”。本论文提出一种诊疗协议的知识表达和转化方法，在支持传统规范化表达的临床诊疗协议的同时，能够管理、调用和集成各类个性化的临床决策支持应用，以支持个性化执行和完成复杂医学知识的转化。基于此方法设计和实现了一个临床知识转化平台，通过与临床信息系统的集成可以智能推荐诊疗方案，并提供可扩展的个性化执行环境，允许以插件的形式转化复杂临床循证知识，为个性化和精细化的循证医疗提供了一种技术解决方案。

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	张寅升^1#李振叶^2#李昊旻^1*郑翔¹ &nb

关键词 ：循证医学, 诊疗协议, 临床路径, 知识表达, 知识转化

Abstract：Standard care based on the best clinical evidence is an effective way to enhance medical care quality and safety. However, various evidence based clinical protocols, such as standard order set and clinical pathway, are not widely accepted and used. One reason is that standard care protocols are represented as simplified medical order suites in the clinical information settings, which are not flexible enough to support personalized care and lack the capability to translate complex knowledge into actionable interventions. Thus, these standard care protocols are criticized as “cookbook medicine”. This study proposed a knowledge representation and translation method for clinical protocols. The method not only supports formally represented knowledge, but can also manage, invoke and integrate various personalized clinical decision support applications. Based on this method, a clinical knowledge translation platform is developed. The platform is integrated with clinical information system, and can recommend clinical protocols to physicians. An extensible personalized execution runtime is provided in the platform where complex knowledge is implemented as a plugin. This provides a technical solution for personalized and finegrained clinical protocols.

Key words： evidence based medicine clinical protocol clinical pathway knowledge representation knowledge translation

基金资助:国家高技术研究发展计划(863计划)(2012AA02A601)；国家自然科学基金(30900329)

引用本文:

张寅升^1#李振叶^2#李昊旻^1*郑翔¹ &nb. 一种面向诊疗协议的知识表达及转化方法[J]. 中国生物医学工程学报, 2014, 33(2): 139-147.
ZHANG Yin Sheng^1# LI Zhen Ye^2#LI HaoMin^1*ZHENG Xiang¹LU Xu Dong¹DUAN Hu. A Knowledge Representation and Translation Method for Clinical Protocols. journal1, 2014, 33(2): 139-147.

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