Design Of Real-time CEM for the Arden Syntax based Decision Supports

Abstract

BACKGROUND : The Arden Syntax is a standard medical knowledge encoding language which is the most widely studied and used. However, performance degradation in monitoring clinical events is the significant barrier to the standard CDSS dissemination. PURPOSE : We propose a design of real-time clinical event monitor(CEM) for the Arden Syntax based CDSS. METHOD : The main idea is to minimize workloads towards existing Hospital Information System (HIS) with least building cost. For the minimum building cost we decided to use trigger. Hripcsak G, P. et al.[4] say that developing CEM using internal function is the easiest and fastest (both in building time and performance) method. However, triggers may cause significant performance degradation of the HIS. Therefore to minimize the workloads we split MLM evoking event into three levels, real-event, macro-event, and micro-event. And we divided monitoring work to be performed both inside the HIS and outside the HIS. The realevent is the event specified in evoke slot. The macro-event is non-constrained real-event which only specifies the sort of data to be monitored and not the constraints. One macro-event can have one or more micro-events. The micro-event is an atomic event of its macro-event. Our CEM is designed to create the least number of triggers when registering events. It monitors only distinct micro-events by triggers. When the system encounters a new micro-event to register, it adds monitoring condition into the existing trigger as many as possible, instead of creating a new one. And macro-events are inferenced from the detected micro-events information. The macro-events and related MLM list is sent to CEM compoenent working outside the HIS and the real-events are validated in that component. RESULT : We successfully implemented and evaluated our design. The experimental results show that adopting our clinical event monitor to real-time hospital information system is promising.