From the Tumor Board to the Oncology Ward: A Practical Approach to Knowledge Management and Clinical Decision Support Systems
Knowledge based systems are used to support knowledge management and problem solving. Case-Based Reasoning (CBR) is a knowledge system that relies on a knowledge base and a reasoning module, re-using past cases to solve new ones. Numerous knowledge representation and knowledge management systems have been designed and tested in different medical domains. Oncology, given the complexity of decision making due to the rapidly evolving domain knowledge and multidisciplinary aspects, has been a popular field for the research and implementation of knowledge based decision support systems. Though previous research was mainly concentrated on computable rule-based reasoning decision support systems (RBR DSS) (Tu & Musen, 2001; Johnson et al., 2001; Seroussi, et al., 2001), CBR has become a more commonly applied methodology in this domain (Jaulent et al., 1998; Schmidt & Gierl, 2001). Systems based on combined methodologies, i.e., RBR and CBR, called multimodal decision support systems, are also being developed and implemented. Two of these systems, the EON system, and the KASIMIR System, will be reviewed.
One of the challenges in developing and implementing knowledge based CDSSs is the significant resources needed to acquire, maintain, and update the knowledge base (Buchanan et al., 1983). This is probably one of the reasons for the delay in fully implementing complex clinical decision support systems. For this, we propose a practical approach to knowledge management and CDSS. We propose a system that, while executing basic functions of knowledge representation and integration, allows clinicians to make the necessary diagnostic and prognostic inferences. The focus of our research is to capture, represent, and distribute the medical knowledge and decision making process expressed and adopted by a panel of experienced clinicians during tumor board meetings. The objective of the research is to bring this expert knowledge and decision making process to clinicians involved in everyday oncology care, for information, educational, and decision support purposes.
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