# Presentation: 528811

## Decision Support

**Notes:**
It then retrieves the result and presents it to the physician...

## Decision Support

- MRSA

- ?

**Notes:**
It then retrieves the result and presents it to the physician...

## Intelligent Decision Support

- MRSA

**Notes:**
It then retrieves the result and presents it to the physician...

## Components

- Extraction of application context
- Knowledge base for clinical context
- Extraction of clinical context
- Knowledge base of generic queries
- Matching algorithm and engine
- Instantiation and presentation to user

## Conceptual Graphs

- Concept  (relation)  Concept

## Application Context

- Laboratory Procedure    (assesses_effect_of) 
- 	Antibiotic   (disrupts) 
- 		Physiologic Function  (process_of) 
- 			Organism  (property_of) 
- 				Organism Attribute

- Culture, Routine Catheterized  	(assesses_effect_of) 
- 	IMIPENEM  (disrupts) 
- 		Physiologic Function  (process_of) 
- 			E. Coli  (property_of) 
- 				Antibiotic Sensitivity

## Application Context in XML

- <appContext appID="DemoCIS" depID="Microbiology">
- <clinEventGraph>
-    <conceptGroup semType="Laboratory Procedure" conGroupID="cgi1">
-       <conceptSet conSetID="csi1">
-           <concept conString="CPMC Battery: Culture, Routine Catheterized“
-                 conContextWeight="0.6"/>
-       </conceptSet>
-    </conceptGroup>
-    <conceptGroup semType="Antibiotic" conGroupID="cgi2">
-       <conceptSet conSetID="csi2"> <concept conString="IMIPENEM“
-                 conContextWeight="0.6"/>
-       </conceptSet>
-    </conceptGroup>
-    <conceptGroup semType="Physiologic Function" conGroupID="cgi3">
-       <conceptSet conSetID="csi3">
-       </conceptSet>
-    </conceptGroup>

## Knowledge Base for Clinical Context

- Medline co-occurrence of MeSH terms
- Identify important co-occurring semantic types
- Knowledge base of specific co-occurring concepts

## Clinical Context Knowledge Base

- Organic Chemical  (interacts with)  Pharmacologic Substance
- Ketoconazole  (interacts with)  Mifepristone
- Disease or Syndrome  (co-occurs with)  Disease or Syndrome
- Hypertension (co-occurs with)  Proteinuria
- Neuroreactive Substance or Biogenic Amine  (disrupts)  Organ or Tissue Function
- Dopamine  (disrupts)  Natriuresis

## Clinical Context

- Laboratory Procedure(measures) 
- 	Biologically Active Substance (result_of)
- 		Finding

- Laboratory Test: Glucose(measures) 
- 	glucose (result_of) hyperglycemia

## Knowledge Base of Generic Queries

- "Madlib" questions: "How do I treat <Disease>?"
- Evidence-Based Medicine conceptual framework
- Multiple sources of example questions
- Express relationships among concepts
- UMLS semantic types as place holders

## Generic Query Knowledge Base

- Pharmacologic Substance  (treats) 
- 	Organism  (causes)  Pathologic Function

## Generic Queries Matching Algorithm

- Each query graphs is decomposed into subgraphs
- Subgraphs matched to application context
- Exact matches vs distant matches
- Similarity based on average score of all subgraphs

## Query Context

- Pharmacologic Substance
-     {one of: IMIPENEM, CEFOXITIN, AMPICILLIN}
-  (interacts_with) 
- Pharmacologic Substance
-     {one of: IMIPENEM, CEFOXITIN, AMPICILLIN}

## User Interface

- Selection of query (ranking)
- Selection of concepts (instantiation)

## User Interface I

## User Interface II

## Output of User Interface

- Pharmacologic Substance {AMPICILLIN}
- 	(interacts_with) 
- 		Pharmacologic Substance {IMIPENEM}

## Next Steps

- Linking to the downstream process
- Integration with the presentation environment
- Evaluation
- Knowledge extraction from the medical record
- Appropriate queries
- Query ranking
- User interface
- Improved retrievals