Knowledge Representation for Relevance Ranking of Patient-Record Contents in Primary-Care Situations

The computer-based patient-record system can play a significant role in physicians’ decision-making process by, for instance, presenting them with information they need from the record, relevant to care situations. However, the patient-record system’s contribution in decision making is often reduced to storing and presenting patient information as time-oriented logs of encounter events. As the record accumulates patient information over time, physicians loose overview over the contents, and the information becomes increasingly inaccessible for them.Several realizations of problem-oriented patient records have attempted to structure the computer-based patient-record system. A persistent complaint against previous problem-oriented record systems refers to the way these systems compels the user to work. Despite less successful efforts, a problem-oriented view of data still offers a foundation for a well-structured patient record.A knowledge-based patient-record system can support physicians during patient care in at least two ways; with a structure and a formalization that encodes information in the record system. A patient-record system with knowledge can reason about its content and use, and a process-aware system can recognize care situations and determine relevant information from the record to these situations. In this thesis, we present a way to represent knowledge for a Norwegian primary-care patient-record system. The knowledge representation enables encoding of record information—based on what primary-care physicians enter into it.The knowledge-elicitation techniques that we have used in this thesis comprise: (1) an observation study of family physicians in clinical settings, (2) a study of patientrecord contents , and (3) a qualitative and a quantitative survey among family physicians regarding the use and the usefulness of the patient-record systems in patient care. Results from these studies, in addition to their inherent empirical values, lay a foundation for further work and contribution of:• An information model that supports a problem-oriented view of patient data• A process model of primary-care activities , their goals and purposes, participants involved in the activities , information needs , and interactions with the patient-record system• An ontology of clinical concepts that classify and represent the patient-record contents. The clinical concepts are associated with activities in the primary-care processThe problem-oriented structure organizes the patient-record contents into medical problems . The ontology classifies the patient-record contents according to clinical concepts. Moreover, the association between clinical concepts and activities enables a ranking of information contents to care activities.For a practical evaluation of the knowledge model, we have developed a prototype implementation that simulates encounter-specific processes. The results demonstrate that the prototype can identify and extract information from the record, relevant to the various activities in the process model.When compared to time-oriented patient-record systems, the problem-oriented information model, in combination with the clinical concepts and their associations to care activities, enables a method for providing a better overview over and easier access to patient-record information.