Physicians often have to combine clinical guideline recommendations with their own basic medical knowledge to cope with specific patients in specific contexts. Both knowledge sources may include temporal constraints for the execution of actions. In this paper we approach the problem of compliance analysis with both sources of knowledge, pointing out discrepancies – including temporal ones – with respect to them, and where such discrepancies may be due to multiple and possibly conflicting recommendations.

1. Temporal
Conformance
Analysis of Clinical
Guidelines
Execution
Reference: AIME 2015
Matteo Spiotta, Paolo Terenziani,
and Daniele Theseider Dupr´e1
DISIT, Sezione di Informatica, Universit`a del Piemonte
Orientale, Alessandria, Italy
Dipartimento di Informatica, Universit`a di Torino, Turin, Italy

2. EVER WONDERED WHY
PATIENTS GO FOR SECOND
OPINION WITH THE DOCTORS ?

3. CG vs BMK?
CG - CLINICAL GUIDANCE
BMK - BASIC MEDICAL KNOWLEDGE

4. Overview
● This paper uses markov model in decision making
● Actions recommended by a CG could be prohibited by the BMK
● CG could force some actions despite the BMK discourages them
● Focuses on the temporal interplay between CGs and BMK from the
viewpoint of a posteriori conformance analysis
● Aimed at identifying, in the trace, situations in which some
recommendation (either in the CG or in the BMK) has not been followed,
and at providing potential justifications for non-conformance to one
knowledge source based on another source.

5. Hip Fracture
● Clinical case of a patient hospitalized for a hip fracture
● Conformance analysis is based on a log trace, a CG and a set of
BMK rules.
● constraints that impose a minimum and maximum delay
between the start/end points of actions and/or preconditions.
● BMK rules considered in this paper are formed by a trigger

6. Excerpt of Fracture

7. Framework
Avoid a States that action a should not be executed; we assume that
such a statement is triggered by conditions that are not
reversible
Delay a
while c
a should not be performed as long as c holds
Delay a
for d
Suggests delaying action a for time d

8. Example case
BMK RULE 1: High body temperature and cough, the presence of a chest
infection
BMK RULE 2: Patients having pain in lower limbs

9. Conformance Analysis with discrepancies and their
justifications
Key:
concurrently (concur case), temporal constraints are not enforced (concur no tc) , delayed after the end
of the CG execution (after), before proceeding with the CG (before), BMK suggestion is ignored
(ignore), temporal constraints from both the CG and BMK (cg bmk constr), either of them (cg constr,
bmk constr), additional precondition for a (add delay)

10. Conclusions
● CGs do not include all knowledge that physicians have to take into
account since patient states and contexts of execution cannot always
be foreseen
● Approach for analyzing temporal conformance of execution traces with
respect to a richer form of medical knowledge
● Final evaluation about the clinical correctness of justifications is left to
physicians.

11. THANK YOU