Topic: “Artificial Intelligence systems Knowledge representation

and tool for specific hospital departments”

By Imran Abdul Ali

Abstract:

Application of Artificial intelligence systems in medical knowledge management are widely

used in healthcare and biomedical engineering for clinical engineers, medical staff required for
computable models. Few knowledge management and acquisitions tools have not routinely used,
since such tools are not perceived by physicians, clinical engineers as part of the clinical
information process. Partially solve this problem, identify two key aspects of knowledge
representation and management tasks. Firstly, is to adopt a medical knowledge standardization to
provide a consistent terminology control and to simplify the integration between knowledge
management tools and health information system. Secondly, is to establish an effective
knowledge acquisition process in specific medical fields by adapting knowledge acquisition
tools. Therefore, main objective of this research is to define computational models and to design
mechanisms for the effective acquisition and management of medical knowledge in real-life
hospital departments and units. Finally, is to analyze the representation of medical knowledge
and development of knowledge management tools within information processing activities of
clinical user.

Introduction:

The early work in medical artificial intelligence (AI) and AI in medicine researchers had
discovered the applicability of AI methods to life science, most visibly in the dendral
experiments [1]. There was an explosive interest in biomedical applications of AI during the
1970s, catalyzed in part by the creation of SUMEX-AIM computing resource at Stanford
University [2].

On going development in biomedical computer-based systems have opened up new perspectives

on medical activity (especially in hospital) due to the availability of large volumes of clinical
data from Electronic Health Records (EHRs). The user needs to interpret, internalize and apply
from the wealth of information in a report [3].The creation of a computer-based system that
manager’s knowledge requires substantial modeling activity, deciding what clinical distinctions
and patients are relevant, identifying the concepts and relationships amongst them. However,
most of medical data structured in hospitals is focused towards HER, which is not structured in a
way that can be reused for decision making, and is often redundant.

Therefore, consider that medical knowledge is double-valued due to its consequences for patients
and difficulty of its acquisition in a computable structure. This difficulty lies in the nature of
medical knowledge (imprecise, incomplete, many years needed to master such knowledge.in
particular, medical specialties also focus, apart from their clinical content, on different aspects of
knowledge.

Content:

Discussion
In the recent years three major projects high light to solve specific health problems in real
medical domains.

The SAPHIRE project [4] is an intelligent cardiovascular monitoring and decision support
system integrated with the HIS. The project acquires medical knowledge by the description of
computerized clinical guidelines. Physicians can use a clinical decision support system based on
these guidelines, and can access patients’ records in the HIS through semantically enriched Web
services to tackle the interoperability problem.

Another example is the DICOEMS project [5], an emergency risk management e-health platform.
This system searches and provides the content for specialized databases and/or digital libraries
(e.g. life-support protocols) for decision making purposes.

It also includes an acquisition platform to transfer critical information from the place where a
medical emergency occurs to remotely located health specialists for immediate assistance.
DICOEMS incorporates its own medical terminology which comprises the semantics of
emergency medical incidents.
Finally, the COCOON project [6] aims to reduce risk management in physician medical practice
by building knowledge driven and dynamically adaptive networked communities within
European healthcare systems.

Knowledge Acquisition tool in ICU:

In hospital department is a Intensive Care Unit (ICU) that provides critical attention to medically
recoverable patients. One of the fundamental distinctiveness of the ICU is that patients require a
permanent availability of monitoring equipment and specialist care. Thus, the temporal evolution
of patients is permanently recorded and analysed by physicians, who must tackle a wide range of
patient pathological problems e.g. cardiovascular, renal, infections, neurological, etc. The
temporal dimension, therefore, plays an essential role for the statement of a correct care,
diagnosis and therapy.

Artificial Intelligent system base decision support systems that gather the evolution of patients’
diseases over prolonged periods of time are useful tools for intensivists.

CATEKATZ 2:

CATAKATZ CATEKAT2 is the Causal and Temporal Knowledge Acquisition tool that
represents medical knowledge by the use of the TBM (Temporal Behavioral Model).
 Figure 1: Causual relations of the pattern
CATEKAT2 has several applications to provide a causal and temporal consistency engine for
assisting experts in knowledge acquisition. It has to provide a multi-user environment in which
users playing different roles could cooperate in the evolution knowledge base. For browsing
purpose capabilities to allow physicians to check the results of their knowledge acquisition
sessions.

Mostly, CATEKAT 2 is the web based knowledge acquisition user interface. In figure 2
architecture of ICU.The most relevant characteristics of knowledge acquisition are:
(a). a multi-user environment;
(b)Role-aware means the management of different roles such as expert engineer or knowledge
engineer;
(b). avoiding inconsistencies;
(c). providing an effective cooperative work platform;
(e). allowing the definition of projects related to different domains;
(f). browsing and searching capabilities.

Figure 2: CATEKAT2 architecture of the ICU

Knowledge acquisition tool in paediatrics: WOMKA

Paediatrics is branch of medicine concerned with the development, care, and diseases of infants
and children. Unlike adult medicine, young bodies are involved in different maturation processes
and, therefore, the neonate physiology differs from children and adolescents. From the point of
view of the hospital departments, the paediatric service also differs from the rest of the
departments since this paediatric service deals with the medical care of a range-limited old-age
population, but covering a range of pathologies that, in adult patients, is covered by several
clinical services. In particular, the paediatric service analysed in this work provides service for
Neonatology, Paediatric critical care, Paediatric cardiology or Paediatric oncology. Unlike ICU,
focused on the temporal evolution of critical patients, the paediatric service covers a wider range
of pathologies since paediatrics could be considered the whole medical science adapted to young
patients. Therefore, it seems reasonable to consider that paediatrics needs as regards
computational knowledge representation requires different models and tools from those required
by an ICU.

Therefore, identify four key requirements on the design of this Knowledge acquisition tools:
 To provide a deep-causal model, flexible enough to be effectively used in peadiatric
environments.
 To integrate the knowledge acquisition tools into clinical information process for better
acceptance.
 A simple graphical interface for clinical sessions and meetings.
 Incorporate mechanisms for Evidence base medicine support in order to share knowledge
and experiences, including, for instance , a medical scientific search engine, extending
models by adding statistical values of prevalence, or providing a physician cooperation
environment.

EBM Support:
Evidence –based medicine means integrating individual clinical expertise with best available
external clinical evidence [7]. In this WOKMA contributes sharing medical knowledge,
providing mechanisms to edit, to search.
HIS Integration:
WOKMA and HIS interact at three different levels. First, according to the local confidential data
laws and the clinic’s policies, the user’s log in and password are stored in the HIS database and
therefore, both systems share the access control mechanisms. Second, HIS uses ICD terminology
to codify diagnoses and a proprietary terminology of the paediatric department.

Search Engine:
WOKMA provides a search engine module that can be used by physicians for query purposes or
by software agents in order to implement knowledge-based diagnosis tasks.

Results from WOKMA:

The current version of WOKMA, recent years, the paediatricians focused on the knowledge-
acquisition process, describing diagnostic patterns for nanotechnology field.

Conclusion

From this research work is to design mechanisms for the effective acquisition and management
of medical knowledge in real-life hospital departments. In particular, we approach this problem
by representing medical knowledge using deep-causal models (TBM and SBM models) for two
hospital departments: ICU and paediatrics with different requirements.

Firstly, to manage medical knowledge in the ICU, we designed and implemented which is
focused on building the TBM and managing the temporal aspects. Secondly, we developed
WOMKA for paediatric departments as a knowledge management tool integrated in the health
information process of the paediatric department. This work first focuses on modelling
knowledge by using an explicit specification of the domain knowledge (considered static
knowledge) and the MBR approach to implement a problem-solving method or PSM (dynamic
knowledge). This means that different implementations of static knowledge could be added or
removed from the system, maintaining the same PSM [8].

In the ICU, the temporal dimension is essential for describing the patient’s evolution, and its
inclusion in the modelling increases the problems associated with the KA bottleneck. As far as
we know, despite the interest in the description of temporal deep-causal models [9] and their
application in the medical field [10], practical experience in the study of this kind of approach is
lacking in real hospital departments. In the ICU domain, causal and temporal knowledge can be
captured by the model (TBM) in which the temporal evolution of diseases can be represented.

The CATEKAT2 system was also used in the paediatric field, by extending its functionality and
simplifying the underlying model according to the domain requirements. The result of this
adaptation is the WOMKA system. WOMKA assists physicians as regards the knowledge
representation, acquisition, management and sharing issues. In order to solve the problem of the
gap that exists between KMS and the clinical environment [11], WOMKA has been integrated
with the health information system, allowing the retrieval of patients data. To communicate
properly with the HIS, it is necessary to use standard terminologies and communication
protocols.

All in all, these artificial intelligence systems are to be applicable to daily work, they must
include standardization of the terminology used, support for Evidence-based medicine and
advance browsing and search capabilities so that information can be easily recovered.

Future Prospect

Future research works include the proposal of diagnosis methods to exploit the Knowledge
acquisition tool WOMKA, and consider extensions of simple behavioral model for non-diagnosis
purposes, such as therapy planning or clinical guideline descriptions. From a more practical point
of view, also require to intend to study the application of the knowledge built up for knowledge
management systems in ICU and paediatrics to other hospital services.
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