Appl Clin Inform 2020; 11(02): 200-209
DOI: 10.1055/s-0040-1705105
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Mapping Patient Data to Colorectal Cancer Clinical Algorithms for Personalized Guideline-Based Treatment

Matthias Becker
1   Department of Computer Science, University of Applied Sciences and Arts, Dortmund, Germany
2   Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
Britta Böckmann
1   Department of Computer Science, University of Applied Sciences and Arts, Dortmund, Germany
2   Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
Karl-Heinz Jöckel
2   Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
Martin Stuschke
3   Radiation and Tumor Clinic, University Hospital Essen, Essen, Germany
Andreas Paul
4   Surgical Clinic, University Hospital Essen, Essen, Germany
Stefan Kasper
5   West German Cancer Center, University Hospital Essen, Essen, Germany
Isabel Virchow
5   West German Cancer Center, University Hospital Essen, Essen, Germany
› Author Affiliations
Funding The research reported in this publication was supported by the West German Cancer Center and the Institute of Medical Informatics, Biometry and Epidemiology in Essen, Germany. This study was performed free of charge and for noncommercial purposes. The content is solely the responsibility of the authors and does not necessarily represent the official views of the University Hospital in Essen, Germany.
Further Information

Publication History

30 August 2019

22 January 2020

Publication Date:
18 March 2020 (online)


Background Colorectal cancer is the most commonly occurring cancer in Germany, and the second and third most commonly diagnosed cancer in women and men, respectively. In this context, evidence-based guidelines positively impact the quality of treatment processes for cancer patients. However, evidence of their impact on real-world patient care remains unclear. To ensure the success of clinical guidelines, a fast and clear provision of knowledge at the point of care is essential.

Objectives The objectives of this study are to model machine-readable clinical algorithms for colon carcinoma and rectal carcinoma annotated by Unified Medical Language System (UMLS) based on clinical guidelines and the development of an open-source workflow system for mapping clinical algorithms with patient-specific information to identify patient's position on the treatment algorithm for guideline-based therapy recommendations.

Methods This study qualitatively assesses the therapy decision of clinical algorithms as part of a clinical pathway. The solution uses rule-based clinical algorithms, which were developed based on the corresponding guidelines. These algorithms are executed on a newly developed open-source workflow system and are visualized at the point of care. The aim of this approach is to create clinical algorithms based on an established business process standard, the Business Process Model and Notation (BPMN), which is annotated by UMLS terminologies. The gold standard for the validation process was set by manual extraction of clinical datasets from 86 rectal cancer patients and 89 colon cancer patients.

Results Using this approach, the algorithm achieved a precision value of 87.64% for colon cancer and 84.70% for rectal cancer with recall values of 87.64 and 83.72%, respectively.

Conclusion The results indicate that the automatic positioning of a patient on the decision pathway is possible with tumor stages that have a less complex clinical algorithm with fewer decision points reaching a higher accuracy than complex stages.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the University Hospital Ethics Committee, Essen Germany.

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