RSS-Feed abonnieren
DOI: 10.1055/s-0041-1731001
A Comparison of Arden Syntax and Clinical Quality Language as Knowledge Representation Formalisms for Clinical Decision Support
Funding Dr. Jenders was supported by NIMHD grants U54MD007598 and S21MD000103 and NCATS grant UL1TR001881 from the National Institutes of Health (USA).
Abstract
Objectives This article presents a comparative study of two Health Level Seven International (HL7) standards for clinical knowledge representation, the Arden Syntax and the Clinical Quality Language (CQL), regarding their expressiveness and utility to represent knowledge for clinical decision support (CDS) systems.
Methods We compiled a concatenated set of features from both languages and made descriptive comparisons of 27 categories covering areas of language characteristics, data, control statements, and operators.
Results Both Arden and CQL have similar constructs that can be used for representing CDS knowledge but also have unique constructs that could support distinct use cases. They have constructs that fully or partially address several of the categories used in the comparison, except for data models and terminologies in Arden and event triggering and iteration statements in CQL.
Conclusion These standards can facilitate the sharing, management, and reuse of computable knowledge, and permit knowledge to be represented with their languages and converted to a machine-friendly executable code that can be shared and reused by other systems. Having support for standard data models and terminologies will continue to be a differential for adoption of a language. The HL7 working groups responsible for developing these standards can direct future development to enhance the functions of the standard and address the gaps identified in this study.
Keywords
clinical decision support - Clinical Quality Language - Arden Syntax - comparison - knowledge representationProtection of Human and Animal Subjects
Human and animal subjects were not included in this project.
Publikationsverlauf
Eingereicht: 15. Januar 2021
Angenommen: 03. Mai 2021
Artikel online veröffentlicht:
30. Juni 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504
- 2 Electronic Specifications for Clinical Quality Measures | CMS. Accessed December 30, 2020 at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Electronic_Reporting_Spec
- 3 Behilng D, Davis D, Sherman G. et al. Quality Data Model Based Health Quality Measures Format (eMeasure) Implementation Guide, Release 1 (US Realm) Based on HL7 HQMF Release 2.0.
- 4 QDM - Quality Data Model | eCQI Resource Center. Accessed December 30, 2020 at: https://ecqi.healthit.gov/qdm
- 5 HQMF - Health Quality Measure Format | eCQI Resource Center. Accessed December 19, 2020 at: https://ecqi.healthit.gov/hqmf
- 6 Value Set Authority Center. Accessed December 28, 2020 at: https://vsac.nlm.nih.gov
- 7 Clinical Quality Language (CQL). Accessed July 23, 2020 at: https://cql.hl7.org.
- 8 Jenders RA, Adlassnig K-P, Fehre K, Haug P. Evolution of the Arden Syntax: key technical issues from the standards development organization perspective. Artif Intell Med 2018; 92: 10-14
- 9 HL7 Standards Product Brief - Arden Syntax v2.10 (Health Level Seven Arden Syntax for Medical Logic Systems, Version 2.10) | HL7 International. Accessed July 23, 2020 at: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=372
- 10 Lomotan EA, Meadows G, Michaels M, Michel JJ, Miller K. To Share is Human! Advancing evidence into practice through a national repository of interoperable clinical decision support. Appl Clin Inform 2020; 11 (01) 112-121
- 11 Jenders RA. Chapter 15 - Decision rules and expressions. In: Greenes RA. ed. Clinical Decision Support. 2nd ed.. Academic Press; 2014: 417-434 ISBN: 9780123984760
- 12 Robert W. Sebesta. Concepts of Programming Languages. 10th ed.. Pearson; 2013. . ISBN-13: 9780131395312
- 13 Jenders RA, Haug P, Adlassnig K. P. Arden Syntax Implementation Guide Release 3. 2019 . Accessed December 27, 2020 at: https://confluence.hl7.org/download/attachments/40741751/arden-syntax-IG-R3-2019-09-16-ballot-reconciliation.pdf
- 14 Cooking with CQL. GitHub. Accessed March 23, 2021 at: https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki
- 15 Backus-Naur Form - an overview | ScienceDirect Topics. Accessed July 23, 2020 at: https://www.sciencedirect.com/topics/computer-science/backus-naur-form
- 16 ANTLR. Accessed July 23, 2020 at: https://www.antlr.org
- 17 Jung CY, Sward KA, Haug PJ. Executing medical logic modules expressed in ArdenML using Drools. J Am Med Inform Assoc 2012; 19 (04) 533-536
- 18 Overview FHIR. HL7 FHIR. Accessed August 4, 2020 at: https://www.hl7.org/fhir/overview.html
- 19 Kraus S, Drescher C, Sedlmayr M, Castellanos I, Prokosch H-U, Toddenroth D. Using Arden Syntax for the creation of a multi-patient surveillance dashboard. Artif Intell Med 2018; 92: 88-94
- 20 Systematized Nomenclature of Medicine (SNOMED). Accessed March 23, 2021 at: https://www.snomed.org
- 21 Logical Observation Identifiers Names and Codes (LOINC). LOINC. Accessed March 23, 2021 at: https://loinc.org
- 22 Hripcsak G, Ludemann P, Pryor TA, Wigertz OB, Clayton PD. Rationale for the Arden Syntax. Comput Biomed Res 1994; 27 (04) 291-324
- 23 Klaus-Peter Adlassnig Karsten Fehre.. Service-Oriented Fuzzy-Arden-Syntax-Based Clinical Decision Support. Indian J Med Inform 2014:75–79. Accessed May 29, 2021 at: http://www.meduniwien.ac.at/kpa/publications/2014_IJOMI_--_Service-Oriented_Fuzzy-Arden-Syntax-Based_Clinical_Decision_Support.pdf
- 24 de Bruin JS, Steltzer H, Rappelsberger A, Adlassnig K-P. Creating clinical fuzzy automata with fuzzy Arden Syntax. AMIA Annu Symp Proc AMIA Symp. 2017 2017. 475-484
- 25 Tiffe S. Defining medical concepts by linguistic variables with fuzzy Arden Syntax. Proc AMIA Symp; 2002: 796-800
- 26 BPMN Specification - Business Process Model and Notation. Accessed March 23, 2021 at: https://www.bpmn.org
- 27 Case Management Model and NotationTM (CMMNTM) | Object Management Group. Accessed March 23, 2021 at: https://www.omg.org/cmmn
- 28 Decision Model and NotationTM (DMNTM) | Object Management Group. Accessed March 23, 2021 at: https://www.omg.org/dmn
- 29 ONC's Cures Act Final Rule. Accessed May 10, 2020 at: https://www.healthit.gov/curesrule