Combining tabular, rule-based, and procedural knowledge in computer-based guidelines for childhood immunization.
IMM/Serve is a computer program which implements the clinical guidelines for childhood immunization. IMM/Serve accepts as input a child's immunization history. It then indicates which vaccinations are due and which vaccinations should be scheduled next. The clinical guidelines for immunization are quite complex and are modified quite frequently. As a result, it is important that IMM/Serve's knowledge be represented in a format that facilitates the maintenance of that knowledge as the field evolves over time. To achieve this goal, IMM/Serve uses four representations for different parts of its knowledge base: (1) Immunization forecasting parameters that specify the minimum ages and wait-intervals for each dose are stored in tabular form. (2) The clinical logic that determines which set of forecasting parameters applies for a particular patient in each vaccine series is represented using if-then rules. (3) The temporal logic that combines dates, ages, and intervals to calculate recommended dates, is expressed procedurally. (4) The screening logic that checks each previous dose for validity is performed using a decision table that combines minimum ages and wait intervals with a small amount of clinical logic. A knowledge maintenance tool, IMM/Def, has been developed to help maintain the rule-based logic. The paper describes the design of IMM/Serve and the rationale and role of the different forms of knowledge used.
Miller
P L
PL
Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut 06520-8009, USA.
Frawley
S J
SJ
Sayward
F G
FG
Yasnoff
W A
WA
Duncan
L
L
Fleming
D W
DW
D000367:Age Factors; D001185:Artificial Intelligence; D019433:Chickenpox Vaccine / Q000008:administration & dosage; D002648:Child; D003628:Database Management Systems; D003663:Decision Trees; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D005544:Forecasting; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006801:Humans; D007114:Immunization; D007115:Immunization Schedule; D008458:Measles Vaccine / Q000008:administration & dosage; D022542:Measles-Mumps-Rubella Vaccine; D016347:Medical Records Systems, Computerized; D009108:Mumps Vaccine / Q000008:administration & dosage; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D012411:Rubella Vaccine / Q000008:administration & dosage; D012985:Software Design; D013997:Time Factors; D014611:Vaccination; D017778:Vaccines, Combined / Q000008:administration & dosage
D019433:Chickenpox Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D017325:Hepatitis B Vaccines; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D011054:Poliovirus Vaccine, Inactivated; D011055:Poliovirus Vaccine, Oral; D012411:Rubella Vaccine; D017778:Vaccines, Combined