title: Integrating HL7 RIM and ontology for unified knowledge and data representation in clinical decision support systems.
abstract: OBJECTIVE
  The broad adoption of clinical decision support systems within clinical practice has been hampered mainly by the difficulty in expressing domain knowledge and patient data in a unified formalism. This paper presents a semantic-based approach to the unified representation of healthcare domain knowledge and patient data for practical clinical decision making applications.
  
  
  METHODS
  A four-phase knowledge engineering cycle is implemented to develop a semantic healthcare knowledge base based on an HL7 reference information model, including an ontology to model domain knowledge and patient data and an expression repository to encode clinical decision making rules and queries. A semantic clinical decision support system is designed to provide patient-specific healthcare recommendations based on the knowledge base and patient data.
  
  
  RESULTS
  The proposed solution is evaluated in the case study of type 2 diabetes mellitus inpatient management. The knowledge base is successfully instantiated with relevant domain knowledge and testing patient data. Ontology-level evaluation confirms model validity. Application-level evaluation of diagnostic accuracy reaches a sensitivity of 97.5%, a specificity of 100%, and a precision of 98%; an acceptance rate of 97.3% is given by domain experts for the recommended care plan orders.
  
  
  CONCLUSIONS
  The proposed solution has been successfully validated in the case study as providing clinical decision support at a high accuracy and acceptance rate. The evaluation results demonstrate the technical feasibility and application prospect of our approach.
authors.affiliation: Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, No. 38 Zheda Road, Hangzhou 310027, China. Electronic address: yifanzhang@zju.edu.cn.
authors.forename: Yi-Fan
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, No. 38 Zheda Road, Hangzhou 310027, China. Electronic address: ty.1987823@163.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, No. 38 Zheda Road, Hangzhou 310027, China. Electronic address: zts@zju.edu.cn.
authors.forename: Tian-Shu
authors.initials: TS
authors.lastname: Zhou
authors.affiliation: Department of Medical Informatics, Miyazaki University Hospital, 5200 Kiyotakecho Kihara, Miyazaki-city, Miyazaki 889-1692, Japan. Electronic address: taichan@med.miyazaki-u.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Araki
authors.affiliation: Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, No. 38 Zheda Road, Hangzhou 310027, China. Electronic address: ljs@zju.edu.cn.
authors.forename: Jing-Song
authors.initials: JS
authors.lastname: Li
mesh_terms: D064229:Biological Ontologies / Q000706:statistics & numerical data; D000066491:Clinical Decision-Making; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D006801:Humans; D051188:Knowledge Bases; D008490:Medical Informatics; D015233:Models, Statistical; D012984:Software
keywords: CDSS; HL7 RIM; Knowledge base; Ontology; Semantic Web Technologies