title: Using Arden Syntax for the creation of a multi-patient surveillance dashboard.
abstract: Most practically deployed Arden-Syntax-based clinical decision support (CDS) modules process data from individual patients. The specification of Arden Syntax, however, would in principle also support multi-patient CDS. The patient data management system (PDMS) at our local intensive care units does not natively support patient overviews from customizable CDS routines, but local physicians indicated a demand for multi-patient tabular overviews of important clinical parameters such as key laboratory measurements. As our PDMS installation provides Arden Syntax support, we set out to explore the capability of Arden Syntax for multi-patient CDS by implementing a prototypical dashboard for visualizing laboratory findings from patient sets.
  
  
  
  Our implementation leveraged the object data type, supported by later versions of Arden, which turned out to be serviceable for representing complex input data from several patients. For our prototype, we designed a modularized architecture that separates the definition of technical operations, in particular the control of the patient context, from the actual clinical knowledge. Individual Medical Logic Modules (MLMs) for processing single patient attributes could then be developed according to well-tried Arden Syntax conventions.
  
  
  
  We successfully implemented a working dashboard prototype entirely in Arden Syntax. The architecture consists of a controller MLM to handle the patient context, a presenter MLM to generate a dashboard view, and a set of traditional MLMs containing the clinical decision logic. Our prototype could be integrated into the graphical user interface of the local PDMS. We observed that with realistic input data the average execution time of about 200ms for generating dashboard views attained applicable performance.
  
  
  
  Our study demonstrated the general feasibility of creating multi-patient CDS routines in Arden Syntax. We believe that our prototypical dashboard also suggests that such implementations can be relatively easy, and may simultaneously hold promise for sharing dashboards between institutions and reusing elementary components for additional dashboards.
authors.affiliation: Center for Communication and Information Technology, University Hospital Erlangen, Glückstraße 11, 91054 Erlangen, Germany; Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen-Tennenlohe, Germany. Electronic address: stefan.kraus@uk-erlangen.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kraus
authors.affiliation: Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen-Tennenlohe, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Drescher
authors.affiliation: Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen-Tennenlohe, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Sedlmayr
authors.affiliation: Department of Anaesthesiology, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany.
authors.forename: Ixchel
authors.initials: I
authors.lastname: Castellanos
authors.affiliation: Center for Communication and Information Technology, University Hospital Erlangen, Glückstraße 11, 91054 Erlangen, Germany; Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen-Tennenlohe, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Prokosch
authors.affiliation: Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen-Tennenlohe, Germany.
authors.forename: Dennis
authors.initials: D
authors.lastname: Toddenroth
mesh_terms: D001185:Artificial Intelligence; D020000:Decision Support Systems, Clinical / Q000458:organization & administration* / Q000592:standards; D005103:Expert Systems; D006751:Hospital Information Systems / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008490:Medical Informatics; D011381:Programming Languages; D062606:Tertiary Care Centers
keywords: Arden Syntax; Medical Logic Modules; Multi-patient clinical decision support; Surveillance dashboard