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25 Years of PROMISES: Lessons Learned from Modeling

Professional Practices

Extending Medical Enterprise Ontologies: Levels; Limits; and

Tensions

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7th International Protégé ConferenceJuly 6, 2004

• Bob Smith, Ph.D. Tall Tree Labs– robsmith5@1talltrees.com

• Bill Elliott, Internal Medical Labs– BillAppl@AOL.com

• Christian Fillies, SemTalk – clillies@semtalk.com www.sentalk.com

• Gay Woods-Albrecht– www.bpmsolutionsgroup.com

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Outline: 25 Years of PROMISES

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Problem Oriented Medical Records and Guidance:

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What happened to our Guidance expectations of

1980?

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Effective Supply and Demand

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Comprehensive Computer Supported Medical Decision

Support Systems?• Comprehensive: Intelligent, Robust, Adaptive?

• Computer Supported: Knowledge, Model Driven, and Data (Factual) Informed?

• Medical: Ecology: Public and Private Health Care and “caring systems”

• Decision Support: NOT Professional Automation but Professional Reasoning Enhancements

• Systems: Social components, technical components, cultural components with explicit guidance “rules for rule making in informed communities”

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OMB’s US Statistical Abstract-XML Altova Project and Practices

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JIT Process Knowledge Integration

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BPMN.Org Perspectives on Liaison Options – June, 2004

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Swim lanes Level 7 to Level 1(?)1. De Facto Standards (Current Practice Tensions between

competing evolving-emergent standards: Knowledge Management, Process Management, Standards Management; Business Strategist’s Strategy (HBR))

2. Standard Abstractions (MS, IBM, SUN: WS-I)

3. Regulatory Guidance Clusters (NIST, NIH, W3C, etc.)

4. CEO-Supply Chain Integration (Health Care Infrastructure and Payment Systems)

5. Medical Practitioners (Internal Medicine Associates, Inc.)

6. Technical Staff (IT-Lab Techs)

7. Patients with medical problem(s) and paper Med Records (Brave Dave with High PSA Radical Surgery)

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This Protégé Conference demonstrates top down strategies

• Vast changes in the supply of technical capability with ontologies, semantic web services standards, tools, vendors: with obvious economic and social ripple effects;

• Vast changes in the demographics of demand for effective and efficient integrated and orchestrated medical practice

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Bottom Up Strategy

• Size distribution of medical practice and associated IT and Process maturity– How and where do most patients receive

medical care? • Garfield model: Distributed health delivery areas

– Scenario: You are the technology “gatekeeper” for an 8 physician practice with a Stat Lab (Statistics go here…)

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Dialectics from HBR?

• Harvard Business Review June 2004 article by Michael Porter challenging current assumptions of US Health Care Competitive Strategies

• Can the Porter-Teisberg policy changes be modeled? With Ontology and Process Management-Knowledge Management simulators?

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Coherent Architectural Plans?

• What kind of a roadmap would you sketch for yourself, today, in thinking about the real needs of these physicians in your organization?

• How might you arrange to brainstorm the options using available process modeling and simulation tools to position Protégé and SAGE Projects in context?

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Application Development Options (Architect Needed)

• Protégé?• SemTalk2 ?• MS_DotNET?• Hybrid?• See link:

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Protege – Sage Project Architecture

• Sharable Active Guidance Environment

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Process Model: AS IS

• Describe current workflow

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References

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Alan Rector: Where are we going?

• Citation: Rector, AL (2001) AIM: A personal view of where I have been and where we might be going. Artificial Intelligence in Medicine 23:111-127

• “My own career in Medical Informatics and AI in Medicine has oscillated between – concerns with medical records and – concerns with knowledge representation with decision support

as a pivotal integrating issue. • It has focused on using AI to organize information and

reduce ‘muddle’ and• improve the user interfaces to produce ‘useful and

usable systems’ to help doctors with a ‘humanly impossible task’. “

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25 Years of PROMISES

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Reference Domains

1. Protégé/Sage Project/CoP linkages

2. Ontology Management of OE

3. Health Care Technology Trends (Cladistics)

4. Strategy and Policy (Direction and Guidance)

5. Business Semantic Primes

6. Knowledge Flow Metrics

7. Process Knowledge Management