A workflow based clinical decision support system through integration of clinical workflow and knowledge processing

This paper proposes a workflow based clinical decision support system(CDSS) incorporating two main parts of CDSSs: 1) clinical workflow to control diagnostic activities and clinical events, and 2) knowledge processing by rule based inference for decisionmaking of clinicians. The requirements of a workflow based CDSS were derived by analyzing SAGE (Standards-Based Sharable Active Guideline Environment), which representatively incorporates the workflow concept into clinical guidelines. An open-source based workflow management system (WfMS) was adopted as a framework for integrating a guideline converter, a rule engine, and a CDS service provider. We implemented the proposed system in local clinical institutes using different guidelines: 1) Lab alerting to test the architectural plausibility, 2) Hypertension to verify the coverage for clinical knowledge processing, and 3) Severe Sepsis to validate the functions of event handling and workflow automation.