EON: a component-based approach to automation of protocol-directed therapy.

Provision of automated support for planning protocol-directed therapy requires a computer program to take as input clinical data stored in an electronic patient-record system and to generate as output recommendations for therapeutic interventions and laboratory testing that are defined by applicable protocols. This paper presents a synthesis of research carried out at Stanford University to model the therapy-planning task and to demonstrate a component-based architecture for building protocol-based decision-support systems. We have constructed general-purpose software components that (1) interpret abstract protocol specifications to construct appropriate patient-specific treatment plans; (2) infer from time-stamped patient data higher-level, interval-based, abstract concepts; (3) perform time-oriented queries on a time-oriented patient database; and (4) allow acquisition and maintenance of protocol knowledge in a manner that facilitates efficient processing both by humans and by computers. We have implemented these components in a computer system known as EON. Each of the components has been developed, evaluated, and reported independently. We have evaluated the integration of the components as a composite architecture by implementing T-HELPER, a computer-based patient-record system that uses EON to offer advice regarding the management of patients who are following clinical trial protocols for AIDS or HIV infection. A test of the reuse of the software components in a different clinical domain demonstrated rapid development of a prototype application to support protocol-based care of patients who have breast cancer.

为实现方案指导治疗的自动化规划支持，需依托计算机程序读取存储于电子病历系统中的临床数据作为输入，并输出由适用诊疗方案所定义的治疗干预措施与实验室检测建议。本论文综合阐述了斯坦福大学开展的相关研究：一是针对治疗规划任务构建计算模型，二是展示了用于搭建基于方案的决策支持系统的组件化架构。我们已开发出通用软件组件，其功能涵盖：(1) 解析抽象方案规范，生成适配患者个体的治疗计划；(2) 从带时间戳的患者数据中推导出更高层级、基于时间区间的抽象概念；(3) 面向时间型患者数据库执行时间相关查询；(4) 以兼顾人类与计算机高效处理的方式，实现方案知识的获取与维护。我们已将上述组件集成于名为EON的计算机系统中。各组件均已独立完成开发、评估并发表相关研究成果。我们通过搭建T-HELPER系统验证了该复合架构的集成效果：T-HELPER是一款基于计算机的病历系统，依托EON为遵循艾滋病（AIDS）或人类免疫缺陷病毒（HIV）感染临床试验方案的患者提供诊疗管理建议。我们在另一临床领域开展了软件组件复用测试，结果表明可快速开发出原型应用，用于支持乳腺癌患者的基于方案的诊疗工作。