Bridging challenges of clinical decision support systems with a semantic approach. A case study on breast cancer

The integration of Clinical Decision Support Systems (CDSS) in nowadays clinical environments has not been fully achieved yet. Although numerous approaches and technologies have been proposed since 1960, there are still open gaps that need to be bridged. In this work we present advances from the established state of the art, overcoming some of the most notorious reported difficulties in: (i) automating CDSS, (ii) clinical workflow integration, (iii) maintainability and extensibility of the system, (iv) timely advice, (v) evaluation of the costs and effects of clinical decision support, and (vi) the need of architectures that allow the sharing and reusing of CDSS modules and services. In order to do so, we introduce a new clinical task model oriented to clinical workflow integration, which follows a federated approach. Our work makes use of the reported benefits of semantics in order to fully take advantage of the knowledge present in every stage of clinical tasks and the experience acquired by physicians. In order to introduce a feasible extension of classical CDSS, we present a generic architecture that permits a semantic enhancement, namely Semantic CDSS (S-CDSS). A case study of the proposed architecture in the domain of breast cancer is also presented, pointing some highlights of our methodology.