The "human Cli-Knowme" Project: Building a universal, formal, procedural and declarative clinical knowledge base, for the automation of therapy and research

Currently, most clinical knowledge is in free text and is not easily accessible to clinicians and medical researchers. A major grand challenge for medical informatics is the creation of a distributed, universal, formal, sharable, reusable, and computationally accessible medical knowledge base. The required knowledge consists of both procedural knowledge, such as clinical guidelines, and declarative knowledge, such as context-sensitive interpretations of longitudinal patterns of raw clinical data accumulating from several sources. In this position paper, I first demonstrate the feasibility of such an enterprise, and explain in detail the overall lifecycle of a clinical guideline, by reviewing the main current components and their respective evaluations of one such comprehensive architecture for management of clinical guidelines: The Digital Electronic Guideline Library (DeGeL), a Web-based, modular, distributed architecture that facilitates gradual conversion of clinical guidelines from text to a formal representation in chosen target guideline ontology. The architecture supports guideline classification, semantic markup, context-sensitive search, browsing, run-time application to a specific patient at the point of care, and retrospective quality assessment. The DeGeL architecture operates closely with a declarative-knowledge temporal-abstraction architecture, IDAN. Thus, there is significant evidence that building a distributed, multiple-ontology architecture that caters for the full life cycle of a significant portion of current clinical procedural and declarative knowledge, which I refer to as "the Human Clin-knowme Project," has become a feasible task for a joint, coordinated, international effort involving clinicians and medical informaticians.