יובל שחר

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.