Arden syntax

Arden syntax is a markup language used for representing and sharing medical knowledge. This clinical and scientific knowledge language is used in an executable format by clinical decision support systems to generate alerts, interpretations, and to screen and manage messages to clinicians. This syntax is used to share medical knowledge within and across many health service institutions. At Columbia Presbyterian Medical center, 40 Arden syntax MLMs have been implemented in which 18 of those are clinical MLMs, including 4 interpretations and 14 alerts. For example, a user is alerted by three MLMs to the presence of hypokalemia and digoxin use that might lead to cardiac dysrhythmia. One MLM is activated by storage of a pharmacy order by digoxin,a second MLM is activated by the storage of a blood potassium result and the third activated by the storage of blood digoxin level. Twelve are research MLM examples, which include the ability to identify patients with abnormal cervical pathology, etc. that notify the researcher of the details of the patient's medical record and their inpatient location to enroll the patient in a study, and the remaining ten are administrative MLMs. IBM's artificial intelligence product, KnowledgeTool, provided the original basis for MLM syntax representation and processing, as enhanced and applied by CPMC researchers Drs. James J. Cimino, George Hripcsak, Steve Johnson, Carol Friedman, and others at CPMC, under the leadership of Paul D. Clayton. In a related effort under the same program, another prototype implementation of the syntax was developed by Peter Ludemann using Quintus Prolog. IBM program management and AI technology services were provided by Terry Rankin, Pete Smith, and Eddie Sanders.

The main aim of fuzzy Arden syntax is to provide easy method in processing of uncertain data which routinely appears in medicine. New concepts are incorporated into Arden syntax by fuzzy Arden syntax in order to assist in processing information that may not be completely defined. For example, a fuzzy logic has been used in knowledge base in Moni–ICU system at clinical institute of hospital hygiene of the Vienna general hospital. It is a system that detects and constantly checks hospital acquired infections. The accompanying plugin for Eclipse called Arden4Eclipse supports MLM developers with an integrated development environment (IDE).

Arden syntax is tested for reliability and imprecision using tools lex and Yacc that, when used together, create a compiler or interpreter. Source file is split into tokens by lex and the hierarchical structure of the programme is found by Yacc. These tools reduce ambiguities in the syntax. A Medical logic Module is composed of four categories, namely maintenance, library, knowledge and resources, with appropriate slots.

This category contains metadata about the MLM. The maintenance category consists of slots that indicate maintenance information unrelated to the medical knowledge in the module. The first slot is the title which gives a brief description of the module followed by a file name, a distinct identifier used to specify the MLM. The third slot is the version which specifies the version used. It also maintains a track of updates to the MLMs. A version slot is followed by institution and author slots that specify where the MLM is written and the person who wrote it. This slot is followed by date and validation slots which show the date at which MLM was last updated. The validation level is set by the specialist, it indicates that the MLM is only used for testing.

This category contains five slots called purpose, explanation, keywords, citations and links. The purpose slot explains what a particular MLM is used for, whereas the explanation slot illustrates how an MLM works. Terms that can be used to search through a knowledge base of MLM is supplied by a keyword slot. The citation and link slots are optional. References to literature that support MLM's medical behaviour are included in the citation slot. Institution specific links to other sources of information such as electronic textbooks and educational modules are contained in the links slot.

This category contains the actual medical knowledge of the MLM. It consists of type, data, priority, evoke, logic and action slots. The way in which MLM is used is known by type slot. Terms used in the rest of the MLM are defined by the data slot. Its goal is to separate those parts of the MLM that are specific to an institution from the more generic parts of the MLM. The order in which the MLM must be invoked are indicated by the priority, which can be a number from 1 (last) to 99 (first). It is a rarely used optional slot. An MLM can be activated by an event, or by a direct call from an MLM or an application programme which is specified by the evoke slot. A real medical condition or rule to test for is contained in the logic slot which may include compound calculations. The action slot creates a message that is sent to the health care provider, such as sending an alert to the destination, evoking other MLMs and returning values. The urgency slot is optional; it can be a number from 1 to 99 which indicates the importance of an MLMs action or message.