GASTON framework

Home page: www.openclinical.org/gmm gaston.html

Gaston is a methodology and a framework that facilitates the development and implementation of computer-interpretable guidelines and guideline-based decision support systems. Gaston has been developed during the last 7 years by a joint effort of the Department of medical Informatics of Maastricht University and the Signal Processing Systems group of the Eindhoven University of Technology. The overall goal of this approach is to improve the acceptance of computer-interpretable guidelines and decision support systems in daily care by facilitating all phases in the guideline development process. The central research questions of the Gaston project are:

• How to represent and share various types of guidelines using a formal and unambiguous representation.
• How to translate guidelines from a textual format into this formal representation.
• How to handle local adaptation and synchronization between (inter)national and local guidelines.
• How to evaluate guidelines and decision support systems in daily practice.
• How to interface guideline-based decision support systems with external patient information systems.
• How to provide decision support to a care provider in daily practice.
• How to handle real-time patient data sources such as patient monitors that contain streaming physiological data (e.g., heart rate or ECG).

1. A guideline representation formalism that uses the concepts of primitives, Problem-Solving Methods (PSMs) and ontologies to represent guidelines of various complexity and granularity and different application domains;
2. A guideline authoring environment that enables guideline authors to define guidelines;
3. A guideline execution environment that translates defined guidelines into a more efficient representation, which can be read in and processed by an execution-time engine.

The guideline representation formalism uses a frame-based model as an underlying mechanism. The formalism is non-monolithic, meaning that it can be extended with additional classes to capture new guideline characteristics. Similar to the GLIF and EON approaches, the Gaston guideline authoring environment represents and visualizes guidelines by temporally sequenced graphs (flowcharts) of frame instances from the guideline model. During the authoring process, Gaston defines different roles a guideline author may play such as 1) the principal guideline author, who defines the control structure and initial contents of the guideline, 2) the local guideline author, who adapts the contents of the guideline to local standards and 3) the local information manager, who specifies communication and implementation details. As a result, guidelines in Gaston consists of various layers (depending on the guideline's complexity or application domain) that describe the control structure of a guideline (flow), its contents (e.g., actual decisions or actions), possible local adaptations, and communication/implementation details (e.g., the method of acquiring patient data or the form of decision support). The Gaston approach defines various methods for the detection of various logical and procedural errors in guidelines. In addition, the framework also contains a simulation environment where developed guidelines and decision support systems can be tested and evaluated. Finally, the framework contains a guideline execution environment that is able to execute guidelines and interface with external patient information systems. The execution environment consists of a core guideline execution engine, which can be extended with additional components (plugins) to communicate with patient information systems, medical databases and patient monitors.