Creating Synthetic Patients to Address Interoperability Issues: A Case Study with the Management of Breast Cancer Patients

Abstract

Interoperability issues are common in biomedical informatics. Reusing data generated from a system in another system, or integrating an existing clinical decision support system (CDSS) in a new organization is a complex task due to recurrent problems of concept mapping and alignment. The GL-DSS of the DESIREE project is a guideline-based CDSS to support the management of breast cancer patients. The knowledge base is formalized as an ontology and decision rules. OncoDoc is another CDSS applied to breast cancer management. The knowledge base is structured as a decision tree. OncoDoc has been routinely used by the multidisciplinary tumor board physicians of the Tenon Hospital (Paris, France) for three years leading to the resolution of 1,861 exploitable decisions. Because we were lacking patient data to assess the DESIREE GL-DSS, we investigated the option of reusing OncoDoc patient data. Taking into account that we have two CDSSs with two formalisms to represent clinical practice guidelines and two knowledge representation models, we had to face semantic and structural interoperability issues. This paper reports how we created 10,681 synthetic patients to solve these issues and make OncoDoc data re-usable by the GL-DSS of DESIREE.

Efficacy of the Whole-Course Case Management Model on Compliance and Satisfaction of Breast Cancer Patients with Whole-Course Standardized Treatment

“…In the present study, the results showed that the experimental group had a lower incidence of adverse reactions, suggesting that the whole case management model contributes to lower postoperative adverse reactions in breast cancer patients. It is presumably due to the fact that the one-to-one case management boosts the patient's selfconfidence in disease management, thereby promoting the recovery of the patient's body function, improving the patient's self-efficacy and self-management behavior, and thus lowering the incidence of postoperative adverse reactions in cancer patients [16]. As previously noted, surgical trauma, disease recurrence, anxiety, and uncertainty of prognosis adversely affect the patients physiologically and psychologically, thereby compromising the patient's treatment compliance [17].…”

Reusing Decisions Made with One Decision Support System to Assess a Second Decision Support System: Introducing the Notion of Complex Cases

“…Thus, a tumor size of "more than 4cm" would have two possible correspondences, T2 (more than 4 cm but less than 5 cm) and T3 (more than 5 cm). To solve this interoperability issue, for each OncoDoc patient, we generated potential corresponding DESIREE synthetic patients [4].…”

“…As the two CDSSs make use of two different domain knowledge models and two different formalisms to represent breast cancer data and CPGs, we developed and implemented a model transformation from OncoDoc to DESIREE to be able to evaluate the GL-DSS with data generated from OncoDoc. Because one-to-one matching between the domain knowledge concepts of OncoDoc and DESIREE could not systematically be performed, we created "synthetic" patients to translate OncoDoc clinical cases in the DESIREE formalism [4]. Going further in the evaluation of the DESIREE GL-DSS, the aim of this paper is to describe the enrichment of the DESIREE ontology to integrate OncoDoc concepts, how the inference engine of the GL-DSS was used to implement the model transformation, and the results of the evaluation of the DESIREE GL-DSS.…”

The “Coherent Data Set”: Combining Patient Data and Imaging in a Comprehensive, Synthetic Health Record

“…There have been prior attempts to create synthetic health data that focus on interoperability [8,17] as well as work that attempted to enrich such data with de-identified time-series data (e.g., ECGs recorded in an ICU) [18] and work that linked together synthetic brain imagery phenotypes and synthetic genomic data to address the complexity of real health data that exist in various forms [13].…”