Improving Medical Protocols by Formal Methods

Title{Improving Medical Protocols by Formal Methods}
Publication TypeJournal Article
Year of Publication2006
Authorsten Teije, A., M. Marcos, J. van Croonenborg, C. Duelli, F. van Harmelen, P. Lucas, S. Miksch, W. Reif, K. Rosenbrand, and A. Seyfang
JournalArtifical Intelligence in Medicine (AIIM)
Type of ArticleRefereed Journal Articles
KeywordsCGP, Formal Methods, Medical Guidelines, Medical Protocols, Modelling of protocols, Verification of protocols

Abstract Objectives During the last decade, evidence-based medicine has given rise to an increasing number of medical practice guidelines and protocols. However, the work done on developing and distributing protocols outweighs the efforts on guaranteeing their quality. Indeed, anomalies like ambiguity and incompleteness are frequent in medical protocols. Recent efforts have tried to address the problem of protocol improvement, but they are not sufficient since they rely on informal processes and notations. Our objective is to improve the quality of medical protocols. This work has been done in the framework of the EU project Protocure (IST-2001-33049 – Protocure, Improving medical protocols by formal methods). See (last accessed 1 October 2005). †corresponding author 1 Approach The solution we suggest to the problem of quality improvement of protocols consists in the utilisation of formal methods. It requires the definition of an adequate protocol representation language, the development of techniques for the formal analysis of protocols described in that language and, more importantly, the evaluation of the feasibility of the approach based on the formalisation and verification of real-life medical protocols. For the first two aspects we rely on earlier work from the fields of Knowledge Representation and Formal Methods. The third aspect, i.e. the evaluation of the use of formal methods in the quality improvement of protocols, constitutes our main objective. The steps with which we have carried out this evaluation are the following: (1) Take two real-life reference protocols which cover a wide variety of protocol characteristics; (2) Formalise these reference protocols; (3) Check the formalisation for the verification of interesting protocol properties; and (4) Determine how many errors can be uncovered in this way. Results Our main results are: a consolidated formal language to model medical practice protocols; two protocols, each both modelled and formalised; a list of properties that medical protocols should satisfy; verification proofs for these protocols and properties; and perspectives of the potentials of this approach. Our results have been evaluated by a panel of medical experts, who judged that the problems we detected in the protocols with the help of formal methods were serious and should be avoided. Conclusions We have succeeded in demonstrating the feasibility of formal methods for improving medical protocols.