Högskolan i Skövde

 Background: Information technology (IT) support for remote collaboration of geographically distributed communities of practice (CoP) in health care must deal with a number of sociotechnical aspects of communication within the community. In the mid-1990s, participants of the Swedish Oral Medicine Network (SOMNet) began discussing patient cases in telephone conferences. The cases were distributed prior to the conferences using PowerPoint and email. For the technical support of online CoP, Semantic Web technologies can potentially fulfill needs of knowledge reuse, data exchange, and reasoning based on ontologies. However, more research is needed on the use of Semantic Web technologies in practice.

Objectives: The objectives of this research were to (1) study the communication of distributed health care professionals in oral medicine; (2) apply Semantic Web technologies to describe community data and oral medicine knowledge; (3) develop an online CoP, Swedish Oral Medicine Web (SOMWeb), centered on user-contributed case descriptions and meetings; and (4) evaluate SOMWeb and study how work practices change with IT support.

Methods: Based on Java, and using the Web Ontology Language and Resource Description Framework for handling community data and oral medicine knowledge, SOMWeb was developed using a user-centered and iterative approach. For studying the work practices and evaluating the system, a mixed-method approach of interviews, observations, and a questionnaire was used.

Results: By May 2008, there were 90 registered users of SOMWeb, 93 cases had been added, and 18 meetings had utilized the system. The introduction of SOMWeb has improved the structure of meetings and their discussions, and a tenfold increase in the number of participants has been observed. Users submit cases to seek advice on diagnosis or treatment, to show an unusual case, or to create discussion. Identified barriers to submitting cases are lack of time, concern about whether the case is interesting enough, and showing gaps in one’s own knowledge. Three levels of member participation are discernable: a core group that contributes most cases and most meeting feedback; an active group that participates often but only sometimes contribute cases and feedback; and a large peripheral group that seldom or never contribute cases or feedback.

Conclusions: SOMWeb is beneficial for individual clinicians as well as for the SOMNet community. The system provides an opportunity for its members to share both high quality clinical practice knowledge and external evidence related to complex oral medicine cases. The foundation in Semantic Web technologies enables formalization and structuring of case data that can be used for further reasoning and research. Main success factors are the long history of collaboration between different disciplines, the user-centered development approach, the existence of a “champion” within the field, and nontechnical community aspects already being in place.

We present a research program for identifying, modeling, and making use of generic pragmatic patterns for clinical knowledge management that support evidence-based medicine (EBM). Part of this program is SOMWeb, a system based on Semantic Web technologies, which is used for knowledge sharing and dissemination within an oral medicine community. A study of the use of SOMWeb has been conducted as the first step in the elicitation of important contextual factors and communicative activities involved in knowledge sharing processes in oral medicine. One such activity, community discussion activation, is described using consultation patterns together with the collaboration patterns of [5]. The general need for context-aware health information systems and the prospective use of approaches within Pragmatic Web in the pursuit of EBM are also discussed.

SOMWeb is an online collaboration system based on Semantic Web technologies, which is used for knowledge sharing and dissemination within an oral medicine community in Sweden. Based on a previous study of the use of SOMWeb, general patterns of interaction and communicative activities involved in community collaboration have been identified. The patterns for one such activity, distance consultation, are described and modeled using techniques from the Pragmatic Web. It is also shown how patterns could inform system design

Founded on the Semantic Web technologies OWL and RDF, SOMWeb is an online community of practice that is used for knowledge sharing and dissemination within an oral medicine community in Sweden. It is shown how patterns for communication and collaboration within SOMWeb can be identified and represented in OWL, in terms of knowledge components, such as ontologies describing domain knowledge, user models, and organization models. It is described how patterns could be put into use and inform the design of future versions of SOMWeb.

In a net-based society, clinicians can come together for cooperative work and distance learning around a common medical material. This requires suitable techniques for cooperative knowledge management and user interfaces that are adapted to both the group as a whole and to individuals. To support distributed management and sharing of clinical knowledge, we propose the development of an intelligent web community for clinicians within oral medicine. This virtual meeting place will support the ongoing work on developing a digital knowledge base, providing a foundation for a more evidence-based oral medicine. The presented system is founded on the use and development of web services and standards for knowledge modelling and knowledge-based systems. The work is conducted within the frame of a well-established cooperation between oral medicine and computer science.

Modern healthcare's need for knowledge sharing and bridging the research–practice gap requires new forms of collaboration, in which clinicians of varying clinical and research expertise work together over geographical and organisational borders. To support such distributed communities of practice (CoPs), an understanding of their collaboration processes, outcomes, challenges and enablers is needed. The article examines these issues through a case study of a long-running CoP, the Swedish Oral Medicine Network (SOMNet). SOMNet's main form of collaboration is monthly telephone conference meetings centred on case consultations. Cases are submitted by the clinicians via a Web-based system. The methods used were interviews, observations, and a questionnaire. The work adds to previous research by studying a distributed CoP explicitly focused on supporting the transfer of scientific results from researchers to practitioners. We found that the regular meetings give a rhythm to the community. The centrality of cases means an immediate benefit for the submitter while the community is provided an authentic context for learning. SOMNet yields opportunities for help and learning for diverse expertise levels; the type of benefits is affected by the participant's degree of oral medicine knowledge and collaboration involvement. There are challenges in accommodating varying levels of expertise and encouraging those less experienced to participate. Enablers of the collaboration include the participation of experts, meeting facilitators and well-adapted ITs.

This thesis addresses how ontology-driven applications can be designed and developed to support distributed clinical knowledge management in oral medicine, where geographically dispersed practitioners need to share practical clinical knowledge. A step in developing tools for knowledge management is representing knowledge in a machine-processable and sharable manner. We investigate the use of the World Wide Web Consortium's recommendations of the Web Ontology Language (OWL) and Resource Description Framework (RDF) to describe clinical knowledge in oral medicine. The MedView project, a cooperation between clinicians in oral medicine and computer scientists, provides a basis for this work. Limitations of MedView's original knowledge model are identified, together with a list of requirements for a new model.

In this new model, OWL and RDF are used for representing examination templates, value lists, aggregates of values, and individual examination records. Further, we give a description of how the ISO/IEC 15288 system life cycle processes can be used to structure the ontology development process. To support distributed knowledge management in oral medicine, an online community for sharing and discussing difficult and interesting cases was built, which uses OWL and RDF for representing examinations, users, meetings, news, and case meta-data. OWL and RDF were found to support the requirements of making ontology reuse possible, and different language versions and meta-data are more easily represented than in the original model. One of the requirements not readily provided for is capturing interactions between different parts of templates, for which the Semantic Web Rule Language could be used. In practice, we found it hard to find ontologies to reuse. Further, there are differing opinions on the appropriate use of constructs, and OWL doesn't directly provide the expected validation facilities. Also, we found a lack of guidance for developing OWL ontologies at different levels of sophistication.

This report describes the remodeling of the representation of clinical examinations in oral medicine, from the previous proprietary format used by the MedView project, to using the World Wide Web Consortium's recommendations Web Ontology Language (OWL) and Resource Description Framework (RDF). This includes the representation of (1) examination templates, (2) lists of values that can be included in individual examination records, and (3) aggregates of such values used for e.g., analyzing and visualizing data. It also includes the representation of (4) individual examination records. We describe how OWL and RDF are used to represent these different knowledge components of MedView, along with the design decisions made in the remodeling process. These design decisions are related to, among other things, whether or not to use the constructs of domain and range, appropriate naming in URIs, the level of detail to initially aim for, and appropriate use of classes and individuals. A description of how these new representations are used in the previous applications and code base is also given, as well as their use in the Swedish Oral Medicine Web (SOMWeb) online community. We found that OWL and RDF can be used to address most, but not all, of the requirements we compiled based on the limitations of the MedView knowledge model. Our experience in using OWL and RDF is that, while there is much useful support material available, there is some lack of support for important design decisions and best practice guidelines are still under development. At the same time, using OWL gives us access to a potentially beneficial array of externally developed tools and the ability to come back and refine the knowledge model after initial deployment.

This thesis concerns supporting the collaboration and knowledge sharing of distributed clinicians of oral medicine, a sub-discipline of dentistry. The Swedish Oral Medicine Network (SOMNet) holds monthly telephone conferences where a group of clinicians discuss interesting and difficult cases, which distinguishes it from one-to-one teleconsultations. SOMNet can be seen as a distributed community of practice, that is, a group of people sharing a concern and who interact regularly to extend their individual and collective expertise. Related to this, several topics need further investigation: How can geographically distributed clinical collaboration be characterized? What is appropriate functionality for a Web-based system supporting such collaborations? What are the impacts of such systems on collaboration? Further, Semantic Web technologies, such as the Web Ontology Language (OWL), have been proposed as a means of enhancing knowledge sharing. What are benefits and limitations of using these technologies to encode domain knowledge in oral medicine and to support clinical collaboration, and what practical issues face developers? The developed system, SOMWeb, focuses on functionality for meetings and structured cases, and has been regularly used for three years. Interviews, observations, a questionnaire, system log analysis, and case analysis were used to study SOMNet's collaboration and identify system impacts. The documentation of the forms of collaboration in SOMNet can serve as a model for other groups of clinicians wishing to establish a distributed collaboration. SOMNet's meetings provide a necessary rhythm for the community and the cases give context to the clinicians' learning which point toward that the centrality of meetings and cases in a tool will benefit collaboration. Impacts on SOMNet's collaboration include enabling the participation of a wider range of clinics. Factors influencing this are the more accessible submission process as well as the increased tangibility of the collaboration. The thesis also provides recommendations for developers of systems supporting clinical collaboration and knowledge sharing. The use of OWL in examination descriptions has enabled reasoning over cases in the system to provide improved case browsing. At the same time, limitations were found in using OWL for examination templates. Based on the lessons learned in this development, the thesis provides recommendations for using Semantic Web technologies, which can be of value for other developers and to guide future research.

This article describes the modeling of clinical examinations in oral medicine using OWL. Based on experiences from our previous work and knowledge model, requirements for an ontology for examinations in oral medicine are identified. OWL can be used to address most, but not all, of the requirements. We found a lack of guidance for several design choices and for development of OWL ontologies at different levels of sophistication. However, using OWL gives us the ability to come back and refine the knowledge model after initial deployment.

To support knowledge sharing between practitioners of oral medicine throughout Sweden, the SOMWeb system for community collaboration has been constructed, based on Semantic Web technologies. A large function of the system is to support the discussion of difficult and interesting cases at a monthly telephone conference. From our observations of these meetings, a the users’ responses to a questionnaire, and discussions with users, we find that many of the improvements that can be made to enable further use of the system relate to adding the use of context. Some initial thoughts on what would be relevant to represent in relation to context are given, such as the experience of the practitioner, the reason for adding a case to the system, and the current activity of the user. The long-term aims of this work is to identify aspects of context relevant to online communities of practice in healthcare, and to investigate how these contexts can be modeled using Semantic Web technologies.

Medical ontologies like GALEN, the FMA or SNOMED represent a kind of “100% certain” medical knowledge which is not inherent to all medical sub-domains. Clinical radiology uses computerized imaging techniques to make the human body visible and interprets the imaging findings in a clinical context delivering a textual report. For clinical radiology few standardized vocabularies are available. We examined the definitions given in the glossary of terms for thoracic radiology published by the Fleischner Society. We further classified these terms with regard to their definitions in terms of (a) describing visible structures on the image itself, (b) referring to ontological entities of the body (anatomical or pathological), and (c) terms imposing knowledge on structures visible on the image, epistemologically representing ontological entities of the body. Each ontological/epistemological definition was rated on a scale of vague/weak-sound/strong and put in context with the evaluation comments for the use of the terms given in the glossary itself. The result of this distinction shows that clinical radiology uses many terms referring to ontological entities valid for representation in a medical ontology. However, many epistemological terms exist in the terminology which impose epistemological knowledge on ontological entities. The analysis of the evaluation comments reveals that terms classified as sound (ontologically) and strong (epistemologically) are evaluated higher than terms bearing vague or weak definitions. On the basis of this, we argue that the distinction between ontological and epistemological definitions is necessary in order to construct epistemologically-sensitive application ontologies for medical sub-domains, like clinical radiology, where knowledge is fragmented in terms of description, inferred from a description, concluded on the basis of imaging, or other additional information with varying degrees of certainty.

This paper describes how Semantic Web technologies have been used in an online community for knowledge sharing between clinicians in oral medicine in Sweden. The main purpose of this community is to serve as repository of interesting and difficult cases, and as a support for monthly teleconferences. All information regarding users, meetings, news, and cases is stored in RDF. The community was built using the Struts framework and Jena was used for interacting with RDF.

This paper describes how Semantic Web technologies have been used in an online community for knowledge sharing between clinicians in oral medicine in Sweden. The main purpose of this community is to serve as repository of interesting and difficult cases, and as a support for monthly teleconferences. All information regarding users, meetings, news, and cases is stored in RDF. The community was built

Att praktisera evidensbaserad odontologi innebär att integrera expertisen hos individuella kliniker med bästa vetenskapliga evidens från externa kunskapskällor.