Argumentation logic for the flexible enactment of goal-based medical guidelines

Research purpose: We have designed a prototype clinical workflow system that allows the specification and enactment of medical guidelines in terms of clinical goals to be achieved, maintained or avoided depending on the patient's disease and treatment evolution. The prototype includes: (1) an argumentation-based decision support system which can be used both to represent medical decisions within guidelines, and to dynamically choose the most suitable plans to achieve clinical goals, and (2) mechanisms to specify a health organization's facilities and health workers skills and roles, which can be taken into account during the decision process in order to improve quality of care. Results: The framework has been fully implemented in the COGENT formal modeling system. The prototype has been evaluated implementing a hypertension guideline. Conclusions: The framework has shown flexibility and adaptability in (1) advising and tailoring health care based on a health organization's resources and a patient's particular medical condition, (2) delegating health care, and (3) replanning when unexpected situations arise.