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A Hybrid Execution Environment for Computer-Interpretable Guidelines in PROforma

Alexandra Kogan, Roy Leizer, Szymon Wilk, David Glasspool

TL;DR

The paper addresses the challenge of executing computer-interpretable guidelines (CIGs) in a clinical setting by building a hybrid execution environment for CAPABLE that augments the Deontics Engine (DE) with specialized wrappers (PDSS, VC, GoCom) and a meta-property layer. This architecture enables handling non-standard tasks and seamless integration with a FHIR-based data platform, case management, and user interfaces, while preserving a standardized engine view. The authors detail operational cycles for the PDSS and VC components, explain the role of master CIGs, and show how meta-properties bridge DE to external data and processing modules. Implemented in Java/Scala and tested with synthetic scenarios, the approach is positioned for ongoing clinical evaluation and demonstrates practical impact for coordinated cancer patient coaching and physician decision support.

Abstract

In this paper, we share our experience of developing a hybrid execution environment for computer-interpretable guidelines (CIGs) in PROforma. The proposed environment is part of the CAPABLE system which provides coaching for cancer patients and decision support for physicians. It extends a standard PROforma execution engine - Deontics Engine (DE) - with additional components that act as wrappers around DE, allow handling of non-standard tasks, and facilitate integration with the rest of the CAPABLE system. This yields a hybrid environment in which the standard engine and specialized components must be interfaced together by some intervening layer. In the CAPABLE system this has been achieved by defining a set of specialized meta-properties which are attached to data and tasks in the PROforma CIGs to specify the interface between engine and components.

A Hybrid Execution Environment for Computer-Interpretable Guidelines in PROforma

TL;DR

The paper addresses the challenge of executing computer-interpretable guidelines (CIGs) in a clinical setting by building a hybrid execution environment for CAPABLE that augments the Deontics Engine (DE) with specialized wrappers (PDSS, VC, GoCom) and a meta-property layer. This architecture enables handling non-standard tasks and seamless integration with a FHIR-based data platform, case management, and user interfaces, while preserving a standardized engine view. The authors detail operational cycles for the PDSS and VC components, explain the role of master CIGs, and show how meta-properties bridge DE to external data and processing modules. Implemented in Java/Scala and tested with synthetic scenarios, the approach is positioned for ongoing clinical evaluation and demonstrates practical impact for coordinated cancer patient coaching and physician decision support.

Abstract

In this paper, we share our experience of developing a hybrid execution environment for computer-interpretable guidelines (CIGs) in PROforma. The proposed environment is part of the CAPABLE system which provides coaching for cancer patients and decision support for physicians. It extends a standard PROforma execution engine - Deontics Engine (DE) - with additional components that act as wrappers around DE, allow handling of non-standard tasks, and facilitate integration with the rest of the CAPABLE system. This yields a hybrid environment in which the standard engine and specialized components must be interfaced together by some intervening layer. In the CAPABLE system this has been achieved by defining a set of specialized meta-properties which are attached to data and tasks in the PROforma CIGs to specify the interface between engine and components.
Paper Structure (7 sections, 6 figures)

This paper contains 7 sections, 6 figures.

Table of Contents

  1. Introduction
  2. High-level Architecture of the Hybrid Environment
  3. Execution of PROforma CIGs
  4. An Operational Cycle of PDSS
  5. An Operational Cycle of VC
  6. Specialized PROforma Meta-properties
  7. Conclusion

Figures (6)

  • Figure 1: A high-level architecture of the CAPABLE system
  • Figure 2: CIGs used in CAPABLE and their organization
  • Figure 3: An operational cycle of PDSS (specific interactions between components are described in the text)
  • Figure 4: An operational cycle of VC (specific interactions between components are described in the text)
  • Figure 5: A list of selected meta-properties characterizing PROforma data items
  • ...and 1 more figures