EXiTCDSS: A framework for a workflow-based CBR for interventional clinical decision support systems and its application to TAVI

Clinical Decision Support System (CDSSs) should form an important part of the field of clinical knowledge management technologies through their capacity to support the clinical process and use of knowledge, including knowledge maintenance and continuous learning, from diagnosis and investigation through surgery, treatment and long-term care. The work presented shows a workflow-based CDSS designed to give case-specific assessment to clinicians during complex surgery or Minimally Invasive Surgery (MISs). Following a perioperative workflow, the designed software will use a Case-Based Reasoning (CBR) methodology to retrieve similar past cases from a case base to provide support at any particular point of the process. The graphical user interface allows easy navigation through the whole support progress, from the initial configuration steps to the final results organized as sets of experiments easily visualized in a user-friendly way. The eXiTCDSS tool is presented giving support to a recent complex minimally invasive surgery which is receiving growing attention lately, the Transcatheter Aortic Valve Implantation (TAVI). The results obtained are presented on a basis of a real TAVI case base of 82 patients operated at Rennes University Hospital We would like to give our special thanks to the Hospital Clinic of Barcelona, the Centre Hospitalier Universitaire de Rennes and the Laboratoire Traitement du Signal et de l'Image from the University of Rennes for helping us with the case model definition and giving us example cases of TAVI patients. This work has been financed by the Spanish Government Commission Ministerio de Industria, Turismo y Comercio (MITyC) under the project PLAN AVANZA 2 labeled by Information Technology for European Advancement 2 (ITEA2). Also, this research project has been partially funded through the project labeled DPI2011-24929