A Systematic Review of Ontologies Applied in Clinical Decision Support System Rules

Clinical decision support systems (CDSSs) are important for the quality and safety of healthcare delivery. Although CDSS rules guide CDSS behavior, they are not routinely shared and reused.Ontology has the potential to promote the reuse of CDSS rules. Therefore, we systematically screened literature to elaborate on the current status of ontology applied in CDSS rules, such as rule management (which uses captured CDSS rule usage data and user feedback data to tailor CDSS services to be more accurate) and maintenance (which updates CDSS rules). Through this systematic literature review, we aim to identify the frontiers of ontologies used in CDSS rules.The literature search was focused on the intersection of ontology, clinical decision support, and rules in PubMed, the Association for Computing Machinery (ACM) Digital Library, and the NursingAllied Health Database. Grounded theory and PRISMA 2020 guidelines were followed. One author initiated the screening and literature review, while the other two validated the processes and results independently. Inclusion and exclusion criteria were developed and refined iteratively.CDSSs were primarily used to manage chronic conditions, alerts for medication prescriptions, reminders for immunizations and preventive services, diagnoses, and treatment recommendations among the 81 included publications. The CDSS rules were presented in Semantic Web Rule Language, Jess, or Jena formats. Despite the fact that ontologies have been used to provide medical knowledge, CDSS rules, and terminologies, they have not been used in CDSS rule management or to facilitate the reuse of CDSS rules.Ontologies have been used to organize and represent medical knowledge, controlled vocabularies, and the content of CDSS rules. So far, there has been little reuse of CDSS rules. More work is needed to improve the CDSS rule reusability and interoperability. This paper identified and described the ontologies that, despite their limitations, enable Semantic Web technology and their applications in CDSS rules.