An integrated fuzzy logic and web-based framework for active protocol support

Objective To develop a general purpose web-based system for active support in using protocols. Methods The conceptual model underlying the design of the overall decision support system is drawn from fuzzy set theory and fuzzy logic giving rise to a framework for both acquiring and representing descriptive and operational protocol knowledge. It has been conceived as a web application, designed and implemented according to the technological standards of Internet, in particular XML language and web services, to guarantee distributed functionalities for multicentric studies and the re-use of domain knowledge and problem solving strategies. Results Solutions have been evaluated experimentally addressing the specific domain of Temporomandibular disorders (TMD) specializing the general purpose procedures to the dedicated “Research Diagnostic Criteria” (RDC)/TMD protocol. The accuracy of the system was correlated with a set of 50 clinically cases consecutively selected from the Gnatology Department. The results were consistent in 100% of cases. The systematic observation by physicians of both activated rules and diagnostic judgements identified and explicitly formalized additional diagnostic rules in the same context. Conclusions Active protocol support based on fuzzy diagnostic reasoning and advanced web-based technologies shows great potentialities for the renewed role DSSs are called to play in the increasingly wide scale context of evidence-based medicine.