=Paper=
{{Paper
|id=Vol-2853/paper4
|storemode=property
|title=Intelligent Information Technology for Supporting the Medical Decision-Making Considering the Legal Basis
|pdfUrl=https://ceur-ws.org/Vol-2853/paper4.pdf
|volume=Vol-2853
|authors=Tetiana Hovorushchenko,Yelyzaveta Hnatchuk,Alla Herts,Oksana Onyshko
|dblpUrl=https://dblp.org/rec/conf/intelitsis/HovorushchenkoH21
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==Intelligent Information Technology for Supporting the Medical Decision-Making Considering the Legal Basis==
https://ceur-ws.org/Vol-2853/paper4.pdf
Intelligent Information Technology for Supporting the Medical
Decision-Making Considering the Legal Basis
Tetiana Hovorushchenkoa, Yelyzaveta Hnatchuka, Alla Hertsb and Oksana Onyshkoa
a
Khmelnytskyi National University, Institutska str., 11, Khmelnytskyi, 29016, Ukraine
b
Ivan Franko National University of Lviv, Universytetska str., 1, Lviv, 79000, Ukraine
Abstract
Decision support systems (DSS) and information technology (IT) for medicine considering
the legal basis allow free and automated verification of all essential terms of contracts and
provide recommendations for the contract's conclusion or its non-conclusion. Current
decisions to support medical decision-making considering the legal basis showed that none of
the known decisions meet all the necessary criteria. Therefore, an actual problem for Ukraine
is the development and implementation of intelligent information technology for supporting
the medical decision-making considering the legal basis, which is the aim of this study. The
developed intelligent information technology for supporting the medical decision-making
considering the legal basis provides support for decision-making on the possibility of using
reproductive technologies (possibility of surrogacy and/or in vitro fertilization), the
possibility of donation and transplantation, the possibility of concluding contracts for
therapeutic services and contracts for dental services, general contracts for medical services.
In addition, intelligent information technology to support medical decision-making based on
the legal basis automates the semantic parsing of contracts and draws conclusions about the
possibility or impossibility of concluding a contract, as well as provides a request stating the
reasons for impossibility to conclude a contract (for example, indicating missing essential
conditions), if it was concluded that such a contract cannot be concluded.
Keywords 1
Decision-making, contract for the provision of medical services, conclusion about the
possibility/impossibility of concluding the medical services contract, intelligent information
technology for supporting the medical decision-making considering the legal basis.
1. Introduction
The implementation of the new information technologies in all human activity's areas in order to
automate routine work, reduce manual labor and minimize the human factor is the strategic goal of
Ukraine's information society [1]. Today, medical information technology must meet 4 requirements:
efficiency, safety, novelty and economic benefits [2].
Today, decision-making processes in the field of medical services are cumbersome, complicated
and non-transparent [3]. The productivity of health workers is significantly increased due to the
successful implementation and use of decision support systems (DSS) and information technology
(IT) [4]. Today in Ukraine there is a problem of development of medical software, IT and DSS.
Successful implementation of medical software, IT and DSS provide doctors with new information on
the specialty, increase the efficiency of doctors, increase the productivity of medical resources and
strengthen the integration of Ukrainian medicine into the medical space of Europe [5, 6]. Intelligent or
IntelITSIS’2021: 2nd International Workshop on Intelligent Information Technologies and Systems of Information Security, March 24–26,
2021, Khmelnytskyi, Ukraine
EMAIL: tat_yana@ukr.net (T. Hovorushchenko); liza_veta@ukr.net (Ye. Hnatchuk); agerc@ukr.net (A. Herts); van4o@ukr.net (O.
Onyshko)
ORCID: 0000-0002-7942-1857 (T. Hovorushchenko); 0000-0003-2989-3183 (Ye. Hnatchuk); 0000-0002-3310-3159 (A. Herts); 0000-
0002-5165-1810 (O. Onyshko)
© 2021 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
intellectualized systems and technologies facilitate medical decision-making and are promising tools
in the era of "evidence-based" medicine [7]. Paper [8] discusses DSS for support doctors in decision-
making and for improving the health care’s quality and safety. The review [9] showed that advanced
clinical decision support is the prospect direction for the next 10 years. Joint decision-making
involves different types of agents with the requirement that they can sufficient possibility to make the
appropriate decision [10]. Intelligent IT can guide doctors in decision-making, reaching a diagnosis,
and improving contract. It can reduce healthcare costs by decreasing medical errors and providing
more dependable predictions [11].
The most important and complicated is the task of developing the multidisciplinary medical IT and
DSS (e.g., IT and DSS for the medical law domain, because many patient health problems have a
legal basis [12]), because in requirements for such IT and DSS the software development standards
and standards in medicine and law need to be considered, preventing to losses of information owing
to different understandings of information needs and contexts [13].
Service contracts are the most common type of contract of civil law. The contract for the medical
services' provision (therapy, transplantation and donation, the reproductive technologies' use, dental
services) is the most common legal basis for the medical services' provision. A contract for the
medical services' provision is an agreement whereby doctor (or clinic) at the patient's request must
relevantly serve the patient (restore and maintain his health) and the patient must pay a certain amount
of money specified in the contract for the services provided to him. Implemented and used medical IT
and DSS can substantially increase the correctness of the contract from the point of view civil and
medical law [4].
The modern therapist makes decisions by integrating several medical specialties; especially this
problem has been exacerbated with the introduction of insurance medicine in Ukraine, when the
physician must know the standards of diagnosis and standards of treatment of therapeutic diseases.
This problem is faced by therapists daily and repeatedly, especially when using innovative medical
technologies [14]. Therefore, nowadays the issue of therapeutic contract's concluding needs a lot of
attention. The therapeutic contract is an agreement whereby doctor at the request of the patient in
accordance with health legislation provides a therapeutic service, which is creation and treatment of
the etiology, pathogenesis and clinical manifestations of internal organs' diseases, their diagnostics,
prophylaxis and rehabilitation, and the patient must pay a certain amount of money specified in the
contract for the services provided to him, unless else provided by contract or law.
Nowadays, transplantation of human organs and (or) tissues is an effective and in many cases the
only means of saving lives and restoring health. According to the Law of Ukraine "On the use of
transplantation of anatomical materials to humans" [15], transplantation is a special treatment method
which involves transplanting to a recipient of an organ or other anatomical material from a person or
animal. Transplantation is the transfer (engraftment) of human cells, tissues or organs from the donor
to the recipient in order to restore their function(s) in the body [16]. Donation is the voluntary transfer
of blood and other human organs to help other people heal and recover [15]. There are 2 types of
donation: posthumous (if the consent of the person given during his life or the consent of family
members given after person's death is available) and lifelong if the consent of the donor is available).
According to the Law of Ukraine "On the use of transplantation of anatomical materials to humans"
[15], transplantation activities should be based solely on the Unified State Information System for
Organ and Tissue Transplantation (USIST). Direct work with data on donors and patients in the
system will be semi-automatic. According to the authors, USIST can and should be fully automated in
terms of the decision-making on the possibility of donation and transplantation considering the civil
law basis to minimize the influence of the human factor in making such important decisions.
Nowadays, almost 15% of Ukrainian families are infertile. The only way of overcoming infertility
for many families is the reproductive technologies' using. Reproductive technologies are modern
high-tech methods of infertility treatment, during of which some or all stages of conception and
development of embryos carried out outside the body, in particular, fertilization of the egg outside the
body, implantation of embryos and pregnancy in case of impossibility of these processes naturally
[17]. The particular importance has two types of reproductive technologies - in-vitro fertilization and
surrogacy. If such conditions exist, then the issue of concluding a contract for in vitro fertilization or
surrogacy is very important. In vitro fertilization contract is an agreement according to which the
doctor (clinic) at the patient's request must serve the patient with appropriate medical services,
applying the assisted reproductive technologies, when the eggs are fertilized with sperm outside the
body, and the patient agrees to pay for the procedure, as it was agreed by the contract's parties.
According to the Order of the Ministry of Health of Ukraine №787 [18], surrogacy is the artificial
egg's insemination with the following placement of the embryo in another woman’s uterine cavity
(surrogate mother). Thus, the being of surrogacy is the transplantation of the fertilized egg into the
body of a woman, whiсh is genetically alien for future child, who bears and gives birth the child not
for herself, but for a family who cannot have children for medical reasons.
Today, dental services are the popular medical service in Ukraine. Applying for dental services is
second after therapeutics services [19]. Today, the issue of concluding the dental services' contract
needs more attention. The dental services' contract is an agreement whereby the dentist at the patient's
request, according to the health care legislation, provides a dental service, preventing the disease of
the teeth, the oral cavity, gums, maxillofacial area, their diagnostics, and treatment, and the patient
must pay this services if other don't specify by the dental services' contract [20].
Therefore, the conclusion of a contract for the provision of medical services, in particular,
verification of the existence of all significant conditions in the contract, is becoming increasingly
important - with the purpose of ensuring the safety both the doctor providing the service and the
patient receiving the service, as the lack of significant conditions in the contract leads to serious
problems and legal conflicts. To date, there is no single form of contract for the provision of various
medical services in Ukraine. The legislative acts have no norms, which give the definition and
regulate the procedure for concluding the medical services' contracts. Resulting, many medical
services' contracts have aggravating conditions for the patient, offer illegal methods of dispute
resolution, and have no characteristics for individualizing the medical services. These disadvantages
often lead to adverse legal consequences for both the patient and the clinics, which continue to use
contract models that have obvious legal limitations. Of course, every clinic cannot hire a lawyer for
preparing the medical services' contracts. Multidisciplinary medical DSS and IT for the medical law
domain allow free and automated verification of all essential conditions' existence in the contract and
the provision of advice on the conclusion of the contract or not.
So, the development and using the intelligent information technology (set of processes, methods,
and tools for accumulating, processing, and transmission of the primary information with the purpose
of obtaining information product with new quality [21- 23]) for supporting the medical decision-
making considering the legal basis is an urgent problem for Ukraine.
2. State-of-the-art
Let conduct state-of-the-art on known decisions for support of the making the medical decisions
based on legal grounds. We are interested in whether the known methods and tools support decision-
making on the using reproductive technologies’ possibility (surrogacy and in vitro fertilization) –
criterion 1, on the donation and transplantation possibility – criterion 2, on the possibility of
concluding therapeutic services’ contracts – criterion 3, dental services’ contracts – criterion 4 and
general medical services’ contracts – criterion 5. In addition, we are interested in whether known
tools automate parsing the contracts and drawing conclusions about the possibility or impossibility of
concluding a contract – criterion 6, whether these tools provide a request, what exactly is missing in
the contract for its conclusion, if a conclusion about the impossibility of concluding the contract is
drawing – criterion 7.
Results of the conducted state-of-the-art are represented in Table 1.
Table 1
State-of-the-art on known decisions for support of the making the medical decisions based on legal
grounds
Known decision Criteria for evaluating the known decisions
1 2 3 4 5 6 7
Mobile decision support no no yes no yes no no
system for emergency
department's healthcare
providers for the correct
procedure's identifying and
following based on applicable
laws [24]
Medical relational model for no no no no no yes no
parsing the logical rules from
medical law documents for a
medical decision support
system's design [25]
IT infrastructure for unified no yes no no yes no no
documentation forms for
organ transplantations [26]
The approximate reasoning no no no no yes no no
system for evaluating the risk
when doctors decide on the
need for surgery for the
patient [27]
Theory, model and the optimal yes no no no no no no
control procedure for
improving outcomes of in vitro
fertilization treatment for one
of the four protocols [28]
Treatment decision-making of yes no no no no no no
women in vitro fertilization
treatment after an unsuccessful
fertilization cycle [29]
Decision-making during female yes no no no no no no
infertility's treatment [30]
Information system and decision no no yes yes yes no no
support system for promoting
and strengthening the care
relationship and trust between
doctor and patient [31]
Autonomy model of decision- no no yes yes yes no no
making in medical matters
(according to French law) [32]
Most important factors, which no no yes yes yes no no
influence the decision-making
process in the selected
healthcare services [33]
Swedish national health yes yes yes yes yes no no
information exchange
platform [34]
Effective method of imputation no no no no no yes yes
of missing data through SGTM
neural-like structure [21]
Ontology-based approach for yes no no no no yes yes
the information sufficiency's
evaluating in the surrogate
motherhood contract [35]
Different models of support of no no no yes yes no no
the clinical ethics [36]
AMBOSS: Method of legal no no yes no yes no no
assessment to make decisions
by the patient's [37]
Portal of Medical Data yes no yes no yes yes no
Models [38]
Information technology for no yes yes yes yes no no
filling the patients' dynamic
consent [39]
Technology for legal support no no no no no no yes
providing for healthcare staff
[12]
System for collection, no yes no no no no no
collation, analysis, distribution
and reaction for serious
adverse events and reactions
in unrelated HPC donors [40]
Global Database on Donation no yes no no no yes no
and Transplantation [41]
Kidney Allocation System [42] no yes no no no yes no
Korean Organ Transplantation no yes no no no yes no
Registry (KOTRY) [43]
Donor Advocacy Team (DAT) no yes no no no yes no
program [44]
National Subsystem of no yes no no no yes no
donation and transplantation
in Mexico [45]
Polish organ transplantation no yes no no no yes no
management system [46]
French national information no yes no no no yes no
system for coordination and
administration of organ
transplant [47]
Intelligent agent for support of yes no no no no yes yes
decision making on civil law
regulation of contract for the
provision of in vitro
fertilization [48]
Decision-making about no no no no yes yes yes
conclusion of medical services'
contractual obligations [49]
Information technology for the no no no yes no yes yes
dental services contract's legal
regulation [50]
Supporting the decision- no yes no no no yes yes
making about the donation's
and transplantation's
possibility considering the civil
law grounds [51]
Decision making process on no no yes no no yes yes
civil law regulation of
contracts for the provision of
therapeutic services [52]
The conducted state-of-the-art on known decisions for support of the making the medical decisions
based on legal grounds showed, none of the known solutions satisfies all 7 criteria in the complex.
Therefore, developing and implementing intelligent information technology for supporting the
medical decision-making considering the legal basis, which would meet all the above 7 criteria
simultaneously is the purpose of this study.
3. Intelligent information technology for supporting the medical decision-
making considering the legal basis
On the basis of the modeling the information flows in the medical decision-making process
considering the legal basis and the investigation of information flows in the process of evaluating
information, which is available for medical decision-making considering the legal basis, conducted by
the authors in [21, 48-52], and theoretical principles of information technology in the form of the
methods for decision-making support, which were presented in [21, 48-52], the block diagram of
intelligent information technology for supporting the medical decision-making considering the legal
basis (set of processes, methods, and tools for accumulating, processing, and transmission of the
primary information with the purpose of obtaining information product with new quality [21, 22]) is
developed and presented in Figure 1.
Intelligent information technology for supporting the medical decision-making considering the
legal basis gives the support for decision-making on the possibility of using reproductive technologies
(the possibility of surrogacy and/or in vitro fertilization), the possibility of donation and
transplantation, the possibility of concluding therapeutic services' contracts, dental services' contracts
and general medical services' contracts. In addition, intelligent information technology for supporting
the medical decision-making considering the legal basis automates the semantic parsing of contracts
and drawing conclusions about the possibility or impossibility of concluding a contract, as well as
provides a request indicating the reasons for impossibility of concluding a contract (for example,
indicating the missing significant conditions in the contract), if it was concluded that it is impossible
to conclude such a contract.
Figure 1 showed that the proposed intelligent information technology for supporting the medical
decision-making considering the legal basis consists of:
1. Parsing the appropriate medical services’ contract (for example, using an intelligent agent for
parsing natural language documents, which was developed in [53])
2. Method of decision-making in the field of legal regulation of surrogacy [21]
3. Method of decision making on civil law regulation of contract for the provision of in-vitro
fertilization [48]
4. Method for supporting the decision on the possibility of donation and transplantation on the
basis of civil law [51]
5. Method of decision making process on civil law regulation of contracts for the provision of
therapeutic services [52]
6. Method for legal regulation of the dental services contract [50]
7. Method of decision-making about conclusion of contractual obligations in the field of medical
services [49]
Figure 1: Intelligent information technology for supporting the medical decision-making considering
the legal basis
Obviously, the main purpose of the developed intelligent information technology for supporting
the medical decision-making considering the legal basis is the automation (minimization of the human
factor impact and simplification of the implementation) of the contracts' parsing and drawing the
conclusions about the possibility or impossibility of concluding the contracts of reproductive
technologies (surrogacy and/or in vitro fertilization), of donation and transplantation, therapeutic
services' contract, dental services' contract, and general medical services' contract.
4. Results & discussion
Let consider the functioning of the developed intelligent information technology for supporting the
medical decision-making considering the legal basis.
For example, the input of the developed information technology is the medical services' contract. It
was determined that this is a contract for the provision of in-vitro fertilization. Developed intelligent
information technology for supporting the medical decision-making considering the legal basis
conducted a semantic analysis (parsing) of the provided contract for the provision of in-vitro
fertilization, as well as processing the contract using the method of decision making on civil law
regulation of the contract for the provision of in-vitro fertilization, which was developed by the
authors in [48]. Resulting in the analysis of the contract, a set of significant conditions, which are
absent in the analyzed contract, was formed. The set of missing significant conditions has the form:
MC = {"indications for in-vitro fertilization", "woman's age", "woman's legal capacity"}. It is not
empty, so intelligent information technology for supporting the medical decision-making considering
the legal basis forms conclusion on the impossibility of concluding the appropriate medical services’
contract, and a request for addition of the in-vitro fertilization contract (indicating the absence of
significant conditions in the contract). Thus, the developed information technology helped to avoid
concluding the incorrectly executed contract, which have no significant conditions, and could lead to
negative effects for one or both parties.
The developed intelligent information technology for supporting medical decision-making
considering the legal basis gives the opportunity to verify the correctness of the structure and content
of the appropriate medical services' contract. Such verification allows the unmistakable (from the
point of view of legal basis) decisions on the possibility/impossibility of concluding the contract,
minimizing the subjectivism influence and the human factor, and eliminating the need to pay for legal
services by the clinics.
5. Conclusions
The conclusion of the medical services' contract, in particular, verification of the availability of all
significant conditions in the contract, is becoming increasingly important, with the purpose of
ensuring the safety of both the doctor providing the service and the patient receiving the service, as
the lack of significant conditions in the contract leads to serious problems and legal conflicts. Many
contracts for the provision of medical services of various kinds contain aggravating conditions for the
patient, offer non-legal method of dispute resolution, and do not contain characteristics that
individualize medical services. These shortcomings can lead to unfavorable legal consequences for
both the patient and the medical organizations, which continue to use such models of contracts, which
have obvious restrictions on the legal side. Of course, not every clinic can afford to hire a lawyer to
prepare contracts for the provision of medical services. Multidisciplinary medical DSS and IT for the
field of medical law are designed to provide the possibility of free and automated verification of the
existence of all significant conditions in the contract and provide advice on whether or not to conclude
the contract. The conducted state-of-the-art on known decisions for support of the making the medical
decisions based on legal grounds showed, that none of the known solutions meets all the necessary
criteria in the complex. Therefore, the current problem for Ukraine is the design and implementation
of intelligent information technology for supporting the medical decision-making considering the
legal basis, which is why this study is devoted.
The proposed intelligent information technology for supporting the medical decision-making
considering the legal grounds provides support for decision-making on the possibility of using
reproductive technologies (on the possibility of surrogacy and/or in-vitro fertilization), on the
possibility of donation and transplantation, on the possibility of concluding contracts for therapeutic
services, contracts for dental services and general contracts for medical services. In addition,
intelligent information technology for supporting the medical decision-making considering the legal
basis automates the semantic parsing of contracts and drawing conclusions about the possibility or
impossibility of concluding a contract, as well as provides a request indicating the reasons for
impossibility of concluding a contract (for example, indicating the missing significant conditions in
the contract), if it was concluded that it is impossible to conclude such a contract.
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