Evolution of a knowledge base for a clinical decision support system encoded in the Arden Syntax

Clinical decision support systems (CDSS) are being used increasingly in medical practice. Thus, long-term maintenance of the knowledge bases (KB) of such systems becomes important. To quantify changes that occur as a KB evolves, we studied the KB at the Columbia-Presbyterian Medical Center. This KB has a total of 229 Medical Logic Modules (MLMs) encoded in the Arden Syntax. Eliminating those never used in practice, we retrospectively analyzed 156 MLMs developed over 78 months. We noted 2020 distinct versions of these MLMs that included 5528 changed statements over time. These changes occurred primarily in the logic slot (38.7% of all changes), the action slot (17.8%), in queries (15.0%) and in the data slot exclusive of queries (12.4%). We conclude that long-term maintenance of a KB for a CDSS requires significant changes over time. We discuss the implications of these results for the design of KB editors for the Arden Syntax.