Clinical Decision Support Systems (CDSS) are computer applications that focus on assisting medical decisions required during clinical tasks. Although CDSS have been extensively studied for more than 30 years, their use is not broadly extended yet in daily clinical practice. Identified challenges of CDSS include (i) automating decision support, (ii) clinical workflow integration, (iii) ability of the system to be maintained and extended, (iv) timely advice and (v) evaluation of decisions effects and costs. In this paper, we hypothesize that Knowledge Engineering techniques and semantic technologies could be applied to CDSS in order to overcome the current identified challenges. We present a generic architecture for a Semantic CDSS, which we call SCDSS, and implementation guidelines for the breast cancer domain. Our approach follows a cyclic-federated paradigm allowing the reutilization of knowledge gathered at every stage of the clinical cycle.
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