gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

17.09. - 21.09.2017, Oldenburg

Frameless Medical Logic Modules as a Groundwork for a Domain-specific Language

Meeting Abstract

Suche in Medline nach

  • Stefan Kraus - Chair of Medical Informatics, University of Erlangen-Nuremberg, Erlangen, Deutschland

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. 62. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS). Oldenburg, 17.-21.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocAbstr. 125

doi: 10.3205/17gmds108, urn:nbn:de:0183-17gmds1080

Veröffentlicht: 29. August 2017

© 2017 Kraus.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Introduction: A domain-specific language (DSL) can be defined as a programming language that is, in contrast to all-purpose programming languages, tailored to the requirements of a specific domain. An example from the medical domain is the Arden Syntax, a language for knowledge representation in the form of Medical Logic Modules (MLMs), which correspond to condition-action rules [1]. Although the Arden Syntax is typically used to monitor clinical events, multiple experiences at our local hospital indicate that its language constructs may be suitable for a use beyond the intended application range, or even as a medical informatics DSL in general. Such a broader context, however, would require reconsidering some language features. The purpose of this paper is to describe the related modifications by means of an experimental, generic implementation termed PLAIN (Programming Language, Arden-INspired).

Methods: The implementation was based on Arden Syntax version 2.8. The grammar has been rewritten from scratch to avoid some ambiguities. The frame-like MLM structure has been removed from the grammar to enable freestyle programming. A frame detector component has been developed to enable the definition and recognition of arbitrary frame-like structures. The prototype has been implemented in the form of a compiler-interpreter pair, equipped with a simple graphic development environment. An XML-based data format has been specified to facilitate access to patient data, supplemented by new language constructs to access and process data structures.

Results: The implemented platform supports data-driven MLMs with the traditional frame-like outer structure. Moreover, it enables three different MLM types that are not part of the standard. The first is a freestyle type which enables the use of programming language constructs without frame structure. The second is a user-driven type, tailored to MLMs evoked by clinical users by the press of a button. The third is a sub-module type, tailored to reuse of encoded knowledge, such as clinical score calculations, from other MLMs. In contrast to the Arden Syntax, PLAIN supports the nesting of lists to assure the closure of the data type system in case of operations on complex patient data structures, such as multiple patient records. Moreover, PLAIN facilitates interactions with clinical information systems by natively providing language constructs for file and network access.

Discussion: This study does not aim to promote an actually new language. PLAIN is simply a working title for an experimental, generic version of the proven Arden Syntax standard that, besides some other modified features, enables appropriate frame structures for heterogeneous algorithms. It was motivated by the repeated observation that the easy-to-understand Arden Syntax language constructs can be beneficial in many application areas beyond its intended use. Examples from the literature describe user-driven decision support functions [2], generation of clinical documents [3], creation of multi-patient dashboards [4], and patient recruiting [5]. Currently, several additional application areas, such as DRG coding and billing, are under research. An easy-to-understand DSL for medical informatics in general may be used as a lingua franca for arbitrary clinical algorithms, therefore avoiding a patchwork of multiple all-purpose languages between, and even within, institutions.


Hripcsak G, Ludemann P, Pryor TA, Wigertz OB, Clayton PD. Rationale for the Arden Syntax. Comput Biomed Res. 1994;(27):291–324.
Karlsson D, Ekdahl C, Wigertz O, Shahsavar N, Gill H, Forsum U. Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique. Methods Inf Med. 1997;(36):108–14.
Kraus S, Castellanos I, Albermann M, Schuettler C, Prokosch H-U, Staudigel M, Toddenroth D. Using Arden Syntax for the Generation of Intelligent Intensive Care Discharge Letters. Stud Health Technol Inform. 2016;(228):471–5.
Kraus S, Drescher C, Sedlmayr M, Castellanos I, Prokosch H-U, Toddenroth D. Using Arden Syntax for the creation of a multi-patient surveillance dashboard. Artif Intell Med. 2015. DOI: 10.1016/j.artmed.2015.09.009 Externer Link
Sarkar IN, Chen ES, Rosenau PT, Storer MB, Anderson B, Horbar JD. Using Arden Syntax to identify registry-eligible very low birth weight neonates from the Electronic Health Record. AMIA Annu Symp Proc. 2014;2014:1028–36.