1. From attention to intention Modelling decisions and plans in clinical practice

2. Hot buttons Notations –cognitive processes –tasks Planning and design Distributed and autonomous agents Software engineering

3. Motivation: medicine and music Guido d'Arezzo Benedictine monk, musical theorist and teacher.

4. Elementary cognitive entities and processes Arguments Plans Actions Goals Candidate solutions Beliefs

5. Reifying processes into “tasks” Arguments Plans Actions Goals Candidate solutions Beliefs Plans Decisions Enquiries Actions

6. Triple assessment of women with suspected breast cancer V Patkar, C Hurt, …, J Fox (Brit J Cancer 2006) Triple assessment of women with suspected breast cancer V Patkar, C Hurt, … (Brit J Cancer 2006)

7. decision :: 'WhichRadiologyDecision' ; caption :: "Which radiology?"; choice_mode :: multiple ; support_mode :: symbolic candidate :: 'mammogram' ; caption :: "Do a mammogram of both breasts"; argument :: -, patientAge < 35 ' ; caption :: "The patient is younger than 35yrs"; argument :: +, patient_latestHistory_priorThoracicRT = "yes" and patient_latestHistory_priorThoracicRT_timing > 8 and patientAge >= 30 caption ::"Patient is over 30 years of age and has received chest radiotherapy … argument :: +, (patient_historyPreviousMalignancyType includes "breast in situ" or patient_historyPreviousMalignancyType includes "breast invasive") caption :: "The patient has had a previous breast malignancy"; argument :: +, patient_latestHistory_pain = "yes" and patient_latestHistory_pain_cyclicity = "non cyclical" ; caption ::"The patient has non-cyclical breast pain recommendation ::netsupport( WhichRadiologyDecision, mammogramCandidate) >= 1; candidate :: 'ultrasound' ; caption :: "Do an ultrasound of the affected area"; argument :: +, patient_latestMammography_appearance includes "mass lesion" or patient_latestMammography_appearance includes "asymmetric density“ recommendation :: netsupport(WhichRadiologyDecision, ultrasoundCandidate) >= 1; candidate :: 'neither' ; caption :: "No imaging is necessary"; recommendation :: netsupport(WhichRadiologyDecision, ultrasoundCandidate) < 1 AND netsupport( WhichRadiologyDecision, mammogramCandidate) < 1 ; end decision. Modelling decisions, plans and processes

8. PROforma decision decision :: 'Diagnosis_decision' ; caption ::"Diagnosis decision"; candidate :: ''peptic ulcer'' ; argument :: for,age < 35 OR weight = normal attributes argument_name :: 'age < 35 OR weight = normal' ; end attributes; recommendation ::netsupport(decision_11, 'peptic ulcer') >= 1; candidate :: 'cancer' ; argument :: for,biopsy = abnormal attributes argument_name :: 'biopsy = abnormal' ; end attributes; argument :: for,age >= 50 AND Weight = down attributes argument_name :: 'age >= 50 AND Weight = down' ; caption ::"Elderly patient has lost weight"; end attributes; recommendation ::netsupport(decision_11, 'cancer') >= 1; end decision.

9. PROforma plan plan :: 'Simple_plan_example' ; caption :: "Example of a plan with 4 components"; abort ::patient_discharged = yes; terminate ::patient_recovered = yes; component :: 'Diagnosis_decision' ; schedule_constraint :: completed('Patient_history') ; number_of_cycles ::1; component :: 'Patient_history' ; number_of_cycles ::1; component :: 'Pathway_1' ; schedule_constraint :: completed('Diagnosis_decision') ; number_of_cycles ::1; component :: 'Pathway_2' ; schedule_constraint :: completed('Diagnosis_decision') ; number_of_cycles ::1; end plan.

10. Project proposal Back group

11. Scenario Services Annotation Simulation Composition Review Debate Notation Synoptic process (“agent”) Describe (“beliefs”) Frame (“Goals”) Options (“Worlds”) Assess (“Argue”) Select (“Commit”) Do (“Implement”)