[email protected] - Agent Based Support of Clinical Processes

In this paper we present a system for agent-based support of clinical processes. We describe the basic engineering concept, along with specific simulation and testing scenarios for agent-based software engineering. Another important focus is the integration of existing agent or healthcare standards like FIPA, DICOM and HL7. Objectives of our research activities in this project are: a substantial increase of the efficiency of hospital process management as well as the development of a specific goal oriented requirements engineering methodology. As most important challenges of the healthcare domain we have identified on the one hand individualized, patient oriented processes in diagnostics, therapy, nursing and administration and on the other hand extremely distributed decision processes and strong local (individual) autonomy with a high degree of situational dynamics. The example scenario on „clinical trials“ illustrates how the system shall support distributed clinical processes and how it interacts with other multiagent systems within the Agent.Hospital Framework and hospital information systems in the eHealth Lab introduced in this paper. The system development is part of the German Priority Research Program (SPP) 1083 “Intelligent Agents and their application in business scenarios”

Agent-based context-aware healthcare information retrieval using DROPT approach

As the volume of information available on the Web information systems is growing continuously, browsing this content becomes a tedious task given the presentation of data that does meet user's aims and needs. In this paper, to satisfy user needs, an agent-based paradigm is an appropriate solution which gives outputs suitable to the user in the form of highly ranked documents. Conversely, patient care and a health condition commonly require collaboration between healthcare providers. The emergence of agent's technology motivates radical changes of how information is obtained. This paper addresses this problem by proposing a novel DROPT (Document Ranking OPTimization) measure for information retrieval results to validate the effectiveness of the information management tasks. We propose information retrieval system architecture, which main components are context aware agent’s technology to meet users' information needs

AGENT-BASED CONTEXT-AWARE HEALTHCARE INFORMATION RETRIEVAL USING DROPT APPROACH

As the volume of information available on the Web information systems is growing continuously, browsing this content becomes a tedious task given the presentation of data that does meet user's aims and needs. In this paper, to satisfy user needs, an agent-based paradigm is an appropriate solution which gives outputs suitable to the user in the form of highly ranked documents. Conversely, patient care and a health condition commonly require collaboration between healthcare providers. The emergence of agent's technology motivates radical changes of how information is obtained. This paper addresses this problem by proposing a novel DROPT (Document Ranking OPTimization) measure for information retrieval results to validate the effectiveness of the information management tasks. We propose information retrieval system architecture, which main components are contextaware agent’s technology to meet users' information needs

Information Systems and Healthcare XX: Toward Seamless Healthcare with Software Agents

Healthcare processes are frequently fragmented and often badly supported with IT. Inter- and intra-organizational communication and media frictions complicate the continuous provision of information according to the principle of information logistics. Based on extensive literature review, we present the vision of seamless healthcare with horizontally and vertically integrated healthcare processes enabled by seamless IT support. Its implementation requires the establishment of a communication infrastructure and the deployment of adequate standards in healthcare. There are already comprehensive approaches for dealing with integrating heterogeneous information systems. However, they lack a common communication infrastructure and do not support proactivity and flexibility which are dominant characteristics in healthcare. We propose a software agent-based approach for realizing the vision of seamless healthcare. We present a corresponding implementation for integrating heterogeneous information systems in the context of the German Health Telematics Infrastructure. Based on the concept and the implementation, we show that the modular approach is capable of supporting a wide range of different applications. We furthermore outline which facets of an agent-based solution could be implemented in an operative real-world environment. In closing we derive implications for IT decision makers in healthcare and show directions for future approaches for reducing information logistics related deficits in healthcare

A Computational Approach to Patient Flow Logistics in Hospitals

Scheduling decisions in hospitals are often taken in a decentralized way. This means that different specialized hospital units decide autonomously on e.g. patient admissions and schedules of shared resources. Decision support in such a setting requires methods and techniques that are different from the majority of existing literature in which centralized models are assumed. The design and analysis of such methods and techniques is the focus of this thesis. Specifically, we develop computational models to provide dynamic decision support for hospital resource management, the prediction of future resource occupancy and the application thereof. Hospital resource management targets the efficient deployment of resources like operating rooms and beds. Allocating resources to hospital units is a major managerial issue as the relationship between resources, utilization and patient flow of different patient groups is complex. The issues are further complicated by the fact that patient arrivals are dynamic and treatment processes are stochastic. Our approach to providing decision support combines techniques from multi-agent systems and computational intelligence (CI). This combination of techniques allows to properly consider the dynamics of the problem while reflecting the distributed decision making practice in hospitals. Multi-agent techniques are used to model multiple hospital care units and their decision policies, multiple patient groups with stochastic treatment processes and uncertain resource availability due to overlapping patient treatment processes. The agent-based model closely resembles the real-world situation. Optimization and learning techniques from CI allow for designing and evaluating improved (adaptive) decision policies for the agent-based model, which can then be implemented easily in hospital practice. In order to gain insight into the functioning of this complex and dynamic problem setting, we developed an agent-based model for the hospital care units with their patients. To assess the applicability of this agent-based model, we developed an extensive simulation. Several experiments demonstrate the functionality of the simulation and show that it is an accurate representation of the real world. The simulation is used to study decision support in resource management and patient admission control. To further improve the quality of decision support, we study the prediction of future hospital resource usage. Using prediction, the future impact of taking a certain decision can be taken into account. In the problem setting at hand for instance, predicting the resource utilization resulting from an admission decision is important to prevent future bottlenecks that may cause the blocking of patient flow and increase patient waiting times. The methods we investigate for the task of prediction are forward simulation and supervised learning using neural networks. In an extensive analysis we study the underlying probability distributions of resource occupancy and investigate, by stochastic techniques, how to obtain accurate and precise prediction outcomes. To optimize resource allocation decisions we consider multiple criteria that are important in the hospital problem setting. We use three conflicting objectives in the optimization: maximal patient throughput, minimal resource costs and minimal usage of back-up capacity. All criteria can be taken into account by finding decision policies that have the best trade-off between the criteria. We derived various decision policies that partly allow for adaptive resource allocations. The design of the policies allows the policies to be easily understandable for hospital experts. Moreover, we present a bed exchange mechanism that enables a realistic implementation of these adaptive policies in practice. In our optimization approach, the parameters of the different decision policies are determined using a multiobjective evolutionary algorithm (MOEA). Specifically, the MOEA optimizes the output of the simulation (i.e. the three optimization criteria) as a function of the policy parameters. Our results on resource management show that the benchmark allocations obtained from a case study are considerably improved by the optimized decision policies. Furthermore, our results show that using adaptive policies can lead to better results and that further improvements may be obtained by integrating prediction into a decision policy

Agent-based management of clinical guidelines

Les guies de pràctica clínica (GPC) contenen un conjunt d'accions i dades que ajuden a un metge a prendre decisions sobre el diagnòstic, tractament o qualsevol altre procediment a un pacient i sobre una determinada malaltia. És conegut que l'adopció d'aquestes guies en la vida diària pot millorar l'assistència mèdica als pacients, pel fet que s'estandarditzen les pràctiques. Sistemes computeritzats que utilitzen GPC poden constituir part de sistemes d'ajut a la presa de decisions més complexos amb la finalitat de proporcionar el coneixement adequat a la persona adequada, en un format correcte i en el moment precís. L'automatització de l'execució de les GPC és el primer pas per la seva implantació en els centres mèdics.Per aconseguir aquesta implantació final, hi ha diferents passos que cal solucionar com per exemple, l'adquisició i representació de les GPC, la seva verificació formal, i finalment la seva execució. Aquesta Tesi està dirigida en l'execució de GPC i proposa la implementació d'un sistema multi-agent. En aquest sistema els diferents actors dels centres mèdics coordinen les seves activitats seguint un pla global determinat per una GPC. Un dels principals problemes de qualsevol sistema que treballa en l'àmbit mèdic és el tractament del coneixement. En aquest cas s'han hagut de tractar termes mèdics i organitzatius, que s'ha resolt amb la implementació de diferents ontologies. La separació de la representació del coneixement del seu ús és intencionada i permet que el sistema d'execució de GPC sigui fàcilment adaptable a les circumstàncies concretes dels centres, on varien el personal i els recursos disponibles.En paral·lel a l'execució de GPC, el sistema proposat manega preferències del pacient per tal d'implementar serveis adaptats al pacient. En aquesta àrea concretament, a) s'han definit un conjunt de criteris, b) aquesta informació forma part del perfil de l'usuari i serveix per ordenar les propostes que el sistema li proposa, i c) un algoritme no supervisat d'aprenentatge permet adaptar les preferències del pacient segons triï.Finalment, algunes idees d'aquesta Tesi actualment s'estan aplicant en dos projectes de recerca. Per una banda, l'execució distribuïda de GPC, i per altra banda, la representació del coneixement mèdic i organitzatiu utilitzant ontologies.Clinical guidelines (CGs) contain a set of directions or principles to assist the health care practitioner with patient care decisions about appropriate diagnostic, therapeutic, or other clinical procedures for specific clinical circumstances. It is widely accepted that the adoption of guideline-execution engines in daily practice would improve the patient care, by standardising the care procedures. Guideline-based systems can constitute part of a knowledge-based decision support system in order to deliver the right knowledge to the right people in the right form at the right time. The automation of the guideline execution process is a basic step towards its widespread use in medical centres.To achieve this general goal, different topics should be tackled, such as the acquisition of clinical guidelines, its formal verification, and finally its execution. This dissertation focuses on the execution of CGs and proposes the implementation of an agent-based platform in which the actors involved in health care coordinate their activities to perform the complex task of guideline enactment. The management of medical and organizational knowledge, and the formal representation of the CGs, are two knowledge-related topics addressed in this dissertation and tackled through the design of several application ontologies. The separation of the knowledge from its use is fully intentioned, and allows the CG execution engine to be easily customisable to different medical centres with varying personnel and resources.In parallel with the execution of CGs, the system handles citizen's preferences and uses them to implement patient-centred services. With respect this issue, the following tasks have been developed: a) definition of the user's criteria, b) use of the patient's profile to rank the alternatives presented to him, c) implementation of an unsupervised learning method to adapt dynamically and automatically the user's profile.Finally, several ideas of this dissertation are being directly applied in two ongoing funded research projects, including the agent-based execution of CGs and the ontological management of medical and organizational knowledge

Une approche logicielle du traitement de la dyslexie : étude de modèles et applications

Neuropsychological disorders are widespread and generate real public health problems. In particular in our modern society, where written communication is ubiquitous, dyslexia can be extremely disabling. Nevertheless we can note that the diagnosis and remediation of this pathology are fastidious and lack of standardization. Unfortunately it seems inherent to the clinical characterization of dyslexia by exclusion, to the multitude of different practitioners involved in such treatment and to the lack of objectivity of some existing methods. In this respect, we decided to investigate the possibilities offered by modern computing to overcome these barriers. Indeed we have assumed that the democratization of computer systems and their computing power could make of them a perfect tool to alleviate the difficulties encountered in the treatment of dyslexia. This research has led us to study the techniques software as well as hardware, which can conduct to the development of an inexpensive and scalable system able to attend a beneficial and progressive changing of practices in this pathology field. With this project we put ourselves definitely in an innovative stream serving quality of care and aid provided to people with disabilities. Our work has been identifying different improvement areas that the use of computers enables. Then each of these areas could then be the subject of extensive research, modeling and prototype developments. We also considered the methodology for designing this kind of system as a whole. In particular our thoughts and these accomplishments have allowed us to define a software framework suitable for implementing a software platform that we called the PAMMA. This platform should theoretically have access to all the tools required for the flexible and efficient development of medical applications integrating business processes. In this way it is expected that this system allows the development of applications for caring dyslexic patients thus leading to a faster and more accurate diagnosis and a more appropriate and effective remediation. Of our innovation efforts emerge encouraging perspectives. However such initiatives can only be achieved within multidisciplinary collaborations with many functional, technical and financial means. Creating such a consortium seems to be the next required step to get a funding necessary for realizing a first functional prototype of the PAMMA, as well as its first applications. Some clinical studies may be conducted to prove undoubtedly the effectiveness of such an approach for treating dyslexia and eventually other neuropsychological disorders.Les troubles neuropsychologiques sont très répandus et posent de réels problèmes de santé publique. En particulier, dans notre société moderne où la communication écrite est omniprésente, la dyslexie peut s’avérer excessivement handicapante. On remarque néanmoins que le diagnostic et la remédiation de cette pathologie restent délicats et manquent d’uniformisation. Ceci semble malheureusement inhérent à la caractérisation clinique par exclusion de la dyslexie, à la multitude de praticiens différents impliqués dans une telle prise en charge ainsi qu’au manque d’objectivité de certaines méthodes existantes. A ce titre, nous avons décidé d’investiguer les possibilités offertes par l’informatique actuelle pour surmonter ces barrières. Effectivement, nous avons supposé que la démocratisation des systèmes informatiques et leur puissance de calcul pourraient en faire un outil de choix pour pallier les difficultés rencontrées lors de la prise en charge de la dyslexie. Cette recherche nous a ainsi mené à étudier les techniques, aussi bien logicielles que matérielles, pouvant conduire au développement d’un système bon marché et évolutif qui serait capable d’assister un changement bénéfique et progressif des pratiques qui entourent cette pathologie. Avec ce projet, nous nous plaçons définitivement dans un courant innovant au service de la qualité des soins et des aides apportées aux personnes souffrant d’un handicap. Notre travail a ainsi consisté à identifier différents axes d’amélioration que l’utilisation de l’outil informatique rend possible. Chacun de ces axes a alors pu faire l’objet de recherches exhaustives, de modélisations et de développements de prototypes. Nous avons également réfléchi à la méthodologie à mettre en œuvre pour concevoir un tel système dans sa globalité. En particulier, nos réflexions et ces différents accomplissements nous ont permis de définir un framework logiciel propice à l’implémentation d’une plate-forme logicielle que nous avons appelée la PAMMA. Cette plate-forme devrait théoriquement pouvoir disposer de tous les outils permettant le développement souple et efficace d’applications médicales intégrant des processus métiers. Il est ainsi attendu de ce système qu’il permette le développement d’applications, pour la prise en charges des patients dyslexiques, conduisant à un diagnostic plus rapide et plus précis ainsi qu’à une remédiation plus adaptée et plus efficace. De notre effort d’innovation ressortent des perspectives encourageantes. Cependant, ce type d’initiative ne peut se concrétiser qu’autour de collaborations pluridisciplinaires disposant de nombreux moyens fonctionnels, techniques et financiers. La constitution d’un tel consortium semble donc être la prochaine étape nécessaire à l’obtention des financements pour réaliser un premier prototype fonctionnel de la PAMMA, ainsi que de premières applications. Des études cliniques pourront être alors menées pour prouver indubitablement l’efficacité d’une telle approche dans le cadre de la prise en charge de la dyslexie, ainsi qu’éventuellement d’autres troubles neuropsychologiques