The Knowledge Grid: A Platform to Increase the Interoperability of Computable Knowledge and Produce Advice for Health

Here we demonstrate how more highly interoperable computable knowledge enables systems to generate large quantities of evidence-based advice for health. We first provide a thorough analysis of advice. Then, because advice derives from knowledge, we turn our focus to computable, i.e., machine-interpretable, forms for knowledge. We consider how computable knowledge plays dual roles as a resource conveying content and as an advice enabler. In this latter role, computable knowledge is combined with data about a decision situation to generate advice targeted at the pending decision. We distinguish between two types of automated services. When a computer system provides computable knowledge, we say that it provides a knowledge service. When computer system combines computable knowledge with instance data to provide advice that is specific to an unmade decision we say that it provides an advice-giving service. The work here aims to increase the interoperability of computable knowledge to bring about better knowledge services and advice-giving services for health. The primary motivation for this research is the problem of missing or inadequate advice about health topics. The global demand for well-informed health advice far exceeds the global supply. In part to overcome this scarcity, the design and development of Learning Health Systems is being pursued at various levels of scale: local, regional, state, national, and international. Learning Health Systems fuse capabilities to generate new computable biomedical knowledge with other capabilities to rapidly and widely use computable biomedical knowledge to inform health practices and behaviors with advice. To support Learning Health Systems, we believe that knowledge services and advice-giving services have to be more highly interoperable. I use examples of knowledge services and advice-giving services which exclusively support medication use. This is because I am a pharmacist and pharmacy is the biomedical domain that I know. The examples here address the serious problems of medication adherence and prescribing safety. Two empirical studies are shared that demonstrate the potential to address these problems and make improvements by using advice. But primarily we use these examples to demonstrate general and critical differences between stand-alone, unique approaches to handling computable biomedical knowledge, which make it useful for one system, and common, more highly interoperable approaches, which can make it useful for many heterogeneous systems. Three aspects of computable knowledge interoperability are addressed: modularity, identity, and updateability. We demonstrate that instances of computable knowledge, and related instances of knowledge services and advice-giving services, can be modularized. We also demonstrate the utility of uniquely identifying modular instances of computable knowledge. Finally, we build on the computing concept of pipelining to demonstrate how computable knowledge modules can automatically be updated and rapidly deployed. Our work is supported by a fledgling technical knowledge infrastructure platform called the Knowledge Grid. It includes formally specified compound digital objects called Knowledge Objects, a conventional digital Library that serves as a Knowledge Object repository, and an Activator that provides an application programming interface (API) for computable knowledge. The Library component provides knowledge services. The Activator component provides both knowledge services and advice-giving services. In conclusion, by increasing the interoperability of computable biomedical knowledge using the Knowledge Grid, we demonstrate new capabilities to generate well-informed health advice at a scale. These new capabilities may ultimately support Learning Health Systems and boost health for large populations of people who would otherwise not receive well-informed health advice.PHDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/146073/1/ajflynn_1.pd

The Knowledge Object Reference Ontology (KORO): A formalism to support management and sharing of computable biomedical knowledge for learning health systems

IntroductionHealth systems are challenged by care underutilization, overutilization, disparities, and related harms. One problem is a multiyear latency between discovery of new best practice knowledge and its widespread adoption. Decreasing this latency requires new capabilities to better manage and more rapidly share biomedical knowledge in computable forms. Knowledge objects package machineâ executable knowledge resources in a way that easily enables knowledge as a service. To help improve knowledge management and accelerate knowledge sharing, the Knowledge Object Reference Ontology (KORO) defines what knowledge objects are in a formal way.MethodsDevelopment of KORO began with identification of terms for classes of entities and for properties. Next, we established a taxonomical hierarchy of classes for knowledge objects and their parts. Development continued by relating these parts via formally defined properties. We evaluated the logical consistency of KORO and used it to answer several competency questions about parthood. We also applied it to guide knowledge object implementation.ResultsAs a realist ontology, KORO defines what knowledge objects are and provides details about the parts they have and the roles they play. KORO provides sufficient logic to answer several basic but important questions about knowledge objects competently. KORO directly supports creators of knowledge objects by providing a formal model for these objects.ConclusionKORO provides a formal, logically consistent ontology about knowledge objects and their parts. It exists to help make computable biomedical knowledge findable, accessible, interoperable, and reusable. KORO is currently being used to further develop and improve computable knowledge infrastructure for learning health systems.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143591/1/lrh210054_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143591/2/lrh210054.pd

Automated Injection of Curated Knowledge Into Real-Time Clinical Systems: CDS Architecture for the 21st Century

abstract: Clinical Decision Support (CDS) is primarily associated with alerts, reminders, order entry, rule-based invocation, diagnostic aids, and on-demand information retrieval. While valuable, these foci have been in production use for decades, and do not provide a broader, interoperable means of plugging structured clinical knowledge into live electronic health record (EHR) ecosystems for purposes of orchestrating the user experiences of patients and clinicians. To date, the gap between knowledge representation and user-facing EHR integration has been considered an “implementation concern” requiring unscalable manual human efforts and governance coordination. Drafting a questionnaire engineered to meet the specifications of the HL7 CDS Knowledge Artifact specification, for example, carries no reasonable expectation that it may be imported and deployed into a live system without significant burdens. Dramatic reduction of the time and effort gap in the research and application cycle could be revolutionary. Doing so, however, requires both a floor-to-ceiling precoordination of functional boundaries in the knowledge management lifecycle, as well as formalization of the human processes by which this occurs. This research introduces ARTAKA: Architecture for Real-Time Application of Knowledge Artifacts, as a concrete floor-to-ceiling technological blueprint for both provider heath IT (HIT) and vendor organizations to incrementally introduce value into existing systems dynamically. This is made possible by service-ization of curated knowledge artifacts, then injected into a highly scalable backend infrastructure by automated orchestration through public marketplaces. Supplementary examples of client app integration are also provided. Compilation of knowledge into platform-specific form has been left flexible, in so far as implementations comply with ARTAKA’s Context Event Service (CES) communication and Health Services Platform (HSP) Marketplace service packaging standards. Towards the goal of interoperable human processes, ARTAKA’s treatment of knowledge artifacts as a specialized form of software allows knowledge engineers to operate as a type of software engineering practice. Thus, nearly a century of software development processes, tools, policies, and lessons offer immediate benefit: in some cases, with remarkable parity. Analyses of experimentation is provided with guidelines in how choice aspects of software development life cycles (SDLCs) apply to knowledge artifact development in an ARTAKA environment. Portions of this culminating document have been further initiated with Standards Developing Organizations (SDOs) intended to ultimately produce normative standards, as have active relationships with other bodies.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

2001 Thirteenth Annual IMSA Presentation Day

Professional associations such as the American Association for the Advancement of Science (AAAS), the National Association of Biology Teachers, the American Society of Microbiology ... have all featured the research work of MSA students through presentations and publications.https://digitalcommons.imsa.edu/archives_sir/1022/thumbnail.jp

Modeling IoT-Based Solutions Using Human-Centric Wireless Sensor Networks

The Internet of Things (IoT) has inspired solutions that are already available for addressing problems in various application scenarios, such as healthcare, security, emergency support and tourism. However, there is no clear approach to modeling these systems and envisioning their capabilities at the design time. Therefore, the process of designing these systems is ad hoc and its real impact is evaluated once the solution is already implemented, which is risky and expensive. This paper proposes a modeling approach that uses  human-centric wireless sensor networks to specify and evaluate models of IoT-based systems at the time of design, avoiding the need to spend time and effort on early implementations of immature designs. It allows designers to focus on the system design, leaving the implementation decisions for a next phase. The article illustrates the usefulness of this proposal through a running example, showing the design of an IoT-based solution to support the first responses during medium-sized or large urban incidents. The case study used in the proposal evaluation is based on a real train crash. The proposed modeling approach can be used to design IoT-based systems for other application scenarios, e.g., to support security operatives or monitor chronic patients in their homes.Fil: Monares, Álvaro . Universidad de Chile; ChileFil: Ochoa, Sergio F.. Universidad de Chile; ChileFil: Santos, Rodrigo Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Bahía Blanca. Instituto de Investigación en Ingeniería Eléctrica; Argentina. Universidad Nacional del Sur. Departamento de Ingenieria Electrica y de Computadoras; ArgentinaFil: Orozco, Javier Dario. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Bahía Blanca. Instituto de Investigación en Ingeniería Eléctrica; Argentina. Universidad Nacional del Sur. Departamento de Ingenieria Electrica y de Computadoras; ArgentinaFil: Meseguer, Roc . Universidad Politecnica de Catalunya; Españ

Software engineering perspectives on physiological computing

Physiological computing is an interesting and promising concept to widen the communication channel between the (human) users and computers, thus allowing an increase of software systems' contextual awareness and rendering software systems smarter than they are today. Using physiological inputs in pervasive computing systems allows re-balancing the information asymmetry between the human user and the computer system: while pervasive computing systems are well able to flood the user with information and sensory input (such as sounds, lights, and visual animations), users only have a very narrow input channel to computing systems; most of the time, restricted to keyboards, mouse, touchscreens, accelerometers and GPS receivers (through smartphone usage, e.g.). Interestingly, this information asymmetry often forces the user to subdue to the quirks of the computing system to achieve his goals -- for example, users may have to provide information the software system demands through a narrow, time-consuming input mode that the system could sense implicitly from the human body. Physiological computing is a way to circumvent these limitations; however, systematic means for developing and moulding physiological computing applications into software are still unknown. This thesis proposes a methodological approach to the creation of physiological computing applications that makes use of component-based software engineering. Components help imposing a clear structure on software systems in general, and can thus be used for physiological computing systems as well. As an additional bonus, using components allow physiological computing systems to leverage reconfigurations as a means to control and adapt their own behaviours. This adaptation can be used to adjust the behaviour both to the human and to the available computing environment in terms of resources and available devices - an activity that is crucial for complex physiological computing systems. With the help of components and reconfigurations, it is possible to structure the functionality of physiological computing applications in a way that makes them manageable and extensible, thus allowing a stepwise and systematic extension of a system's intelligence. Using reconfigurations entails a larger issue, however. Understanding and fully capturing the behaviour of a system under reconfiguration is challenging, as the system may change its structure in ways that are difficult to fully predict. Therefore, this thesis also introduces a means for formal verification of reconfigurations based on assume-guarantee contracts. With the proposed assume-guarantee contract framework, it is possible to prove that a given system design (including component behaviours and reconfiguration specifications) is satisfying real-time properties expressed as assume-guarantee contracts using a variant of real-time linear temporal logic introduced in this thesis - metric interval temporal logic for reconfigurable systems. Finally, this thesis embeds both the practical approach to the realisation of physiological computing systems and formal verification of reconfigurations into Scrum, a modern and agile software development methodology. The surrounding methodological approach is intended to provide a frame for the systematic development of physiological computing systems from first psychological findings to a working software system with both satisfactory functionality and software quality aspects. By integrating practical and theoretical aspects of software engineering into a self-contained development methodology, this thesis proposes a roadmap and guidelines for the creation of new physiological computing applications.Physiologisches Rechnen ist ein interessantes und vielversprechendes Konzept zur Erweiterung des Kommunikationskanals zwischen (menschlichen) Nutzern und Rechnern, und dadurch die Berücksichtigung des Nutzerkontexts in Software-Systemen zu verbessern und damit Software-Systeme intelligenter zu gestalten, als sie es heute sind. Physiologische Eingangssignale in ubiquitären Rechensystemen zu verwenden, ermöglicht eine Neujustierung der Informationsasymmetrie, die heute zwischen Menschen und Rechensystemen existiert: Während ubiquitäre Rechensysteme sehr wohl in der Lage sind, den Menschen mit Informationen und sensorischen Reizen zu überfluten (z.B. durch Töne, Licht und visuelle Animationen), hat der Mensch nur sehr begrenzte Einflussmöglichkeiten zu Rechensystemen. Meistens stehen nur Tastaturen, die Maus, berührungsempfindliche Bildschirme, Beschleunigungsmesser und GPS-Empfänger (zum Beispiel durch Mobiltelefone oder digitale Assistenten) zur Verfügung. Diese Informationsasymmetrie zwingt die Benutzer zur Unterwerfung unter die Usancen der Rechensysteme, um ihre Ziele zu erreichen - zum Beispiel müssen Nutzer Daten manuell eingeben, die auch aus Sensordaten des menschlichen Körpers auf unauffällige weise erhoben werden können. Physiologisches Rechnen ist eine Möglichkeit, diese Beschränkung zu umgehen. Allerdings fehlt eine systematische Methodik für die Entwicklung physiologischer Rechensysteme bis zu fertiger Software. Diese Dissertation präsentiert einen methodischen Ansatz zur Entwicklung physiologischer Rechenanwendungen, der auf der komponentenbasierten Softwareentwicklung aufbaut. Der komponentenbasierte Ansatz hilft im Allgemeinen dabei, eine klare Architektur des Software-Systems zu definieren, und kann deshalb auch für physiologische Rechensysteme angewendet werden. Als zusätzlichen Vorteil erlaubt die Komponentenorientierung in physiologischen Rechensystemen, Rekonfigurationen als Mittel zur Kontrolle und Anpassung des Verhaltens von physiologischen Rechensystemen zu verwenden. Diese Adaptionstechnik kann genutzt werden um das Verhalten von physiologischen Rechensystemen an den Benutzer anzupassen, sowie an die verfügbare Recheninfrastruktur im Sinne von Systemressourcen und Geräten - eine Maßnahme, die in komplexen physiologischen Rechensystemen entscheidend ist. Mit Hilfe der Komponentenorientierung und von Rekonfigurationen wird es möglich, die Funktionalität von physiologischen Rechensystemen so zu strukturieren, dass das System wartbar und erweiterbar bleibt. Dadurch wird eine schrittweise und systematische Erweiterung der Funktionalität des Systems möglich. Die Verwendung von Rekonfigurationen birgt allerdings Probleme. Das Systemverhalten eines Software-Systems, das Rekonfigurationen unterworfen ist zu verstehen und vollständig einzufangen ist herausfordernd, da das System seine Struktur auf schwer vorhersehbare Weise verändern kann. Aus diesem Grund führt diese Arbeit eine Methode zur formalen Verifikation von Rekonfigurationen auf Grundlage von Annahme-Zusicherungs-Verträgen ein. Mit dem vorgeschlagenen Annahme-Zusicherungs-Vertragssystem ist es möglich zu beweisen, dass ein gegebener Systementwurf (mitsamt Komponentenverhalten und Spezifikation des Rekonfigurationsverhaltens) eine als Annahme-Zusicherungs-Vertrag spezifizierte Echtzeiteigenschaft erfüllt. Für die Spezifikation von Echtzeiteigenschaften kann eine Variante von linearer Temporallogik für Echtzeit verwendet werden, die in dieser Arbeit eingeführt wird: Die metrische Intervall-Temporallogik für rekonfigurierbare Systeme. Schließlich wird in dieser Arbeit sowohl ein praktischer Ansatz zur Realisierung von physiologischen Rechensystemen als auch die formale Verifikation von Rekonfigurationen in Scrum eingebettet, einer modernen und agilen Softwareentwicklungsmethodik. Der methodische Ansatz bietet einen Rahmen für die systematische Entwicklung physiologischer Rechensysteme von Erkenntnissen zur menschlichen Physiologie hin zu funktionierenden physiologischen Softwaresystemen mit zufriedenstellenden funktionalen und qualitativen Eigenschaften. Durch die Integration sowohl von praktischen wie auch theoretischen Aspekten der Softwaretechnik in eine vollständige Entwicklungsmethodik bietet diese Arbeit einen Fahrplan und Richtlinien für die Erstellung neuer physiologischer Rechenanwendungen

Stratégies pour le raisonnement sur le contexte dans les environnements d assistance pour les personnes âgées

Tirant parti de notre expérience avec une approche traditionnelle des environnements d'assistance ambiante (AAL) qui repose sur l'utilisation de nombreuses technologies hétérogènes dans les déploiements, cette thèse étudie la possibilité d'une approche simplifiée et complémentaire, ou seul un sous-ensemble hardware réduit est déployé, initiant un transfert de complexité vers le côté logiciel. Axé sur les aspects de raisonnement dans les systèmes AAL, ce travail a permis à la proposition d'un moteur d'inférence sémantique adapté à l'utilisation particulière à ces systèmes, répondant ainsi à un besoin de la communauté scientifique. Prenant en compte la grossière granularité des données situationnelles disponible avec une telle approche, un ensemble de règles dédiées avec des stratégies d'inférence adaptées est proposé, implémenté et validé en utilisant ce moteur. Un mécanisme de raisonnement sémantique novateur est proposé sur la base d'une architecture de raisonnement inspiré du système cognitif. Enfin, le système de raisonnement est intégré dans un framework de provision de services sensible au contexte, se chargeant de l'intelligence vis-à-vis des données contextuelles en effectuant un traitement des événements en direct par des manipulations ontologiques complexes. L ensemble du système est validé par des déploiements in-situ dans une maison de retraite ainsi que dans des maisons privées, ce qui en soi est remarquable dans un domaine de recherche principalement cantonné aux laboratoiresLeveraging our experience with the traditional approach to ambient assisted living (AAL) which relies on a large spread of heterogeneous technologies in deployments, this thesis studies the possibility of a more stripped down and complementary approach, where only a reduced hardware subset is deployed, probing a transfer of complexity towards the software side, and enhancing the large scale deployability of the solution. Focused on the reasoning aspects in AAL systems, this work has allowed the finding of a suitable semantic inference engine for the peculiar use in these systems, responding to a need in this scientific community. Considering the coarse granularity of situational data available, dedicated rule-sets with adapted inference strategies are proposed, implemented, and validated using this engine. A novel semantic reasoning mechanism is proposed based on a cognitively inspired reasoning architecture. Finally, the whole reasoning system is integrated in a fully featured context-aware service framework, powering its context awareness by performing live event processing through complex ontological manipulation. the overall system is validated through in-situ deployments in a nursing home as well as private homes over a few months period, which itself is noticeable in a mainly laboratory-bound research domainEVRY-INT (912282302) / SudocSudocFranceF