Clinical decision support system for point of care use--ontology-driven design and software implementation

OBJECTIVES: The objective of this research was to design a clinical decision support system (CDSS) that supports heterogeneous clinical decision problems and runs on multiple computing platforms. Meeting this objective required a novel design to create an extendable and easy to maintain clinical CDSS for point of care support. The proposed solution was evaluated in a proof of concept implementation. METHODS: Based on our earlier research with the design of a mobile CDSS for emergency triage we used ontology-driven design to represent essential components of a CDSS. Models of clinical decision problems were derived from the ontology and they were processed into executable applications during runtime. This allowed scaling applications' functionality to the capabilities of computing platforms. A prototype of the system was implemented using the extended client-server architecture and Web services to distribute the functions of the system and to make it operational in limited connectivity conditions. RESULTS: The proposed design provided a common framework that facilitated development of diversified clinical applications running seamlessly on a variety of computing platforms. It was prototyped for two clinical decision problems and settings (triage of acute pain in the emergency department and postoperative management of radical prostatectomy on the hospital ward) and implemented on two computing platforms--desktop and handheld computers. CONCLUSIONS: The requirement of the CDSS heterogeneity was satisfied with ontology-driven design. Processing of application models described with the help of ontological models allowed having a complex system running on multiple computing platforms with different capabilities. Finally, separation of models and runtime components contributed to improved extensibility and maintainability of the system

Domain ontology learning from the web

El Aprendizaje de Ontologías se define como el conjunto de métodos utilizados para construir, enriquecer o adaptar una ontología existente de forma semiautomática, utilizando fuentes de información heterogéneas. En este proceso se emplea texto, diccionarios electrónicos, ontologías lingüísticas e información estructurada y semiestructurada para extraer conocimiento. Recientemente, gracias al enorme crecimiento de la Sociedad de la Información, la Web se ha convertido en una valiosa fuente de información para casi cualquier dominio. Esto ha provocado que los investigadores empiecen a considerar a la Web como un repositorio válido para Recuperar Información y Adquirir Conocimiento. No obstante, la Web presenta algunos problemas que no se observan en repositorios de información clásicos: presentación orientada al usuario, ruido, fuentes no confiables, alta dinamicidad y tamaño abrumador. Pese a ello, también presenta algunas características que pueden ser interesantes para la adquisición de conocimiento: debido a su enorme tamaño y heterogeneidad, se asume que la Web aproxima la distribución real de la información a nivel global. Este trabajo describe una aproximación novedosa para el aprendizaje de ontologías, presentando nuevos métodos para adquirir conocimiento de la Web. La propuesta se distingue de otros trabajos previos principalmente en la particular adaptación de algunas técnicas clásicas de aprendizaje al corpus Web y en la explotación de las características interesantes del entorno Web para componer una aproximación automática, no supervisada e independiente del dominio. Con respecto al proceso de construcción de la ontologías, se han desarrollado los siguientes métodos: i) extracción y selección de términos relacionados con el dominio, organizándolos de forma taxonómica; ii) descubrimiento y etiquetado de relaciones no taxonómicas entre los conceptos; iii) métodos adicionales para mejorar la estructura final, incluyendo la detección de entidades con nombre, atributos, herencia múltiple e incluso un cierto grado de desambiguación semántica. La metodología de aprendizaje al completo se ha implementado mediante un sistema distribuido basado en agentes, proporcionando una solución escalable. También se ha evaluado para varios dominios de conocimiento bien diferenciados, obteniendo resultados de buena calidad. Finalmente, se han desarrollado varias aplicaciones referentes a la estructuración automática de librerías digitales y recursos Web, y la recuperación de información basada en ontologías.Ontology Learning is defined as the set of methods used for building from scratch, enriching or adapting an existing ontology in a semi-automatic fashion using heterogeneous information sources. This data-driven procedure uses text, electronic dictionaries, linguistic ontologies and structured and semi-structured information to acquire knowledge. Recently, with the enormous growth of the Information Society, the Web has become a valuable source of information for almost every possible domain of knowledge. This has motivated researchers to start considering the Web as a valid repository for Information Retrieval and Knowledge Acquisition. However, the Web suffers from problems that are not typically observed in classical information repositories: human oriented presentation, noise, untrusted sources, high dynamicity and overwhelming size. Even though, it also presents characteristics that can be interesting for knowledge acquisition: due to its huge size and heterogeneity it has been assumed that the Web approximates the real distribution of the information in humankind. The present work introduces a novel approach for ontology learning, introducing new methods for knowledge acquisition from the Web. The adaptation of several well known learning techniques to the web corpus and the exploitation of particular characteristics of the Web environment composing an automatic, unsupervised and domain independent approach distinguishes the present proposal from previous works.With respect to the ontology building process, the following methods have been developed: i) extraction and selection of domain related terms, organising them in a taxonomical way; ii) discovery and label of non-taxonomical relationships between concepts; iii) additional methods for improving the final structure, including the detection of named entities, class features, multiple inheritance and also a certain degree of semantic disambiguation. The full learning methodology has been implemented in a distributed agent-based fashion, providing a scalable solution. It has been evaluated for several well distinguished domains of knowledge, obtaining good quality results. Finally, several direct applications have been developed, including automatic structuring of digital libraries and web resources, and ontology-based Web Information Retrieval

An adaptive physiology-aware communication framework for distributed medical cyber physical systems

For emergency medical cyber-physical systems, enhancing the safety and effectiveness of patient care, especially in remote rural areas, is essential. While the doctor to patient ratio in the United States is 30 to 10,000 in large metropolitan areas, it is only 5 to 10,000 in most rural areas; and the highest death rates are often found in the most rural counties. Use of telecommunication technologies can enhance effectiveness and safety of emergency ambulance transport of patients from rural areas to a regional center hospital. It enables remote monitoring of patients by the physician experts at the tertiary center. There are critical times during transport when physician experts can provide vital assistance to the ambulance Emergency Medical Technicians (EMT) to associate best treatments. However, the communication along the roads in rural areas can range irregularly from 4G to low speed 2G links, including some parts of routes with cellular network communication breakage. This unreliable and limited communication bandwidth together with the produced mass of clinical data and the many information exchanges pose a major challenge in real-time supervision of patients. In this study, we define the notion of distributed emergency care, and propose a novel adaptive physiology-aware communication framework which is aware of the patient condition, the underlying network bandwidth, and the criticality of clinical data in the context of the specific diseases. Using the concept of distributed medical CPS models, we study the semantics relation of communication Quality of Service (QoS) with clinical messages, criticality of clinical data, and an ambulance's undertaken route all in a disease-aware manner. Our proposed communication framework is aimed to enhance remote monitoring of acute patients during ambulance transport from a rural hospital to a regional center hospital. We evaluate the components of our framework through various experimentation phases including simulation, instrumentation, real-world profiling, and validation