Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

Advanced analytical methods for fraud detection: a systematic literature review

The developments of the digital era demand new ways of producing goods and rendering services. This fast-paced evolution in the companies implies a new approach from the auditors, who must keep up with the constant transformation. With the dynamic dimensions of data, it is important to seize the opportunity to add value to the companies. The need to apply more robust methods to detect fraud is evident. In this thesis the use of advanced analytical methods for fraud detection will be investigated, through the analysis of the existent literature on this topic. Both a systematic review of the literature and a bibliometric approach will be applied to the most appropriate database to measure the scientific production and current trends. This study intends to contribute to the academic research that have been conducted, in order to centralize the existing information on this topic

Building a normative decision support system for clinical and operational risk management in hemodialysis.

This paper describes the design and implementation of a decision support system for risk management in hemodialysis (HD) departments. The proposed system exploits a domain ontology to formalize the problem as a Bayesian network. It also relies on a software tool, able to automatically collect HD data, to learn the network conditional probabilities. By merging prior knowledge and the available data, the system allows to estimate risk profiles both for patients and HD departments. The risk management process is completed by an influence diagram that enables scenario analysis to choose the optimal decisions that mitigate a patient's risk. The methods and design of the decision support tool are described in detail, and the derived decision model is presented. Examples and case studies are also shown. The tool is one of the few examples of normative system explicitly conceived to manage operational and clinical risks in health care environments

An ontology-driven architecture for data integration and management in home-based telemonitoring scenarios

The shift from traditional medical care to the use of new technology and engineering innovations is nowadays an interesting and growing research area mainly motivated by a growing population with chronic conditions and disabilities. By means of information and communications technologies (ICTs), telemedicine systems offer a good solution for providing medical care at a distance to any person in any place at any time. Although significant contributions have been made in this field in recent decades, telemedicine and in e-health scenarios in general still pose numerous challenges that need to be addressed by researchers in order to take maximum advantage of the benefits that these systems provide and to support their long-term implementation. The goal of this research thesis is to make contributions in the field of home-based telemonitoring scenarios. By periodically collecting patients' clinical data and transferring them to physicians located in remote sites, patient health status supervision and feedback provision is possible. This type of telemedicine system guarantees patient supervision while reducing costs (enabling more autonomous patient care and avoiding hospital over flows). Furthermore, patients' quality of life and empowerment are improved. Specifically, this research investigates how a new architecture based on ontologies can be successfully used to address the main challenges presented in home-based telemonitoring scenarios. The challenges include data integration, personalized care, multi-chronic conditions, clinical and technical management. These are the principal issues presented and discussed in this thesis. The proposed new ontology-based architecture takes into account both practical and conceptual integration issues and the transference of data between the end points of the telemonitoring scenario (i.e, communication and message exchange). The architecture includes two layers: 1) a conceptual layer and 2) a data and communication layer. On the one hand, the conceptual layer based on ontologies is proposed to unify the management procedure and integrate incoming data from all the sources involved in the telemonitoring process. On the other hand, the data and communication layer based on web service technologies is proposed to provide practical back-up to the use of the ontology, to provide a real implementation of the tasks it describes and thus to provide a means of exchanging data. This architecture takes advantage of the combination of ontologies, rules, web services and the autonomic computing paradigm. All are well-known technologies and popular solutions applied in the semantic web domain and network management field. A review of these technologies and related works that have made use of them is presented in this thesis in order to understand how they can be combined successfully to provide a solution for telemonitoring scenarios. The design and development of the ontology used in the conceptual layer led to the study of the autonomic computing paradigm and its combination with ontologies. In addition, the OWL (Ontology Web Language) language was studied and selected to express the required knowledge in the ontology while the SPARQL language was examined for its effective use in defining rules. As an outcome of these research tasks, the HOTMES (Home Ontology for Integrated Management in Telemonitoring Scenarios) ontology, presented in this thesis, was developed. The combination of the HOTMES ontology with SPARQL rules to provide a flexible solution for personalising management tasks and adapting the methodology for different management purposes is also discussed. The use of Web Services (WSs) was investigated to support the exchange of information defined in the conceptual layer of the architecture. A generic ontology based solution was designed to integrate data and management procedures in the data and communication layer of the architecture. This is an innovative REST-inspired architecture that allows information contained in an ontology to be exchanged in a generic manner. This layer structure and its communication method provide the approach with scalability and re-usability features. The application of the HOTMES-based architecture has been studied for clinical purposes following three simple methodological stages described in this thesis. Data and management integration for context-aware and personalized monitoring services for patients with chronic conditions in the telemonitoring scenario are thus addressed. In particular, the extension of the HOTMES ontology defines a patient profile. These profiles in combination with individual rules provide clinical guidelines aiming to monitor and evaluate the evolution of the patient's health status evolution. This research implied a multi-disciplinary collaboration where clinicians had an essential role both in the ontology definition and in the validation of the proposed approach. Patient profiles were defined for 16 types of different diseases. Finally, two solutions were explored and compared in this thesis to address the remote technical management of all devices that comprise the telemonitoring scenario. The first solution was based on the HOTMES ontology-based architecture. The second solution was based on the most popular TCP/IP management architecture, SNMP (Simple Network Management Protocol). As a general conclusion, it has been demonstrated that the combination of ontologies, rules, WSs and the autonomic computing paradigm takes advantage of the main benefits that these technologies can offer in terms of knowledge representation, work flow organization, data transference, personalization of services and self-management capabilities. It has been proven that ontologies can be successfully used to provide clear descriptions of managed data (both clinical and technical) and ways of managing such information. This represents a further step towards the possibility of establishing more effective home-based telemonitoring systems and thus improving the remote care of patients with chronic diseases

Contrôle intelligent de la domotique à partir d'informations temporelles multi sources imprécises et incertaines

La Maison Intelligente est une résidence équipée de technologie informatique qui assiste ses habitant dans les situations diverses de la vie domestique en essayant de gérer de manière optimale leur confort et leur sécurité par action sur la maison. La détection des situations anormales est un des points essentiels d'un système de surveillance à domicile. Ces situations peuvent être détectées en analysant les primitives générées par les étages de traitement audio et par les capteurs de l'appartement. Par exemple, la détection de cris et de bruits sourds (chute d'un objet lourd) dans un intervalle de temps réduit permet d'inférer l'occurrence d'une chute. Le but des travaux de cette thèse est la réalisation d'un contrôleur intelligent relié à tous les périphériques de la maison capable de réagir aux demandes de l'habitant (par commande vocale) et de reconnaître des situations à risque ou détresse. Pour accomplir cet objectif, il est nécessaire de représenter formellement et raisonner sur des informations, le plus souvent temporelles, à des niveaux d'abstraction différents. Le principale défi est le traitement de l'incertitude, l'imprécision, et incomplétude, qui caractérisent les informations dans ce domaine d'application. Par ailleurs, les décisions prises par le contrôleur doivent tenir compte du contexte dans lequel une ordre est donné, ce qui nous place dans l'informatique sensible au contexte. Le contexte est composé des informations de haut niveau tels que la localisation, l'activité en cours de réalisation, la période de la journée. Les recherches présentées dans ce manuscrit peuvent être divisés principalement en trois axes: la réalisation des méthodes d'inférence pour acquérir les informations du contexte(notamment, la localisation de l'habitant y l'activité en cours) à partir des informations incertains, la représentation des connaissances sur l'environnement et les situations à risque, et finalement la prise de décision à partir des informations contextuelles. La dernière partie du manuscrit expose les résultats de la validation des méthodes proposées par des évaluations amenées à la plateforme expérimental Domus.A smart home is a residence featuring ambient intelligence technologies in order to help its dwellers in different situations of common life by trying to manage their comfort and security through the execution of actions over the effectors of the house. Detection of abnormal situations is paramount in the development of surveillance systems. These situations can be detected by the analysis of the traces resulting from audio processing and the data provided by the network of sensors installed in the smart home. For instance, detection of cries along with thuds(fall of a heavy object) in a short time interval can help to infer that the resident has fallen. The goal of the research presented in this thesis is the implementation of an intelligence controller connected with the devices in the house that is able to react to user's commands(through vocal interfaces) and recognize dangerous situations. In order to fulfill this goal, it is necessary to create formal representation and to develop reasoning mechanism over informations that are often temporal and having different levels of abstraction. The main challenge is the processing the uncertainty, imprecision, and incompleteness that characterise this domain of application. Moreover, the decisions taken by the intelligent controller must consider the context in which a user command is given, so this work is made in the area of Context Aware Computing. Context includes high level information such as the location of the dweller, the activity she is making, and the time of the day. The research works presented in this thesis can be divided mainly in three parts: the implementation of inference methods to obtain context information(namely, location and activity) from uncertain information, knowledge representation about the environment and dangerous situations, and finally the development of decision making models that use the inferred context information. The last part of this thesis shows the results from the validation of the proposed methods through experiments performed in an experimental platform, the Domus apartment.SAVOIE-SCD - Bib.électronique (730659901) / SudocGRENOBLE1/INP-Bib.électronique (384210012) / SudocGRENOBLE2/3-Bib.électronique (384219901) / SudocSudocFranceF