Promoting Health for Chronic Conditions: a Novel Approach that integrates Clinical and Personal Decision Support

Direct and indirect economic costs related to chronic diseases are increasing in Europe due to the aging of population. One of the most challenging goals is to improve the quality of life of patients affected by chronic conditions, and enhance their self-management. In this paper, we propose a novel architecture of a scalable solution, based on mobile tools, aimed to keep patients with chronic diseases away from acute episodes, to improve their quality of life and, consequently, to reduce their economic impact. Our solution aims to provide patients with a personalized tool for improving self-management, and it supports both patients and clinicians in decision-making through the implementation of two different Decision Support Systems. Moreover, the proposed architecture takes into account the interoperability and, particularly, the compliance with data transfer protocols (e.g., BT4/LE, ANT+, ISO/IEEE 11073) to ensure integration with existing devices, and with the semantic web approaches and standards related to the content and structure of the information (e.g., HL7, ICD-10 and openEHR) to ensure correct sharing of information with hospital information systems, and classification of patient behaviors (Coelition). The solution will be implemented and validated in future study

Management of drug-disease interactions:a best practice from the Netherlands

Background Drug-disease interactions are situations where pharmacotherapy may have a negative effect on patients' comorbidities. In these cases, it can be necessary to avoid that drug, adjust its dose or monitor therapy. In the Netherlands, pharmacists have developed a best practice how to systematically evaluate drug-disease interactions based on pharmacological considerations and implement recommendations for specific drug-disease interactions. Aim To describe the development of recommendations for drug-disease interactions and the implementation in prescribing and dispensing practice in the Netherlands. Setting Pharmacies and physicians' practices in primary care and hospitals in the Netherlands. Development A multi-disciplinary expert panel assessed if diseases had clinically relevant drug-disease interactions and evaluated drug-disease interactions by literature review and expert opinion, and subsequently developed practice recommendations. Implementation The recommendations were implemented in all clinical decision support systems in primary care and hospitals throughout the Netherlands. Evaluation Recommendations were developed for 57 diseases and conditions. Cardiovascular diseases have the most drug-disease interactions (n = 12, e.g. long QT-syndrome, heart failure), followed by conditions related to the reproductive system (n = 7, e.g. pregnancy). The number of drugs with recommendations differed between 6 for endometriosis and tympanostomy tubes, and up to 1171 in the case of porphyria or even all drugs for pregnancy. Conclusion Practice recommendations for drug-disease interactions were developed, and implemented in prescribing and dispensing practice. These recommendations support both pharmacists and physicians by signalling clinically relevant drug-disease interactions at point of care, thereby improving medication safety. This practice may be adopted and contribute to safer medication use in other countries as well

A Cloud Telemedicine Platform Based on Workflow Management System: A Review of an Italian Case Study

The paper aims to describe a new technological and organizational approach in order to manage teleconsultation and telemonitoring processes involving a Physician, who remotely interacts with one or more Specialists, in order to evaluate and discuss the specific clinical conditions of a patient, based primarily on the sharing of digital clinical data, reports and diagnostic images. In the HINT project (Healthcare INtegration in Telemedicine), a teleconsultation and telemonitoring cloud platform has been developed using a Hub and Spoke architecture, based on a Business Process Management System (BPMS). The specialized clinical centres (Hubs) operate in connection with the territorial hospital centres (Spokes), which receive specific diagnostic consultations and telemonitoring data from the appropriate Specialist, supported by advanced AI systems. The developed platform overcomes the concepts of a traditional and fragmented teleconsultation and consequently the static organization of Hubs and Spokes, evolving towards an integrated clinical workflow management. The project platform adopts international healthcare standards, such as HL7 FHIR, IHE (XDS and XDW) and DICOM for the acquisition and management of healthcare data and diagnostic images. A Workflow Management System implemented in the platform allows to manage multiple and contemporaneous processes through a single platform, correctly associating the tasks to the Physicians responsible for their execution, monitoring the status of the health activities and managing possible clinical issues

Ontology-driven monitoring of patient's vital signs enabling personalized medical detection and alert

A major challenge related to caring for patients with chronic conditions is the early detection of exacerbations of the disease. Medical personnel should be contacted immediately in order to intervene in time before an acute state is reached, ensuring patient safety. This paper proposes an approach to an ambient intelligence (AmI) framework supporting real-time remote monitoring of patients diagnosed with congestive heart failure (CHF). Its novelty is the integration of: (i) personalized monitoring of the patients health status and risk stage; (ii) intelligent alerting of the dedicated physician through the construction of medical workflows on-the-fly; and (iii) dynamic adaptation of the vital signs' monitoring environment on any available device or smart phone located in close proximity to the physician depending on new medical measurements, additional disease specifications or the failure of the infrastructure. The intelligence lies in the adoption of semantics providing for a personalized and automated emergency alerting that smoothly interacts with the physician, regardless of his location, ensuring timely intervention during an emergency. It is evaluated on a medical emergency scenario, where in the case of exceeded patient thresholds, medical personnel are localized and contacted, presenting ad hoc information on the patient's condition on the most suited device within the physician's reach

Supporting integrated care pathways with workflow technology

Modern healthcare has moved to a focus on providing patient centric care rather than disease centred care. This new approach is provided by a unique care team which is formed to treat a patient. At the start of the treatment, the care team decide on the treatment pathway for the patient. This is a series of treatment stages where at the end of each stage, the care team use the patient’s current condition to decide whether the treatment moves to the next stage, continues in the treatment stage, or moves to an unanticipated stage. The initial treatment pathway for each patient is based on the clinical guidelines in an Integrated Care Pathway (ICP) [1] modified to suit the patient state. This research mapped a patient ICP decided by the healthcare providers into a Workflow Management System (WFMS) [2]. The clinical guidelines reflect the patient-centric flow to create an IT system supporting the care team. In the initial stage of the research the IT development team at Velindre Hospital identified that team communication and care coordination were obstacles hindering the implementation of a patient-centric delivery model. This was investigated to determine the causes, which were identified as difficulty in accessing the medical information held in dispersed legacy systems. Moreover, a major constraint in the domain is the need to keep legacy systems in operation and so there is a need to investigate approaches to enhance their functionalities. These information systems cannot be changed across all healthcare organisations and their complete autonomy needs to be retained as they are in constant use at the sites. Using workflow technology, an independent application representing an ICP was implemented. This was used to construct an independent layer in the software architecture to interact with legacy Clinical Information Systems (CISs) and so evolve their offered functionalities to support the teams. This was used to build a Virtual Organisation (VO) [3, 4] around a patient which facilitates patient-centric care. Moreover, the VO virtually integrates the data from legacy systems and ensures its availability (as needed) at the different treatment stages along the care pathway. Implications of the proposal include: formalising the treatment process, filtering and gathering the patient’s information, ensuring care continuity, and pro-acting to change. Evaluation of the proposal involved three stages; First, usefulness evaluation by the healthcare providers representing the users; Second, setup evaluation by developers of CISs; and Finally, technical evaluation by the community of the technology. The evaluation proved; the healthcare providers’ need for an adaptive and a proactive system, the possibility of adopting the proposed system, and the novelty and innovation of the proposed approach. The research proposes a patient-centric system achieved by creating a version of an ICP in the system for each patient. It also provides focussed support for team communication and care coordination, by identifying the treatment stages and providing the care team requirements at each stage. It utilises the data within the legacy system to be proactive. Moreover, it makes these required data for the actions available from the running legacy system which is required for patient-centred care. In the future the worth could be extended by mapping other ICPs into the system. This work has been published in four full papers. It found acceptance in the health informatics community [5, 6, 7] as well as the BPM community [8, 9]. It is also the winner of the 2011 “Global Award of Excellence in Adaptive Case Management (ACM)” in “Medical and Healthcare” [10] of the Workflow Management Coalition (WFMC) [11].EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Tracebook : a dynamic checklist support system

It has recently been demonstrated that checklist scan enable significant improvements to patient safety. However, their clinical acceptance is significantly lower than expected. This is due to the lack of good support systems. Specifically, support systems are too static: this holds for paper-based support as well as for electronic systems that digitize paper-based support naively. Both approaches are independent from clinical process and clinical context. In this paper, we propose a process-oriented and context-aware dynamic checklist support system: Tracebook. This system supports the execution of complex clinical processes and rules involving data from Electronic Medical Record systems. Workflow activities and forms are specific to individual patients based on clinical rules and they are dispatched to the right user automatically based on a process model. Besides describing the Tracebook functionality in general, this paper demonstrates the support system specifically on an example application that we are preparing for a controlled clinical evaluation. At last we discuss the difference between Tracebook and other support systems which also rely on a checklist format

Supporting integrated care pathways with workflow technology

Modern healthcare has moved to a focus on providing patient centric care rather than disease centred care. This new approach is provided by a unique care team which is formed to treat a patient. At the start of the treatment, the care team decide on the treatment pathway for the patient. This is a series of treatment stages where at the end of each stage, the care team use the patient’s current condition to decide whether the treatment moves to the next stage, continues in the treatment stage, or moves to an unanticipated stage. The initial treatment pathway for each patient is based on the clinical guidelines in an Integrated Care Pathway (ICP) [1] modified to suit the patient state. This research mapped a patient ICP decided by the healthcare providers into a Workflow Management System (WFMS) [2]. The clinical guidelines reflect the patient-centric flow to create an IT system supporting the care team. In the initial stage of the research the IT development team at Velindre Hospital identified that team communication and care coordination were obstacles hindering the implementation of a patient-centric delivery model. This was investigated to determine the causes, which were identified as difficulty in accessing the medical information held in dispersed legacy systems. Moreover, a major constraint in the domain is the need to keep legacy systems in operation and so there is a need to investigate approaches to enhance their functionalities. These information systems cannot be changed across all healthcare organisations and their complete autonomy needs to be retained as they are in constant use at the sites. Using workflow technology, an independent application representing an ICP was implemented. This was used to construct an independent layer in the software architecture to interact with legacy Clinical Information Systems (CISs) and so evolve their offered functionalities to support the teams. This was used to build a Virtual Organisation (VO) [3, 4] around a patient which facilitates patient-centric care. Moreover, the VO virtually integrates the data from legacy systems and ensures its availability (as needed) at the different treatment stages along the care pathway. Implications of the proposal include: formalising the treatment process, filtering and gathering the patient’s information, ensuring care continuity, and pro-acting to change. Evaluation of the proposal involved three stages; First, usefulness evaluation by the healthcare providers representing the users; Second, setup evaluation by developers of CISs; and Finally, technical evaluation by the community of the technology. The evaluation proved; the healthcare providers’ need for an adaptive and a proactive system, the possibility of adopting the proposed system, and the novelty and innovation of the proposed approach. The research proposes a patient-centric system achieved by creating a version of an ICP in the system for each patient. It also provides focussed support for team communication and care coordination, by identifying the treatment stages and providing the care team requirements at each stage. It utilises the data within the legacy system to be proactive. Moreover, it makes these required data for the actions available from the running legacy system which is required for patient-centred care. In the future the worth could be extended by mapping other ICPs into the system. This work has been published in four full papers. It found acceptance in the health informatics community [5, 6, 7] as well as the BPM community [8, 9]. It is also the winner of the 2011 “Global Award of Excellence in Adaptive Case Management (ACM)” in “Medical and Healthcare” [10] of the Workflow Management Coalition (WFMC) [11].EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Internet of Things-Based ECG and Vitals Healthcare Monitoring System

Health monitoring and its associated technologies have gained enormous importance over the past few years. The electrocardiogram (ECG) has long been a popular tool for assessing and diagnosing cardiovascular diseases (CVDs). Since the literature on ECG monitoring devices is growing at an exponential rate, it is becoming difficult for researchers and healthcare professionals to select, compare, and assess the systems that meet their demands while also meeting the monitoring standards. This emphasizes the necessity for a reliable reference to guide the design, categorization, and analysis of ECG monitoring systems, which will benefit both academics and practitioners. We present a complete ECG monitoring system in this work, describing the design stages and implementation of an end-to-end solution for capturing and displaying the patient’s heart signals, heart rate, blood oxygen levels, and body temperature. The data will be presented on an OLED display, a developed Android application as well as in MATLAB via serial communication. The Internet of Things (IoT) approaches have a clear advantage in tackling the problem of heart disease patient care as they can transform the service mode into a widespread one and alert the healthcare services based on the patient’s physical condition. Keeping this in mind, there is also the addition of a web server for monitoring the patient’s status via WiFi. The prototype, which is compliant with the electrical safety regulations and medical equipment design, was further benchmarked against a commercially available off-the-shelf device, and showed an excellent accuracy of 99.56%

Supporting integrated care pathways with workflow technology

Modern healthcare has moved to a focus on providing patient centric care rather than disease centred care. This new approach is provided by a unique care team which is formed to treat a patient. At the start of the treatment, the care team decide on the treatment pathway for the patient. This is a series of treatment stages where at the end of each stage, the care team use the patient’s current condition to decide whether the treatment moves to the next stage, continues in the treatment stage, or moves to an unanticipated stage. The initial treatment pathway for each patient is based on the clinical guidelines in an Integrated Care Pathway (ICP) [1] modified to suit the patient state. This research mapped a patient ICP decided by the healthcare providers into a Workflow Management System (WFMS) [2]. The clinical guidelines reflect the patient-centric flow to create an IT system supporting the care team. In the initial stage of the research the IT development team at Velindre Hospital identified that team communication and care coordination were obstacles hindering the implementation of a patient-centric delivery model. This was investigated to determine the causes, which were identified as difficulty in accessing the medical information held in dispersed legacy systems. Moreover, a major constraint in the domain is the need to keep legacy systems in operation and so there is a need to investigate approaches to enhance their functionalities. These information systems cannot be changed across all healthcare organisations and their complete autonomy needs to be retained as they are in constant use at the sites. Using workflow technology, an independent application representing an ICP was implemented. This was used to construct an independent layer in the software architecture to interact with legacy Clinical Information Systems (CISs) and so evolve their offered functionalities to support the teams. This was used to build a Virtual Organisation (VO) [3, 4] around a patient which facilitates patient-centric care. Moreover, the VO virtually integrates the data from legacy systems and ensures its availability (as needed) at the different treatment stages along the care pathway. Implications of the proposal include: formalising the treatment process, filtering and gathering the patient’s information, ensuring care continuity, and pro-acting to change. Evaluation of the proposal involved three stages; First, usefulness evaluation by the healthcare providers representing the users; Second, setup evaluation by developers of CISs; and Finally, technical evaluation by the community of the technology. The evaluation proved; the healthcare providers’ need for an adaptive and a proactive system, the possibility of adopting the proposed system, and the novelty and innovation of the proposed approach. The research proposes a patient-centric system achieved by creating a version of an ICP in the system for each patient. It also provides focussed support for team communication and care coordination, by identifying the treatment stages and providing the care team requirements at each stage. It utilises the data within the legacy system to be proactive. Moreover, it makes these required data for the actions available from the running legacy system which is required for patient-centred care. In the future the worth could be extended by mapping other ICPs into the system. This work has been published in four full papers. It found acceptance in the health informatics community [5, 6, 7] as well as the BPM community [8, 9]. It is also the winner of the 2011 “Global Award of Excellence in Adaptive Case Management (ACM)” in “Medical and Healthcare” [10] of the Workflow Management Coalition (WFMC) [11]