Patient-tailored prioritization for a pediatric care decision support system through machine learning

Objective Over 8 years, we have developed an innovative computer decision support system that improves appropriate delivery of pediatric screening and care. This system employs a guidelines evaluation engine using data from the electronic health record (EHR) and input from patients and caregivers. Because guideline recommendations typically exceed the scope of one visit, the engine uses a static prioritization scheme to select recommendations. Here we extend an earlier idea to create patient-tailored prioritization. Materials and methods We used Bayesian structure learning to build networks of association among previously collected data from our decision support system. Using area under the receiver-operating characteristic curve (AUC) as a measure of discriminability (a sine qua non for expected value calculations needed for prioritization), we performed a structural analysis of variables with high AUC on a test set. Our source data included 177 variables for 29 402 patients. Results The method produced a network model containing 78 screening questions and anticipatory guidance (107 variables total). Average AUC was 0.65, which is sufficient for prioritization depending on factors such as population prevalence. Structure analysis of seven highly predictive variables reveals both face-validity (related nodes are connected) and non-intuitive relationships. Discussion We demonstrate the ability of a Bayesian structure learning method to ‘phenotype the population’ seen in our primary care pediatric clinics. The resulting network can be used to produce patient-tailored posterior probabilities that can be used to prioritize content based on the patient's current circumstances. Conclusions This study demonstrates the feasibility of EHR-driven population phenotyping for patient-tailored prioritization of pediatric preventive care services

What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

The Value of Information Technology-Enabled Diabetes Management

Reviews different technologies used in diabetes disease management, as well as the costs, benefits, and quality implications of technology-enabled diabetes management programs in the United States

Real-Time Context-Aware Microservice Architecture for Predictive Analytics and Smart Decision-Making

The impressive evolution of the Internet of Things and the great amount of data flowing through the systems provide us with an inspiring scenario for Big Data analytics and advantageous real-time context-aware predictions and smart decision-making. However, this requires a scalable system for constant streaming processing, also provided with the ability of decision-making and action taking based on the performed predictions. This paper aims at proposing a scalable architecture to provide real-time context-aware actions based on predictive streaming processing of data as an evolution of a previously provided event-driven service-oriented architecture which already permitted the context-aware detection and notification of relevant data. For this purpose, we have defined and implemented a microservice-based architecture which provides real-time context-aware actions based on predictive streaming processing of data. As a result, our architecture has been enhanced twofold: on the one hand, the architecture has been supplied with reliable predictions through the use of predictive analytics and complex event processing techniques, which permit the notification of relevant context-aware information ahead of time. On the other, it has been refactored towards a microservice architecture pattern, highly improving its maintenance and evolution. The architecture performance has been evaluated with an air quality case study

Accommodating repair actions into gas turbine prognostics

Elements of gas turbine degradation, such as compressor fouling, are recoverable through maintenance actions like compressor washing. These actions increase the usable engine life and optimise the performance of the gas turbine. However, these maintenance actions are performed by a separate organization to those undertaking fleet management operations, leading to significant uncertainty in the maintenance state of the asset. The uncertainty surrounding maintenance actions impacts prognostic efficacy. In this paper, we adopt Bayesian on-line change point detection to detect the compressor washing events. Then, the event detection information is used as an input to a prognostic algorithm, advising an update to the estimation of remaining useful life. To illustrate the capability of the approach, we demonstrated our on-line Bayesian change detection algorithms on synthetic and real aircraft engine service data, in order to identify the compressor washing events for a gas turbine and thus provide demonstrably improved prognosis

A Methodology for the Diagnostic of Aircraft Engine Based on Indicators Aggregation

Aircraft engine manufacturers collect large amount of engine related data during flights. These data are used to detect anomalies in the engines in order to help companies optimize their maintenance costs. This article introduces and studies a generic methodology that allows one to build automatic early signs of anomaly detection in a way that is understandable by human operators who make the final maintenance decision. The main idea of the method is to generate a very large number of binary indicators based on parametric anomaly scores designed by experts, complemented by simple aggregations of those scores. The best indicators are selected via a classical forward scheme, leading to a much reduced number of indicators that are tuned to a data set. We illustrate the interest of the method on simulated data which contain realistic early signs of anomalies.Comment: Proceedings of the 14th Industrial Conference, ICDM 2014, St. Petersburg : Russian Federation (2014

Overview of Remaining Useful Life prediction techniques in Through-life Engineering Services

Through-life Engineering Services (TES) are essential in the manufacture and servicing of complex engineering products. TES improves support services by providing prognosis of run-to-failure and time-to-failure on-demand data for better decision making. The concept of Remaining Useful Life (RUL) is utilised to predict life-span of components (of a service system) with the purpose of minimising catastrophic failure events in both manufacturing and service sectors. The purpose of this paper is to identify failure mechanisms and emphasise the failure events prediction approaches that can effectively reduce uncertainties. It will demonstrate the classification of techniques used in RUL prediction for optimisation of products’ future use based on current products in-service with regards to predictability, availability and reliability. It presents a mapping of degradation mechanisms against techniques for knowledge acquisition with the objective of presenting to designers and manufacturers ways to improve the life-span of components