Enhancing Decision-making Systems with Relevant Patient Information by Leveraging Clinical Notes

[Abstract] Hospitalised patients suffering from secondary illnesses that require daily medication typically need personalised treatment. Although clinical guidelines were designed considering those circumstances, existing decision-support features fail in assimilating detailed relevant patient information, which opens up opportunities for systems capable of performing a real-time evaluation of such data against existing knowledge and providing recommendations during clinical treatments. In this paper, we present a proposal for a new feature to integrate with electronic health record (EHR) systems that enriches the health treatment process by automatically extracting information from patient medical notes and aggregating it in clinical protocols. Our goal is to leverage the historical component of the patient trajectory to improve clinical decision support systems performance.EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking; 806968NETDIAMOND project; POCI-01-0145-FEDER-016385Foundation for Science and Technology; PD/BD/142878/2018Foundation for Science and Technology; SFRH/BD/147837/201

Ferramenta de gestão de protocolos clínicos

Decision support systems are currently important tools to guide the clinician’s decisions and to help on the patient’s treatments. These systems have been studied over the last decades, leading to some well-defined best practices for building new solutions. This project had the objective of building a clinical decision system with a core engine based on predefined rules, which can be customized by end-users. This work had as main motivation the treatment of diabetic inpatients and outpatients, in hospital services others than endocrinology. To keep the solution generic, the system does not depend on any specific patient data, neither on the protocols. This application follows the client-server model. based on a microservice architecture, providing a modern web user interface. The project was carried out in a close collaboration with the Hospital Center of Baixo do Vouga, resulting in a solution that can assists health professionals in the treatment of patients, reducing errors and providing a better monitoring of health care services.Nos últimos anos, têm sido estudadas diversas metodologias para aumentar a qualidade da execução dos tratamentos oferecidos aos doentes hospitalizados. Foram igualmente desenvolvidos sistemas computacionais para auxiliar a tomada de decisões clínicas. O objetivo deste trabalho consistiu no desenvolvimento de uma aplicação web para apoiar a execução de tratamentos clínicos, seguindo regras previamente estabelecidas. Estas regras constituem as premissas base que definem o procedimento a aplicar, ou seja, a estrutura do protocolo clínico. Este trabalho teve como principal motivação o tratamento de pacientes com diabetes que são internados ou atendidos em serviços hospitalares não especializados nesta doença. Contudo, para não limitar a sua aplicação a um cenário específico, a solução foi pensada para ser flexível e ser aplicável em qualquer cenário clínico. Esta aplicação segue o modelo cliente-servidor. com base numa arquiteture de microserviços, fornecendo uma interface de utilizador web moderna. O projeto decorreu em estreita colaboração com o Centro Hospitalar do Baixo do Vouga, tendo como resultado uma solução que auxilia os profissionais de saúde no tratamento de doentes internados, reduzindo o risco de erros e aumentando o controlo e monitorização dos cuidados de saúde.Mestrado em Engenharia de Computadores e Telemátic

Interoperability Maturity Model: Orchestrator Tool for Platform Ecosystems

The orchestration of platform ecosystems is becoming increasingly complex due to the growing number of players, complementary services and technological innovations. Interoperability is an important prerequisite for convincing customer journeys as well as functional and quality-assured data exchange and offers increasing potential for automation, especially with the help of machine learning or artificial intelligence. The interoperability maturity model developed in this study can be used as a conceptual framework to measure the interoperability of current and future platform ecosystem components and complements. The model, developed as an artifact of design science research, was evaluated using an iterative approach with orchestrators of health data platforms and their ecosystem. The results suggest that it can contribute to achieving and sustaining integrated value chains with multiple actors and diverse technologies, and can be used to assess the interoperability of care chains (e.g., care scenarios such as diabetes or cardiac insufficiency) and guide future interoperability considerations

The appraisal of Facebook online community: An exposition of mobile commerce in social media reviews

Peer reviewe

ICT-Driven Development in India and Africa

Information and Communications Technology (ICT) has developed into one of the most significant tools at India’s disposal for confronting challenges of development and poverty alleviation. In particular, ICT has proven useful when applied to the fields of agriculture, education, health, governance, and urban development. In recent years, numerous African countries have likewise introduced ICT solutions to various development challenges. While these initiatives have made great contributions, African countries interested in improving their ICT for development programs would greatly benefit from strategic and technical cooperation with India. India faces similar development challenges in an environment of high geographical, social, and economic diversity, making it an ideal testbed for developing interventions which scale in the developing world. Programs which have proven themselves in this context could likely be smoothly adopted to the African context, accelerating the pace of development for African ICT solutions. Ideally, India and Africa could cooperate not just on developing individual platforms, but on formulating an ethical and strategic framework for ICT-driven development which encourages inclusion, respects privacy, and shapes both regions to meet the future demands of the global economy

An Interoperable Clinical Cardiology Electronic Health Record System - a standards based approach for Clinical Practice and Research with Data Reuse

Currently in hospitals, several information systems manage, very often autonomously, the patient’s personal, clinical and diagnostic data. This originates a clinical information management system consisting of a myriad of independent subsystems which, although efficient in their specific purpose, make the integration of the whole system very difficult and limit the use of clinical data, especially as regards the reuse of these data for research purposes. Mainly for these reasons, the management of the Genoese ASL3 decided to commission the University of Genoa to set up a medical record system that could be easily integrated with the rest of the information system already present, but which offered solid interoperability features, and which could support the research skills of hospital health workers. My PhD work aimed to develop an electronic health record system for a cardiology ward, obtaining a prototype which is functional and usable in a hospital ward. The choice of cardiology was due to the wide availability of the staff of the cardiology department to support me in the development and in the test phase. The resulting medical record system has been designed “ab initio” to be fully integrated into the hospital information system and to exchange data with the regional health information infrastructure. In order to achieve interoperability the system is based on the Health Level Seven standards for exchanging information between medical information systems. These standards are widely deployed and allow for the exchange of information in several functional domains. Specific decision support sections for particular aspects of the clinical life were also included. The data collected by this system were the basis for examples of secondary use for the development of two models based on machine learning algorithms. The first model allows to predict mortality in patients with heart failure within 6 months from their admission, and the second is focused on the discrimination between heart failure versus chronic ischemic heart disease in the elderly population, which is the widest population section served by the cardiological ward

Blockchain from a Modern Perspective: An Evolution to Health Science

This paper gives a thorough evaluation of the literature on blockchain applications in healthcare. The evaluation included 42 papers that presented current information on the existing implications and gaps in the usage of blockchain technology for enhancing healthcare systems. According to the SLR results, blockchain is being utilized to produce unique and sophisticated solutions to enhance the prevailing standards of medical data handling, sharing, and processing. In the healthcare business, blockchain technology is experiencing conceptual evolution, adding considerable value through enhanced efficiency, access control, technical innovation, privacy protection, and data management process security. The findings also indicate that the current limits are mostly related to model performance, as well as the constraints and costs involved with implementation. An integrated approach is offered to cover prospective areas where future researchers might bring considerable value, such as regulatory compliance, system architecture, and data protection. Finally, the SLR believes that further research can help to enable the wider implementation of blockchain applications to handle crucial challenges like as medical diagnostics, legal compliance, preventing fraud, and enhancing patient care in remote monitoring or medical emergencies

A Survey of Multimodal Information Fusion for Smart Healthcare: Mapping the Journey from Data to Wisdom

Multimodal medical data fusion has emerged as a transformative approach in smart healthcare, enabling a comprehensive understanding of patient health and personalized treatment plans. In this paper, a journey from data to information to knowledge to wisdom (DIKW) is explored through multimodal fusion for smart healthcare. We present a comprehensive review of multimodal medical data fusion focused on the integration of various data modalities. The review explores different approaches such as feature selection, rule-based systems, machine learning, deep learning, and natural language processing, for fusing and analyzing multimodal data. This paper also highlights the challenges associated with multimodal fusion in healthcare. By synthesizing the reviewed frameworks and theories, it proposes a generic framework for multimodal medical data fusion that aligns with the DIKW model. Moreover, it discusses future directions related to the four pillars of healthcare: Predictive, Preventive, Personalized, and Participatory approaches. The components of the comprehensive survey presented in this paper form the foundation for more successful implementation of multimodal fusion in smart healthcare. Our findings can guide researchers and practitioners in leveraging the power of multimodal fusion with the state-of-the-art approaches to revolutionize healthcare and improve patient outcomes.Comment: This work has been submitted to the ELSEVIER for possible publication. Copyright may be transferred without notice, after which this version may no longer be accessibl

Using large-scale dataset to identify opportunity for implementing technology based intervention to improve cancer care in India : innovation report

Cancer incidence in India is increasing, owing to a mix of risk factors such as changes in diet and lifestyle, high tobacco consumption rates and an aging and population with cancer being more common in older populations. In India, the crude cancer incidence rate increased by 28·2% from 63·4 per 100,000 in 1990 to 81·2 per 100,000 in 2016. Kerala and Mizoram had the highest rate of crude cancer incidence (figure 1) (Lancet Oncol, 2020). The age-standardised incidence rate of breast cancer in females from 1990 to 2016 increased by 39·1%, with increase observed in every state of the country. The age-standardised incidence rate of cervical cancer decreased by 39·7% in India from 1990 to 2016 (Lancet Oncol, 2020). The trends observed in the top seven cancer type-specific incidence rates in India is shown in figure 2. As per the latest National Cancer Registry Programme Report (2020) by the Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR) the number of cancer cases in India in 2020 was 1.39 million (100.7 per 100,000 population) (Mathur, 2020). Lung, oral cavity, stomach, and colorectal cancers are the most common cancers in men. Cancer of the breast and cervix uteri are the most common cancers in women. Lung cancer is the leading site in metropolitan cities and the southern region, whereas mouth cancer was the leading site in the West and Central regions. The highest burden of breast cancer is observed in metropolitan cities (Naik, 2021). Within India, the incidence of cancer varies dramatically based on the geographical location (north/south/northeast, rural/urban, and Ganges belt/Deccan plains). The highest rate of incidence of cancer is observed in the North-East (NE) region. The trend for crude cancer disability-adjusted life-years (DALY) rate in India shows an increase by 25·3% from 1990 to 2016. Among females, breast, cervical, and stomach cancer were responsible for the highest DALYs in 2016. The highest cancer DALYs among males in India in 2016 were due to lung cancer, followed by lip and oral cavity cancer, other pharynx cancer, and stomach cancer. (Lancet Oncol, 2020) The DALY due to different types of cancer in 2016 is provided in figure 3. As the country suffers from a lack of adequate healthcare infrastructure, there is a wider dearth of awareness on cancers and a severe scarcity of skilled human resources for cancer, hence, conventional healthcare delivery methods involving interpersonal doctor–patient interactions might not be available to most of the people in India (Golechha, 2015). Despite the introduction of government-funded schemes and cancer care facilities at the medical colleges, for the average patient with cancer in India, health care remains highly privatised, with more than 80% of outpatient care and 40% of inpatient care provided by the private sector (Thakur et al, 2011). Consequently, expenditures on private health, especially on drugs, remain very high, exacerbating health inequalities