Verification of clinical guidelines encoded into knowledge-based DSSs

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Healthcare Process Support: Achievements, Challenges, Current Research

Healthcare organizations are facing the challenge of delivering high-quality services to their patients at affordable costs. To tackle this challenge, the Medical Informatics community targets at formalisms for developing decision-support systems (DSSs) based on clinical guidelines. At the same time, business process management (BPM) enables IT support for healthcare processes, e.g., based on workflow technology. By integrating aspects from these two fields, promising perspectives for achieving better healthcare process support arise. The perspectives and limitations of IT support for healthcare processes provided the focus of three Workshops on Process-oriented Information Systems (ProHealth). These were held in conjunction with the International Conference on Business Process Management in 2007-2009. The ProHealth workshops provided a forum wherein challenges, paradigms, and tools for optimized process support in healthcare were debated. Following the success of these workshops, this special issue on process support in healthcare provides extended papers by research groups who contributed multiple times to the ProHealth workshop series. These works address issues pertaining to healthcare process modeling, process-aware healthcare information system, workflow management in healthcare, IT support for guideline implementation and medical decision support, flexibility in healthcare processes, process interoperability in healthcare and healthcare standards, clinical semantics of healthcare processes, healthcare process patterns, best practices for designing healthcare processes, and healthcare process validation, verification, and evaluation

Guideline-based decision support in medicine : modeling guidelines for the development and application of clinical decision support systems

Guideline-based Decision Support in Medicine Modeling Guidelines for the Development and Application of Clinical Decision Support Systems The number and use of decision support systems that incorporate guidelines with the goal of improving care is rapidly increasing. Although developing systems that are both effective in supporting clinicians and accepted by them has proven to be a difficult task, of the systems that were evaluated by a controlled trial, the majority showed impact. The work, described in this thesis, aims at developing a methodology and framework that facilitates all stages in the guideline development process, ranging from the definition of models that represent guidelines to the implementation of run-time systems that provide decision support, based on the guidelines that were developed during the previous stages. The framework consists of 1) a guideline representation formalism that uses the concepts of primitives, Problem-Solving Methods (PSMs) and ontologies to represent guidelines of various complexity and granularity and different application domains, 2) a guideline authoring environment that enables guideline authors to define guidelines, based on the newly developed guideline representation formalism, and 3) a guideline execution environment that translates defined guidelines into a more efficient symbol-level representation, which can be read in and processed by an execution-time engine. The described methodology and framework were used to develop and validate a number of guidelines and decision support systems in various clinical domains such as Intensive Care, Family Practice, Psychiatry and the areas of Diabetes and Hypertension control

Improving the Relevance of Cyber Incident Notification for Mission Assurance

Military organizations have embedded Information and Communication Technology (ICT) into their core mission processes as a means to increase operational efficiency, improve decision making quality, and shorten the kill chain. This dependence can place the mission at risk when the loss, corruption, or degradation of the confidentiality, integrity, and/or availability of a critical information resource occurs. Since the accuracy, conciseness, and timeliness of the information used in decision making processes dramatically impacts the quality of command decisions, and hence, the operational mission outcome; the recognition, quantification, and documentation of critical mission-information resource dependencies is essential for the organization to gain a true appreciation of its operational risk. This research identifies existing decision support systems and evaluates their capabilities as a means for capturing, maintaining and communicating mission-to-information resource dependency information in a timely and relevant manner to assure mission operations. This thesis answers the following research question: Which decision support technology is the best candidate for use in a cyber incident notification system to overcome limitations identified in the existing United States Air Force cyber incident notification process

A new trend for knowledge-based decision support systems design

Knowledge-based decision support systems (KBDSS) have evolved greatly over the last few decades. The key technologies underpinning the development of KBDSS can be classified into three categories: technologies for knowledge modelling and representation, technologies for reasoning and inference and web-based technologies. In the meantime, service systems have emerged and become increasingly important to value adding activities in the current knowledge economy. This paper provides a review on the recent advances in the three types of technologies, as well as the main application domains of KBDSS as service systems. Based on the examination of literature, future research directions are recommended for the development of KBDSS in general and in particular to support decision-making in service industry

Efficient Decision Support Systems

This series is directed to diverse managerial professionals who are leading the transformation of individual domains by using expert information and domain knowledge to drive decision support systems (DSSs). The series offers a broad range of subjects addressed in specific areas such as health care, business management, banking, agriculture, environmental improvement, natural resource and spatial management, aviation administration, and hybrid applications of information technology aimed to interdisciplinary issues. This book series is composed of three volumes: Volume 1 consists of general concepts and methodology of DSSs; Volume 2 consists of applications of DSSs in the biomedical domain; Volume 3 consists of hybrid applications of DSSs in multidisciplinary domains. The book is shaped decision support strategies in the new infrastructure that assists the readers in full use of the creative technology to manipulate input data and to transform information into useful decisions for decision makers

The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions : a review

Clinical practice guidelines (CPGs) document evidence-based information and recommendations on treatment and management of conditions. CPGs usually focus on management of a single condition; however, in many cases a patient will be at the centre of multiple health conditions (multimorbidity). Multiple CPGs need to be followed in parallel, each managing a separate condition, which often results in instructions that may interact with each other, such as conflicts in medication. Furthermore, the impetus to deliver customised care based on patient-specific information, results in the need to be able to offer guidelines in an integrated manner, identifying and managing their interactions. In recent years, CPGs have been formatted as computer-interpretable guidelines (CIGs). This enables developing CIG-driven clinical decision support systems (CDSSs), which allow the development of IT applications that contribute to the systematic and reliable management of multiple guidelines. This study focuses on understanding the use of CIG-based CDSSs, in order to manage care complexities of patients with multimorbidity. The literature between 2011 and 2017 is reviewed, which covers: (a) the challenges and barriers in the care of multimorbid patients, (b) the role of CIGs in CDSS augmented delivery of care, and (c) the approaches to alleviating care complexities of multimorbid patients. Generating integrated care plans, detecting and resolving adverse interactions between treatments and medications, dealing with temporal constraints in care steps, supporting patient-caregiver shared decision making and maintaining the continuity of care are some of the approaches that are enabled using a CIG-based CDSS

MedLAN: Compact mobile computing system for wireless information access in emergency hospital wards

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.As the need for faster, safer and more efficient healthcare delivery increases, medical consultants seek new ways of implementing a high quality telemedical system, using innovative technology. Until today, teleconsultation (the most common application of Telemedicine) was performed by transferring the patient from the Accidents and Emergency ward, to a specially equipped room, or by moving large and heavy machinery to the place where the patient resided. Both these solutions were unpractical, uneconomical and potentially dangerous. At the same time wireless networks became increasingly useful in point-of-care areas such as hospitals, because of their ease of use, low cost of installation and increased flexibility. This thesis presents an integrated system called MedLAN dedicated for use inside the A&E hospital wards. Its purpose is to wirelessly support high-quality live video, audio, high-resolution still images and networks support from anywhere there is WLAN coverage. It is capable of transmitting all of the above to a consultant residing either inside or outside the hospital, or even to an external place, thorough the use of the Internet. To implement that, it makes use of the existing IEEE 802.11b wireless technology. Initially, this thesis demonstrates that for specific scenarios (such as when using WLANs), DICOM specifications should be adjusted to accommodate for the reduced WLAN bandwidth. Near lossless compression has been used to send still images through the WLANs and the results have been evaluated by a number of consultants to decide whether they retain their diagnostic value. The thesis further suggests improvements on the existing 802.11b protocol. In particular, as the typical hospital environment suffers from heavy RF reflections, it suggests that an alternative method of modulation (OFDM) can be embedded in the 802.11b hardware to reduce the multipath effect, increase the throughput and thus the video quality sent by the MedLAN system. Finally, realising that the trust between a patient and a doctor is fundamental this thesis proposes a series of simple actions aiming at securing the MedLAN system. Additionally, a concrete security system is suggested, that encapsulates the existing WEP security protocol, over IPSec

Decision Support Systems

Decision support systems (DSS) have evolved over the past four decades from theoretical concepts into real world computerized applications. DSS architecture contains three key components: knowledge base, computerized model, and user interface. DSS simulate cognitive decision-making functions of humans based on artificial intelligence methodologies (including expert systems, data mining, machine learning, connectionism, logistical reasoning, etc.) in order to perform decision support functions. The applications of DSS cover many domains, ranging from aviation monitoring, transportation safety, clinical diagnosis, weather forecast, business management to internet search strategy. By combining knowledge bases with inference rules, DSS are able to provide suggestions to end users to improve decisions and outcomes. This book is written as a textbook so that it can be used in formal courses examining decision support systems. It may be used by both undergraduate and graduate students from diverse computer-related fields. It will also be of value to established professionals as a text for self-study or for reference