Healthcare interoperability through intelligent agent technology

With technological advances, the amount of data and the information systems in healthcare units has been increasing exponentially. The accessibility and availability of patients’ clinical information are a constant need. The Agency for Integration, Diffusion and Archive of Medical Information (AIDA) was developed to fulfill this need and it was implemented at the Centro Hospitalar do Porto (CHP), revealing a highly successful, ensuring interoperability among CHP healthcare information systems. This paper presents a new AIDA module, which aims to monitor the activity of its agents. It revealed its usefulness, providing to the user the functionalities and the necessary data for it to make a complete monitoring of the activities of each AIDA agent. It was still considered an efficient system, since it does not compromise the resources of the machine where it was implemented. In addition, this module increases AIDA functionality and efficiency

Intelligent systems for monitoring and preventing in healthcare information systems

Nowadays the interoperability in Healthcare Information Systems (HIS) is a fundamental requirement. The Agency for Integration, Diffusion and Archive of Medical Information (AIDA) is an interoperability healthcare platform that ensures these demands and it is implemented in Centro Hospitalar do Porto (CHP), a major healthcare unit in Portugal. Therefore, the overall performance of CHP HIS depends on the success of AIDA functioning. This paper presents monitoring and prevention systems implemented in the CHP, which aim to improve the system integrity and high availability. These systems allow the monitoring and the detection of situations conducive to failure in the AIDA main components: database, machines and intelligent agents. Through the monitoring systems, it was found that the database most critical period is between 11:00 and 12:00 and the resources are well balanced. The prevention systems detected abnormal situations that were reported to the administrators that took preventive actions, avoiding damage to AIDA workflow

Critical events in mechanically ventilated patients

Mechanical Ventilation is an artificial way to help a Patient to breathe. This procedure is used to support patients with respiratory diseases however in many cases it can provoke lung damages, Acute Respiratory Diseases or organ failure. With the goal to early detect possible patient breath problems a set of limit values was defined to some variables monitored by the ventilator (Average Ventilation Pressure, Compliance Dynamic, Flow, Peak, Plateau and Support Pressure, Positive end-expiratory pressure, Respiratory Rate) in order to create critical events. A critical event is verified when a patient has a value higher or lower than the normal range defined for a certain period of time. The values were defined after elaborate a literature review and meeting with physicians specialized in the area. This work uses data streaming and intelligent agents to process the values collected in real-time and classify them as critical or not. Real data provided by an Intensive Care Unit were used to design and test the solution. In this study it was possible to understand the importance of introduce critical events for Mechanically Ventilated Patients. In some cases a value is considered critical (can trigger an alarm) however it is a single event (instantaneous) and it has not a clinical significance for the patient. The introduction of critical events which crosses a range of values and a pre-defined duration contributes to improve the decision-making process by decreasing the number of false positives and having a better comprehension of the patient condition.- Fundação para a Ciência e Tecnologia within the Project Scope UID/CEC/00319/2013 . The authors would like to thank FCT (Foundation of Science and Technology, Portugal) for the financial support through the contract PTDC/EEI-SII/1302/2012 (INTCare II

Intelligent decision support in Intensive Care : towards technology acceptance

Decision support technology acceptance is a critical factor in the success of the adoption this type of systems by the users. INTCARE is an intelligent decision support system for intensive care medicine. The main purpose of this system is to help the doctors and nurses making decisions more proactively based on the prediction of the organ failure and the outcome of the patients. To assure the adoption of INTCARE by the doctors and by the nurses, several requirements had taken into account: process dematerialization (information is now in electronic format); interoperability among the systems (the AIDA platform was used to interoperate with other information systems); on-line data acquisition and real-time processing (a set of software agents has been developed to accomplish these tasks). A technology acceptance methodology has been followed in the Intensive Care Unit (ICU) of Centro Hospitalar do Porto in order to assure the most perfect alignment between the functional and technical characteristics of INTCARE and the user expectations. Results showed that the ICU staff is permeable to the system. In general more than 90 % of the answers are scored with 4 or 5 points which gives a good motivation to continue the work.Fundação para a Ciência e a Tecnologia (FCT

Real-time decision support in intensive medicine: an intelligent approach for monitoring data quality

Intensive Medicine is an area where big amounts of data are generated every day. The process to obtain knowledge from these data is extremely difficult and sometimes dangerous. The main obstacles of this process are the number of data collected manually and the quality of the data collected automatically. Information quality is a major constrain to the success of Intelligent Decision Support Systems (IDSS). This is the case of INTCare an IDSS which operates in real-time. Data quality needs to be ensured in a continuous way. The quality must be assured essentially in the data acquisition process and in the evaluation of the results obtained from data mining models. To automate this process a set of intelligent agents have been developed to perform a set of data quality tasks. This paper explores the data quality issues in IDSS and presents an intelligent approach for monitoring the data quality in INTCare system.Fundação para a Ciência e a Tecnologia (FCT

Knowledge discovery for pervasive and real-time intelligent decision support in intensive care medicine

Pervasiveness, real-time and online processing are important requirements included in the researchers’ agenda for the development of future generation of Intelligent Decision Support Systems (IDSS). In particular, knowledge discovery based IDSS operating in critical environments such of intensive care, should be adapted to those new requests. This paper introduces the way how INTCare, an IDSS developed in the intensive care unit of the Centro Hospitalar do Porto, will accommodate the new functionalities. Solutions are proposed for the most important constraints, e.g., paper based data, missing values, values out- of-range, data integration, data quality. The benefits and limitations of the approach are discussed.Fundação para a Ciência e a Tecnologia (FCT) - PTDC/EIA/72819/ 2006, SFRH/BD/70156/201

Predicting plateau pressure in intensive medicine for ventilated patients

Barotrauma is identified as one of the leading diseases in Ventilated Patients. This type of problem is most common in the Intensive Care Units. In order to prevent this problem the use of Data Mining (DM) can be useful for predicting their occurrence. The main goal is to predict the occurence of Barotrauma in order to support the health professionals taking necessary precautions. In a first step intensivists identified the Plateau Pressure values as a possible cause of Barotrauma. Through this study DM models (classification) where induced for predicting the Plateau Pressure class (>=30 cm2O) in a real environment and using real data. The present study explored and assessed the possibility of predicting the Plateau pressure class with high accuracies. The dataset used only contained data provided by the ventilators. The best models are able to predict the Plateau Pressure with an accuracy ranging from 95.52% to 98.71%.This work has been supported by FCT - Fundação para a Ciência e Tecnologia within the Project Scope UID/CEC/00319/2013. The authors would like to thank FCT (Foundation of Science and Technology, Portugal) for the financial support through the contract PTDC/EEI-SII/1302/2012 (INTCare II)

Improving high availability and reliability of health interoperability systems

The accessibility and availability of patient clinical information are a constant need. The Agency for Interoperation, Diffusion and Archive of Medical Information (AIDA) was then developed to ensure the interoperability among healthcare information systems successfully. AIDA has demonstrated over time the need for greater control over its agents and their activities as the need for monitoring and preventing its machines and agents. This paper presents monitoring and prevention systems that were developed for machines and agents, which allow not only prevent faults, but also watch and evaluate the behaviour of these components through monitoring dashboards. The Biomedical Multiagent Platform for Interoperability (BMaPI) implemented in Centro Hospitalar do Porto (CHP) revealed provide the necessary data and functionalities capable to manage and to monitor agents’ activities. It was found that the prevention systems identified critical situations successfully, contributing to an increase in the integrity and availability of AIDA implemented in CHP

Assessment of technology acceptance in intensive care units

The process of deploy a technology in critical services need to be very careful planned and processed. As an example it is the Intensive Care Unit (ICU). In the ICU the patients are in critically ill condit ions and there aren’t available time to make experiences or to develop incomplete systems. With the objective to improve the implementation process, the same should be accompanied in order to understand the environment and user behaviour. In this case and with the goal to evaluate the implementation process, an assessment model was applied to a real system called INTCare. INTCare is a Pervasive Intelligent Decision Support System (PIDSS). It was deployed in the ICU of Centro Hospitalar do Porto and was evaluated using the Technology Acceptance Model 3 (TAM). This assessment was made using the four constructs proposed by the TAM and a questionnaire-based approach guided by the Delphi Methodology. The results obtained so far show that although the users are satisfied with the offered information recognizing this importance, they demand for a faster system. This work present the main results achieved and suggest one way to follow when some technology is deployed in an environment like is ICU