Distributed Application of Guideline-Based Decision Support through Mobile Devices: Implementation and Evaluation

by   Erez Shalom, et al.

Traditionally Guideline(GL)based Decision Support Systems (DSSs) use a centralized infrastructure to generate recommendations to care providers. However, managing patients at home is preferable, reducing costs and empowering patients. We aimed to design, implement, and demonstrate the feasibility of a new architecture for a distributed DSS that provides patients with personalized, context-sensitive, evidence based guidance through their mobile device, and increases the robustness of the distributed application of the GL, while maintaining access to the patient longitudinal record and to an up to date evidence based GL repository. We have designed and implemented a novel projection and callback (PCB) model, in which small portions of the evidence based GL procedural knowledge, adapted to the patient preferences and to their current context, are projected from a central DSS server, to a local DSS on the patient mobile device that applies that knowledge. When appropriate, as defined by a temporal pattern within the projected plan, the local DSS calls back the central DSS, requesting further assistance, possibly another projection. Thus, the GL specification includes two levels: one for the central DSS, one for the local DSS. We successfully evaluated the PCB model within the MobiGuide EU project by managing Gestational Diabetes Mellitus patients in Spain, and Atrial Fibrillation patients in Italy. Significant differences exist between the two GL representations, suggesting additional ways to characterize GLs. Mean time between the central and local interactions was quite different for the two GLs: 3.95 days for gestational diabetes, 23.80 days for atrial fibrillation. Most interactions, 83 notifications, mostly to change context. Robustness was demonstrated through successful recovery from multiple local DSS crashes.


Artificial Intelligence Decision Support for Medical Triage

Applying state-of-the-art machine learning and natural language processi...

Certainty Modeling of a Decision Support System for Mobile Monitoring of Exercise induced Respiratory Conditions

Mobile health systems in recent times, have notably improved the healthc...

PMC-Patients: A Large-scale Dataset of Patient Notes and Relations Extracted from Case Reports in PubMed Central

We present PMC-Patients, a dataset consisting of 167k patient notes with...

A Novel Alternating Joint Longitudinal Model for Post-ICU Hemoglobin Prediction

Anemia is common in patients post-ICU discharge. However, which patients...

A recommender for the management of chronic pain in patients undergoing spinal cord stimulation

Spinal cord stimulation (SCS) is a therapeutic approach used for the man...

The TESTMED Project Experience. Process-aware Enactment of Clinical Guidelines through Multimodal Interfaces

Healthcare is one of the largest business segments in the world and is a...

Please sign up or login with your details

Forgot password? Click here to reset