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An Intelligent Healthcare Monitoring and Decision Support System The SAPHIRE Project [1] is developing an
intelligent healthcare monitoring and decision support system on a platform integrating the wireless medical
sensor data with hospital information systems to address the problem of an ever-increasing workload in
medical fields due to the increasing percentage of elderly people. In this project, the patient monitoring is
achieved by using agent technology where the "agent behaviour" is supported by intelligent decision support
systems based on clinical practice guidelines. In the SAPHIRE system, patient history stored in medical
information systems is accessed through semantically enriched Web services and IHE XDS
Registry/Repository to tackle the interoperability problem. In this way, not only the observations received from
wireless medical sensors but also the patient medical history is used in the reasoning process. The overall
vision of the SAPHIRE project can be seen in Figure 1.
treatment. Coupled with increased demands on healthcare delivery systems, this rapid growth has made the
practice of medicine increasingly complex. The healthcare community response to this growing complexity
has been to develop clinical practice guidelines to simplify and improve healthcare delivery. As an example,
the National Guideline Clearinghouse⢠(NGC) [2] provides a comprehensive database of evidence-based
clinical practice guidelines and related documents. Despite the widespread publication of clinical standards
and practice guidelines, however, healthcare professionals have difficulties in understanding and applying
these guidelines in the clinical care setting. This necessitates computerized decision support systems
automating clinical guidelines to support the health professionals.
This is an essential component, because in clinical guidelines, the physiological signs received from wireless
medical sensors, the patient care plan and medical history (such as previous diagnosis, medication list,
allergy/adverse drug reactions) all affect the clinical path to be followed. More specifically the interoperability
problem that needs to be addressed to develop an effective intelligent healthcare monitoring tool is as
follows: the data coming from the wireless medical sensors are either in proprietary format (for example, for
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electrocardiogram data, Philips' XML ECG Data Format) or when it conforms to a standard, this still does not
solve the interoperability problem since there are very many standards (again for electrocardiogram data, the
available standards include: SCP-ECP, US Food and Drug Administration FDA/HL7 Annotated ECG, I-Med
and ecgML). When integrating this data with electronic healthcare records, the problem gets more complex
since hospital information systems are also mostly proprietary and when they conform to an interface
standard, there are again very many standards (such as HL7v2.x, HL7v3 CDA, CEN ENV 13606
EHRExtract, openEHR Archetypes) and thus the standards do not achieve the aimed interoperability.
Furthermore, interoperability of data coming from various wireless medical sensors is also essential to infer
information by combining data coming from various sensors.
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An Agent-based Architecture
The SAPHIRE system continuously monitors the patients through dedicated agents and supports the
healthcare professionals through intelligent decision support system. Apart from the alerts that are produced
automatically by the wireless medical sensors, SAPHIRE system produces alarms by combining flow of data
coming from medical sensors and medical summary of the patient and sends them to the related people.
Guideline Agent, which is responsible of executing the computerized clinical guideline models, creates alarm
messages and reminders to be sent to doctors, nurses or healthcare relatives and passes those messages to
Alarm Distribution Agent. Alarm Distribution Agent is responsible of delivering these alarm messages to
related people according to rules of emergency by means of email, SMS or instant messaging. Alarm
Distribution Agent is also able to track successful delivery of the messages.
The SAPHIRE project is being built upon the results of a European commission funded project, IST-1-002103
Artemis [9], which has developed a semantic Web service-based P2P Infrastructure for the Interoperability of
Medical Information Systems. Artemis project enables the Healthcare Institutes to exchange Electronic
Healthcare Records in interoperable manner through semantically enriched Web services and semantic
mediation. The SAPHIRE project exploits these results by integrating the patient data collected through
wireless medical sensor devices with the hospital information systems. This infrastructure constitutes the
interoperability base for the intelligent healthcare monitoring system.
test the safety and the accuracy of the sensor data, the Alerts System, the accuracy of the history data from
the electronic medical records and the recommendations generated by the system by correct interpretation
and implementation of the guidelines. For each of the pilot applications, each patient will sign up an informed
consent which is mandatory to participate at this project.
The end users of the project envisions that the system could not only reduce the workload in the hospital and
out-patient departments, diminish probability of human error, but could also in future endure reduced medical
costs by cutting down intensive care stay and complex diagnostic investigations or therapeutic approaches
where these are not necessary, and lead to a reduction of medical costs by cutting down rehospitalisation
procedures in future.
REFERENCES
[1]. SAPHIRE Project Web Page, http://www.srdc.metu.edu.tr/webpage/projects/saphire/
(http://www.srdc.metu.edu.tr/webpage/projects/saphire/)
[2]. National Guideline Clearinghouse⢠(NGC), http://www.guideline.gov/ (http://www.guideline.gov/)
[3]. Guideline Interchange Format (GLIF), http://www.glif.org/ (http://www.glif.org/)
[4]. FIPA Ontology Service Specification, http://www.fipa.org/specs/fipa00086/XC00086C.html
(http://www.fipa.org/specs/fipa00086/XC00086C.html)
[5]. UMLS Knowledge Source Server, http://umlsks.nlm.nih.gov/kss (http://umlsks.nlm.nih.gov/kss)
[6]. XDS, IHE IT infrastructure technical framework, http://www.ihe.net/Technical Framework/upload/ihe_iti_tf
_2.0_vol1 FT 2005-08-15.pdf (http://www.ihe.net/Technical Framework/upload/ihe_iti_tf _2.0_vol1 FT 2005-
08-15.pdf)
[7]. IHE-OS, Open-source IHE-XDS implementation, http://sourceforge.net/projects/iheos
(http://sourceforge.net/projects/iheos)
[8]. HL7 Clinical Document Architecture,, Release 2.0, http://hl7.org/library/Committees/structure/
CDA.ReleaseTwo.Committee-Ballot03.Aug.2004.zip
(http://hl7.org/library/Committees/structure/CDA.ReleaseTwo.Committee-Ballot03.Aug.2004.zip)
[9]. Artemis in eHealthNews.eu Portal, http://www.ehealthnews.eu/content/view/216/27/
(http://www.ehealthnews.eu/content/view/216/27/)
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