Derek G. Cramp

Clinical decision support, systems methodology, and telemedicine: their role in the management of chronic disease

In this paper, the design and evaluation of decision support systems, including those incorporating a telematic component, are considered. It is argued that effective design and evaluation are dependent upon the adoption of appropriate methodology set firmly within a systemic framework. Systems modeling is proposed as an approach to system design, with evaluation adopting an approach incorporating evaluability analysis and formative and summative evaluation, including the use of stakeholder matrix analysis. The relevance of such systemic methodology is demonstrated in the context of diabetes and end-stage renal disease as examples of the generic clinical problem of the management of chronic disease.

A proposed semantic framework for diabetes education content management, customisation and delivery within the M2DM project

M2DM (multi access services for telematic management of diabetes mellitus, ) is an EU-funded telemedicine project that aims at increasing the quality of diabetes care by improving communication between patients and caregivers. As part of this project, we have undertaken the initial work of describing the necessary requirements (framework) of an advanced educational component for M2DM in accordance with the latest Semantic Web concepts. This paper describes our proposed semantic framework for educational content management, customisation and delivery. A big internet challenge today is to find and push situation and user-specific quality knowledge to users based on their actual individual needs, circumstances and profiles at any given time. We believe that the semantic framework presented in this paper could be a good step towards meeting this challenge. Benefits for users, both developers and end users, of adopting such framework are also discussed. The ideas discussed in this paper could be easily adapted to other similar services besides M2DM and to different health topics besides diabetes mellitus.

Assessing health policy strategies: a model-based approach to decision support

The problems of making strategic decisions in relation to health policy, where there is the need to strive for both acceptability and cost-effectiveness, constitute major challenges be the decisions local, regional or national. In such a context alternative scenarios need to be generated, and then assessed and evaluated, in order that an appropriate decision can be made. In this paper an approach to supporting such decision making is presented which combines systems-based cybernetic modelling for scenario analysis with a Bayesian method for assessment and evaluation.

Computers and control in clinical medicine

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Design, implementation and preliminary evaluation of a telemedicine system for home haemodialysis.

A telemedicine system for home haemodialysis was designed using a systems approach and a feedback model to produce the hardware and software specifications. Preliminary clinical trials at four European locations involved 29 patients and 305 sessions of haemodialysis. The evaluation included an evaluability assessment and formative evaluation. Central to the methodology was the detailed specification of a stakeholder/evaluation criterion matrix. Preliminary results indicated that the telemedicine system was capable of satisfying the requirements of formative evaluation as a precursor to evaluating its overall worth.

INFORM: development of information management and decision support systems for High Dependency Environments.

The long-term aim in the INFORM Project is to develop, evaluate and implement a new generation of Information Systems for hospital High Dependency Environments (HDE — Intensive Care Units, Neonatal Units, Burns Units, Operating and Recovery Rooms, and other specialised areas). The distinguishing feature of the HDE is the very large amount of data that is collected through monitors and paper records about the state of critically ill patients; this has made the role of the staff a technical one in addition to a caring one. The INFORM System will integrate Decision Support with on-line, off-line and observed patient data and, in addition, will incorporate and integrate unit management features.In the Exploratory Phase of the Project, functional requirements have been set out. These are based on four components: conceptual model of the HDE; evaluation of existing HDE Information Systems; development of a novel software architecture using a Knowledge-Based Systems (KBS) methodology, and based on a critical review of KBS applied to the HDE; monitoring of appropriate leading-edge technological developments.The conceptual model has two components: a patient-related information model, and a department-related cost model. The patient-related model is identifying key and difficult areas of decision making. A key aspect of INFORM is integration of clinical Decision Support for these areas into the Information System through a layered software architecture. The lower layers are concerned with monitoring and alarming and the higher levels with patient assessment and therapy planning. The functionality and interconnection of these layers are being determined.

Ventilator management: the role of knowledge-based technology

The authors discuss the problems associated with introducing an intelligent measurement and information system into a clinical high-dependency environment (HDE), typified by the intensive care unit (ICU) and postoperative recovery room. One specific situation in which intelligent instrumentation is required is during mechanical ventilation. A novel methodology that provides a structure for the incorporation of a knowledge-based component into the measurement process has been proposed. This methodology covers the entire development process, from a particular measurement system to evaluation of the final product. Specification and implementation for a prototype system designed for those patients who require ventilatory therapy as part of their overall management strategy has been developed using this methodology. This system is known as AIRS (Artificial Intelligent Respirator System).<<ETX>>

The role of soft systems methodology in healthcare policy provision and decision support

Developing and implementing policy at governmental level implies dealing with complexity and hence understanding the multi-faceted nature of the domain in question. This paper offers a candidate framework for such policy analysis and implementation. A key feature of the framework is the adoption of soft systems methodology (SSM). The approach is illustrated in the context of a healthcare application; namely the introduction by the UK National Health Service of a National Service Framework for delivering services to diabetic patients. This application demonstrates the power of SSM in providing a rigorous and logical approach to determining the attributes, criteria and cost elements of the system that can then be fed into a more formal model to yield information as to cost effectiveness.

A systems methodology for the development and evaluation of a telematic home haemodialysis service

The advent of telematic technology offers the prospects of developing home haemodialysis as a viable treatment for end-stage renal disease. In this paper, the role of systems methodology in devising such a service is discussed. It is shown how systems modelling enables the problem to be analysed, user requirements to be identified, the system architecture to be specified and a basis provided for evaluation. The approach adopted to system evaluation is described and a framework is produced. The current status and key issues are discussed.

REALITY in Home Telecare: A Systemic Approach to Evaluation

This paper describes the REALITY telecare system, designed to enable a range of commonly occurring chronic diseases to be managed in the home setting. This uses hand-held computers linked to the internet for collecting and transmitting clinical and quality of life data and providing remote clinical advice. Key to the success of such telecare is a proper scheme of evaluation. An overall framework for such evaluation is proposed. Within this schema formative evaluation results are presented, focusing particularly on technical issues being addressed, patient recruitment and retention, and data collection. User acceptability is then considered as a first ingredient of summative evaluation