Femke De Backere

Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

BackgroundComputerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs.The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase.MethodsA framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA).ResultsThe applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows.ConclusionsThe framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline.

On the Design of a Management Platform for Antibiotic Guidelines in the Intensive Care Unit

Clinical guidelines are used in the Intensive Care Unit to assist physicians and nurses in taking diagnostic or treatment decisions. Although these guidelines can be transformed into a computer executable format, they often are handwritten and not in a standardized format, which makes it difficult to convert them into working services. Moreover, manually translating guidelines can cause communication problems between software developers and the medical staff. Problems can also arise in the integration of clinical decision support into the clinical workflow and the uptake by doctors. To counter this, a modular, distributed, multi-tier framework was developed for translating guidelines into software applications and providing clinical decision support in the Intensive Care Unit. Different requirements were taken into account. The architecture has been implemented using Java Enterprise Edition. A service-oriented approach is used, allowing an easy introduction of new functionalities and integration with other systems. The architecture was evaluated with the antibiotic dosage guideline, which is used on a daily basis in the Intensive Care Unit.

The MASSIF platform: a modular and semantic platform for the development of flexible IoT services

In the Internet of Things (IoT), data-producing entities sense their environment and transmit these observations to a data processing platform for further analysis. Applications can have a notion of context awareness by combining this sensed data, or by processing the combined data. The processes of combining data can consist both of merging the dynamic sensed data, as well as fusing the sensed data with background and historical data. Semantics can aid in this task, as they have proven their use in data integration, knowledge exchange and reasoning. Semantic services performing reasoning on the integrated sensed data, combined with background knowledge, such as profile data, allow extracting useful information and support intelligent decision making. However, advanced reasoning on the combination of this sensed data and background knowledge is still hard to achieve. Furthermore, the collaboration between semantic services allows to reach complex decisions. The dynamic composition of such collaborative workflows that can adapt to the current context, has not received much attention yet. In this paper, we present MASSIF, a data-driven platform for the semantic annotation of and reasoning on IoT data. It allows the integration of multiple modular reasoning services that can collaborate in a flexible manner to facilitate complex decision-making processes. Data-driven workflows are enabled by letting services specify the data they would like to consume. After thorough processing, these services can decide to share their decisions with other consumers. By defining the data these services would like to consume, they can operate on a subset of data, improving reasoning efficiency. Furthermore, each of these services can integrate the consumed data with background knowledge in its own context model, for rapid intelligent decision making. To show the strengths of the platform, two use cases are detailed and thoroughly evaluated.

The OCareCloudS project: Toward organizing care through trusted cloud services

The increasing elderly population and the shift from acute to chronic illness makes it difficult to care for people in hospitals and rest homes. Moreover, elderly people, if given a choice, want to stay at home as long as possible. In this article, the methodologies to develop a cloud-based semantic system, offering valuable information and knowledge-based services, are presented. The information and services are related to the different personal living hemispheres of the patient, namely the daily care-related needs, the social needs and the daily life assistance. Ontologies are used to facilitate the integration, analysis, aggregation and efficient use of all the available data in the cloud. By using an interdisciplinary research approach, where user researchers, (ontology) engineers, researchers and domain stakeholders are at the forefront, a platform can be developed of great added value for the patients that want to grow old in their own home and for their caregivers.

Design of a security mechanism for RESTful Web Service communication through mobile clients

Security is not taken into account by default in the Representational State Transfer (REST) architecture, but its layered architecture provides many opportunities for implementing it. In this paper, a security mechanism for Web Service communication through mobile clients devices is proposed, that conforms to the REST architecture as much as possible. This approach has been inspired by some known security mechanisms, but implemented in such a way that it focusses on statelessness and aims to be lightweight. Results indicate that the custom security mechanism outperforms the Transport Layered Security (TLS) based system. Because of the genericness of REST, the proposed security mechanism can be adopted by a wide variety of other RESTful Web Services.

Automated generation and deployment of clinical guidelines in the ICU

The complexity and amount of medical information and data keeps increasing, which makes it difficult to maintain the same quality of care in the Intensive Care Unit, without significant cost increases. In order to contain this complexity, clinical guidelines are used to structure best practices and patient care, but they also support physicians and nurses in the diagnostic and treatment process. Currently, no standardized format exists to represent these guidelines. Moreover, they are often handwritten. Translating guidelines into a computer interpretable format can overcome problems in their workflow and improve clinicians uptake. To this end, we developed an automated generation and execution engine. Based on the requirements, both functional and non-functional, an architecture using the microkernel pattern is presented. This allows us to easily add and modify functionality. This architecture was evaluated with the guideline for the calculation of calorie need for burn patients, used on a daily basis in the Intensive Care Unit of the University Hospital of Ghent.

Zone-it before IT zones you: a location-based digital notice board to build community while preserving privacy

The current success of ephemeral communication apps such as Snapchat points to the growing awareness among users about online ‘biographic mining’ through information technology by advertisers, companies and government agencies. Based on the literature, we argue that location-based services (LBS) can be the answer to preserving privacy, on the condition that they target trusted communities of anonymous users and that the communication is transient. The paper describes in three steps the development of an app fulfilling these conditions. From the interdisciplinary exchange between digital anthropologists, GIScientists and ICT engineers resulted Zone-it, a virtual notice board for self-zoning, permitting the user to start location-based interactions under certain categories. We present the results of a user survey that determined the apps functionalities. The functionalities offer a way for LBS to invert the purpose of social media such as Facebook by shifting attention from person-based to goal-oriented communication. The paper discusses why this move away from ‘faces’ to ‘places’ meets the purpose of community-building, rather than jeopardising it.

Personalized robotic intervention strategy by using semantics for people with dementia in nursing homes

The Semantic Web - 14th International Conference, ESWC 2017, Portorož, Slovenia, May 28 - June 1, 2017, Proceedings, Part II

Internet of Robotic Things: Context-Aware and Personalized Interventions of Assistive Social Robots (Short Paper)

Assistive service and companion robots are versatile and dexterous actuators that operate in our daily living environment. These robots are able to manipulate physical objects, to displace themselves and to engage in conversations. Human behavior is dynamic and oftentimes unpredictable, therefore it is crucial for such robotic systems to be assisted by a cloud-backend which: i) analyzes data from sensor and wearables ii) determines which robotic tasks need to be executed and iii) provides the necessary support for the execution of these tasks in our daily living environment. In this paper, we present our Internet-of-Robotic-Things system architecture design for a case study on personal interactions by a companion robot to alleviate behavioral disturbances of people with dementia.

Social-aware Event Handling within the FallRisk Project

OBJECTIVES With the uprise of the Internet of Things, wearables and smartphones are moving to the foreground. Ambient Assisted Living solutions are, for example, created to facilitate ageing in place. One example of such systems are fall detection systems. Currently, there exists a wide variety of fall detection systems using different methodologies and technologies. However, these systems often do not take into account the fall handling process, which starts after a fall is identified or this process only consists of sending a notification. The FallRisk system delivers an accurate analysis of incidents occurring in the home of the older adults using several sensors and smart devices. Moreover, the input from these devices can be used to create a social-aware event handling process, which leads to assisting the older adult as soon as possible and in the best possible way. METHODS The FallRisk system consists of several components, located in different places. When an incident is identified by the FallRisk system, the event handling process will be followed to assess the fall incident and select the most appropriate caregiver, based on the input of the smartphones of the caregivers. In this process, availability and location are automatically taken into account. RESULTS The event handling process was evaluated during a decision tree workshop to verify if the current day practices reflect the requirements of all the stakeholders. Other knowledge, which is uncovered during this workshop can be taken into account to further improve the process. CONCLUSIONS The FallRisk offers a way to detect fall incidents in an accurate way and uses context information to assign the incident to the most appropriate caregiver. This way, the consequences of the fall are minimized and help is at location as fast as possible. It could be concluded that the current guidelines on fall handling reflect the needs of the stakeholders. However, current technology evolutions, such as the uptake of wearables and smartphones, enables the improvement of these guidelines, such as the automatic ordering of the caregivers based on their location and availability.