Matt-Mouley Bouamrane

Using OWL ontologies for adaptive patient information modelling and preoperative clinical decision support

We here present our research and experience regarding the design and implementation of a knowledge-based preoperative assessment decision support system. We discuss generic design considerations as well as the practical system implementation. We developed the system using semantic web technology, including modular ontologies developed in the OWL web ontology language, the OWL Java application programming interface and an automated logic reasoner. We discuss how the system enables to tailor patient information collection according to personalized medical context. The use of ontologies at the core of the system’s architecture permits to efficiently manage a vast repository of preoperative assessment domain knowledge, including classification of surgical procedures, classification of morbidities and guidelines for routine preoperative tests. Logical inference on the domain knowledge according to individual patient’s medical context enables personalized patients’ reports consisting of a risk assessment and clinical recommendations such as relevant preoperative tests.

Delivering Digital Health and Well-Being at Scale: Lessons Learned during the Implementation of the dallas Program in the United Kingdom

Abstract Objective To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program—a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Materials and Methods Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit–led interviews at baseline/mid-point ( n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events ( n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Results Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale ; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. Conclusions The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care.

Ontology-driven adaptive medical information collection system

Computer-based surveys and questionnaires have become ubiquitous. Yet in many cases, Information Collection Systems (ICS) offer limited support in terms of tailoring structure and content of surveys in response to user interaction. Previous techniques for content adaptation such as conditional branching do not scale well and are also hard to maintain as structural dependencies in a survey often need to be hard-coded in the system. We here propose a generic model for contextsensitive self adaptation of ICS, based on a questionnaire ontology. We illustrate the model with a description of our own medical ICS implementation and discuss the potential benefits of such system, especially in the context of tailored healthcare.

A study of general practitioners’ perspectives on electronic medical records systems in NHSScotland

BackgroundPrimary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012.MethodsWe carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs’ perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees’ responses, using Normalisation Process Theory as the underpinning conceptual framework.ResultsThe majority of GPs’ interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities – for example: in relation to usability, system navigation and information visualisation.ConclusionOur study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs’ interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors.

A Hybrid Architecture for a Preoperative Decision Support System Using a Rule Engine and a Reasoner on a Clinical Ontology

We report on a preventive care software system for preoperative risk assessment of patient undergoing elective surgery. The system combines a rule engine and a reasoner which uses a decision support ontology developed with a logic based knowledge representation formalism. We specifically discuss our experience of using a representation of a patients medical history in OWL, combined with a reasoning tool to suggest appropriate preoperative tests based on an implementation of preoperative assessment guidelines. We illustrate the reasoning functionalities of the system with a number of practical examples.

Development of an ontology for a preoperative risk assessment clinical decision support system

We report on the development of a decision support ontology developed in the web ontology language OWL-DL (Description Logic). The ontology is combined within a preoperative risk assessment software system with a DL reasoner in order to provide a number of clinical decision support functionalities, including risk assessment, recommended tests and recommended clinical precaution protocols.

Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment

BackgroundEffective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway (eForm) allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet.MethodsWe conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement (PCIP) and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board.ResultsIn January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts.ConclusionThe adoption of the eForm into routine preoperative work practices can be attributed to: (i) a policy context – including performance targets – promoting the rationalisation of surgical pre-assessment pathways, (ii) financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, (iii) a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation and the eForm development, (iv) the use of a pragmatic and domain-agnostic technology solution and finally: (v) a consensual and contextualised implementation.

Optimizing semantic MEDLINE for translational science studies using semantic web technologies

Semantic MEDLINE provides comprehensive resources with structured annotations that have a potential to facilitate translational studies in the biomedical domain. It is computationally challenging, however, to perform queries directly from the data in the current Semantic MEDLINE database. In this research, we propose a domain pattern driven approach to optimize the Semantic MEDLINE data organization and representation for translational science studies using the Resource Description Framework (RDF) and Semantic Web technologies.

A study of clinical and information management processes in the surgical pre-assessment clinic

BackgroundEstablishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients.MethodsAs part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team.ResultsThe pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team.ConclusionSuccessful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully integrate preoperative assessment within the health-board surgical care pathway. A substantial – yet unfulfilled – potential benefit in embedding information technology in routine use within the preoperative clinic would be to improve the reporting of surgical outcomes.

Managing complexity in pre-operative information management systems

Preoperative assessment is composed of a set of clinical investigations that precede anaesthesia and surgery. Due to the vast scope of pre-operative assessment, the clinical domain knowledge potentially relevant for assessment is virtually limitless. For this reason, a generic preoperative assessment has traditionally focused on identifying common allergies, cardiovascular and respiratory risks and pre-empting potential airway complications, such as difficult intubation during anaesthesia. Complex surgical procedures may require additional precautions or even have separate specific pre-operative protocols. This article contributes to a review of the layers of knowledge management complexity within preoperative assessment processes which -- although often approached from a clinical perspective have seldom been addressed specifically from an information elucidation and knowledge management perspective.