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A knowledge-based architecture for the management of patient-focused care pathways

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Abstract

There is need for software systems in order to coordinate the activities of healthcare professionals involved in the treatment of a patient, aligning the care delivery around already existing Clinical Practice Guidelines (CPGs). This is being carried out in care organizations by implementing integrated Care Pathways (CPs). Nonetheless, the generation of these care pathways is not trivial, and multiple barriers exist for their development and enactment. In this paper, a knowledge-based architecture is presented that, by means of Knowledge Engineering methods and Artificial Intelligence Planning and Scheduling (AI P&S) techniques, is able to automatically generate these care pathways from a computer-interpretable representation of CPGs, tackling some of these barriers. Firstly, these techniques consider the patient profile, the care organization details as well as the temporal and resource constraints, implicit in a care process, in order to generate a patient-focused care pathway. Moreover, they also allow the enactment of personalized care plans in a web-based format, powered by a workflow runtime engine, thus providing an ubiquitous and interactive execution to healthcare professionals. Finally, the architecture also includes monitoring and replanning techniques in order to check the current health status of patients and adapt care plans when they do not progress as expected. For the experimental evaluation of the architecture, several tests have been carried out in order to simulate a clinical environment where different care plans were automatically executed, monitored and adapted regarding the health conditions of patients as well as the recommendations specified in a real, CPG of the paediatric oncology area. As conclusion, the proposed architecture seems to be an adequate infrastructure for supporting the automated generation as well as the interactive execution and monitoring of patient-focused care pathways.

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Notes

  1. This AI planner, formerly known as HTNP (Hierarchical Task Network Planner), has been extended as a commercial product called Decisor, currently property of our start-up IActive Intelligent Technologies [31].

  2. This code is a simplification of the representation of a clinical protocol described in more detail in Sect. 4.

  3. Business Process Management [1].

  4. XPDL (XML Process Definition Language) is a standard language defined by the Workflow Management Coalition [64].

  5. In the application domain of this paper, this context is a clinical environment.

  6. This CPG was created by SEHOP, which is the Spanish Society of Paediatric Haematology and Oncology [58]. This text-based guideline (in Spanish) can be downloaded from [57].

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Authors and Affiliations

  1. Department of Computer Science and Artificial Intelligence, Universidad de Granada, C/Periodista Daniel Saucedo Aranda s/n, CP 18071, Granada, Spain

    Inmaculada Sánchez-Garzón & Juan Fernández-Olivares

  2. Department of Information Systems, University of Haifa, Haifa, 31905, Israel

    Arturo González-Ferrer

Authors
  1. Inmaculada Sánchez-Garzón
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  2. Arturo González-Ferrer
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  3. Juan Fernández-Olivares
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Correspondence to Inmaculada Sánchez-Garzón.

Additional information

This research work has been partially supported by the Andalusian Regional Ministry and the Spanish Ministry of Innovation under projects P08-TIC-3572 and TIN2008-06701-C03-02 respectively.

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Sánchez-Garzón, I., González-Ferrer, A. & Fernández-Olivares, J. A knowledge-based architecture for the management of patient-focused care pathways. Appl Intell 40, 497–524 (2014). https://doi.org/10.1007/s10489-013-0466-0

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