Numerous Research paper suggests that being physically active promotes a positive impact of on health and wellbeing in older age. Plentiful of authors agree that systematic physical exercises are capable of positively impact healthy ageing, attenuating declines in health, exerting positive cognitive and psychological effects, on the top of physical ones.The transition from hospital to home-care is known to be a time of high discontinuity in assistance due to poor adherence and patient motivation, poor understanding of benefits of rehabilitation care, poor predisposition to change in lifestyle.Effective Rehabilitation interventions deployed in a home-based scenario could provide effective therapy for elderly population, consequently leading to system improvements including decreased costs, more appropriate resource use, and avoidance of institutional placements.Although promising, the management of chronicity with innovative information and communication technologies (ICT) has not yet reached a sufficient level of specialization, quality, and robustness. Furthermore, ICT solutions are often seen as "isolated elements" in patient management rather than being primarily supportive interventions change, in the organization and in the paradigms of care.The regional project in which the PhD is inserted, has the aim to connect the bridge of ICT and home rehabilitation.The project intends to respond to this need by creating an integrated platform involving patients, healthcare professionals, caregivers, and ICT technologies, to plan and carry out individualized and remotely controlled home treatments. The goal of the work presented in this dissertation is to design and implement an interoperable, Decision Support System (DSS) that can support the physician in the process of prescribing an elder patient a home-care rehabilitation treatment.The desired outcome requires the system to present personalized recommendations based on patients’ data to make a tailored prescription on patient current condition and desired outcomes.The recommendation delivered by the DSS must be coming from the most recent Evidence Based Medicine and needs to be fully machine-interpretable in order to support automatic analysis of patient data, thus eliminating any repetitive manual data entry to the DSS by the physician. The goal has been achieved by different propaedeutic phases. A thorough literature analysis, to identify the state of the art.In addition, the laws and regulations that need to be followed to treat a patient with ICT solutions are briefly analyzed. The research activity progress by identifying functional requirements. Special attention is paid to the choice of adhering to the most recent but stable healthcare standards at different levels: data modeling level: HL7 FHIR R4; communication paradigm: CDS Hooks Version 1.0.0;knowledge base formalization: HL7 CQL Version 1.3, FHIR clinical guidelines. The dissertation presents thorough detailing of the technical design that guided the development of the DSS, stressing importance of adhering to international standard drives the discussion, with a specific focus on how to build an interoperable system that can be easily integrated in a real setting.Key points of the implementation of the DSS that represent the original contribution of this work are provided and, when possible, a reference to an open source repository code or a code snippet is supplied. In addition, a plugin is outlined, which enhances navigation of the free text of a guideline using knowledge graphs. Finally, the discussion presents the validation methodology that will be applied in the experimental phase. The validation is presented from different points of view: technical, functional and usability. Future developments of this work include a service to automatic solicit the revision of a home-care treatment by analyzing the data coming from remote monitoring sensors.
Numerosi articoli di ricerca suggeriscono che dedicarsi all’attività fisica promuove un impatto positivo sulla salute e sul benessere in età avanzata. Il passaggio al regime domiciliare è noto in letteratura per essere un momento di elevata discontinuità nell'assistenza a causa della scarsa aderenza e motivazione del paziente, scarsa comprensione dei benefici delle cure riabilitative, scarsa predisposizione al cambiamento nello stile di vita. Efficaci interventi di riabilitazione implementati in uno scenario domiciliare possono fornire una terapia efficace per la popolazione anziana, portando di conseguenza a miglioramenti del sistema tra cui una riduzione dei costi e un uso più appropriato delle risorse.Sebbene promettente, la gestione della cronicità con tecnologie innovative dell'informazione e della comunicazione (ICT) non ha ancora raggiunto un livello sufficiente di specializzazione, qualità e robustezza. Inoltre, le soluzioni ICT sono spesso viste come "elementi isolati" nella gestione del paziente piuttosto che essere principalmente interventi di supporto al cambiamento, nell'organizzazione e nei paradigmi di cura. Il progetto regionale in cui è inserito il dottorato ha l'obiettivo di separare il divario tra soluzioni dell’Information Technology e della riabilitazione domestica. La soluzione proposta intende rispondere a questa esigenza creando una piattaforma integrata che coinvolga pazienti, operatori sanitari, caregiver e tecnologie ICT, per pianificare ed eseguire trattamenti domiciliari individualizzati e controllati da remoto. L'obiettivo del lavoro presentato in questa dissertazione è la progettazione tecnica e implementazione di un sistema di supporto decisionale (DSS) interoperabile in grado di supportare il medico nel processo di prescrizione di un trattamento riabilitativo domiciliare a un paziente anziano. L’obiettivo che si prefigge il lavoro è di presentare al medico raccomandazioni personalizzate basate sui dati del paziente al fine di costruire una prescrizione “su misura” in base alle condizioni attuali del paziente e ai risultati desiderati. La raccomandazione fornita dal DSS deve essere basata sulle evidenze scientifiche più recenti disponibili, completamente interpretabile dalla macchina per supportare l'analisi automatica dei dati del paziente, eliminando così qualsiasi inserimento manuale ripetitivo di dati da parte del medico. In primis è stata effettuata un’analisi approfondita della letteratura, per identificare lo stato dell'arte. Inoltre, vengono brevemente analizzate le leggi e i regolamenti che devono essere seguiti per prendere in carico un paziente sfruttando soluzioni ICT. L'attività di ricerca prosegue individuando requisiti funzionali.Particolare attenzione è riservata alla scelta di aderire ai più recenti e stabili standard disponibili in sanità a diversi livelli: livello di modellazione dei dati: HL7 FHIR R4; paradigma di comunicazione: CDS Hooks versione 1.0.0; formalizzazione knowledge base: HL7 CQL versione 1.3, linee guida cliniche FHIR. La dissertazione presenta in dettaglio il progetto tecnico che ha guidato lo sviluppo del DSS. Vengono offerti i punti chiave dell'implementazione del DSS che rappresentano il contributo originale di questo lavoro e, quando possibile, viene fornito un riferimento ad un repository open source o a una porzione di codice sorgente. Inoltre, viene descritto un plug-in che arricchisce la navigazione del testo libero di una linea guida utilizzando il concetto di knowledge graph. Viene infine presentata la metodologia con la quale si intende validare il DSS nella fase sperimentale del progetto dal punto di vista tecnico, funzionale e di usabilità. Tra gli sviluppi futuri di questo lavoro citati si menziona lo sviluppo di un servizio per sollecitare automaticamente la revisione di un trattamento domiciliare analizzando i dati provenienti da sensori di monitoraggio remoto.
EXPLOITING HEALTHCARE STANDARDS TO BUILD A MODULAR DECISION SUPPORT SYSTEM INTEGRATED IN A REAL-WORLD REHABILITATION SETTING
BASADONNE, ALESSIA
2021-02-23
Abstract
Numerous Research paper suggests that being physically active promotes a positive impact of on health and wellbeing in older age. Plentiful of authors agree that systematic physical exercises are capable of positively impact healthy ageing, attenuating declines in health, exerting positive cognitive and psychological effects, on the top of physical ones.The transition from hospital to home-care is known to be a time of high discontinuity in assistance due to poor adherence and patient motivation, poor understanding of benefits of rehabilitation care, poor predisposition to change in lifestyle.Effective Rehabilitation interventions deployed in a home-based scenario could provide effective therapy for elderly population, consequently leading to system improvements including decreased costs, more appropriate resource use, and avoidance of institutional placements.Although promising, the management of chronicity with innovative information and communication technologies (ICT) has not yet reached a sufficient level of specialization, quality, and robustness. Furthermore, ICT solutions are often seen as "isolated elements" in patient management rather than being primarily supportive interventions change, in the organization and in the paradigms of care.The regional project in which the PhD is inserted, has the aim to connect the bridge of ICT and home rehabilitation.The project intends to respond to this need by creating an integrated platform involving patients, healthcare professionals, caregivers, and ICT technologies, to plan and carry out individualized and remotely controlled home treatments. The goal of the work presented in this dissertation is to design and implement an interoperable, Decision Support System (DSS) that can support the physician in the process of prescribing an elder patient a home-care rehabilitation treatment.The desired outcome requires the system to present personalized recommendations based on patients’ data to make a tailored prescription on patient current condition and desired outcomes.The recommendation delivered by the DSS must be coming from the most recent Evidence Based Medicine and needs to be fully machine-interpretable in order to support automatic analysis of patient data, thus eliminating any repetitive manual data entry to the DSS by the physician. The goal has been achieved by different propaedeutic phases. A thorough literature analysis, to identify the state of the art.In addition, the laws and regulations that need to be followed to treat a patient with ICT solutions are briefly analyzed. The research activity progress by identifying functional requirements. Special attention is paid to the choice of adhering to the most recent but stable healthcare standards at different levels: data modeling level: HL7 FHIR R4; communication paradigm: CDS Hooks Version 1.0.0;knowledge base formalization: HL7 CQL Version 1.3, FHIR clinical guidelines. The dissertation presents thorough detailing of the technical design that guided the development of the DSS, stressing importance of adhering to international standard drives the discussion, with a specific focus on how to build an interoperable system that can be easily integrated in a real setting.Key points of the implementation of the DSS that represent the original contribution of this work are provided and, when possible, a reference to an open source repository code or a code snippet is supplied. In addition, a plugin is outlined, which enhances navigation of the free text of a guideline using knowledge graphs. Finally, the discussion presents the validation methodology that will be applied in the experimental phase. The validation is presented from different points of view: technical, functional and usability. Future developments of this work include a service to automatic solicit the revision of a home-care treatment by analyzing the data coming from remote monitoring sensors.File | Dimensione | Formato | |
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Tesi di Dottorato_Basadonne_Completa.pdf
Open Access dal 05/09/2022
Descrizione: EXPLOITING HEALTHCARE STANDARDS TO BUILD A MODULAR DECISION SUPPORT SYSTEM INTEGRATED IN A REAL-WORLD REHABILITATION SETTING
Tipologia:
Tesi di dottorato
Dimensione
9.13 MB
Formato
Adobe PDF
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9.13 MB | Adobe PDF | Visualizza/Apri |
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