Patient care: Intelligent Clinical Decision Support System

European and Turkish doctors and technicians are perfecting a medical support system that can track patients' real-time vital signs, link those to patient medical history, and, crucially, provide the latest clinical guidelines for patient care. Better yet, it can alert doctors when necessary.

It’s not a digital doctor, but it’s getting there.

It is called Saphire, and it is an Intelligent Clinical Decision Support System (ICDSS) offering a range of services that combines scattered information stored in different systems into a new, more powerful application.

It will mean better, and cheaper, medical care. Finally.

Information technology has long promised to improve healthcare by assigning a scarce resource, a doctor’s time, wherever and whenever it is needed, but so far it has struggled to deliver on the promises.

The problem is that patients’ records, for example, are often stored on different platforms in various formats. Saphire cracks that problem by converting diverse formats into one that can be combined with other data. In the process, the team initially used ontology mapping to mediate semantically between one set of defined pieces of information and another set.

“Later on, we noticed that XSLT mapping can also perform some of the conversions adequately in much shorter time,” remarks Mehmet Olduz, a researcher with Saphire. “So, the team included XSLT mapping ability as well as ontology mapping which has given a considerable performance improvement to the system.”

XSLT converts one type of XML, the language of Web 2.0, to another type. The upshot is more effective translation with less work. Using techniques like these can translate medical records into a standard format and integrate them with patients’ real-time vital signs -a huge advance.

The team also initially used web services to access patient Electronic Healthcare Records (EHR). But they finally switched to a standard called Healthcare Cross-Enterprise Clinical Document Sharing (IHE-XDS) instead. It is a widely accepted practice by the industry, and also adopted by many countries for implementing their national healthcare networks.

Clinical decisions, stat

But that is not the really clever bit. “I think what makes Saphire unique is the semi-automatic deployment of clinical guidelines to healthcare institutes,” says Olduz. Clinical guidelines are the distilled wisdom of medical research and doctors’ experience and they identify the most reasonable response in specific circumstances.

For example, percutaneous coronary infusion (PCI) –inserting a balloon into a blocked artery to re-establish blood flow– is the recommended procedure for STEMI, a particular kind of heart attack, according to the Australian medical association.

If a patient presents late to a medical centre without PCI, the guidelines state it is better to transfer a patient to a hospital with PCI if it takes less than two hours to get there. If it takes more, it is better to treat immediately using whatever method available at hand, typically drug-stimulated fibrinolysis, which thins blood clots.

That is just one simple example. There are literally thousands of guidelines for the multitude of emergency conditions a doctor can face. And they change, all the time, as new information refines established therapies. It is essential information for effective treatment, but right now it relies on a doctor’s knowledge and experience.

But with Saphire, that knowledge is updated regularly, matched against a patient’s real symptoms and vital signs, and at the doctors’ fingertips via sms, pager, email, web browser or PDA whenever doctors’ need it or an emergency occurs. It is unique to Saphire.

“There had been efforts to computerise the guidelines and automatically execute them, for example Guideline Interchange Format (GLIF),” explains Olduz. But these attempts mainly focused on sharing of guidelines and had to be manually deployed to the computer or device. The European Funded Saphire solves this, suggests Olduz.

The team have finished the technical implementation and now they will go forward with the pilots, one in the hospital and one at home. Doctors are excited that it may mean certain patients can be transferred to regular wards sooner, freeing beds in critical care units.

The system will also provide an enormous boost to the training of young doctors and it should minimise the risk of medical errors. And it will mean a far better level of at home care, too.

Saphire also presents a commercial opportunity. The team will seek to commercialise the platform for use in hospitals throughout the world.

But Saphire, which recently attended the e-Challenges 2007 event in The Netherlands, will also help SMEs seeking to enter the medical sensor market. “It aims to facilitate SME participation [in] healthcare network infrastructure development efforts by providing the necessary interoperability platform for wireless medical sensor data and medical information systems,” notes Olduz.