CAREPATH: Developing Digital Integrated Care Solutions for Multimorbid Patients with Dementia.

CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients' independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.

A Method for the Classification of Digital Health Architectures as Medical Devices; a Digital Health Research Perspective.

It is typical for many digital health research projects to develop IT architectures that will implement integrated care services that may also deliver interventions. As part of compliance with the requirements of the regulation, the components that are considered as a medical device will need to be classified to a medical device category. This is often seen as task that may increase the business risk and a major barrier of the project, particularly during the earlier stages when not all information is available.

Bottom-Up Natural Language Processing Based Evaluation of the Fitness of UMLS as a Semantic Source for a Computer Interpretable Guidelines Ontology.

Background: CIGs languages consist of approach specific concepts. More widely used concepts, such as those in UMLS are not typically used.

Objective: An evaluation of UMLS concept sufficiency for CIG definition.

A method for machine learning generation of realistic synthetic datasets for validating healthcare applications.

Digital health applications can improve quality and effectiveness of healthcare, by offering a number of new tools to users, which are often considered a medical device. Assuring their safe operation requires, amongst others, clinical validation, needing large datasets to test them in realistic clinical scenarios. Access to datasets is challenging, due to patient privacy concerns.

Hazards for the Implementation and Use of Artificial Intelligence Enabled Digital Health Interventions, a UK Perspective.

Background: Artificial Intelligence (AI) has seen an increased application within digital healthcare interventions (DHIs). DHIs use entails challenges about their safety assurance. Exacerbated by regulatory requirements, in the UK, this places the onus of safety assurance not only on the manufacturer, but also on the operator of a DHI.

An Electronic Health Record Approach to Understanding Drug to Drug Interactions and Associated Knowledge Gaps in Intergrated Care of Multimorbidity.

Multimorbid patients are prescribed a number of medications in parallel, which may often interact with each other, resulting in adverse effects. However, clinical guidelines on prescription of medications predominantly focus on individual conditions do not consider the guidance in the context of other guidelines, resulting in conflicts. C3-Cloud is an integrated care architecture managing multimorbidity, which amongst others, provides clinical decision support, based on reconciled guidelines, and active monitoring of drug interactions.

Generation of Realistic Synthetic Validation Healthcare Datasets Using Generative Adversarial Networks.

Background: Assurance of digital health interventions involves, amongst others, clinical validation, which requires large datasets to test the application in realistic clinical scenarios. Development of such datasets is time consuming and challenging in terms of maintaining patient anonymity and consent.

Objective: The development of synthetic datasets that maintain the statistical properties of the real datasets.

A Method of Justifying Confidence in the Safety of Digital Health Interventions.

Digital health interventions (DHIs) enable improvements in health strategy and address health system challenges. The World Health Organization provides a formal classification for DHIs. However, safety claims, about such interventions, vary in quality and are often vague as to how they are communicated between technical, clinical experts and stakeholders.

Safety Justification of Healthcare Applications Using Synthetic Datasets.

Background: Increasing numbers of intelligent healthcare applications are developed by analysing big data, on which they are trained. It is necessary to assure that such applications will be safe for patients; this entails validation against datasets. But datasets cannot be shared easily, due to privacy, and consent issues, resulting in delaying innovation.

Localisation, Personalisation and Delivery of Best Practice Guidelines on an Integrated Care and Cure Cloud Architecture: The C3-Cloud Approach to Managing Multimorbidity.

Background: C3-Cloud is an integrated care ICT infrastructure offering seamless patient-centered approach to managing multimorbidity, deployed in three European pilot sites. Challenge: The digital delivery of best practice guidelines unified for multimorbidity, customized to local practice, offering the capability to improve patient personalization and benefit.

Method: C3-Cloud has adopted a co-production approach to developing unified multimorbidity guidelines, by collating and reconciling best practice guidelines for each condition.

Evaluation of patient perception towards dynamic health data sharing using blockchain based digital consent with the Dovetail digital consent application: A cross sectional exploratory study.

Background: New patient-centric integrated care models are enabled by the capability to exchange the patient's data amongst stakeholders, who each specialise in different aspects of the patient's care. This requires a robust, trusted and flexible mechanism for patients to offer consent to share their data. Furthermore, new IT technologies make it easier to give patients more control over their data, including the right to revoke consent.

Concurrent Execution of Multiple Computer-interpretable Clinical Practice Guidelines and Their Interrelations.

Execution of multiple computer-interpretable guidelines (CIGs), enables the creation of patient-centered care plans for multimorbidity, which can be monitored by clinical decision support systems. This paper introduces an execution framework to manage multiple, concurrently implemented CIGs, also discussing the approaches used such as constraint satisfaction.

Drug Interaction Advisory Service for Clinical Decision Support of Multimordity Patient Centric Care Plans in the C3-Cloud System.

C3-Cloud is a project aiming to provide an ICT infrastructure, which will allow patient centric and integrated care, based on best practice guideline, for patients with multi-morbidity. Clinical Decision Support, by checking the patient's record for known adverse interactions when the medication changes. The drug interaction advisory service provides recommendations in the three languages used in the project's pilot sites, for over 1000 substances, based on the UK's NICE BNF body of knowledge.

A Collaborative Platform for Management of Chronic Diseases via Guideline-Driven Individualized Care Plans.

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients.

The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions: A review.

Clinical practice guidelines (CPGs) document evidence-based information and recommendations on treatment and management of conditions. CPGs usually focus on management of a single condition; however, in many cases a patient will be at the centre of multiple health conditions (multimorbidity). Multiple CPGs need to be followed in parallel, each managing a separate condition, which often results in instructions that may interact with each other, such as conflicts in medication.

Structuring Clinical Decision Support Rules for Drug Safety Using Natural Language Processing.

Drug safety is an important aspect in healthcare, resulting in a number of inadvertent events, which may harm the patients. IT based Clinical Decision Support (CDS), integrated in electronic-prescription or Electronic Health Records (EHR) systems, can provide a means for checking prescriptions for errors. This requires expressing prescription guidelines in a way that can be interpreted by IT systems.

Implications and Modelling of Data Quality on Confidence of Clinical Decision Support: A Conceptual Framework.

Integrated care paradigms depend on multiple sources of data. The quality of data used in decision-making will ultimately affect the delivered care to the patient. Quality includes several dimensions, which may affect the result.

Telehealth and the Re-Design of Emergency Medical Services.

As patient numbers continue to rise Emergency Department's (ED's) are struggling to not only control patient wait times but also to maintain the quality of patient care. Improving patient flow through the ED has been a priority for many years with techniques such as Lean Six-Sigma being implemented specifically to help alleviate the problem. The Institute for Healthcare Improvement recently stated that the best opportunities to improving patient flow relate to the front-end of the ED, namely triage.

A framework for synthesis of safety justification for digitally enabled healthcare services.

Background: Digitally enabled healthcare services combine socio-technical resources to deliver the required outcomes to patients. Unintended operation of these services may result in adverse effects to the patient. Eliminating avoidable harm requires a systematic way of analysing the causal conditions, identifying opportunities for intervention.

Root Cause Analysis and Health Informatics.

Root Cause Analysis (RCA) is the most widely used system analysis tool for investigating safety related incidents in healthcare. This contribution reviews RCA techniques, using a Health Informatics example, and discusses barriers to their successful uptake by healthcare organisations. It is concluded that a critical assessment to examine the uptake and evaluate the success of RCA, and other safety related techniques, within healthcare is long overdue.

Converting Text to Structured Models of Healthcare Services.

The paper presents a concise method for transforming textual representations of healthcare services, to a structured, semantically unambiguous modelling language. The method is designed based on literature, as well as trial and error by the authors, using text descriptions of healthcare services. Employing the method can convert textual descriptions to structured graphical models, facilitating stakeholder collaboration on requirements analysis and simulation.

Using Event Trees to Inform Quantitative Analysis of Healthcare Services.

The paper illustrates how event tree diagrams, used in safety engineering, can be applied to test the design of a healthcare service. Event tree diagrams can be employed to inform quantitative approaches to quality, by providing justification with respect to safety, of operational aspects to be monitored and measured.

The Challenges of Balancing Safety and Security in Implantable Medical Devices.

Modern Implantable Medical Devices (IMDs), implement capabilities that have contributed significantly to patient outcomes, as well as quality of life. The ever increasing connectivity of IMD's does raise security concerns though there are instances where implemented security measures might impact on patient safety. The paper discusses challenges of addressing both of these attributes in parallel.

Understanding and De-risking the Dependencies between Operator and Manufacturer of Clinical IT.

Health IT, in addition to benefits can also have unintended consequences both in terms of operational and business risks. Understanding the dependencies between operator and manufacturer as well as issues that need to be addressed during procurement is essential to increase confidence in the operation of health IT. The paper provides the context, and a number of issues health IT operators such as clinical organisations, need to investigate during acquisition of health IT.

Key Issues on Assuring the Safe Operation of Heath IT Systems.

The paper discusses the motivation behind the safety assurance of health IT, lists pertinent standards and regulation, as well as discussing prominent challenges in the field of health I safety.