In eHealth it is increasingly necessary to develop tele-informatic applications to support people involved in providing basic medical care (physicians, nurses, patients, relatives, and citizens in general).The care of chronic and disabled patients involves life long treatment under continuous expert supervision. Moreover, health care workers and patients accept that being cared for in hospitals or residential facilities may be unnecessary and even counterproductive.
From a global view, such patients may saturate national health services and increase health related costs. The debate over the crisis of financing health care is open and is a basic political issue for old and new EU member countries and could hinder European convergence. To face these challenges we can differentiate medical assistance in health centres from assistance in a ubiquitous way (Home Care -HC- model); the latter can undoubtedly benefit from the introduction of ICT.
The project started under an EU initiative towards the convergence of the diverse health care systems in the EU countries. The project was aimed to boost the integration of the best European health care practices of old and new EU Eastern countries. These objectives have been achieved with the project at the technological level, though the political situation has not reached the same level of maturity.
Description of target users and groups
The system implements three different sorts of personalisation: user, patient, and treatment. The users of the system are: health care professionals, patients, and citizens in general. Professionals can be of several sorts (defined as a hierarchy in the APO ontology): physician in charge, family doctor, head nurse, nurse, social worker, etc. Each user in the system has a modifiable default profile obtained by automatic personalization of the APO that avoids a nurse for example starting a service or accessing a document not allowed to nurses.
The information in the Health Record is used to personalise the health care knowledge of patients. This personalisation adapts the general CPO ontology that contains medical knowledge to each single patient. This personalised knowledge helps users of the system to make decisions for that patient (e.g., detecting contraindications). The FIPs (or formal intervention plans) of the diseases of one patient, together with the procedures of the services started for that patient are personalised and semi-automatically combined to provide an Individual Intervention Plan (IIP) for that patient. This unified IIP, formalised in SDA notation, is the treatment plan that the ICT system uses to automate the coordination of human resources around that patient.
Description of the way to implement the initiative
This project will develop a platform to manage the information needed to guarantee an ICT Home Care service. It will:
- integrate information of different types and from different sources;
- be integrated with ICT whilst ensuring private and customized data access;
- use ontologies to define the profile of accessing subjects (e.g. physicians, patient) and objects (e.g. disease, case study);
- have a mechanism to combine and refine the ontologies to personalize the system, taking into account the way a physician works and the individual patient characteristics;
- incorporate 'know-how' from geriatric clinical guidelines as Intervention Plans (IP);
- generate IPs from the healthcare centres databases if clinical guidelines do not exist or are inappropriate for a particular situation;
- configure a knowledge-based decision support tool that can supply eServices to all subjects involved in the Home Care model;
- extract evidence from real patients and integrate it with published evidence derived from RCT.
All the documents (e.g., requests, authorisations, prescriptions, scales, laboratory results, etc.) in the health care model are XML files, which are managed by a sophisticated relational database that also stores information about the actors (i.e., health care professionals, patients, relatives, etc.), roles, groups (e.g., evaluation units) and relations between actors (e.g., who the family doctor for a particular patient is).Each sort of document in the Health Record is formalised by a XML Schema that prevents the system from incorporating wrong documents, and a couple of XSL files allowing the documents to be shown or filled through the Web.
An Agent Profile Ontology (APO) formalises all the concepts and constraints of the health care model so that any modification of the APO represents a change in the model and an automatic and immediate adaptation of the ICT system operation. The APO knowledge about actors, services, etc. is complemented with a formalisation of the procedures that implement the health care services of the model (e.g., comprehensive assessment, nursing care, follow-up, etc.), represented as health care algorithms with the SDA notation. The medical knowledge related to fifteen common chronic diseases was distributed between the Case Profile Ontology (CPO) and a library of Formal Intervention Plans (FIPs).
The CPO gathers all the concepts and interactions of these diseases at the levels of signs and symptoms, syndromes, means of assessment, social issues, and interventions. FIPs formalise the therapies of these diseases and syndromes as medical algorithms in SDA notation.
Main results, benefits and impacts
The K4CARE project involved the joint effort of 4 technological institutions and 7 health care centres. This consortium combined experiences of old and new EU countries to define a new health care model for care of elderly people. New knowledge-based ICT technologies were researched, developed and integrated in a final product that implements the health care model as a web platform. This is a validated prototype that optimises the safe management of the care of chronically ill patients at home.
The project was awarded as eHealth month focus of Feb 2010 by the EC (see http://www.epractice.eu/en/library/308165).
Return on investmentReturn on investment: Not applicable / Not available
ICT is an effective way of reducing costs and making health care more homogeneous and fair throughout Europe. The technologically-driven homogenization of health care brings a clear benefit to the society of the XXI century with a care which is adapted to the particular circumstances of each patient and the health care professionals involved, and incorporating computers in the care processes. The K4CARE technologies are validated in real scenarios and ready for authorities to use them.Scope: Pan-European