Distributed Application of Guideline-Based Decision Support through Mobile Devices: Implementation and Evaluation. (arXiv:2102.11314v1 [cs.AI])

Traditionally Guideline(GL)based Decision Support Systems (DSSs) use a
centralized infrastructure to generate recommendations to care providers.
However, managing patients at home is preferable, reducing costs and empowering
patients. We aimed to design, implement, and demonstrate the feasibility of a
new architecture for a distributed DSS that provides patients with
personalized, context-sensitive, evidence based guidance through their mobile
device, and increases the robustness of the distributed application of the GL,
while maintaining access to the patient longitudinal record and to an up to
date evidence based GL repository. We have designed and implemented a novel
projection and callback (PCB) model, in which small portions of the evidence
based GL procedural knowledge, adapted to the patient preferences and to their
current context, are projected from a central DSS server, to a local DSS on the
patient mobile device that applies that knowledge. When appropriate, as defined
by a temporal pattern within the projected plan, the local DSS calls back the
central DSS, requesting further assistance, possibly another projection. Thus,
the GL specification includes two levels: one for the central DSS, one for the
local DSS. We successfully evaluated the PCB model within the MobiGuide EU
project by managing Gestational Diabetes Mellitus patients in Spain, and Atrial
Fibrillation patients in Italy. Significant differences exist between the two
GL representations, suggesting additional ways to characterize GLs. Mean time
between the central and local interactions was quite different for the two GLs:
3.95 days for gestational diabetes, 23.80 days for atrial fibrillation. Most
interactions, 83%, were due to projections to the mDSS. Others were data
notifications, mostly to change context. Robustness was demonstrated through
successful recovery from multiple local DSS crashes.

Source: https://arxiv.org/abs/2102.11314


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