Patient monitoring

Saphire combines patient monitoring with clinical decision support

26 November 2007

The EU-funded Saphire project is developing an intelligent healthcare monitoring and decision-support system on a platform integrating wireless medical sensor data with hospital information systems.

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 solves that problem by converting diverse data formats into one that can be combined with other data.

The five-country research team initially used ontology mapping to link different sets  of information. “Later on, we noticed that XSLT mapping can also perform some of the conversions adequately in much shorter time,” said 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, a Web 2.0 programming language, to another type. The result is more effective translation with less work. Techniques like these can translate medical records into a standard format and integrate them with patients’ real-time vital signs.

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

“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 is 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 mobile phone messaging (SMS), pager, email, web browser or PDA, whenever doctors’ need it or an emergency occurs.

“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 two pilot applications, one to monitor cardiovascular patients in a hospital in Romania and one for homecare monitoring of cardiovascular patients in Germany.

The aim is to enable some patients to be transferred to regular wards sooner, freeing beds in critical care units. The system will also aid the training of young doctors and it should minimise the risk of medical errors. It could also result in better level of home care.

Source: ICT Results

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