ubi:paths Self-Adaptive Clinical Pathways
A core research and business challenge regarding the healthcare sector is to achieve at the same time the increment of the treatment quality while reducing the healthcare provision financial and organizational costs. A possible solution to this challenge is the utilization of standardized clinical protocols alongside with their modeling while covering all the possible domains of medical practice. The standardized protocols comprise detailed medical plans that correspond to specific actions for the diagnosis, treatment and follow-ups of the patient. These protocols also encapsulate domain-specific knowledge in order to tackle any exceptional events (adverse events) that might occur during their execution and entail quick response and appropriate modifications to the proposed treatment scheme. Thus, achieving the flexibility and high personalization of the treatment process. A tool that corresponds to above mentioned desired characteristics, is the “Clinical Pathways”. UBITECH is performing research activities regarding self-adaptive Clinical Pathways for the provision of highly personalized healthcare treatment schemes based on the domain knowledge of the complete of stakeholders inside a healthcare provision organization. More specifically, UBITECH R&D team has designed and recently developed an integrated software infrastructure that leverages the provision of highly personalized health care treatment by the utilization and maintenance of health care business processes.
ubi:paths comprises a software platform that can offer personalization of the treatment plans for every single patient. ubi:paths main technical highlights could be summarized below:
- Real-time composition of clinical pathways: the ubi:paths approach is based on continuous reasoning over the existing knowledge (represented by a respective rule set), in order to select and execute the most appropriate “next” sub-process of the treatment scheme under execution. The innovation feature of ubi:paths approach is the fact that the Clinical Pathway is being composed during its execution, as the platform selects, combines and executes sub-processes stored inside a repository;
- ubi:paths rule base: the integrated ubi:paths environment encloses a rule-set repository created in order to ensure the interoperation between the rule base and the semantic model. The rule base is able to produce new facts and update the ontology accordingly, thus creating new knowledge as each pathway evolves and concludes.
- Clinical Pathway Rule Designer: taking under consideration that one of the most vital components of the software infrastructure is the rule set repository since it encloses the required knowledge assets, UBITECH R&D team designed and implemented a software infrastructure that could facilitate its continuous maintenance by the domain experts in an integrated way.
- Multi-view environment: the design and implementation of ubi:paths environment is based on the assumption that the health care provision team inside an organization is multidisciplinary, thus, it contains people with different needs and know-how. Moreover, it is obligatory for such an environment to offer multiple and various views of the information stored, since each type of personnel should have access to a specific part of the dataset stored for each patient.
A core principle that was followed through the whole design and implementation of ubi:paths infrastructure is the maintainability of the implemented environment. The characteristic of maintainability can be divided into the two following axes:
- the property of interoperability between the platform itself and third party applications that already exist in the health care domain, as well as
- the extensibility of the produced system. The rapidly evolving environment in which the platform operates mandates both these two properties.
The property of interoperability is ensured by initially utilizing widely accepted standards regarding the implementation of the platform. More specifically, the design-time environment is implemented as a Protégé plug-in, which constitutes a well known ontology authoring environment to the end users while it provides a smooth integration and utilization of the implemented ontology with the rule designer during the semantic rules creation. On the level of the Ontology definition and instantiation, the utilization of existing ontologies and terminologies ensures the extensibility of the implemented system while at the same time this decision is heavily influenced by the best practices that are proposed by experts in the Ontology engineering domain.
In particular, ubi:paths facilitates the provision of highly-personalized treatment schemes by utilizing semantic web technologies. ubi:paths software framework covers the complete lifecycle of Clinical Pathways (both design- and execution-time) by offering a toolkit incorporating a set of functional features:
- Clinical Pathways Adaptability: The traditional Clinical Pathways are normally static and lack of dynamicity. ubi:paths introduces an innovative methodological approach that allows for the real-time adaptation of the Clinical Pathways during their execution, leading to a highly-personalized treatment scheme. The adaptation is empowered by the design and deployment semantic info-structure that provides assistive decision-making;
- Maintenance: The implementation of Clinical Pathways is based on medical guidelines and additional types of knowledge. Clinical Pathways constitute a multi-modal healthcare business process that requires a multi-disciplinary team in order to be maintained and executed. ubi:paths encloses a Semantic Model utilized for the representation of the various domains of knowledge required, as well as the creation of a set of semantic rules. ubi:paths software infrastructure offers the required UIs to the medical personnel in order to maintain and update the stored knowledge and experience;
- Medical Guidelines Formalization: The formalization of medical guidelines is being performed in a specific and per case manner. Their formalization is required since their parameters will be able to be handled by an IT infrastructure that supports their execution. ubi:paths provides the framework for the formalization of the Clinical Pathways in a machine-interpretable manner, so as to be maintained and utilized by an IT platform; and
- Clinical Pathways Modeling: The modeling of Clinical Pathways lacks a formal structure. Different approaches exist in the area of modeling. Their interoperation could be of major significance since the Clinical Pathway exchange between healthcare organizations could optimize the respective treatment schemes. ubi:paths utilizes the established Semantic Model in conjunction with the Semantic Rules defined so as to model the pathways both in terms of business processes as well as in terms of knowledge enclosed.
Potential Application Areas
The technological backbone of ubi:paths may be utilized, deployed and parameterized to serve various needs and business scenarios. The main utilization of ubi:paths is the Personalized Healthcare Treatment, since its main focus is towards the totally dynamic execution of Clinical Pathways during the treatment of a patient. Furthermore, ubi:paths can be easily parameterized in order to serve various case studies that could utilize adaptive healthcare business processes. Thus, in the case of Clinical Trials, ubi:paths could be instantiated in order to capture the data produced, as well as dynamically adapt and reconfigure the following steps of the process according to specific business rules based on the knowledge on the specific domain.