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New approach helps computers deal with conflicts and duplications when applying more than one clinical practice guideline to a patient

Researchers in WMG at the University of Warwick have developed a new method that could solve the problem of how to automate support of managing the complexities of care when applying multiple clinical practice guidelines, to patients with more than one medical issue.

This will preserve the speed and accuracy of automated treatment decisions without introducing serious treatment conflicts or wasteful duplication of treatments and procedures.

Clinical Practice Guidelines (CPGs) are evidence-based statements or flow charts, which are used to support the decision-making of health professionals. CPGs are a body of knowledge representing best practice, based on the available evidence. Guidelines are relatively straightforward to input into a computer (a.k.a Computer Interpretable Guidelines (CIGs)), enhancing the speed and accuracy of patient care in many situations.

However, it becomes more problematic for patients who have more than one conditions. In such cases (known as multimorbid patients), the guideline recommendations for each treatment can be at odds, produce serious treatment conflicts and ultimately potential harm to the patient.

For instance, one drug-based medication might assist one condition but could worsen the other. This is particularly critical for elderly patients who are most likely to have dynamic and multiple health conditions.

The research team from WMG’s Institute of Digital Healthcare at the University of Warwick (Ms Eda Bilici, Dr George Despotou and Professor Theodoros Professor Theo ArvanitisArvanitis) have implemented a framework of automating computer-based management of multiple Clinical Practice Guidelines to overcome this problem.

The new framework is called MuCIGREF – (Multiple Computer Interpretable Guideline Representation and Execution Framework). It allows development CIG models for each CPG. Once the CIG models are created, they are then concurrently executed to generate a unified personal plan for each individual multimorbid patient.

It ensures care optimisation to avoid unnecessary resource use or potential care duplications because of the multiple plans (e.g., carer time, lab test).

It identifies potential conflicts in the care plan and resolves them through the modification of clinical activities (e.g., activity start time, duration), or its associated care element (e.g. the drug dose level)

The researchers tested the new framework on several CPGs from the UK National Institute of Care Excellence (NICE), and they hope to conduct further work that will involve user validation and application in real-world cases.

This first stage in the work has just been published in a chapter entitled “Concurrent Execution of Multiple Computer- interpretable Clinical Practice Guidelines and Their Interrelations” in the Ebook Health Informatics Vision: From Data via Information to Knowledge  

 ENDS

4 OCTOBER 2019

NOTES TO EDITORS

Paper Available to view at: https://www.ncbi.nlm.nih.gov/pubmed/31349252

Eda Bilici has received a PhD scholarship from WMG, University of Warwick. Prof Theodoros Arvanitis and Dr George Despotou have been supported by the EU H2020 C3-Cloud Project

FOR FURTHER INFORMATION PLEASE CONTACT:

Alice Scott
Media Relations Manager – Science
University of Warwick
Tel: +44 (0) 2476 574 255 or +44 (0) 7920 531 221
E-mail: alice.j.scott@warwick.ac.uk

 


WMG project tackles data sharing issues in the healthcare sector

Researchers from the Institute of Digital Healthcare (IDH) at WMG are working with healthcare software experts at Dovetail Lab on ‘General Practice of the Future.’

Using Blockchain Technology, our team of Assistant Professor George Despotou, Research Assistant Jill Evans, Professor Theo Arvanitis and PhD student Tim Robbins are developing a digital consent service for the exchange of patient data across electronic health records in an integrated care setting. High levels of encryption allow information to be shared securely with consent, and audit records stored on a “Blockchain” to ensure compliance with information governance rules.

Patients using this consent mechanism will be able to actively control how they share their data, and approve or refuse (case-by-case), from a mobile app.


Using e-health to support the challenges of an ageing population

Researchers at our Institute of Digital Healthcare have published a systematic review on e-health based active ageing interventions.

As life expectancy is at an all-time high, this type of research has become an international priority offering enormous potential to support individuals, communities, clinicians and policy makers.

Our Professor of e-Health Innovation and Head of Research, Theo Arvanitis, Dr Timothy Robbins and Dr Sarah Lim Choi Keung, worked alongside experts at University Hospitals Coventry and Warwickshire to establish the extent to which current research literature considers e-health-based and telemedicine-based active ageing interventions.


WMG research helps expand Sweatcoin capabilities

Researchers at our Institute of Digital Healthcare (IDH) have been working, with the health and fitness app Sweatcoin, to develop a new verification process that will now allow indoor steps to be tracked for the first time.

Sweatcoin monitors steps throughout the day, via an app downloaded to a smartphone. Users are rewarded with one Sweatcoin (SWC) per every 1,000 steps. The digital currency can then be redeemed for items including magazines, clothing, music downloads and even televisions.

Previously the app was only capable of tracking outdoor steps - a big disadvantage for those with active jobs indoors or even those using the gym.

The 12-month project, funded by Innovate UK, collected large amounts of data from the sensors built into smartphones in parallel with step-count data recorded using high accuracy activity monitors. Researchers on the project then used this data to create a new step-verification model to work in any environment, not just outdoors.


WMG part of £30 million funding to help transform health through data science

Theo ArvanitisWMG, at the University of Warwick, is a key partner in the Midlands site helping to deliver a £30 million project by Health Data Research UK, to address challenging UK healthcare issues using data science, which is looking at making game-changing improvements in people’s health by harnessing data science at scale across the UK.

WMG will be part of the “Midlands HDR UK Substantive Site”, which will tackle the challenge of how to make NHS data more useable and accessible for research; and will develop, evaluate and apply appropriate analytical tools to NHS data in real time in order to inform decision making and improve health for both the patient and population. The Institute of Digital Healthcare (IDH), WMG will lead the Warwick part of the programme, together with colleagues from Warwick Medical School and Warwick’s Mathematics Institute.


Pregnancy loss biobank to receive £1.2million in funding

Research to help identify women at risk of pregnancy complications is to receive a huge financial boost.

The Medical Research Council (MRC) is to give The Tommy's Reproductive Health Biobank a grant of £1.2million.

The biobank will be the most significant collection of reproductive health tissues in the UK. Operating on a virtual basis with its server based at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) and will begin operating on 29 September. It will store biological samples collected by scientists and clinicians at UHCW, the University of Warwick, University of Birmingham, Imperial College, Kings College London, University of Edinburgh and University of Manchester. The tissues, donated by women who have a history of pregnancy problems, and clinical data will help scientists find new causes and cures for miscarriage, stillbirth, and premature birth.


People are reluctant to use public defibrillators to treat cardiac arrests

A study led the University of Warwick suggests that people are reluctant to use public access defibrillators to treat cardiac arrests.

The analysis of existing international studies, which has been published in the European Heart Journal – Quality of Care and Clinical Outcomes, suggests that there are a number of factors that prevent members of the public from using them and potentially saving lives.

The researchers’ study suggests that many members of the public don’t know what an automated external defibrillator (AED) is, where to find one and how to use one. This is despite AEDs being suitable for use by untrained members of the public. Although studies suggest there is variation across the studies they analysed in the number of people willing to use an AED a lack of confidence and fear of harm are common themes.

The research, Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review, was conducted by Warwick Medical School, the University of Warwick; the Institute of Digital Healthcare, WMG, the University of Warwick; Heart of England NHS Trust, Birmingham; London Ambulance Service NHS Trust and Imperial College Neurotrauma Centre, St Mary’s Hospital, London.


Expert comment: Dr Sudakshina Lahiri - Increased NHS demand is reshaping the service environment

Sudakshina Lahiri“As recent news headlines have highlighted, the demand for health and social care services is growing at an unprecedented rate. Demographic changes, presence of long-term conditions, technological advancements, and patient expectations are just some of the factors driving this growth.

“Addressing the increased demand for service through an efficient integrated care delivery structure, that puts the patient at the centre of the service system, is an idea that has wide support. Developing that integrated framework of care will require thoughtful and systematic approaches however, including new ways of training the healthcare workforce, particularly those who are in middle management and tasked with the essential role of overseeing healthcare operational management.

“The increased demand is reshaping the service environment, making it dynamic and subject to rapid change. To address some of the challenges that come with such changes, it will be essential to provide health sector managers with the skills and knowledge to effectively operationalize issues of quality, productivity, and cost so as to ensure that the health service system delivers dual advantages of patient benefits while remaining efficient.