The Conceptual MADE Framework for Pervasive and Knowledge-Based Decision Support in Telemedicine

Abstract

Telemedicine systems are inherently distributed, but, especially in the context of the Internet-of-Things, their complete physical configuration may only be determined after design time by considering, for example, the individual patient's needs. Therefore, to enable pervasive and knowledge-based decision support to be provided in telemedicine, a conceptual framework was developed for modelling and executing clinical knowledge as networks of four types of concurrent processes: Monitoring (M), Analysis (A), Decision (D) and Effectuation (E). In this way, the required decision support functionality can, as presented in this article, be distributed at run-time by mapping different portions of the knowledge across the devices constituting the system. This MADE framework was applied to model a clinical guideline for gestational diabetes mellitus and to derive a prototype knowledge-based system that executes the resulting MADE network. Thus it is shown to support the full development trajectory of a telemedicine system, including analysis, design and implementation.

A Verified, Executable Formalism for Resilient and Pervasive Guideline-Based Decision Support for Patients

“…Therefore, while our formalism also focuses on data flow rather than control flow, we base our formalism on previous work [3] which introduced an informal conceptual data flow model of disease management. Our model comprises four types of data flow processes interacting with the environment (e.g.…”

“…Our MADE model (Fig. 1) was demonstrated to be a useful conceptual tool for analyzing clinical guidelines and designing decision support systems in the context of pervasive healthcare [3]. To support interoperability in pervasive healthcare systems, we also derived from it a reference information model (the MADE RIM) for representing clinical data [2].…”

Propuesta y evaluación de un sistema de telemedicina y de ayuda a la decisión para el cuidado de pacientes con diabetes gestacional

“…La formalización de las guías clínicas se hace mediante el uso de ontologías (Shahar et al, 2004) y el funcionamiento del sistema se basa en un marco de formalización y ejecución del conocimiento clínico que los autores han denominado "MADE", monitorización, análisis, decisión y efecto (Fung et al, 2016). En el caso de las pacientes con DMG se estarían refiriendo a la monitorización de la glucemia y de la actividad física; el análisis para determinar si el control glucémico de la paciente y su adherencia al tratamiento son adecuados; la decisión terapéutica a tomar en función del control metabólico, por ejemplo si se debe iniciar el tratamiento con insulina; y finalmente efectuar las acciones pertinentes para ejecutar dicho cambio en la terapia (García-Sáez, .…”