CLINIC D64C Final Workshop Turin

7/28/2019 CLINIC D64C Final Workshop Turin

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CLINIC eTen 517372-2004/1

Report of CLINIC Final WorkshopTurin, December 13

th, 2006 page 1 Vers. 1

Project Acronym: CLINIC

Project Title: Collaborative pLatform for supportINg knowledge managementprocesses In the healthCare sector

Contract Number: 517372

Starting date: 01/07/2005 Ending date: 31/12/2006

Deliverable Number: D 6.4C

Title of the Deliverable: CLINIC Final WorkshopVersion: 1

Task/WP related to the Deliverable: WP6

Type (Internal or Restricted or Public) : P

Author(s): BOEHRINGER INGELHEIM ITALIA S.P.A.

Partner(s) Contributing: RATIO

Contractual Date of Delivery to the CEC: 31/12/06

Actual Date of Delivery to the CEC: 15/12/06

Project Co-ordinator

Company name : Boehringer Ingelheim Italia S.p.A.Name of representative : Francesca C. AlbaneseAddress : Via Lorenzini 8- MilanoPhone number : +39.02.5355.480Fax number : +39.02.5355.329E-mail : [email protected] WEB site address : www.clinic-project.com


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Abstract:

A final demonstration and presentation workshop was held in Torino to present CLINIC results to MedicalDoctors, IT companies representatives, staff of the IT departments of healthcare institutions and ITCresearchers. The workshop was organised by Boehringer Ingelheim Italia S.p.A. in collaboration with @ITIMin the frame of an international session of the 7

th@ITIM congress.

The aim of the workshop was to present the results of CLINIC project, to demonstrate the systemapplications and to collect feedbacks from potential business partners and representatives of ICT vendorsand also evaluation impressions from health professionals.

The event was attended by 30 persons of different nationalities in Europe with one representative fromEgypt (Italian hospital of Cairo). The CLINIC Consortium was represented by Boehringer, ANCO, GL andRATIO. Feedbacks were collected through questionnaires (business partners screening).

Keywords List: Demonstration, dissemination, market validation.


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Table of Contents

1. HIGHLIGHTS ON THE WORKSHOP ...................................................................................4

1.1. Speakers of CLINIC workshop................................................................. 41.2. Participants ........................................................................................... 4

2. TOPICS COVERED BY THE WORKSHOP.............................................................................5

2.1. Introduction session............................................................................... 52.2. Thematic session ................................................................................... 52.3. Demonstration session ........................................................................... 72.4. Presentations: ....................................................................................... 8

3. RESULTS AND FEEDBACKS COLLECTED............................................................................9

3.1. Main findings......................................................................................... 93.2. Next steps............................................................................................. 9

4. ANNEXES .....................................................................................................................10

4.1. List of presentations and speeches ........................................................ 104.2. Workshop leaflet.................................................................................. 114.3. Some pictures from the workshop ......................................................... 124.4. Abstracts of the presentations............................................................... 13


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1. Highlights on the workshop

The workshop was held in Turin (Italy) in the INFN aula magnaon December 13th, 2006.Other projects and initiatives were presented as part of the workshop to provide a widerframework of the ICT developments for content and risk management in healthcare.The CLINIC workshop was part of and concluded an international session (see annexprogram) where speakers form different European Countries presented experiences and

initiatives for eHealth and ICT systems for knowledge management, decision support and riskmanagement in healthcare.This organisation of the works enabled the confrontation of experiences and applications andthe establishment of interesting Q&A rounds between speakers and participants.Attendees were contacted by @ITIM and by CLINIC consortium members via mailing-lists,direct mailing and direct contacts.

1.1. Speakers of CLINIC workshop

The first session (presentations) of the workshop was chaired by Mrs. Elena Martinelli,consultant for Boehringer Ingelheim Italia. She introduced the concept of knowledgemanagement and decision support systems in healthcare and introduced the speakers,chairing the Q&A sessions and taking note of comments and feedbacks from participants

An initial overlook on the role of ICT in the decisional process in health institutions waspresented and discussed by Prof. Stefano Calciolari of CERGAS and SDA Bocconi University ofMilan.

Mr. Michele Vitali, MD, from the Health Agency of Parma and evaluator for the IST programsof European Commission illustrated the strategies proposed by the European Union (eEuropeand eHealth action plans) and the European Commission (Framework Programs, themes andinitiatives) towards the promotion of ICT in healthcare.

These introduction lectures were followed by targeted presentation of CLINIC project, by Mrs.Eftihia Desipri (ANCO) who presented the market validation results

During the presentation questionnaires were distributed to participants from ICT companies

or hospital IT departments (Business partners screening questionnaires), to collect theirfeedbacks.

Mrs. Maria Tzima (University of Ioannina) and Mr. Salvatore Chessa (Siemens Espaa) ofNoesis consortium presented the main technical achievements of Noesis personalisation,advanced search and clinical decision support tools.

Finally Mr. Puccetti, MD, from European Medical Association, completed the frame of ICT toolsfor knowledge management presenting aims and results of COCOON project addressing riskmanagement in healthcare.

The second session of the workshop offered a demonstration of CLINIC functionalities, byMrs. Elena Martinelli, where participants interacted either directly of by posing questions and

suggesting activities which were directly demonstrated by the CLINIC Consortium members.

At the end a short demonstration of Noesis Decision Support Tools was given by Mrs. Tzima.

Before the workshop closed 10 filled-in questionnaires were collected from participants.

1.2. Participants

The workshop was attended by Medical Doctors and and IT experts interested in ICT for thehealth sector.


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2. Topics covered by the workshop

The workshop addressed the role of ICT for the decisional processes in the healthcare sector,including managerial decision support (for hospital/health agencies general directors andhealth directors) and clinical decision support systems both indirect (through knowledge andcompetence management and sharing) and direct (through clinical decision support ICTtools).

This is well described by the workshop title A Medical Doctor inside your PC. RiskManagement and Decision Support in healthcare and by the introductory lecture by Prof.Calciolari, who well introduced the concept of ICT and its role and implementation strategiesin the health institutions.

2.1. Introduction session

Before addressing the specific applications, in the first part of the workshop, a generalscenario was drawn by the first two speakers, who presented the state of the art of thestrategies and policies for adoption of knowledge management and decision support ICTsystems in hospitals and in health institutions in general.A survey on the main future E.C. supported action lines was also provided.

Role of ICT decision support systems in the healthcare sector. Outlooks and market.Stefano Calciolari presented the results of periodic surveys on ICT in the health sector in Italyperformed, with some outlooks on the European situation, conducted by CERGAS (ResearchCenter on Health and Social Assistance) and SDA Bocconi in the last three years.The subjects addressed were the decision support systems for hospital and health agencymanagers (general directors, administrative directors and health directors) and chiefs ofhospital departments.The intervention highlighted also the importance of knowledge sharing tools and of clinicaldecision support systems, which are seen as important support tools to link administrativeand financial data to clinical outcomes and quality parameters and to improve the overallevaluation parameters for hospitals care-giving.Questions were raised and answered regarding the strategies foreseen for the adoption of ICTin health institutions and also regarding the role of healthcare stakeholders (RegionalGovernments, National Health Ministry) in driving the adoption of ICT by public health

organisations.The presentation was held in English with slides in Italian, to enable the foreign attendees tofollow. The discussion was partially in Italian and partially in English.

European strategies for eHealth. Information systems fro medicine and healthcare:proposals from the European Commission..Mr. Vitali, MD, evaluator of E.C. funded projects in the IST FP6 programme, illustrated thestrategies proposed by the European Commission, towards the development and adoption ofICT tools for the health sector.Starting from the political framework, a survey on the practical and institutional actions of theCommission Offices were presented, with particular attention to the more recent action planeEurope2010 and to the more recent published action lines for eHealth.Questions were raised and answered regarding the E.C. action plans, programmes and

funding opportunities and on the results of the already concluded actions.The presentation was held in Italian on English-language slides and the Q&A session was heldin Italian and English.

2.2. Thematic session

This session addressed the knowledge management and knowledge sharing aspects of healthcare, with a further look on computer-aided clinical decision support tools.

The leading presentation of this session referred to CLINIC project and its market validationapproach and results.


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The objectives were to collect feedbacks and impressions from the audience questionnaireswere distributed and collected and to present the outcomes of the market validationperformed by the CLINIC Consortium on CLINIC tool and more generally on the role ofknowledge management and knowledge sharing tools in health institutions and for healthcarein particular.Impressions were also collected during the morning session (preliminary to CLINICWorkshop) where different international eHealth initiatives were presented addressing

different aspects of health care. In this morning session questions were raised by CLINICpartners to raise awareness on the importance and role of knowledge management andcollaboration tools in health institutions.

To complete a survey on knowledge management and decision support ICT tools, twoadditional E.C. funded project were presented: NOESIS and COCOON.

Knowledge management and knowledge sharing systems in healthcare. CLINIC an

experience of market validation.Mrs. Eftihia Desipri from CLINIC consortium (ANCO) gave an overview presentation of CLINICproject and objectives, of main feedbacks and results of the market validation conducted inthe five EU Countries (France, Greece, Italy, Romania and UK) involved in CLINIC byinterviewing stakeholders and opinion leaders (peer-reviewers) and ICT vendors.

The different possible applications of knowledge management and knowledge sharing inhealth institutions were discussed with the audience and the results of the market validationraised comments and stimulated opinions.The chairman stressed with some examples the importance of knowledge sharing andknowledge management in healthcare and gave some results of successful experiences inspecific areas of interest, as its the case of Parma Hospital where CLINIC is adopted also toshare knowledge on an innovative image diagnostic technique (multilayer tomography) todetect cardio-vascular diseases, the only experimental application in Italy, so of extremeinterest for all Italian hospitals cardiology departments.This experience showed that even a simple system like CLINIC can provide a valuablesupport to a community of clinicians sharing a same interest and willing to communicateresearch results and clinical evidences and outcomes. This opinion was reinforced by otherattendees.The presentation was in English with slides in both English and Italian. The discussion was in

English and in Italian.

Noesis management of medical information through adaptive search mechanisms.The concept of knowledge sharing was also addressed by Ing. Salvatore Chessa fromSiemens Spain and Noesis Consortium, who presented and demonstrated the adaptive searchengine implemented in Noesis.This mechanism based on users preferences both directly indicated by the users themselvesand automatically detected and recorded by Noesis system by means of intelligent userinterfaces and profiling algorithms, drastically improves search and knowledge andinformation retrieval, automatically ranking search results based on users preferences andinterests.Examples and indicators of search performance were provided to illustrate the solutionsimplemented in Noesis.

While CLINIC is a tools supporting medical decisions but not providing automatic suggestionsfor diagnosis or therapy definition, the next two E.C. funded projects presented during theworkshop are examples of Clinical Decision Support Systems (CDSS).

The COCOON project: a semantics-based health care information infrastructure ableto seamlessly integrate medical information and eHealth servicesMr. Puccetti, MD from European Medical Association (EMA) provided an overview of COCOONproject, so introducing the discussion on clinical decision support systems.COCOON is a decision support systems based on clinical guidelines and electronic healthrecords, which enables health professionals to achieve the most appropriate decision also by


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establishing communications with MD experts of the COCOON health network. The mainexpected benefits refer to risk management and risk reduction in both diagnosis and therapyprovision.The Q&A session addressed the role of automatic and semi-automatic decision support toolsin medicine, and also their reliability and other legal implications (privacy, security of datatransmission etc.).The audience expressed interest for the sharing of clinical guidelines and for the mechanism

of second-opinion with experts, but concerns were expressed towards the real applicability ofdecision support tools in daily medical practice due to the need to fast decisions, to the roleand expertise of the caring health professionals in charge of a patient and to the complexityand often too specific and restricted areas of application of semi-automatic decision supporttools.

Noesis a decision support system for cardiologyMrs. Maria Tzima from the University of Ioannina presented the state-of-art of Noesisresearch in terms of clinical decision support applied to four specific problems of cardiology:

detection of arrhythmias and ischemias based on ECG leads processing risk assessment for Coronary Artery Disease based on patients health information

(and optionally on Electronic Health Records) Prediction of clinical restenosis in patients undergoing angioplasty with stenting based

on patients health information (and optionally on Electronic Health Records) Decision aid for post-surgery anticoagulant prescription based on patients health

information (and optionally on Electronic Health Records)

The concept of Clinical Decision support systems was here discussed in more details and ademonstration was provided to the assembly to show the features offered by the system.Even though the audience commented that market products already exist embedded in ECGequipment for ECG analysis, the accuracy of the Noesis tool was recognised.During the Q&A session the audience recognised that Noesis tools as provided couldconstitute a good education system for practicing cardiologists and specialising MDprofessionals, rather than a decision aid for experienced cardiologists.Questions were also raised regarding the standards for Electronic Health Records, and theaudience recognised that some actions must be taken to stimulate ICT providers for healthcare to establish shared and common de facto standards for EHRs.

2.3. Demonstration session

The demonstration session was devoted to show the functionalities of CLINIC. This sessionwas conducted jointly by Mrs. Martinelli and Mrs. Desipri (CLINIC Consortium).The audience followed the demonstration of the CLINIC tools and specific questions wereraised and answered regarding

the personalisation and customisation possibilities to adapt to different medical andscientific domains

the integration possibilities with hospital information systems the open source development platform the individual functionalities with specific interest for query recording and query

enrichment

the future applications (for example annotation of digitalised diagnostic images)

Clarifications were asked and provided with regard to:- knowledge indexing- user profiling- access to external literature (Pubmed and other resources)- workflow management- annotation

The demonstrated functionalities were recognised as appropriate for the current normalusage in health institutions.


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Particular interest was declared by a consultant of Regional Health Agency of Trentino Regionand of other health institutions in Northern Italy, who will be contacted in the next weeks topossibly build a collaboration and a plan for demonstrating and presenting CLINIC to moreinterested potential customers in Italy.

2.4. Presentations:

To download the presentations click on the icon inserted in the download column in thetable here below inserted

First Session, chairman E. MartinelliSpeaker Title Download

StefanoCalciolari

Role of ICT decision support systems in the healthcaresector. Outlooks and market.

CLINIC_Workshop_pres_Calciolari.pdf

MicheleVitali

European strategies for eHealth. Information systems fromedicine and healthcare: proposals from the EuropeanCommission.. Presentazione eHealth.pdf

Second Session, chairman E. MartinelliSpeaker Title Download

EftihiaDesipri

Knowledge Management & Knowledge Sharing inHealthcare:Il progetto CLINIC Unesperienza di validazionesul mercato CLINIC_Torino_13122006.pdf

LucaPuccetti

COCOON: Building knowledge driven & dynamicallyadaptive networked communities within Europeanhealthcare systems LucaPuccetti.pdf

MariaTzima

Noesis a decision support system for cardiologyDemonstration:http://88.218.97.5/NoesisDS/main.aspx?userid=Fiammetta

SalvatoreChessa

Noesis management of medical information throughadaptive search mechanisms.Demonstration: http://88.218.97.5:8180/noesis/

Demonstration Session, chairman F.C. AlbaneseSpeaker Title See

ElenaMartinelliEftihiaDesipri

CLINIC project demonstration www-clinic-project.com


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3. Results and feedbacks collected

The discussions and the Q&A sessions immediately after the presentations and during thedemonstration of CLINIC provided many feedbacks, already highlighted in the precedingparagraphs, which are shortly presented below.At the end of the demonstration session ten business partners screening questionnaires andthree peer-reviewers questionnaires were collected at the end of the session, after the CLINIC

demonstration.

3.1. Main findings

Knowledge management systems raised real interest among the audience also among healthprofessionals who are usually cautious regarding non-clinical-specific ICT tools.The role of shared protocols and data for a more efficient and effective care to patients, withthe additional added value of increased productivity and better usage of human and financialresources appears to be now well understood at all levels of healthcare institutions.Issues however still remain on security (hospital firewalls prevent the implementation of opencommunication networks to share knowledge at cross-country and also cross-regional level)and on data privacy.

The simplicity and user-friendliness of CLINIC was really appreciated by clinicians whoprefer simple tools even though sometimes less accurate or efficient than moresophisticated systems due to their lack of time for learning to use ICT tools.

ICT vendors commented that knowledge management platforms are already well-establishedon the market and a new tool such as CLINIC could encounter entry difficulties to find amarket in the health sector. They however recognised that the system is cheap comparedwith existing solutions and that its open source platform facilitates customisation.Also ICT vendors expressed interest for the future proposed development of CLINIC toannotation of portions of digitalised diagnostic images, which could constitute a real asset forCLINIC tool, mainly if associated to existing diagnostic images technologies.

Regarding search optimisations as presented by Noesis, some doubts were raised on theusage of Ontology whose real efficacy in optimising search results was questioned as no

conclusive evidence exists so far on its adoption benefits.

Also Decision Support Systems appear to be considered still a field for research or in thebest case for education, rather than real support systems for the everyday clinical practiceboth in hospitals and in private GP and MD ambulatories.The market for such Clinical Decision Support Systems is so far a niche market, where onlyspecific applications such as therapy monitoring DSS seem to raise interest for the nearfuture.

3.2. Next steps

The interest raised by the workshop convinced CLINIC Coordinator and Ratio Consulta of the

opportunity to organise a new event in January 2007.This event will be probably held in Emilia Romagna and will present the outcomes of themarket validation in Italy.


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4. Annexes

4.1. List of presentations and speeches

1. Stefano Calciolari: Role of ICT decision support systems in the healthcare sector.Outlooks and market.

2. Michele Vitali: European strategies for eHealth. Information systems fro medicine and

healthcare: proposals from the European Commission.3. Eftihia Desipri: Knowledge Management & Knowledge Sharing in Healthcare:Il

progetto CLINIC Unesperienza di validazione sul mercato4. Luca Puccetti. COCOON: Building knowledge driven & dynamically adaptive

networked communities within European healthcare systems.5. Maria Tzima: Noesis a decision support system for cardiology6. Salvatore Chessa: Noesis management of medical information through adaptive

search mechanisms.


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4.2. Workshop leaflet


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4.3. Some pictures from the workshop

The audience and presentation by Mr. Chessa

Presentation by Prof. Calciolari Presentation by Mr. Vitali, MD


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Presentation and Demonstration of CLINIC Presentation of Mrs. Tzima: NOESIS

4.4. Abstracts of the presentations

Ruolo dei sistemi ICT di supporto alle decisioni in ambito sanitario. Prospettive e mercato

(Durata: 20)

Relatore: Stefano Calciolari, SDA Bocconi-CERGAS, Milano

The current health care systems in Europe are often described as undergoing an informationrevolution. The rapid expansion of scientific and clinical knowledge has changed the health carelandscape so that no longer is the questionhow much of clinical practice is based in evidence?butratherhow much of the available evidence is applied at the front lines of patient care?Point-of-care connectivity between the relevant evidence base and patient data is often nonexistent,providing for innumerable delays in decision making and thus subjecting patients to potential harm.Research indicates that if evidence was properly filtered and combined with patient data at the time of

clinical decision making, 30-60% of decisions would be different.This human limitation, the explosion of medical knowledge, and the complexities of illness contributeto wide variations in clinical practice, to clinical error, and to poor compliance with guidelines. It issimply unrealistic to believe that modern health care can continue to be delivered without the adoptionof information technologies. Research in the field of clinical informatics (an application subfield ofmedical informatics) has led to the development of health care information technology that enhancesdecision making by improving the connectivity between patient data and knowledge.Clinical decision support systems are the primary clinical informatics technologies at the nexus ofpatient-specific and knowledge-based information.

The clinical decision support software market is set to grow in Europe, but a number of obstaclescurrently stand in the way of vendors' success, a report published by industry consultants Frost &Sullivan is suggesting.

Frost & Sullivan expects that in six years time, the market for decision software support systems forclinicians will be worth 227m, up from the current value of 126m. However, to reach that pointtesting, research and awareness issues must be addressed.Frost predicts a surge in product development in clinical decision support systems over the next fewyears, and believes that existing vendors will have the best opportunity of taking advantage of thegrowing market. Government-funded research, however, may be restricted due to low awareness of theproduct.Currently, market participants include large firms offering enterprise solutions with CDS support as

well as small-medium vendors, some of whom have single specialty offerings. While large HIT vendors


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granted IS contracts seek expertise from these specialty firms, small-medium sized specialty CDSSproviders are, in turn, benefiting from these alliances in terms of improved visibility.Small as well as large software companies may stand to benefit, however. Even though the main actorsalready possess the expertise needed to carve distinct niches for themselves, they will have toconcentrate on building strategic alliances, in order to increase their visibility in the industry, as well asto have more effective access to decision makers.

European strategies for eHealth. Information systems fro medicine and healthcare:

proposals from the European Commission.

Relatore: Michele Vitali, MD

Il Consiglio Europeo, riunito a Lisbona nel Marzo 2000, ha stabilito un nuovo obiettivo strategico daraggiungere entro il decennio.

Tale obiettivo consiste nel trasformare leconomia europea in un sistema economico Knowledge -basedche sia il pi competitivo e dinamico a livello mondiale, capace di una crescita economica sostenibilecon maggiori e migliori posti di lavoro e pi grande coesione sociale.

Tuta la ricerca co-finanziata dalla Comunit Europea riunisce ricercatori europei per focalizzare e

concentrare le loro risorse ed organizzata in programmi quadro pluriennali (Framework ResearchProgrammes ).Le Information Communications Technologies (ICT) sono una componente essenziale dei programmiquadro di ricerca dell'UE. Infatti, il programma specifico " Tecnologie per la societ dell'informazione "del Sesto programma quadro della Comunit Europea per la ricerca e lo sviluppo tecnologico (2002-2006) , in termini di bilancio, la sezione pi importante.Nell'ambito del Settimo programma quadro (2007-2013) - in corso di adozione - le ICT sono uno deinove temi del programma specifico di cooperazione. Le attivit previste intendono potenziare la basescientifica e tecnologica dell'Europa nel settore delle ICT, contribuire a stimolare l'innovazionemediante l'uso delle IT e fare in modo che i progressi in questo campo vengano rapidamentetrasformati in vantaggi per i cittadini, le imprese, l'industria e i governi.eHealth uno degli obiettivi strategici prioritari della Information Society Technologies (IST).Lo scopo della Information Communication Technology for Health (conosciuta anche come eHealth) quello di migliorare la qualit , laccessibilit e lefficacia dellassistenza sanitaria.La ricerca finanziata nellambito dellobiettivo strategico eHealth intende facilitare la creazione di unambiente intelligente che permetta di gestire lo stato di salute di ogni cittadino in maniera ubiquitariae che assista i professionisti sanitari nellaffrontare le sfide maggiori della loro attivit quotidiana.eHealth, che in precedenza aveva un profilo puramente improntato alla ricerca e sviluppo, ora mediantelassociato programma eTEN assicura una validazione di mercato ed una dimostrazione su larga scaladelle applicazioni .Questa breve presentazione intende:

illustrare i programmi ed i criteri di finanziamento dei progetti di ricerca, nellodierno SestoProgramma Quadro, gestiti dalla eHealth ed eTEN con particolare riguardo ad alcuniprogetti cosiddetti di Knowledge Management

esplorare brevemente le future direzioni potenziali della ICT proposte soprattutto inrelazione al prossimo settimo programma quadro.

Knowledge Management & Knowledge Sharing in Healthcare:Il progetto CLINIC

Unesperienza di validazione sul mercato

Relatore: Eftihia desipri, ANCO and CLINIC Consortium, Athens Greece

Sistemi di gestione e condivisione delle conoscenze in medicina. CLINIC: unesperienza divalidazione del mercato


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Knowledge management and knowledge sharing systems in healthcare. CLINIC experienceof market validation.

Knowledge Management solutions have been introduced into companies information systems someyears ago, following the diffusion of personal computers and personal computing software in officesand among working and travelling personnel, with PDAs and mobile communication technologies.

The increased mobility of workers along with the need to share business information to optimizecompanies response to market was the driver to such a diffusion. This phenomenon started from theprivate sector, led initially by large multinational business companies and has gradually reached thepublic administration sector and more institutional areas of business and intervention, among whichhealth care.

Even though priorities for technology investments and expenditures in health care are oriented toimprove medical equipment and information systems devoted to the transmission and sharing ofadministrative and patients data, the need is slowly emerging for systems and tools facilitating thetransaction of knowledge and experience among medical communities operating on a territorial basis,

with the objective to maximise the ratio between resources and results and to avoid unnecessary orduplicate medical practice. The promotion and funding of health networks based on Intranet andinternet networks which is one priority for the health authorities in EU countries is setting the basis for

the deployment of knowledge management services and systems in healthcare.

This paper presents how the CLINIC consortium addresses this market by proposing the CLINICsolution, an ICT platform designed to manage knowledge recording and transaction in a community ofhealth professionals, ad draws a draft business plan for its commercialization in Europe.

CLINIC is aweb-based service that offers a collaborative work environment for sharing andmanaging medical knowledge (research results, trials, protocols, recommendations, etc.) andreferencingexpertise (e.g. experience of healthcare professionals in dealing with particular cases,opinion of experts in a particular clinical domain) among a given healthcare community. Indeed theCLINIC IT solution proposes both a Knowledge Management service that links the medicalknowledge databases of healthcare operators, and collaboration tools (white pages, forum, etc.)enabling bidirectional interaction between users. In addition the platform enables users to access

external knowledge from distributed web sources (scientific and medical literature, accredited databases,information provided by pharmaceutical and medical devices companies about their products, etc.).

The first knowledge domain addressed by the CLINIC service is Cardiology.

Depending on the situation in each country and of the choice of the local operator, CLINIC can besold either as a Software solution (Set up at users site or Application Service Provider model) forinternal purpose, or either as an Online Service through which medical knowledgeand expertise areshared among subscribing healthcare operators.

The customers targeted by the CLINIC service are typicallyRegional Healthcare Authorities.These institutions are in charge of coordinating the care delivery at regional level. They can implementand/or finance the CLINIC application to provide healthcare professionals with CLINIC services

within their territory. Large healthcare organisations, Doctors associations and Research

organisations are also potential customers. In this context, the CLINIC users population includehealthcare professionals and in particular general practitioners, cardiologists and other MD specialists,but also staff from pharmaceutical, medical equipment and biomedical devices companies, and stafffrom Research organisations and Doctors associations.


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NOESIS: a Decision Support System for cardiology

Relatore: Maria Tzima, University of Ioannina

In this paper we present the Decision Support approach of the NOESIS platform. NOESIS addresseswide scale integration and visual representation of medical intelligence in cardiology and aims at thedevelopment of a web-based personalized system with enhanced intelligence, which supports health

professionals in taking the best possible decision for diagnosis, prevention and treatment.

The core of the NOESIS platform is a set of Decision Support Systems (DSSs), which support healthprofessionals in decision-making, in certain cardiovascular areas. These DSSs are automaticallygenerated by applying the Decision Support Framework (DSF) methodology to several differentcardiovascular sub-domains and data types. In order to use the DSF in a specific domain, an initialannotated dataset is required. This dataset is obtained from several resources, distributed over the web.

The quality of the diagnosis, produced by the DSS, is analogous to the quality of this initial dataset.

The DSF methodology has been employed to generate five DSSs, in the following cardiovascular sub-domains: (a) Ischaemic and (b) arrhythmic episode detection, (c) diagnosis of coronary artery disease(CAD) (d) prediction of clinical restenosis in patients undergoing angioplasty and (e) dose adjustment

in patients with recent valve prosthesis.

The NOESIS challenge concerning Decision Support (DS) was not to create another medical DSS butto:

research current approaches deficiencies in DS, create a generic Framework (methodology that utilises a set of tools, methods and algorithms)

that can be applied efficiently in different data types (i.e. both continuous and discrete data) ofthe same (or different) medical fields,

apply this framework to several different data types (i.e. ECG signal and patient data) in a givenmedical field (Cardiology), creating pilot applications of interest to Medical Doctors (MDs).

In order to create the DSSs, the following elements are required:

the symptoms which are described by the patient, the clinical findings, described by the physician after his physical examination and the test results (e.g. ECG, Pulse Wave Velocity Carotid).

The employed DSF methodology utilised in order to generate the 5 previously-described DSSs, consistsof 5 stages:

1. Discretization of the continuous valued features.2. Association rule mining3. Association rule pruning4. Development of crisp and fuzzy models5. Threshold optimization and fuzzy expert system creation.

However, the methodology can be further simplified by considering the first three steps as one process,

namely the Creation of Initial Set of Crisp Rules. The final DSS is created by applying theOptimized thresholds to the Fuzzy Model.

For each medical sub-domain (e.g. Ischaemia, Coronary Artery Disease), the generated DSS and thecorresponding results are presented in the current paper.


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The COCOON project: a semantics-based health care information infrastructure able to

seamlessly integrate medical information and eHealth services.

Relatore: Luca Puccetti, EMA

Introduction - Issues to be addressed

Presenting the right knowledge to the right medical personnel in the right place and at the right time isof paramount importance in making critical medical decision. Driven by this paradigm, COCOON, aEuropean Community1 funded research project, concerns the development of a knowledge-basedapproach to diagnostic and therapeutic risk management. The project takes 42 months (from January2004 to July 2007) and it involves several regions from different Countries: Italy, France and Greece. Itis led by Associazione Impresa Politecnico (Italy), a no profit organisation of Politecnico Milano, andsupported by great large IT industrial enterprises such as Microsoft, Siemens, Telecom Italia.

A semantics-based healthcare information infrastructure is designed to offer interactive support tohealthcare professionals, assist them to efficiently handle complex medical cases, such that diagnosisand treatment errors are minimized, potentially saving lives and the rising costs of healthcare andmalpractice suits. Providing infrastructure for proficient knowledge sharing and transfer, this approachcan significantly improve knowledge-driven collaborative practices among healthcare communities in

Europe and provide a test bed for similar efforts elsewhere.

Web services provide standard technologies and protocols to exchange data and services, so they seemto be a proper solution to Internet-wide scale integration problems, However, while Web services are amajor contribution to Service Oriented Architecture, the problem is not in the plumbing, its in thesemantics. Semantic Web Services (SWS) are better suited than non-semantic ones to solve theintegration problem, as they enable dynamic, scalable and reusable cooperation between differentsystems and organizations that employ different syntax, formats, and schemata.

Considering the described elements, three business cases for the technical researches applications anddemonstration have been identified:

Decision Support System (DSS): COCOON Decision Support System utilises clinical guidelinesthat have been issued by medical Authorities as a basis for designing workflows. A clinical guidelineis transformed into series of steps that may include diagnostic and treatment activities. Based on thepatients electronic health record and results of previous steps, the decision support system offers aset of recommendations regarding the next step(s) to be taken. Clinical guidelines can differsignificantly for various patients profiles, depending on such factors as demographics, medicalhistory, age and gender. Selecting the most appropriate medical guidelines for each individualpatient is thus of utmost importance. The Decision Support System accomplishes this through acategorisation engine that systematically compares personal background information with medicalprofiles and employs complex heuristics in order to evaluate which medical profile is most suitablefor the patient being treated. The Decision Support System also consults pharmaceutical databasesto match medications to patients and detect individual counter-indications. Moreover, COCOONprovides some support to the care delivery phase preparing a workflow of treatments andexaminations for the patient. COCOON builds workflows taking into account some parameterssuch as patient current residences, their mobility, their urgency, amount and modalities of payment,etc..

Continuous personal medical education: COCOON provides the general practitioners with aKnowledge Management platform which gives access to heterogonous and distributed medicalinformation included in medical journals, clinical guide lines and any free text document eachRegion makes available to its general practitioners. The Knowledge Management platform allowsthe general practitioner to homogenously navigate the results, deepen or generalise the search and

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cache valuable information. COCOON offers also the opportunity to store the query (in relation toa specific medical information) so that the system can push to the general practitioner new relevantdocuments which increase and update his/her knowledge cache.

Advice support: COCOON aims at supporting healthcare professionals in finding the mostappropriate group of experts to ask for an opinion. This is a simple scenarios were no integrationamong the services is needed (because the healthcare professionals have a common instant

messaging platform), but semantics might help in finding exactly what is needed. Once the group ofexperts has been identified, the involved actors can exchange information and share data viaCOCOON multi-channel collaborative work platform. Moreover the results of the work sessionsmight be indexed using COCOON ontology and stored for a future use. In this way a part of thetacit knowledge exchanged in the collaborative work sessions can be made explicit.

Objectives of the paperThe goals of the paper are two. The first one is to describe the two main types of COCOON servicesthat will be used in order to realise the demonstration scenarios: Semantic Information Retrieval, whichemploys concept-based indexing, and Decision Support, which is based on selected clinical guidelines.Semantic Web Service technologies serve to glue these services in existing healthcare informationsystems.

The second one is to describe the main innovation and benefits of these researches which consist ofsupporting knowledge driven collaborative practices in Networks of Healthcare Professionals in dealingefficiently with complex case, in order to minimise medical errors in diagnosis and treatment andraising quality of care and to join knowledge driven and dynamically adaptive learning communities in

which healthcare professionals and citizens are fully knowledge driven in taking promptly the bestpossible decision for prevention, diagnosis and treatment.

CLINIC D64C Final Workshop Turin

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