A decision support system for the management of heart failure

Colantonio S., Martinelli M., Moroni D., Pieri G., Tampucci M., Salvetti O.

Cardiac Imaging  Image Processing  Decision Support  Health Care Standards 

This technical report details the activity carried out within the European Project HEARTFAID, a knowledge based platform of services for supporting medical-clinical management of the heart failure within the elderly population. HEARTFAID aims at devising and deploying an integrated platform of services meant to assist Chronic Heart Failure (CHF) stakeholders in their routine workflow and to provide an optimal management of CHF patients, by exploiting the most advanced technologies, compliant to medical standards, advanced instruments for diagnostic data processing, and significant and up-to-date knowledge, suitably formalized. The platform consists in a distributed and heterogeneous infrastructure developed by integrating different and functionally independent, but cooperating, components according to the up-to-date service oriented technologies. The main functionalities of the platform are: (i) patients' telemonitoring; (ii) timely and interactive access to patients' data; (iii) interpretation of diagnostic investigations; (iv) therapy planning. These functionalities mainly rely on the platform intelligence core represented by a Knowledge-based Clinical Decision Support System (CDSS), which is aimed at aiding the decisional processes of CHF caregivers. Innovative results on computational modelling, knowledge discovery methodologies, visualization and imaging techniques, and the medical knowledge of the relevant domain have been considered and integrated to assure the CDSS effectiveness and reliability. This report summarizes the activities carried out in the implementation of the CDSS, following the design activities that was performed in the previous years of the Project and summarized in previous technical reports (2006-TR-52, 2007-TR-34, 2007-TR-35). Such a design was based on a deep investigation of CHF stakeholders' needs and expectations which resulted in a detailed list of CDSS functional requirements; while an accurate analysis of the methodological and technological foundations resulted in the detailed definition of the CDSS functional specifications. The CDSS has been then devised by integrating, in functionally advanced settings: (i) deductive knowledge, elicited from guidelines and medical experts; (ii) inductive knowledge, extracted by data mining techniques applied to significant sets of data; (iii) computational methods for the analysis and interpretation of diagnostic data (i.e., ECG signals and Echocardiographic images). This document mainly focuses on the implementation of each component of the CDSS architecture and their integration into the system, and on the integration of the CDSS itself within the platform (integration that is realized mainly by means of the HEARTFAID Web Portal). For the implementation activity, Semantic Web Technologies (SWT) have been used as the most advanced tools for formalizing, re-using and sharing medical knowledge, and reasoning on it; while a service oriented approach has been adopted for the integration and easy access to a number of functionalities. Moreover, realistic clinical scenarios have been carefully defined in cooperation with clinical partners for assuring the realness and effectiveness of the developed functionalities of the system. More in details, the document is organized as follows. In the first introductory chapter, a recall of the significance of decision support in the management of CHF is reported along with a brief description of the main issues to be faced when developing a decision support system. Afterwards, in the second chapter, HEARTFAID CDSS architecture is described and motivated. Also, the integration of the system within HEARTFAID platform is summarized for assuring a global view of the system functioning. In Chapter 3, attention is focused on the implementation details, hence each component of the CDSS architecture is considered and its implementation described in details along with the problems faced and the solutions adopted. Particular attention is devoted to the ontological Knowledge Base, the computational reasoning methods included into the Model Base, as well as the algorithms defined and developed for processing Echocardiographic images. Finally, the implementation of the Meta Level of the system is described and discussed. In the fourth chapter, the integration within the Platform through the Middleware is discussed along with the issues faced and the technological choices made. The implementation of the showcase related to the clinical management of a HF patient is reported in Chapter 5. Two appendixes close the document. Appendix A contains technological details about the developing tools and software used for the implementation activities are reported. Appendix B reports some code of the developed software.

Source: ISTI Technical reports, 2008