CPS:TTP Option:Synergy: Collaborative Research: An Executable Distributed Medical Best Practice Guidance (EMBG) System for End-to-End Emergency Care from Rural to Regional Center

在美国，在医疗保健方面仍然存在很大的差距，最严重的是在急救方面，有限的设施和偏远的位置发挥着核心作用。根据韦塞尔生活历史农场报告，美国大城市地区的医生与病人的比例为30：1万，而大多数农村地区只有5：1万；死亡率最高的往往是农村地区。对于紧急病人的护理，确定治疗的时间至关重要。然而，决定对急性病人进行最有效的护理需要知识和经验。虽然医疗最佳实践指南已经存在，并在医院手册中，但它们往往很长，很难在临床上应用。农村地区的医生和急救医疗技术人员(EMT)在运送病人期间面临的挑战被夸大了。该项目改变农村医院急救的解决方案是使用创新的CPS技术来帮助医院提高对医疗最佳实践的遵守。帮助具有不同水平经验和技能的医务人员遵守医疗最佳实践的关键是将医学文本中描述的所需流程转换为可执行的、自适应的和分布式的医疗最佳实践指南(EMBG)系统。与计算机化的脓毒症最佳实践方案相比，EMBG系统面临着更大的挑战，因为它必须在具有不同水平的工作人员专业知识和设备能力的乡村医院、救护车和中心医院之间采用最佳实践。利用全球定位系统的类比，GPS根据司机的偏好通过一条最佳路线引导不同路线熟悉的司机到达目的地，EMBG系统引导医务人员遵循最佳医疗指南路径提供紧急护理，并将急诊患者的最终治疗时间降至最低。该项目的贡献如下：1)复杂医学知识的编码是知识获取和表示的重要进展；2)高速救护车中的病理生理模型驱动的通信促进了生命关键通信技术的发展；3)为形式化验证而设计的降低复杂性的软件体系结构架起了形式方法研究和系统工程之间的桥梁。

In the United States, there is still a great disparity in medical care and most profoundly for emergency care, where limited facilities and remote location play a central role. Based on the Wessels Living History Farm report, the doctor to patient ratio in the United States is 30 to 10,000 in large metropolitan areas, only 5 to 10,000 in most rural areas; and the highest death rates are often found in the most rural counties. For emergency patient care, time to definitive treatment is critical. However, deciding the most effective care for an acute patient requires knowledge and experience. Though medical best practice guidelines exist and are in hospital handbooks, they are often lengthy and difficult to apply clinically. The challenges are exaggerated for doctors in rural areas and emergency medical technicians (EMT) during patient transport. This project's solution to transform emergency care at rural hospitals is to use innovative CPS technologies to help hospitals to improve their adherence to medical best practice. The key to assist medical staff with different levels of experience and skills to adhere to medical best practice is to transform required processes described in medical texts to an executable, adaptive, and distributed medical best practice guidance (EMBG) system. Compared to the computerized sepsis best practice protocol, the EMBG system faces a much bigger challenge as it has to adapt the best practice across rural hospitals, ambulances and center hospitals with different levels of staff expertise and equipment capabilities. Using a Global Positioning System analogy, a GPS leads drivers with different route familiarity to their destination through an optimal route based on the drivers' preferences, the EMBG system leads medical personnel to follow the best medical guideline path to provide emergency care and minimize the time to definitive treatment for acute patients. The project makes the following contributions: 1) The codification of complex medical knowledge is an important advancement in knowledge capture and representation; 2) Pathophysiological model driven communication in high speed ambulance advances life critical communication technology; and 3) Reduced complexity software architectures designed for formal verification bridges the gap between formal method research and system engineering.