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，医疗保健方面仍然存在巨大差距，其中最严重的是急诊护理，其中有限的设施和偏远的位置发挥了核心作用。根据Wessels Living History Farm的报告，在美国大城市地区，医生与病人的比例是30:1万，而在大多数农村地区，只有5:1万；死亡率最高的往往是大多数农村县。对于紧急病人护理，确定治疗的时间是至关重要的。然而，决定对急性病人最有效的护理需要知识和经验。虽然存在医疗最佳实践指南，并在医院手册中，但它们往往很长，难以在临床上应用。对于农村地区的医生和运送病人过程中的紧急医疗技术人员来说，这些挑战被夸大了。本项目改造农村医院急诊护理的解决方案是使用创新的CPS技术，帮助医院更好地遵循最佳医疗实践。帮助具有不同经验和技能水平的医务人员坚持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、分布式的医疗最佳实践指南（EMBG）系统。与计算机化败血症最佳实践方案相比，EMBG系统面临着更大的挑战，因为它必须适应不同水平的工作人员专业知识和设备能力的农村医院、救护车和中心医院的最佳实践。与全球定位系统（GPS）类似，GPS可以根据驾驶员的偏好，引导不同路线熟悉的驾驶员通过最优路线到达目的地；EMBG系统可以引导医务人员遵循最佳医疗指导路径，提供紧急护理，并最大限度地缩短对急性患者的最终治疗时间。本项目的贡献如下：1)复杂医学知识的编纂是知识获取和表达的重要进展；2)高速救护车的病理生理模型驱动通信推进了生命关键通信技术；3)为形式化验证设计的降低复杂性的软件架构在形式化方法研究和系统工程之间架起了桥梁。

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.