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，医疗保健仍然存在很大的差距，最严重的是紧急护理，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，美国大都市地区的医生与病人的比例为30比10，000，而大多数农村地区只有5比10，000;最高的死亡率往往出现在大多数农村县。对于急诊患者护理，确定治疗的时间至关重要。然而，决定对急性病人最有效的护理需要知识和经验。虽然医疗最佳实践指南存在，并在医院手册，他们往往是冗长和难以应用于临床。对于农村地区的医生和紧急医疗技术人员（EMT）来说，在运送病人时所面临的挑战被夸大了。该项目旨在改变农村医院急诊护理的解决方案是使用创新的CPS技术来帮助医院改善其对医疗最佳实践的坚持。帮助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过程转换为可执行的、自适应的和分布式的医疗最佳实践指导（EMBG）系统。与计算机化脓毒症最佳实践方案相比，EMBG系统面临着更大的挑战，因为它必须适应具有不同工作人员专业知识和设备能力水平的农村医院，救护车和中心医院的最佳实践。使用全球定位系统类比，GPS引导具有不同路线熟悉度的驾驶员通过基于驾驶员的偏好的最佳路线到达他们的目的地，EMBG系统引导医务人员遵循最佳医疗指南路径以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。该项目做出了以下贡献：1）复杂医学知识的编码是知识捕获和表示的重要进步; 2）高速救护车中的病理生理模型驱动通信推进了生命关键通信技术; 3）为形式验证设计的降低复杂性的软件架构弥合了形式方法研究和系统工程之间的差距。

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.