Design of meta-DSS to support the decision-making process: supporting activities on a clinical pathway in the emergency department

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In clinical decision-making there are many situations where a final outcome is a result of multiple intertwined tasks. Managing a patient in the Emergency Department (ED) comes to mind. In order to facilitate patient management and to follow evidence-based medicine, hospitals introduce clinical pathways as tools to ensure that patients receive the most appropriate care. These pathways are developed from clinical practice guidelines and they outline a sequence of temporal clinical evaluations and interventions. In that sense a pathway is a prescriptive model of a decision-making process with individual tasks corresponding to different, time-dependent activities. While there are clinical DSS created to support one activity at a time, there is no design methodology that provides comprehensive support for a set of activities. The purpose of the research described in this proposal is to develop a methodology for designing a meta-DSS that brings together different support requirements and capabilities so that entire decision-making process is supported. We will create a meta-DSS design using the Organizational-based Multiagent System Engineering (O-MaSE) methodology that allows for modeling changes to the problem structure as a result of interactions between agents (common situation for patient management where treatment changes depending on latest assessment and previous actions). We will be looking at individual tasks comprising a pathway as independent agents (entities), each with its own requirements and capabilities. We will model these agents, as "services" that should be brought together in order to accomplish a common goal. We will use the Service-Oriented Architecture (SOA) paradigm for connecting on demand loosely coupled tasks from a clinical pathway as well as support capabilities provided by stand-alone clinical DSS. The implementation of the SOA will involve identification and description of tasks (service requestors) that invoke individual support requirements associated with some specific clinical DSS (service providers). We are planning to evaluate the capabilities of a meta-DSS design using clinical pathways for ED management of pediatric head trauma and asthma.