Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.
Int J Med Inform. 2012 Aug;81(8):556-65. doi: 10.1016/j.ijmedinf.2012.03.001. Epub 2012 Mar 31.
The use of expert systems to generate automated alerts and patient instructions based on telemonitoring data could enable increased self-care and improve clinical management. However, of great importance is the development of the rule set to ensure safe and clinically relevant alerts and instructions are sent. The purpose of this work was to develop a rule-based expert system for a heart failure mobile phone-based telemonitoring system, to evaluate the expert system, and to generalize the lessons learned from the development process for use in other healthcare applications.
Semi-structured interviews were conducted with 10 heart failure clinicians to inform the development of a draft heart failure rule set for alerts and patient instructions. The draft rule set was validated and refined with 9 additional interviews with heart failure clinicians. Finally, the clinical champion of the project vetted the rule set. The concerns voiced by the clinicians during the interviews were noted, and methods to mitigate these concerns were employed. The rule set was then evaluated as part of a 6-month randomized controlled trial of a mobile phone-based heart failure telemonitoring system (n=50 for each of the telemonitoring and control groups).
The developed expert system generated alerts and instructions based on the patient's weight, blood pressure, heart rate, and symptoms. During the trial, 1620 alerts were generated, which led to various clinical actions including 105 medication changes/instructions. The findings from the trial indicated the rule set was associated with improved quality of life and self-care.
A rule set was developed with extensive input by heart failure clinicians. The results from the trial indicated the rule set was associated with significantly increased self-care and improved the clinical management of heart failure. The developed rule set can be used as a basis for other heart failure telemonitoring systems, but should be validated and modified as necessary. In addition, the process used to develop the rule set can be generalized and applied to create robust and complete rule sets for other healthcare expert systems.
利用专家系统根据远程监测数据生成自动化警报和患者医嘱，可以实现更好的自我护理并改善临床管理。然而，制定规则集对于确保发送安全且具有临床相关性的警报和医嘱至关重要。本研究旨在开发一种基于心力衰竭手机远程监测系统的基于规则的专家系统，并对该系统进行评估，同时总结开发过程中的经验教训，以便将其应用于其他医疗保健应用中。
对 10 名心力衰竭临床医生进行半结构化访谈，以制定心力衰竭警报和患者医嘱规则草案。通过另外 9 名心力衰竭临床医生的访谈对该草案进行验证和修订。最后，项目的临床负责人对规则集进行了审核。记录临床医生在访谈中提出的关注点，并采取措施减轻这些顾虑。该规则集作为基于手机的心力衰竭远程监测系统的 6 个月随机对照试验的一部分进行了评估（远程监测组和对照组各 50 例）。
开发的专家系统根据患者的体重、血压、心率和症状生成警报和医嘱。试验期间共生成了 1620 条警报，导致了各种临床操作，包括 105 次药物调整/医嘱。试验结果表明，该规则集与提高生活质量和自我护理有关。
心力衰竭临床医生广泛参与制定了规则集。试验结果表明，该规则集与显著提高的自我护理和心力衰竭的临床管理有关。开发的规则集可作为其他心力衰竭远程监测系统的基础，但需要根据需要进行验证和修改。此外，开发规则集所使用的方法可以推广并应用于创建其他医疗保健专家系统的强大而完整的规则集。
