A Decision Support Architecture for Telecare Patient Management of Chronic and Complex Disease

A major challenge facing designers of telecare systems today is providing decision support to enhance the health carer's review of remotely acquired monitoring data and to support clinical decision-making for the management of chronic and complex disease in this setting. We are implementing a decision support framework to analyze clinical information generated from subjects at their place of residence (home, residential care settings) and from other clinical environments. The telecare information generated from these environments is both substantial and multi-modal (physiological, questionnaire, medication data, etc.). Using the JBoss Application Server, a rules engine is used to analyze these data. The health carer will be alerted to any deterioration in the health status of a patient by way of a Web page that will stratify a clinical data summary into high, medium and low risk groups. In this way, outputs from the decision support system can be used to assist in the efficient review and risk stratification of multiple patient records, and ultimately influence changes in work flow by targeting scarce human resources to patients of most need.