Multi-agent systems in health care. An example in palliative care.

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29 Οκτ 2013 (πριν από 4 χρόνια και 11 μέρες)

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Multi
-
agent systems in health care.

An example in palliative care.

Antonio Moreno

Multi
-
Agent Systems Group (GruSMA)

Research Group on Artificial Intelligence

Computer Science and Maths Dep.

University Rovira i Virgili (URV)

Tarragona, Spain

Czech Technical University,
Prague

May 31st 2005

Outline of the talk


Introduction


Information and Communication Technologies


Intelligent agents and Multi
-
Agent Systems


MAS applied in Health Care


PalliaSys

project


Use of ICT and MAS to help to manage the care of palliative
patients


Research and development challenges on the use of
agents in HC


Some final thoughts

Outline of the talk


Introduction


Information and Communication Technologies


Intelligent agents and Multi
-
Agent Systems


MAS applied in Health Care


PalliaSys

project


Use of ICT and MAS to help to manage the care of palliative
patients


Research and development challenges on the use of
agents in HC


Some final thoughts


Information and Communication
Technologies


End of 20th century: enormous development of
information technologies


Mobile phones


Personal and portable computers


Personal Digital Assistants (PDAs)


Internet


Information Society


Easy, flexible and cheap access to information

Computer Science: Intelligent Agents


Definition by Dr Michael Wooldridge:


An
intelligent agent

is a computational process
that is able to perform tasks autonomously and
that communicates with other agents in order to
solve problems through cooperation,
coordination and negotiation.


These agents work in a complex and dynamic
environment and interact with it in real time to
achieve their goals.

ICT and MAS


Recent trend: join the intelligent performance
of multi
-
agent systems with the flexible
access to information through new
technologies.


Future scenario:
ambient intelligence
, in
which ubiquitous agents communicate
wirelessly to provide intelligent services to
users.


In particular,
AmI@Medicine

Basic agent properties (I)


Reactivity
: awareness of the environment


Autonomy:
control over its own actions


Proactivity:
anticipation to user’s requests


Reasoning/planning (AI):
basis of intelligent
behaviour

Basic agent properties
(II)



Learning:

improvement of its performance


Communication
: exchange of information
with other agents; implies standardization
of languages and protocols; allows
cooperation, negotiation, ...

Agent classification


Collaborative:
group of agents that cooperate
in the joint solution of a problem


Interface:
collaboration with a user to solve a
task


Internet:
manage the search and manipulation
of information through Internet



Mobile:
physical movement through different
machines


Hybrid:
combination of the previous types

Collaborative Agents
-

Motivation


To solve problems that are too complex for a
single agent


To be able to solve inherently distributed
problems


To be able to interconnect already existing
systems (
agentification
)

Multi
-
Agent Systems

Multi
-
agent systems


A
multi
-
agent system

is a set of autonomous
agents that can communicate (exchange
information) and thus negotiate and
cooperate in the joint solution of a distributed
problem.

Domains of application of MAS


Distributed knowledge


Joint effort of a set of autonomous entities


Problem decomposable in subproblems


Possibly inter
-
dependent

Health Care problems


Distributed knowledge


E.g. different units of a hospital


Coordinated effort


E.g. receptionist, general and specialised
doctors, nurses, tests personnel, ...


Complex problems


E.g. organ transplant management


Great amount of information


E.g. medical information in Internet

MAS applied in Health Care


Summary of main motivations



Use of spatially distributed knowledge



Coordination of tasks among several autonomous
entities



Complex problems decomposable in subproblems



Personalised information to doctors and patients


Example: national organ transplant coordination

(Cortés


CARREL, Moreno et al.
-

URV, Calisti

Switzerland)

Growing interest


AI in Medicine special issue (2003)


Specialised workshops at AA00, ECAI02, ECAI04.


AI
-
Communications special issues (2003, 2005)


Int. Workshop on Health Care Applications of
Intelligent Agents


February 2003


Book on Whitestein Series on Agent Technology (2003)


Forthcoming workshop at IJCAI05, Edinburgh.


AgentCities WG on HC applications =>


AgentLink III TFG on HC applications


Fields of application


Patient scheduling


Patient monitoring


Agent
-
based decision support systems


Information agents in Internet


Community care, care of old/disabled people


Access to medical information


Management of distributed processes

Outline of the talk


Introduction


Information and Communication Technologies


Intelligent agents and Multi
-
Agent Systems


MAS applied in Health Care


PalliaSys

project


Use of ICT and MAS to help to manage the care of palliative
patients


Research and development challenges on the use of
agents in HC


Some final thoughts


PalliaSys

Project


Integration of Information Technologies and
Multi
-
Agent Systems to improve the care given
to palliative patients.


Spanish research project, 2004
-
05.


Work conducted between the Research Group
on Artificial Intelligence at URV and the
Palliative Care Unit of the Hospital de la Santa
Creu i Sant Pau of Barcelona.

Palliative care


Palliative patients

are in a very advanced stage
of a fatal disease. The aim of their care is to
ease their pain.


These patients may be located in hospitals
(
Palliative Care Units
-
PCU
, or other units of the
hospital), specialised hospice centres or
at their
own homes
.

Aims of the
PalliaSys

project


To improve the process of
collecting
information
from the palliative patients.


To improve the
access

to this information by
patients and doctors.


To
monitor

the state of the patients.


To apply
intelligent data analysis

techniques on
the data of the PCU.


WAP

Server
Simul.

Web

Server

DB Wrapper

Doctor

Doctor

Patient

Patient

PCU Database

Data

Anal.

PCU Head


PALLIASYS

Architecture

Multi
-
Agent

System

Information

Technologies

Web interface

Web interface

Alarm
management

Information collection (I)


Patients have to send periodically non
-
technical
information relative to their health state.


Fill in a form with 10 items to be valued [0
-
10]


In the current prototype forms can be sent


through a web page, or


with a mobile phone via WAP (simulated).


Other communication means (PDAs, e
-
mails, SMS
messages) have not (yet) been implemented; a study of
their potential usefulness is being carried out with a
questionnaire given to patients.

Information collection

(II


future extensions)


We could associate an agent to each bed in the PCU,
that would periodically send information about the
patient status.


A doctor might also send information to the system
when he is performing a home visit, through an agent
running on a mobile phone or a PDA via GPRS.


We have already been available to implement agents in
Nokia
n
-
gage

mobile phones using the JADE
-
LEAP environment, and
they can communicate succesfully with agents running on a
standard PC via GPRS.


A MSc
-
Final Year Project on tourism information using this kind
of agents will be presented in June 2005.

Information access


All the data of the palliative patients is stored in a
central
Data Base

at the PCU of the hospital.


Personal information, family data, auto
-
evaluations, health record


Patients and doctors may make
queries

on the stored
information.


Patient queries are made directly on the DB (via web or WAP
-
simulated interface).


Doctor queries are made through agent communication (the
Doctor Agent requesting the information from the DB Wrapper).

Data Base at the PCU / Security


There is an agent that controls the access to
the Data Base (the
DataBase Wrapper
).


The whole system includes security
mechanisms to protect the privacy of the
medical data.


User authentication (private
-
public keys)


Encrypted messages (SSL)


Access through login/password


Permissions associated to user types

WAP

Server
Simul.

Web

Server

DB Wrapper

Doctor

Doctor

Patient

Patient

PCU Database

Data

Anal.

PCU Head


PALLIASYS

Present State

Multi
-
Agent

System

Information

Technologies

Web interface

Web interface

Alarm
management

Patient agents


There is a
patient agent

associated to each
palliative patient.


It has to continuously monitor the status of the
patient, and send alarms to the doctor
associated to the patient if something goes
wrong.

Doctor agents


A
doctor agent

is an agent associated to each
doctor of the PCU, which would be running in the
doctor’s desktop computer.


It provides a graphical interface to help:


Request information about his patients.


Define alarm situations.


Receive alarm signals from patient agents.

Classes of alarms


General alarms


They are defined by the PCU head (through his
Doctor Agent), and they have to be applied to all the
patients of the unit.


Doctor
-
specific alarms


A doctor can define personal alarms, and he can
assign them


to a single patient, or


to all his patients.

Patient auto
-
evaluation


There are 10 differents aspects in patient’s
auto
-
evaluation forms (weakness, pain,
anxiety, hunger, etc).


Each of the aspects has to be evaluated by the
patient with an integer number from 0 to 10.


Each patient has to send an auto
-
evaluation
form every 2
-
3 weeks.

Alarm types (I)


Alarms defined on a single auto
-
evaluation


(Weakness >7) and (Pain > 8) :
extreme_weakness


(Hunger < 3) and
extreme_weakness
: dangerous
_weakness


Extreme_weakness

=> patients 1, 3 and 4


Dangerous_weakness

=> patients 2, 3 and 7.


They can be combined with and/or/not operators.

Basic alarms can be used to define more complex alarms.

Alarm types (II)


Alarms defined on a sequence of auto
-
evaluations


(Last 2 evaluations
a,b
) Weakness
b
-
Weakness
a

> 2 :
fast_weakness_increase


(Last 4 autoevaluations a,b,c,d) Pain
d
-
Pain
a

> 3:
extreme_pain_increase


(Evaluations received in the last 3 weeks) Increase of pain
degree > 4


These types of alarms may be defined on the last
n

evaluations
or on the evaluations received in a certain amount of time.

The use of Boolean operators and the definition of complex alarm
situations is also allowed.

Alarm management


Alarms are defined by doctors through their
Doctor
Agents
.


When an alarm is defined, it is automatically sent to the
corresponding Patient Agent (or set of agents).


When a new auto
-
evaluation is stored on the DB, the
associated Patient Agent gets a signal, and then it
checks all the alarms associated to that patient.


If any alarm situation is detected, a message is sent to
the Doctor Agent that defined it with an explanation of
why the alarm has been activated.

WAP

Server
Simul.

Web

Server

DB Wrapper

Doctor

Doctor

Patient

Patient

PCU Database

Data

Anal.

PCU Head


PALLIASYS

Present State

Multi
-
Agent

System

Information

Technologies

Web interface

Web interface

Alarm
management

Data Analyser: main tasks


To apply
Data Mining

and
Machine
Learning

techniques to analyse the
information of the DB.


To provide general statistics on the data,
which are useful to the PCU head to fill
in the annual report.

Available medical data


Input data: sequence of treatment episodes


Patient location (home, PCU, socio
-
sanitary centre)


Length of stay (days)


Medication received by the patient


Medical tests and procedures made on the patient


General patient health status

Intelligent Data Analysis


Generation of patient circuits
(circuit graph)


Automatic detection of patient states


Clustering techniques, unsupervised learning


Generation of models of patient evolution
(state
graph)


Generation of decision structures (decision trees,
set of rules).


Possibility of making predictions on future states and
anticipate and prevent undesired situations.


Circuit graph

Movement of
each patient
among different
locations

Training sets for each location

State graph

Numerical
analysis of
the flow of
palliative
patients

Palliative patients evolution flowchart

Conclusion
-

Main ideas


Information technologies

and
Intelligent agents

may be used to build useful systems in the
Health Care domain.


The
PalliaSys

project is an example of the use
of those tools.


Most of the ideas underlying this project might
also be applied in
elderly care

or
home care
.


Use of Information Technologies


Automated patient monitoring


Intelligent data analysis

Work to be carried out in PalliaSys


Explore the
use of new ICTs

to be used by
home patients (SMS messages, e
-
mail).


Implement and test the algorithms of
data
analysis
.


Test the final prototype

at the PCU of the
hospital.

Outline of the talk


Introduction


Information and Communication Technologies


Intelligent agents and Multi
-
Agent Systems


MAS applied in Health Care


PalliaSys

project


Use of ICT and MAS to help to manage the care of palliative
patients


Research and development challenges on the use of
agents in HC


Some final thoughts

Some research topics on the use
of MAS in Health Care


Communication standards


Medical ontologies


Security mechanisms


Implementation of agents in mobile devices


PDAs, mobile phones


Personalised access to information


Less social and professional reluctance to adopt
agent technology


Legal issues

General research topics on MAS


Service description, discovery, composition


Standard agent communication languages and
protocols


Negotiation, coordination, cooperation techniques


Agent
-
Oriented Software Engineering


Trust


Human
-
agent interaction


Integration with legacy software


...

Outline of the talk


Introduction


Information and Communication Technologies


Intelligent agents and Multi
-
Agent Systems


MAS applied in Health Care


PalliaSys

project


Use of ICT and MAS to help to manage the care of palliative
patients


Research and development challenges on the use of
agents in HC


Some final thoughts

Some general thoughts (I)


It is difficult to work with doctors


Very busy, unaware of technical details, change
requirements…


However, they may end up being happy with a rather
simple system (e.g. a well
-
organised DB, statistics for
annual report)


It is difficult to sell “agents” to hospital computer
units


Understanding, maintenance, …


Information systems are hospital
-
wide, centralised

Some general thoughts (II)


Security is a matter of degree …


Sometimes “real life” technical issues make it
unsuitable to use agents


Use of previous prototypes or programming
languages


The frontier between “agents” and “non
-
agents” seems to be difficult to define.


Multi
-
agent systems in health care.
An example in palliative care.

Antonio Moreno

Multi
-
Agent Systems Group,

Research Group on Artificial Intelligence

Computer Science and Maths Dep.

University Rovira i Virgili (URV)

Tarragona, Spain

http://grusma.etse.urv.es

antonio.moreno@urv.net