Dashboard to Support the Decision-Making within a Chronic Disease: A Framework for Automatic Generation of Alerts and KPIs

Introduction

Currently, we have witnessed an explosion of different Information and Communication Technologies (ICTs) with the aim to help the management of clinical information and support the decision-making process. These ICTs have appeared sporadically in time and independently structured, resulting in the existence of different applications, each with its own purpose, and without any effective mechanism for their integration in the context of an institution. This fact, not only contributes to data redundancy and time spent on analysis and maintenance of data, but can also be a source of errors due to the possibility of the inconsistency of information. Usually the amount of the data contained on Health Information Systems (HISs) is very large, and consequently the process of retrieving the information necessary to answer a particular clinical question may be both difficult and time consuming. Moreover, it is no coincidence that on the top of the needs of the research in HISs are issues relating to interoperability. The need for system integration solutions in healthcare reported in the literature, not only confirms the existence of a wide variety of heterogeneous systems, but also highlights the negative impact associated with the severity of data inconsistency when used to support decision-making. Least explored in the literature are the types of applications that try to compensate the lack of availability that usually exists in healthcare providers to select and analyze the amount of scattered data by the different HISs, in order to support the clinical decision process. In the context of chronic diseases, as in haemophilia, this situation requires more attention due to the constant flow of data entry, sometimes requiring immediate analysis and interpretation by clinicians in order to take clinical action. In fact, the main mission of the clinicians is to provide healthcare and therefore it is not expected that they spend much of their available time analyzing the information needed for decision-making. Furthermore, managing this continuously growing of clinical information within the finite amount of time available to clinicians can be difficult.

Given those two resources of extreme importance within the provision of health services (information and time), we believe that monitoring systems can help healthcare providers finding the balance between the use of those two resources, providing the relevant information in real-time, through alerts and Key Performance Indicators (KPIs), displayed in a dashboard, on a push-logic supply. This type of applications, based on dashboards, although widely used in healthcare, more specifically associated with the capture of vital signs and symptoms of chronic patients through remote monitoring devices (e.g., (Blount, et al., 2007; Castro, et al., 2010; Kroch, et al., 2006; Rosow, Adam, Coulombe, Race, & Anderson, 2003), is still an underexplored approach in real-time monitoring of clinical data stored in different HISs.

This chapter aims to present a data monitoring system based on alerts and KPIs, applied in the chronic diseases, more specifically in haemophilia care. This application uses heterogeneous data from an integrated clinical information management system, in the haemophilia care, developed in collaboration with the Haematology Service of Coimbra Hospital Centre (SH_CHC) to provide a quick reading of the relevant information for decision-making through a set of alerts and KPIs displayed on a dashboard (hemo@care_dashboard). With this solution, it is possible to present in real-time a wide range of data in an easy format visualization to a group of professionals, contributing to an increase of the healthcare service quality.