Let us assume that a patient goes to see his or her GP. The GP is not sure what is wrong, and notes down on the computer the patient’s details, medical history and symptoms. After some questions have been answered, the screen shows what the disease could be, what the treatment involves and indicates that the patient needs to see such-and-such a specialist. Today this is utopia, but the Erabaki research team is trying to turn it into reality. The team comprises nine researchers from the University of the Basque Country’s (UPV/EHU) Faculty of Computing and four physicians from three of the Basque Country’s hospitals: Cruces, Donostia-San Sebastian and Basurto. Professionals from both disciplines are needed to achieve the aim: to democratise the knowledge contained in clinical guidelines.
Clinical guidelines are documents indicating the steps needed for treating a disease. Juan Manuel Pikatza, head of the research team, explains that the knowledge they contain is of high quality. “But the problem is that this knowledge tends to be transmitted on paper. So, how are all those professionals who are at the end of the chain and who are not specialists (i.e. GPs) going to read all those guidelines? They have neither the time nor the capacity to assimilate all the contents.” So at Erabaki they have set up a technological platform to simplify the knowledge and not lose it. “We have to get the best practices in the clinical guidelines executed on computer, and turn the process unto a rapid one."
First of all, the computer programmers and the specialist doctors who participate as suppliers of the content of the platform need to understand each other. In other words, when it comes to inputting the clinical guidelines into the programme, the computer programmers need to assimilate everything that the specialists want to transmit. This is why the platform contains an editor: “The specialist can input whatever he or she wants with the help of graphics and in a straightforward way without anyone needing to attend any courses." This tool also contains the UMLS (Unified Medical Language System); nearly two million concepts, each accompanied by its standard definition. Decision tables are also essential, since they link factors and diseases together: “By inputting all this information we can create a high level diagnosis-treatment system.”
If it is possible to get all the computerised guidelines executed on a server, the user would receive recommendations for each disease as well as graphics on the diagnosis and treatment processes. Details like the following would come up on screen: "the information on the corresponding guideline, bibliography, information on the drugs, terminology and the scientific evidence (to what extent it has been proven that what is recommended is the best option)."
So far, the Erabaki team has computerised one guideline on hyperamonemia and two on asthma; these can be executed from www.e-guidesmed.ehu.es. The applications dealing with asthma are in fact the ones they have made most progress in. “They are being used in a clinical study. We have four doctors in Gipuzkoa and as many others in Bizkaia (both are Basque provinces) with asthmatic patients, and the evolution of 80 about patients is being studied. We want to see what the doctors think, above all those in out-patients’ clinics.”
The setting up of the enterprise iKude Telemed is another of the steps being taken by the team at the UPV/EHU to turn this utopia into reality. “Right now we are transferring technology to the enterprise. Spreading good practices has many fields of application. In addition to channelling quality services, it is about a market without competition. I think the step can be taken now. However, before that, we have to computerize the guidelines of certain diseases and see the results. All this is something that has to be done, there is unanimity on it within the scientific community,” explains Pikatza.
He emphasises that now it can be done, because Erabaki technology is cutting edge and user friendly. They tried it before with other resources, but they did not manage to execute it in the health sphere; the same happened with other attempts of this type tried out worldwide. However, Pikatza believes this fresh initiative could be well received. “It is a huge qualitative leap forward. The technology we have now is highly automated, and I think it should be given an opportunity. At least, the doctors have told us that for them it is a big step forward.” Furthermore, it could be useful not just for GPs but also for students on specialisation courses (MIR-Resident Medical Intern courses). Or for chronic patients; for example, for diabetics, so that they themselves are capable of controlling the treatment they need at each moment.
Implementing a platform of this type requires an all-round effort. “This does not fall to the computer programmers alone; the doctors need to participate. They are busy, but we have to organise ourselves.” It is a fact that it is hard work changing ways of working, but it is worthwhile. “When this knowledge is transmitted, a great range of possibilities could be opened up; even with respect to cost cutting.”
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