SummaryBecause of growing financial pressures in healthcare and a shift in pathologies, patients are discharged earlier and care is organized at home, requiring e-homecare services to support care and patient integration in society. As these services are built by different vendors, integration is complex. Therefore a broker platform has been designed using the web service technology. The broker allows efficient data communication and guarantees quality requirements such as security, availability and cost-efficiency by dynamically selecting and composing services, minimizing user interactions and simplifying authentication through single-signon so that users do not need to authenticate to each service separately. A platform prototype and several e-homecare services (e-alarm, tele-monitoring, audiodiary and video-chat) have been implemented and were evaluated by diabetes and multiple sclerosis patients. When a user starts the application, he is requested to authenticate himself using his electronic identity card. Once authenticated, a set of buttons is added to the client, giving access to the e-homecare services. The startup time and overhead imposed by the platform was experienced by the patients to be small enough. Combined with having all e-homecare services integrated in a single client application, requiring only one login, resulted in a high quality of experience by the patients.

The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, Infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's office PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches.

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SummaryObjectives: This paper addressesthe design of aplatform forthe management of medical decision datain the ICU. Whenever new medicaldata from laboratories or monitors is available or at fixed times, the appropriatemedicalsupport servicesare activated andgenerate amedicalalert or suggestion to the bedside terminal, the physician'sPDA,smart phoneormailbox. Since future ICU systemswill rely ever more on medical decisionsupport,ageneric andflexible subscription platform is of high importance. Methods: Our platform is designed basedonthe principles of service-oriented architectures, andisfundamentalfor service deployment since themedicalsupport servicesonlyneed to implement theiralgorithm andcan rely on theplatform forgeneral functionalities. Asecure communication andexecutionenvironment are also provided. Results: Aprototype, where medicalsupport services can be easilyplugged in,has been implemented using Webservicetechnology andiscurrentlybeing evaluatedbythe Department of Intensive Careofthe Ghent UniversityHospital. To illustratethe platform operation andperformance,two prototype medical support servicesare used, showingthatthe extraresponse time introducedbythe platform is less than 150 ms. Conclusions: Theplatform allowsfor easy integration with hospital informationsystems. Theplatform is generic andoffersuser-friendly patient/service subscription, transparent data andserviceresource management andpriority-based filteringofmessages. Theperformance hasbeen evaluatedand it wasshown thatthe response time of platform components is negligible comparedtothe execution time of the medical support services.

The ICU of Ghent University Hospital is currently evaluating a Service-Oriented Architecture (SOA) that supports physicians in the follow-up of patients by providing a number of medical support services. The main idea behind SOA is the separation of the functions of the system into well-defined, independent, reusable and distributable services. However, sometimes physicians require a more specific or slightly different functionality than the existing services offer. In these situations the system architecture imposes the time-consuming and error-prone development and testing of a new service. To counter this, a framework was developed that integrates a Rule-based component with the existing SOA platform. This allows users to add new functionalities as easy understandable Rules. This integration can be constructed in two ways. In the database-driven approach the Rule-based system is an extra layer between the database and the services. The service-oriented approach, on the other hand, works with the data provided by the services and does not interact directly with the database. Both approaches are detailed and compared to each other. Both solutions were evaluated with a medical use case, namely detecting Systemic Inflammatory Response Syndrome (SIRS) in patients in the ICU