SmartCareTM-Automated Clinical Guidelines in Critical Care

In critical care environments important medical and economical challenges are presented by the enhancement of therapeutic quality and the reduction of therapeutic costs. For this purpose several clinical studies have demonstrated a positive impact of the adoption of so-called clinical guidelines. Clinical guidelines represent well documented best practices in health care and are fundamental aspects of evidence-based medicine. However, at the bedside, such clinical guidelines remain difficult to use by the clinical staff. Recently, we have designed and implemented the knowledge-based SmartCare™ system that allows automated control of medical devices in critical care. SmartCare™ constitutes a clinical guideline engine since it executes one or more clinical guidelines on a specific medical device. The underlying methodology comprises two sequential phases and seamlessly combines knowledge engineering with expert system techniques, e.g. rule-based forward chaining and temporal reasoning, for clinical guidelines modelling and software engineering techniques for source code generation and for integration to the target platform. SmartCare™ was initially applied for the automated control of a mechanical ventilator and is currently being evaluated in a European multi-centre clinical study started two years ago. Intermediate reports have been extremely positive and suggest a statistically significant reduction in the duration of mechanical ventilation using SmartCare™. The methodology allows SmartCare™ to be implemented effectively with other medical devices and/or with other appropriate guidelines. In this paper we report on the methodology, architecture and the resulting versatility of SmartCare™ for the automated execution of clinical guidelines. Benefits and lessons learned during its development are discussed.