Informing physicians using a situated decision support system: Disease management for the smart city

We are in the midst of a healthcare paradigm shift driven by the wide adoption of ubiquitous computing and various modes of information communications technologies. As a result, cities worldwide are undergoing a major process of urbanization with ever increasing wealth of sensing capabilities - hence the Internet of Things (IoT). These trends impose great pressure on how healthcare is done. This paper describes the design and implementation of a situated clinical decision support (SCDSS) system, most appropriate for smart cities. The SCDSS was prototyped and enhanced in a clinic. The SCDSS was then used in a clinic as well as in a university hospital centre. In this article, the system's architecture, subcomponents and integrated workflow are described. The systems' design was the result of a knowledge acquisition process involving interviews with five specialists and testing with 50 patients. The reports (specialist consultation report) generated by the SCDSS were shown to general practitioners who were not able to distinguish them from human specialist reports. We propose a context-aware CDSS and assess its effectiveness in managing a wide medical range of patients. Five different patient cases were identified for analysis. The SCDSS was used to produce draft electronic specialist consultations, which were then compared to the original specialists' consultations. It was found that the SCDSS-generated consults were of better quality for a number of reasons discussed herein. SCDSSs have great promise for their use in the clinical environment of smart cities. Valuable insights into the integration and use of situated clinical decision support systems are highlighted and suggestions for future research are given.