108 IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 15, NO. 1, JANUARY 2011 A Holistic Environment for the Design and Execution of Self-Adaptive Clinical Pathways Dimitrios Al. Alexandrou, Ioannis E. Skitsas, and Gregoris N. Mentzas Abstract—One of the main challenges to be confronted by mod- ern health care, so as to increase treatment quality, is the person- alization of treatment. The treatment personalization requires the continuous reconfiguration and adaptation of the selected treat- ment schemes according to the “current” clinical status of each patient and “current” circumstances inside a health care organiza- tion that change rapidly, as well as the updated medical knowledge. In this paper, we present an innovative software environment that provides an integrated IT solution concerning the adaptation of health care processes (clinical pathways) during execution time. The software comprises a health care process execution engine assisted by a semantic infrastructure for reconfiguring the clini- cal pathways. During the execution of clinical pathways, the sys- tem reasons over the rules and reconfigures the next steps of the treatment. A graphical designer interface is implemented for the definition of the rule-set for the clinical pathways adaptation in a user-friendly way. Index Terms—Adaptive clinical pathways, clinical pathway ontology (CPO), personalized treatment. I. INTRODUCTION T HE MAIN challenge of the modern health care organi- zations is the increment of treatment quality combined with the decrement of health care provision costs. In order to achieve the specific goal, they need to utilize standardized clin- ical protocols used in the various domains of medical practice. The specific kind of protocol contains detailed medical plans and corresponding actions for diagnosis, therapy scheme, and follow-up. Additionally, it includes the required information so as to deal with any exceptional situations, occurring during the treatment execution time and require quick response and appropriate modifications/reconfigurations of the treatment of a patient, thus increasing the flexibility of the treatment processes. One valuable and efficient tool to achieve the aforementioned objectives is “clinical pathways.” Clinical pathways can be utilized for the implementation of medical guidelines in a specific health care environment and to decrease undesired variability of medical practice [1]. Clinical pathways model a timed process of patient-focused care, which Manuscript received April 17, 2010; revised July 30, 2010; accepted August 22, 2010. Date of publication September 27, 2010; date of current version January 4, 2011. D. Al. Alexandrou and I. E. Skitsas are with UBITECH Research, 15343 Athens, Greece (e-mail: dalexandrou@ubitech.eu; iskitsas@ubitech.eu). G. N. Mentzas is with the Electrical and Computer Engineering, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece (e-mail: gmentzas@mail.ntua.gr). Color versions of one or more of the figures in this paper are available online at http://ieeexplore.ieee.org. Digital Object Identifier 10.1109/TITB.2010.2074205 TABLE I CLINICAL P ATHWAYS VERSUS MEDICAL GUIDELINES specifies key events, clinical exams, and assessments to produce the best prescribed outcomes, within the limits of the resources available, for an appropriate episode of care [2]. In practice, this process seeks to model a priori the treatment of patients within specific case types. The medical practitioner may deviate from the pathway, and such deviations permit clinical freedom and are called “variances.” The benefits identified include im- proved patient outcomes [3], increased patient satisfaction with the service [4], improved communication between doctors and nurses [5], increased participation of patient or carer in patient treatment procedure [6], reduction in the length of stay in hospi- tal, reduction of costs of patient care, and reduction in the time health staff spent carrying out paperwork. In contradiction with the medical guidelines, clinical path- ways enclose multidisciplinary valuable resources like person- nel, education level, medical equipment availability, and other operational and administrative information. Medical guidelines require the consensus between medical experts. On the other hand, clinical pathways require a consensus between multidis- ciplinary groups of hospital personnel taking actions during the treatment execution. Clinical pathways constitute treatment process patterns, which aim to increase both the health care process quality and the utilization of resources. Consequently, a clinical pathway may deviate from a clinical guideline due to administrative reasons, and a treatment scheme may deviate from the clinical pathway due to patient’s symptoms during its execution. Table I presents some fundamental differences between clin- ical pathways and medical guidelines. In order to support the execution of treatment schemes based on clinical pathways and to relieve the medical personnel, a software system is required, which will handle the health care business processes in an efficient manner [7]. Such a system would be responsible for the observation of the execution and the current status of the applied clinical pathways, offer the 1089-7771/$26.00 © 2011 IEEE