The Case Manager: An Agent Controlling the Activation of Knowledge Sources in a FHIR-Based Distributed Reasoning Environment

Giordano Lanzola; Francesca Polce; Enea Parimbelli; Matteo Gabetta; Ronald Cornet; Rowdy de Groot; Alexandra Kogan; David Glasspool; Szymon Wilk; Silvana Quaglini

doi:10.1055/a-2113-4443

Applied Clinical Informatics, Table of Contents

CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(04): 725-734
DOI: 10.1055/a-2113-4443

Research Article

The Case Manager: An Agent Controlling the Activation of Knowledge Sources in a FHIR-Based Distributed Reasoning Environment

Giordano Lanzola

¹Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy

,

Francesca Polce

¹Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy

,

Enea Parimbelli

¹Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy

,

Matteo Gabetta

²Research and Development Division, Biomeris S.r.l, Pavia, Italy

,

Ronald Cornet

³Medical Informatics, Amsterdam Public Health Institute, Methodology & Digital Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands

,

Rowdy de Groot

³Medical Informatics, Amsterdam Public Health Institute, Methodology & Digital Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands

,

Alexandra Kogan

⁴Department of Information Systems, University of Haifa, Haifa, Israel

,

David Glasspool

⁵Deontics Ltd., London, United Kingdom

,

Szymon Wilk

⁶Research and Development Division, Institute of Computing Science, Poznan University of Technology, Poznan, Poland

,

Silvana Quaglini

¹Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy

› Author Affiliations

Abstract

Background Within the CAPABLE project the authors developed a multi-agent system that relies on a distributed architecture. The system provides cancer patients with coaching advice and supports their clinicians with suitable decisions based on clinical guidelines.

Objectives As in many multi-agent systems we needed to coordinate the activities of all agents involved. Moreover, since the agents share a common blackboard where all patients' data are stored, we also needed to implement a mechanism for the prompt notification of each agent upon addition of new information potentially triggering its activation.

Methods The communication needs have been investigated and modeled using the HL7-FHIR (Health Level 7-Fast Healthcare Interoperability Resources) standard to ensure proper semantic interoperability among agents. Then a syntax rooted in the FHIR search framework has been defined for representing the conditions to be monitored on the system blackboard for activating each agent.

Results The Case Manager (CM) has been implemented as a dedicated component playing the role of an orchestrator directing the behavior of all agents involved. Agents dynamically inform the CM about the conditions to be monitored on the blackboard, using the syntax we developed. The CM then notifies each agent whenever any condition of interest occurs. The functionalities of the CM and other actors have been validated using simulated scenarios mimicking the ones that will be faced during pilot studies and in production.

Conclusion The CM proved to be a key facilitator for properly achieving the required behavior of our multi-agent system. The proposed architecture may also be leveraged in many clinical contexts for integrating separate legacy services, turning them into a consistent telemedicine framework and enabling application reusability.

Keywords

HL7 FHIR - multi-agent systems - clinical decision support - telemedicine

Full Text

References

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Supplementary Material

Supplementary Material