- Email: [email protected]
Model and Software Design for Health Care and Life Support
Copyright © IFAC Advances in Control Education Oulu. Finland. 2003
ELSEVIER
IFAC PUBLICATIONS www.elsevicr.comllocatelifac
MODEL AND SOFTWARE DESIGN FOR HEALTH CARE AND LIFE SUPPORT Tsutomu Matsumoto· Shigeyasu Kawaji ••
• Kumamoto National College of Technology 2659-2 Suya, Nishigoshi, Kilruchi, Kumamoto 861-1102, Japan [email protected] •• Graduate School of Science and Tecnology Kumamoto University 2-39-1 Kurokami, Kumamoto 860-8555, Japan [email protected]
Abstract: The importance of developing a intelligent control system has been pointed out for ill structure which includes human such as health care support, life support, education and so on. In order to develop the software system which targets these field, analyzing task and information based on cybernetics are very useful for modeling and software design. Unfortunately, design methodology education is not given to student. Because it is very difficult to derive mathematical equation for the behaviour of object. In this paper, modcling and software design of health care life support system as an typical example of ill structure are described. Main part of this paper has been used as an educational material to final project students who belong to our research group. They learn the design method of the system including human via the tutorial and the educational material. Copyright e 2003 IFAC Keywords: III structure, Modeling, Patient Model, Disease Model, Clinical Diagnosis Decision Support, Health Care Modeling, Design Method
1. INTRODUCTION
client information and gives medical treatment as control input to client. Education is also regarded as one of control system since educator identifies the understanding of student and gives an appropriate teaching material.
When control system is desgined, the first thing, the behavior of controlled object is expressed by mathematical equation based on the physical law. If the controlled object is complex or large scale, the mathematical equation that expresses the behaviour of controlled object could be determined by the input output relationship and/or the assumption of internal structure. In the case of controlled object being non linear and/or obtaining no mathematical equation for expressing the behaviour of controlled object, the behaviour of object by Neural Networks or Fuzzy may be expressed. Like these objects which are formulated are well known as good structure issue.
Development of modeling and control law to ill structured object should be created byanalyzing controlled object based on cybernetic. Unfortunately design method of control system by cybernetic has not educated to student. In this paper, first a design method of information support system to ill structure object including human is described using clinical diagnosis support system and health care life support system as actual examples. Second how educates student for design method of ill structured information support system is discussed. Finally evaluation of proposed method is described.
On the other hand, issues such as medical, education and emotion and so on which include human in itself or are difficulty or impossible formulated . These are well known as ill structure. Real world has many issues such ill structure. Medical diagnosis is regarded as one of control system since clinician identifies client by obtained
197
interval of changing is ignored, e.g. sex, age, etc. The dynamic information indicates variation with time and other causes, e.g. body temperature, auscultation sound, index of clinical laboratory data. In this paper client information is classified as follows. The zero order information is static information. And first - third order informations are dynamic.
2. HEALTH CARE AND LIFE SUPPORT MODEL Development of a health care and life support model including medical diagnosis by analyzing task and information is discussed in this section as a typical example of ill structure problem.
(1) Zero order information : Personal information(sex, age, disease history, career), disease history of family, life style (smoking, drinking, meal custom etc). (2) First order information: Obtaining directly or using simple detector Main compliant, inspection, auscultation, blood pressure, pulse count, body temperature etc. (3) Secondary information: Blood check and biochemical check up data Information from analyzing available sample of living body, ex blood, urine, stool, pus, snivel. (4) Third order information: using electro and information technology ECG, electromyogram, sphygmogram, X-ray image, MRI, X-ray CT etc.
2.1 Task of Health Care and Life Support In order to construct a medical consultation model, first we discuss the medical task of physician's diagnosis and giving therapy to patient. Physician interviews a new patient for acquiring various personal information, disease history of patient and family, life style, main complaint and so on. And physician does inquiry, inspection, auscultation to find abnormal states of patient. Physician orders blood check and/or bio-chemical medical check as occasion demands to clinical laboratory.
Physician estimates the state of patient using the data from patient and clinical laboratory data and inspection. Finally physician identifies the disease of client. Then physician makes a medical treatment plan after discussion on the subject with the client and/or fanlily. After that, the physician makes a detail treatment plan. The treatment has two types. The one is to provide directly treatment to the client. The other is to provide indirectly to the client's treatment, for example through nursing staff. In this case physician gives an instruction to nursing staff then nurse staff carries out the instruction. There may be a case that physician gives a description to client and/or gives some advice to family. The family then cares for the client. Physician should confirm that treatment is given to the client.
Note that higher order information is also advanced health care information.
2.3 Health Care and Life Support Model Analyzing the physician's and comedical's task in the health care life support and structuring the client information will yield a scheme as shown in Fig. 1. In the figure disturbance shown means inputs for client to take bad turn. Fig. 2 is simplified by detector parts and treatment parts becoming each one black box. We call it "Health Care and Life Support Model".
In the case of health care and life support which include nursing elderly people, comedical who are family and nursing staff finds client's problem as client identification. For this decision making, Minimum Data Set is used. Then care plan is developed, is implemented.
Physician plays role of a controller in the Medical Consultation Model, i.e. he diagnoses client using the output y of detector which is originated from client, makes a treatment plan and gives directly and/or indirectly the medical treatment u to the client. The feedback from treatment block to physician block is required to confirm whether or not the client receives treatment. The r is normal health situation. The treatment is recognized as same as an operation in a control system. At this time physician verifies whether or not treatment is given.
Some time later physician and comedical evaluates the effect of treatment and/or care plan given to client and improves the plan. Above-mentioned tasks of physician and comedical are similar to an feedback control system configuration, a client as a controlled object, healthy as target and manipulated variables are medical treatment and care plan with cybernetics. 2.2 Information for Health Care and Life Support
3. DIAGNOSIS ALGORITHM OF PHYSICIAN
Client information can be cl~ified into two categories types of static and dynamic. The static information is not to change or even if change, time
In this section, we propose a medical diagnosis algorithm based on the medical consultation model described in Section 2. Concepts of client disease
198
or more system have some problems, output of the system includes abnormal state. Diseases depend on this level of abnormal state. When the abnormal exceeds a threshold, human recognizes some subjective symptoms. Subjective symptom becomes one of first order information in Section 2. Output of the metabolism and regulation system causes the second order information.
p----------------. • 3re1ln1o.
· ·
I
: 2nd.... I
1at tnIo.
OetK1Of2
Do' 0Ckw2
: Zero Wo.
.------- --------- -!
-l
r--- . - 1-----......
~;.~T~ _ •
f\
I
Mostly physician decides kinds of required secondary information to diagnose based on zero and first order client. This paper deal with symptoms and remarks as first order client information, clinical laboratory data as secondary client information.
Client
--
y
-----.-- .. -------- - --- ..~-- .... ! ....... Uf.SU~
Fig. 1. Information from client and task
3.2 Client Model
CIInId8n ComecIIcaI
Client model is expressed by equation (2), in similar way of disease model constructed by medical knowledge.
IDlegno8ial
r
ITa. Planning I
Refwence
(~)
Fig. 2. Medical COIlHultation Model
.:
model are also introduced. Developing diagnosis algorithm in the m<.:dical consultation model is equivalent to designing a controller. The disease model and client model corresponds to respective represented knowledge on disease and modeling of controlled object.
PI
The model which gives normal value P to physician is called disease model. Let disease be Pi and information of client be Y j , then physician's diagnosis algorithm is expressed by equation (1) .
P,
: : .. :
.
.
WIl W,2
. .
W'J
.: 1";
Wn
:
'.
:
WI2 .•• Wlm
:
(2)
Ym
Individual normal range of each client clinical laboratory data are set up by adopting Tango's method (Tango, 1982). This is to set a normal range of each clinical laboratory data with past no problem data (t/1t, t/12, . .. , t/1(n-t». Thus this range is used for finding whether or not current data t/1n in the normal range. Furthermore distribution of clinical laboratory data general index has been studied in medical field . Individual normal range could be set up by obtaining a interval estimation of population mean p.. This interval estimation would be individual normal range.
3.1 Dise4Se Model
.:
:
Let Ym be the client information and PI be pathological state and disease. In order to solve individuality, client model has individual weighted coefficients Wlm. Next a method of determining Wlm is explained.
Medical diagnosis algorithm is generally expressed to compare evaluated va lue of p = wy using client information y with relevant sample P based on medical knowledge (Furukawa, 1982). From the view of control theory, physician develops a real client model using client information y as a output of controlled object and evaluates p of each disease with medical knowledge. Finally a medical decision making is carried out by comparing p with normal value P which is output of disease model developed by medical knowledge.
(~~ ) (~~~ ~~~ ::: ~~~) (~)
(:~~. .:~~ :::.:~:) (~) . .
3.3 Diagnosis Algorithm Physician estimates disease name from zero and/or first order information of client or makes medical decision. In order to improve the accuracy estimation, physician uses the secondary and/or the third information. Otherwise physician may identify the name of disease with them. Consequently, this system searches the name of disease with the remarks and the symptoms and estimates the pathology of client by clinical laboratory data.
(1)
Next a method of determilling weighted coefficients W ij is discussed . Human living body system generally consists of the central nervous system, the metabolism system, the regulation system and generation system that affects each other. If one
Searching the name of disease is carried out with the zero and/or the first order information, and
199
comes to the conclusion of distinction using multivariate analysis. The clinical laboratory data belongs to the secondary data but its futures can be expressed by words, e.g. GOT increasing. As clinical laboratory data shows the output of the metabolizing system and the regulatory system, these data are used for estimating the pathological state of client. When the number of sampled data is short, general index is used. The number of sampled data exceeding specified number, individual index is placed by equation (3). Furthermore as those data have different units and index, then the index of PI is normalized.
Fig. 3. Layer Structure for tele-health care
4.2.2. Sensor Layer The sensor layer is to gather information of client and to find urgency of client(Matsumoto et al., 20(0). If sensor layer finds an urgency of client, the sensor layer sends a message to application layer. The message has ID of client and urgency level that client needs clinician or not, needs nursing staff or not and so on. In addition the sensor layer provides health care record to clinician via application layer. This system focuses life information (Zero order), pulse and body temperature as the third order.
4. TELE-HEALTH CARE LIFE SUPPORT SYSTEM This section describes the modeling method of telehealth care information system based upon above the health care and life support model.
4.1 System Design The telehealth care and life support system is regarded as setting up feedback system to share/transfer the information among client, clinician and comedical in the case of some problem of client happening. This paper defines the telehealth care information system as follows. When an irregular habitual life behavior and abnormal health condition is detected , the system confirms safety of client. And the system sends a message to clinician, nursing staff and/or neighbors depending on answer of client. In addition the system provides health advice from clinician to client.
Fig. 4. Sensor layer
4.2.3. Application Layer Application layer searches contacts of family doctor, comedical and/or client corresponding to urgency level for sending a message. With the search results application layer sends a message to interface layer. Application layer continues to send a message in order to the reply from receiver. If nobody replies, the system call an ambulance.
Consequently the system has following specifications in order to perform above mentioned. (1) (2) (3) (4) (5) (6)
Obtaining the information of client Transferring the information of client Finding problem of client Confirming client safety Informing urgency to comedical, clinician Providing health care advice
The application layer requests information of client to sensor layer after receiving a message of "Request: providing information of client". The application layer transfers the data to appropriate interface layer.
The fourth and the fifth mean the collaboration among client, comedical and clinician. Finally the telehealth care life support system can be designed using layer structure shown by figure3 .
4.2.4. User Interface Layer (1) Clinician Interface Clinician interface informs urgency of client and transfers reply from clinician to the application layer. Clinician inputs the process into the system via the clinician interface. Clinician is able to retrieve health record of client. (2) Comedical Interface Urgency of client is informed to registered
4.2 Layer Structure This section describes the relations among layers and functions of each layers.
4.2 .1. Real World The object of this system are clients, clinicians and comedi cal including client's family and/or neighbors.
200
for each interface. A use case represents a complete functionality as perceived by an actor. The actions can involve communicating with a number of actors (users and other systems) as well as performing calculations and work inside the system. The functionality of use case is described as Use Case Description.
comedical via the comedical-medical interface. Comedical who received a message has to inform the condition of client and/or result of treatment to the sy~tem via the comedical interface. Also comedical retrieves health advice from the sy~telll that clinician has provided, and comedical guides client to keep health condition. (3) Client Interface(Interactive Response System) Client interface sends a message to confirm safety. Client can reply "No problem", ''need help", "need clinician" or no answer. The client interface informs content of reply to the system. (4) System Administrator Interface The system administrator interface provides functions of system administrating such as registration, removing, modifyinguscr(client, clinician, nursing staff, lleighbors) .
Client U. .rlnterface
Fig. 5. Use Case for Client Interface
5. DESIGN OF SOFTWARE SYSTEM
5.3 Use Case Description
In this section design and implementation of user interface as an actual example are described based on system design described in section 4 with Object Oriented Method . Software development by Object Oriented Method has some benefits as reuse, flexibility. Furthermore UML (Unified Modeling Language) can be used to design and implement the software for Object Oriented method.
Normally Use Case Description defines a functionality of use case. This is a simple and consistent specification about how the actor and the use case (the system) interact. Some of use case description for explaining briefly the system behaviour.
5.4 Diagrams UML recommends the development of some kinds of diagrams to express the relation among objects and sequence of messages among objects.
5.1 Scenario UML method suggests us to develop scenario to find use case. Because an instantiation of a use case is called a scenario, and it represents an actual usage of the system; that is a specific execution path through the system. An example for the sensor layer finding the problem of client is shown as follows.
A sequence diagram shows a dynamic collaboration between a number of objects. The importance aspect of this diagram is to show a sequence of message sent between the objects. Here a sequence diagrams for showing a set messages arranged in time sequence are shown as figure6.
When the sensor layer finds pathological state transition. The sensor layer sends a message to the application layer. Then the application layer decode it, simultaneously sends a message to client for confirming whether or not the client has problem. If no reply from the client, the application layer sends a message for sending a comedical to the client. Also the application layer sends a message to appropriate staff according to reply from the client.
A collaboration diagram shows a dynamic collaboration and shows the objects and their relationships. The collaboration diagram is drawn
-
-...-
---
5.2 Use Case After developing scenario, use case could be found. Figure 5, figure ?? and figure ?? show use cases
Fig. 6. Sequence Diagram: No response of client
201
Q
Layering system is useful for software design. This is to educate with an example shown by chapter 4.1.
Receive message
~. Clinlclanl Comedlcal
This flow shows how educate students to develop an information support system including human based on cybernetics. Also students is expected to understand that control theory and cybernetics is useful not only developing traditional control system but design of information support system.
Fig. 7. Problem Happening 7. DISCUSSION
as an object diagram , where a number of objects are shown along with their relationships using the notation in the class/ object diagram. Message arrows are drawn between the objects t o show the flow of message betw<-'C n the objects.
At the class, more details on software design documents are distributed to students. The students try to develop whole required software design documents. The software system can be developed on Java programming environment according to whole software design documents. Student can capture the thinking way of modeling and software design through the lecture and practical development of software.
For convenience, a collabora tion diagrams is shown in figure 7. Figure 7 shows that when sensor layer finds client problem , how the message flows between objects.
This program is carried out on the beginning of final project. Then students obtain the fundamental modeling and software design method by analyzing task and information based on cybernetics.
6. APPLYING TO EDUCATION In this chapter, how educates developing of information support software system including human to students is sequentially described.
8. REFERENCES
(l)Developing structure of the object
Furukawa, T. (1982). Computer-based Medical Decision Support (J). Kyouritsu Co., Ltd. Matsumoto, T., Y. Shimada, K. Shibasato, H. Ohtsuka and S. Kawaji (2000). Creating behavior model of a senior solitary life and detecting an urgency. Proceedings of the International ICSC Congress on Intelligent System and Applications pp. 234- 238. Tango, T. (1982). A new statistical method for the determination of individual normal range. JAMHTS 9, 241- 246.
When an information suppurt system is developed, finding a structure of the object is a very importance. This is educated by giving actual example shown by the intlOduction of chapter two at the tutorial class. Simultaneously teaching material let student also clear what is supported by the software system at developing a structure. (2)Analyzing information Second thing to educate is to analyze information which flows feedback loop from the object to controller. Information could be categorized by their attribute. This analysis clears what information can be used for making decision and feed back loop should be either cont inuous or discrete. (3) Modeling of controlled object The third thing is to show some modeling of eontrolled object. As the t arget of the software system is to support human, this modeling has strongly related to aim of support. (4) Formulated of making decision In case of controller being human which is concerned , formulating of hurnall's acting and thinking way is required. An example is shown by chapter 3.3. (5) Layer structure
202
ELSEVIER
IFAC PUBLICATIONS www.elsevicr.comllocatelifac
MODEL AND SOFTWARE DESIGN FOR HEALTH CARE AND LIFE SUPPORT Tsutomu Matsumoto· Shigeyasu Kawaji ••
• Kumamoto National College of Technology 2659-2 Suya, Nishigoshi, Kilruchi, Kumamoto 861-1102, Japan [email protected] •• Graduate School of Science and Tecnology Kumamoto University 2-39-1 Kurokami, Kumamoto 860-8555, Japan [email protected]
Abstract: The importance of developing a intelligent control system has been pointed out for ill structure which includes human such as health care support, life support, education and so on. In order to develop the software system which targets these field, analyzing task and information based on cybernetics are very useful for modeling and software design. Unfortunately, design methodology education is not given to student. Because it is very difficult to derive mathematical equation for the behaviour of object. In this paper, modcling and software design of health care life support system as an typical example of ill structure are described. Main part of this paper has been used as an educational material to final project students who belong to our research group. They learn the design method of the system including human via the tutorial and the educational material. Copyright e 2003 IFAC Keywords: III structure, Modeling, Patient Model, Disease Model, Clinical Diagnosis Decision Support, Health Care Modeling, Design Method
1. INTRODUCTION
client information and gives medical treatment as control input to client. Education is also regarded as one of control system since educator identifies the understanding of student and gives an appropriate teaching material.
When control system is desgined, the first thing, the behavior of controlled object is expressed by mathematical equation based on the physical law. If the controlled object is complex or large scale, the mathematical equation that expresses the behaviour of controlled object could be determined by the input output relationship and/or the assumption of internal structure. In the case of controlled object being non linear and/or obtaining no mathematical equation for expressing the behaviour of controlled object, the behaviour of object by Neural Networks or Fuzzy may be expressed. Like these objects which are formulated are well known as good structure issue.
Development of modeling and control law to ill structured object should be created byanalyzing controlled object based on cybernetic. Unfortunately design method of control system by cybernetic has not educated to student. In this paper, first a design method of information support system to ill structure object including human is described using clinical diagnosis support system and health care life support system as actual examples. Second how educates student for design method of ill structured information support system is discussed. Finally evaluation of proposed method is described.
On the other hand, issues such as medical, education and emotion and so on which include human in itself or are difficulty or impossible formulated . These are well known as ill structure. Real world has many issues such ill structure. Medical diagnosis is regarded as one of control system since clinician identifies client by obtained
197
interval of changing is ignored, e.g. sex, age, etc. The dynamic information indicates variation with time and other causes, e.g. body temperature, auscultation sound, index of clinical laboratory data. In this paper client information is classified as follows. The zero order information is static information. And first - third order informations are dynamic.
2. HEALTH CARE AND LIFE SUPPORT MODEL Development of a health care and life support model including medical diagnosis by analyzing task and information is discussed in this section as a typical example of ill structure problem.
(1) Zero order information : Personal information(sex, age, disease history, career), disease history of family, life style (smoking, drinking, meal custom etc). (2) First order information: Obtaining directly or using simple detector Main compliant, inspection, auscultation, blood pressure, pulse count, body temperature etc. (3) Secondary information: Blood check and biochemical check up data Information from analyzing available sample of living body, ex blood, urine, stool, pus, snivel. (4) Third order information: using electro and information technology ECG, electromyogram, sphygmogram, X-ray image, MRI, X-ray CT etc.
2.1 Task of Health Care and Life Support In order to construct a medical consultation model, first we discuss the medical task of physician's diagnosis and giving therapy to patient. Physician interviews a new patient for acquiring various personal information, disease history of patient and family, life style, main complaint and so on. And physician does inquiry, inspection, auscultation to find abnormal states of patient. Physician orders blood check and/or bio-chemical medical check as occasion demands to clinical laboratory.
Physician estimates the state of patient using the data from patient and clinical laboratory data and inspection. Finally physician identifies the disease of client. Then physician makes a medical treatment plan after discussion on the subject with the client and/or fanlily. After that, the physician makes a detail treatment plan. The treatment has two types. The one is to provide directly treatment to the client. The other is to provide indirectly to the client's treatment, for example through nursing staff. In this case physician gives an instruction to nursing staff then nurse staff carries out the instruction. There may be a case that physician gives a description to client and/or gives some advice to family. The family then cares for the client. Physician should confirm that treatment is given to the client.
Note that higher order information is also advanced health care information.
2.3 Health Care and Life Support Model Analyzing the physician's and comedical's task in the health care life support and structuring the client information will yield a scheme as shown in Fig. 1. In the figure disturbance shown means inputs for client to take bad turn. Fig. 2 is simplified by detector parts and treatment parts becoming each one black box. We call it "Health Care and Life Support Model".
In the case of health care and life support which include nursing elderly people, comedical who are family and nursing staff finds client's problem as client identification. For this decision making, Minimum Data Set is used. Then care plan is developed, is implemented.
Physician plays role of a controller in the Medical Consultation Model, i.e. he diagnoses client using the output y of detector which is originated from client, makes a treatment plan and gives directly and/or indirectly the medical treatment u to the client. The feedback from treatment block to physician block is required to confirm whether or not the client receives treatment. The r is normal health situation. The treatment is recognized as same as an operation in a control system. At this time physician verifies whether or not treatment is given.
Some time later physician and comedical evaluates the effect of treatment and/or care plan given to client and improves the plan. Above-mentioned tasks of physician and comedical are similar to an feedback control system configuration, a client as a controlled object, healthy as target and manipulated variables are medical treatment and care plan with cybernetics. 2.2 Information for Health Care and Life Support
3. DIAGNOSIS ALGORITHM OF PHYSICIAN
Client information can be cl~ified into two categories types of static and dynamic. The static information is not to change or even if change, time
In this section, we propose a medical diagnosis algorithm based on the medical consultation model described in Section 2. Concepts of client disease
198
or more system have some problems, output of the system includes abnormal state. Diseases depend on this level of abnormal state. When the abnormal exceeds a threshold, human recognizes some subjective symptoms. Subjective symptom becomes one of first order information in Section 2. Output of the metabolism and regulation system causes the second order information.
p----------------. • 3re1ln1o.
· ·
I
: 2nd.... I
1at tnIo.
OetK1Of2
Do' 0Ckw2
: Zero Wo.
.------- --------- -!
-l
r--- . - 1-----......
~;.~T~ _ •
f\
I
Mostly physician decides kinds of required secondary information to diagnose based on zero and first order client. This paper deal with symptoms and remarks as first order client information, clinical laboratory data as secondary client information.
Client
--
y
-----.-- .. -------- - --- ..~-- .... ! ....... Uf.SU~
Fig. 1. Information from client and task
3.2 Client Model
CIInId8n ComecIIcaI
Client model is expressed by equation (2), in similar way of disease model constructed by medical knowledge.
IDlegno8ial
r
ITa. Planning I
Refwence
(~)
Fig. 2. Medical COIlHultation Model
.:
model are also introduced. Developing diagnosis algorithm in the m<.:dical consultation model is equivalent to designing a controller. The disease model and client model corresponds to respective represented knowledge on disease and modeling of controlled object.
PI
The model which gives normal value P to physician is called disease model. Let disease be Pi and information of client be Y j , then physician's diagnosis algorithm is expressed by equation (1) .
P,
: : .. :
.
.
WIl W,2
. .
W'J
.: 1";
Wn
:
'.
:
WI2 .•• Wlm
:
(2)
Ym
Individual normal range of each client clinical laboratory data are set up by adopting Tango's method (Tango, 1982). This is to set a normal range of each clinical laboratory data with past no problem data (t/1t, t/12, . .. , t/1(n-t». Thus this range is used for finding whether or not current data t/1n in the normal range. Furthermore distribution of clinical laboratory data general index has been studied in medical field . Individual normal range could be set up by obtaining a interval estimation of population mean p.. This interval estimation would be individual normal range.
3.1 Dise4Se Model
.:
:
Let Ym be the client information and PI be pathological state and disease. In order to solve individuality, client model has individual weighted coefficients Wlm. Next a method of determining Wlm is explained.
Medical diagnosis algorithm is generally expressed to compare evaluated va lue of p = wy using client information y with relevant sample P based on medical knowledge (Furukawa, 1982). From the view of control theory, physician develops a real client model using client information y as a output of controlled object and evaluates p of each disease with medical knowledge. Finally a medical decision making is carried out by comparing p with normal value P which is output of disease model developed by medical knowledge.
(~~ ) (~~~ ~~~ ::: ~~~) (~)
(:~~. .:~~ :::.:~:) (~) . .
3.3 Diagnosis Algorithm Physician estimates disease name from zero and/or first order information of client or makes medical decision. In order to improve the accuracy estimation, physician uses the secondary and/or the third information. Otherwise physician may identify the name of disease with them. Consequently, this system searches the name of disease with the remarks and the symptoms and estimates the pathology of client by clinical laboratory data.
(1)
Next a method of determilling weighted coefficients W ij is discussed . Human living body system generally consists of the central nervous system, the metabolism system, the regulation system and generation system that affects each other. If one
Searching the name of disease is carried out with the zero and/or the first order information, and
199
comes to the conclusion of distinction using multivariate analysis. The clinical laboratory data belongs to the secondary data but its futures can be expressed by words, e.g. GOT increasing. As clinical laboratory data shows the output of the metabolizing system and the regulatory system, these data are used for estimating the pathological state of client. When the number of sampled data is short, general index is used. The number of sampled data exceeding specified number, individual index is placed by equation (3). Furthermore as those data have different units and index, then the index of PI is normalized.
Fig. 3. Layer Structure for tele-health care
4.2.2. Sensor Layer The sensor layer is to gather information of client and to find urgency of client(Matsumoto et al., 20(0). If sensor layer finds an urgency of client, the sensor layer sends a message to application layer. The message has ID of client and urgency level that client needs clinician or not, needs nursing staff or not and so on. In addition the sensor layer provides health care record to clinician via application layer. This system focuses life information (Zero order), pulse and body temperature as the third order.
4. TELE-HEALTH CARE LIFE SUPPORT SYSTEM This section describes the modeling method of telehealth care information system based upon above the health care and life support model.
4.1 System Design The telehealth care and life support system is regarded as setting up feedback system to share/transfer the information among client, clinician and comedical in the case of some problem of client happening. This paper defines the telehealth care information system as follows. When an irregular habitual life behavior and abnormal health condition is detected , the system confirms safety of client. And the system sends a message to clinician, nursing staff and/or neighbors depending on answer of client. In addition the system provides health advice from clinician to client.
Fig. 4. Sensor layer
4.2.3. Application Layer Application layer searches contacts of family doctor, comedical and/or client corresponding to urgency level for sending a message. With the search results application layer sends a message to interface layer. Application layer continues to send a message in order to the reply from receiver. If nobody replies, the system call an ambulance.
Consequently the system has following specifications in order to perform above mentioned. (1) (2) (3) (4) (5) (6)
Obtaining the information of client Transferring the information of client Finding problem of client Confirming client safety Informing urgency to comedical, clinician Providing health care advice
The application layer requests information of client to sensor layer after receiving a message of "Request: providing information of client". The application layer transfers the data to appropriate interface layer.
The fourth and the fifth mean the collaboration among client, comedical and clinician. Finally the telehealth care life support system can be designed using layer structure shown by figure3 .
4.2.4. User Interface Layer (1) Clinician Interface Clinician interface informs urgency of client and transfers reply from clinician to the application layer. Clinician inputs the process into the system via the clinician interface. Clinician is able to retrieve health record of client. (2) Comedical Interface Urgency of client is informed to registered
4.2 Layer Structure This section describes the relations among layers and functions of each layers.
4.2 .1. Real World The object of this system are clients, clinicians and comedi cal including client's family and/or neighbors.
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for each interface. A use case represents a complete functionality as perceived by an actor. The actions can involve communicating with a number of actors (users and other systems) as well as performing calculations and work inside the system. The functionality of use case is described as Use Case Description.
comedical via the comedical-medical interface. Comedical who received a message has to inform the condition of client and/or result of treatment to the sy~tem via the comedical interface. Also comedical retrieves health advice from the sy~telll that clinician has provided, and comedical guides client to keep health condition. (3) Client Interface(Interactive Response System) Client interface sends a message to confirm safety. Client can reply "No problem", ''need help", "need clinician" or no answer. The client interface informs content of reply to the system. (4) System Administrator Interface The system administrator interface provides functions of system administrating such as registration, removing, modifyinguscr(client, clinician, nursing staff, lleighbors) .
Client U. .rlnterface
Fig. 5. Use Case for Client Interface
5. DESIGN OF SOFTWARE SYSTEM
5.3 Use Case Description
In this section design and implementation of user interface as an actual example are described based on system design described in section 4 with Object Oriented Method . Software development by Object Oriented Method has some benefits as reuse, flexibility. Furthermore UML (Unified Modeling Language) can be used to design and implement the software for Object Oriented method.
Normally Use Case Description defines a functionality of use case. This is a simple and consistent specification about how the actor and the use case (the system) interact. Some of use case description for explaining briefly the system behaviour.
5.4 Diagrams UML recommends the development of some kinds of diagrams to express the relation among objects and sequence of messages among objects.
5.1 Scenario UML method suggests us to develop scenario to find use case. Because an instantiation of a use case is called a scenario, and it represents an actual usage of the system; that is a specific execution path through the system. An example for the sensor layer finding the problem of client is shown as follows.
A sequence diagram shows a dynamic collaboration between a number of objects. The importance aspect of this diagram is to show a sequence of message sent between the objects. Here a sequence diagrams for showing a set messages arranged in time sequence are shown as figure6.
When the sensor layer finds pathological state transition. The sensor layer sends a message to the application layer. Then the application layer decode it, simultaneously sends a message to client for confirming whether or not the client has problem. If no reply from the client, the application layer sends a message for sending a comedical to the client. Also the application layer sends a message to appropriate staff according to reply from the client.
A collaboration diagram shows a dynamic collaboration and shows the objects and their relationships. The collaboration diagram is drawn
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5.2 Use Case After developing scenario, use case could be found. Figure 5, figure ?? and figure ?? show use cases
Fig. 6. Sequence Diagram: No response of client
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Layering system is useful for software design. This is to educate with an example shown by chapter 4.1.
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This flow shows how educate students to develop an information support system including human based on cybernetics. Also students is expected to understand that control theory and cybernetics is useful not only developing traditional control system but design of information support system.
Fig. 7. Problem Happening 7. DISCUSSION
as an object diagram , where a number of objects are shown along with their relationships using the notation in the class/ object diagram. Message arrows are drawn between the objects t o show the flow of message betw<-'C n the objects.
At the class, more details on software design documents are distributed to students. The students try to develop whole required software design documents. The software system can be developed on Java programming environment according to whole software design documents. Student can capture the thinking way of modeling and software design through the lecture and practical development of software.
For convenience, a collabora tion diagrams is shown in figure 7. Figure 7 shows that when sensor layer finds client problem , how the message flows between objects.
This program is carried out on the beginning of final project. Then students obtain the fundamental modeling and software design method by analyzing task and information based on cybernetics.
6. APPLYING TO EDUCATION In this chapter, how educates developing of information support software system including human to students is sequentially described.
8. REFERENCES
(l)Developing structure of the object
Furukawa, T. (1982). Computer-based Medical Decision Support (J). Kyouritsu Co., Ltd. Matsumoto, T., Y. Shimada, K. Shibasato, H. Ohtsuka and S. Kawaji (2000). Creating behavior model of a senior solitary life and detecting an urgency. Proceedings of the International ICSC Congress on Intelligent System and Applications pp. 234- 238. Tango, T. (1982). A new statistical method for the determination of individual normal range. JAMHTS 9, 241- 246.
When an information suppurt system is developed, finding a structure of the object is a very importance. This is educated by giving actual example shown by the intlOduction of chapter two at the tutorial class. Simultaneously teaching material let student also clear what is supported by the software system at developing a structure. (2)Analyzing information Second thing to educate is to analyze information which flows feedback loop from the object to controller. Information could be categorized by their attribute. This analysis clears what information can be used for making decision and feed back loop should be either cont inuous or discrete. (3) Modeling of controlled object The third thing is to show some modeling of eontrolled object. As the t arget of the software system is to support human, this modeling has strongly related to aim of support. (4) Formulated of making decision In case of controller being human which is concerned , formulating of hurnall's acting and thinking way is required. An example is shown by chapter 3.3. (5) Layer structure
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