Decision Support System for Health Continuous           Vigilance in Industrial Environments               María Martínez-...
systems classify data and generate alarms associated to the           specific summaries about the state and evolution of ...
•    Trend analyzer data. This system is in charge of detecting                                                           ...
Technologies) will have an outstanding role in the healthsector. This will allow the improvement of the currentprocesses, ...
needs of Fasys requirements is being developed. This kind of                                                              ...
Future steps will be focused on the detailed definition of some                    [10]   Fasys:    “Fábrica     Absolutam...
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Paper María Martínez - Decision support system for health continuous vigilance in industrial environments

  1. 1. Decision Support System for Health Continuous Vigilance in Industrial Environments María Martínez-Piqueras#1, Carlos Fernández-Llatas#2, Carlos Cebrián*3, Teresa Meneu#4 # ITACA - Health and Wellbeing Technologies Universidad Politécnica de Valencia, Spain 1 2 4 * TISSAT, S.A. Parque Tecnológico de Valencia, Spain 3 ccebrian@tissat.esAbstract— Several European statistics confirm that a large promotion and development of relevant instruments, andnumber of people have fatal accidents every year in the technical assistance [1].workplace. For this reason, one of the most important European One of the European objectives set for 2020 is theobjectives is to reduce the number of industrial accidents 25%reduction in the number of industrial accidents [2-3]. Insignificantly. Fasys Project, focused on factories of machining order to reduce accidents it is essential to pay attention to theand assembly operations, aims to achieve this improvement workers, their single workplaces and to their workingpromoting the use of technologies and giving, at the same time, a conditions. In this way, if workers had a safer environment,principal role to the worker. From now on, the worker, who has the number of accidents could be significantly reduced,represented a neglected element in the factories, will be thecenter of attention. The increase of his security, and the implying therefore a reduction in costs. This economic savingenhancement of his working conditions and health, will be key is very important to the general economy of the company. Inelements for the Factory of the Future performance. addition, these favourable environments make workers feelIn this paper, a health continuous vigilance system is proposed. more comfortable while they are in the factories, and thus theThe system includes both the monitoring to characterize workers efficiency is increased. As a consequence, it is possible toactivity and environment, and aspects related to prevention obtain the maximum efficiency in the factory as a whole,protocols. To manage it, several systems of collecting data are which also produces economic benefit for the company. Fromneeded. They can be distributed around the factory and monitor, a healthcare point of view, factories lack normally in anfor example, personal and environment data, or get information, amount of enough information to allow a holistic care of thefor example, from medical knowledge or previous medicalinformation of the worker. Besides, due to the big amount of worker. Health data stored by companies are only a smallgenerated information, intelligent systems for massive data amount of data, usually stored once a year, and referred to theprocessing are needed. In this way, the information could be physical condition of a person just in a particular moment [4].easily managed and classified, in order to obtain data from aspecific situation that could be required. For this reason, the future work has to be oriented on new technological applications to get a factory safer and to reduce I. INTRODUCTION significantly the number of accidents. To control the accidentsThe International Labour Organization (ILO) estimates that it is necessary to anticipate and estimate what can happen. So,160 million workers are victims of occupational accidents and prevention will be a key point. To manage it, it is important todiseases every year [1]. The base of several associations is collect and measure data during a period of time, in order tothat workers should be protected from sickness, disease and evaluate their progress. Consequently, the perfect modelinjury arising from their employment. But currently two would be a factory in which the risks and health weremillion of people lose their lives every year from work-related controlled at any time.accidents and diseases. The suffering caused by suchaccidents and illnesses to workers and their families is So, this paper describes the objective to turn the punctualinnumerable. The standards on occupational safety and health monitoring into a more frequent and personalized vigilance.provide necessary tools for governments, employers, and To achieve this goal, it is necessary a continuous andworkers to establish such practices and to provide for full individual monitoring, respectively. Collecting data of manysafety at work. In 2003, ILO assumed a global strategy to people during a long period of time requires collecting a bigimprove occupational safety and health, which included the amount of information. People are not able to process so muchintroduction of a preventive safety and health culture, the information, so intelligent systems for massive data processing are needed. Examples of this kind of systems are: CEP [5], Process Mining [6], ECA [7]. These intelligent
  2. 2. systems classify data and generate alarms associated to the specific summaries about the state and evolution of the person.worker. Thanks to these alerts and all the other environmental This enables a more efficient management of events.and personal data stored, it is possible to predict health threats.Thus, it is possible to act in the most appropriate way for each With the purpose of completing the personal data stored inworker in particular. These preventive actions, adapted for NOMHAD, Fasys project proposes a connection to the currenteach worker, are represented by workflows [8]. In order to health system. This connection provides a register about theconfigure templates of these prevention actions, it is required health state of the person during his lifetime, which collectsto develop a visual and intuitive interface that allows experts data such as his diseases, surgically interventions or directly do it. In addition, the created protocol must be This health system is commonly known as EHR (Electronicautomatically executable in computer systems. To manage it, Health Record) [11].a specific system has to turn the design of the plan into anexecutable format. Finally, once the information has been monitored andNowadays, the concept of absolutely safe and healthy classified, the next point is focused on the intervention. Withenvironments [9] is increasingly used. In order to get the main the aim of representing prevention protocols for thisobjective, that is, the reduction of industrial accidents, Fasys intervention, workflows are developed. Given the workersProject [10] aims to an absolutely safe and healthy factory, singularity, the adaptation of the prevention protocols isdeveloping knowledge and technology to guarantee both the needed for each one of them. In this way, the elimination ofsafety and permanent wellbeing of the worker in the factories the occupational hazard is much more effective.of machining, handling and assembly operations of the future.Through this, the workers will become the key factors of III. RESULTScompetitiveness and differentiation of the new productive Several studies confirm that, in European Union,model. To solve the lack of the continuous and personal approximately 5,500 people per year have fatal accidents invigilance and the personalization of the preventive actions, the workplace [1]. These accidents cost a high price for theFasys proposes a general scheme of a decision support system EU and affect all sectors of the economy, mainly enterprisesfor health continuous vigilance in industrial environments. with less than 50 workers. It has been checked that preventThis scheme includes blocks focused on monitoring, work accidents has more benefits than just reducing damagescollecting and managing data, creating diagnosis and [1]. In addition, from the European point of view, theestablishing prevention plans. With the purpose of Factories of the Future (FoF) will have fabricationinterrelating this modules, in the project emerges the need to environments highly dynamics, what entails that workers willdevelop an architecture which connects and relates all of be involved progressively in more diverse situations [10].them. The increase in the number of accidents that currently occurs in factories, added to the European ideas in the factories of the II. MATERIALS AND METHODS future, makes workers the key roles in the industrialNowadays, the number of sensors for monitoring personal environments. The worker health and safety become a centralhealth data is increasing. In addition, sensors that collect element in the production process, relating it to theenvironmental parameters in industrial factories are being performance, productivity and efficiency. Consequently, thereintroduced more and more. The problem encountered so far, is a need to generate systems for health continuous vigilanceand intended to be solved in this project, is that these data are of workers.not connected. The information is only collected in order to The Figure1 presents the scheme, developed in Fasys, for aproduce isolated diagnosis, but not common results, and the health continuous vigilance system. This system is based oncollected data become less relevant if they are not treated five main parts: Monitoring Module; Response Medicaltogether. The final decision, in a dynamic environment like a Center; Differential Diagnosis Module; Prevention Plansfactory, could be more precise if results came from a study of Module; and Intervention Module. Each of these parts cana diverse set of parameters. be influenced by a number of external variables andAccording to Fasys project, the first step to improve the health parameters such as the Electronic Healthcare Recordand safety in factories is to increase the personal andenvironmental monitored data. Consequently, there is a need Given the big amount of generated information in this model,to develop a system able to store all this information. it is necessary to process all the collected data, since suchNowadays, NOMHAD system is an application able to stored amount of information would not be easily understandable bypart of this required information: workers personal parameters health professionals. Services and intelligent devices that havesuch as blood pressure, pulse and oxygen saturation. The been generated will provide a classification of the monitoredsystem performs a prioritization and an intelligent data. Some data will be set inside a normal range, and othersmanagement of alarms. These alarms are based on the rules will be out of the settled limits, generating alarms due to this.and protocols accepted by health professionals and by the Furthermore, this classification will help the doctor tohealth system. This service will combine the information, organize and evaluate all workers’ data and at the same time itthrough the prioritized alarm list, with the generation of will be able to act more precisely against a particular diagnostic.
  3. 3. • Trend analyzer data. This system is in charge of detecting how some parameters of a person are changing during the pass of time. These parameters can be added to the absolute values in order to get a more complete evaluation of the person. • Evaluation module results. It can be defined as a “photograph of the person” in a particular moment, with no need to detect a problem. These four mentioned sources are the subsystems shown in the general scheme, Figure 1, which provide important information to the main blocks. To manage all this information, Fasys has developed the Differential Diagnosis Module, shown in Figure1. This module, through intelligent systems, helps in decision making by health personal. - The next step is to reach the Prevention Plans Module, where it is defined how to act. The measures to be taken can be of two types: on one hand a medical diagnosis and on the other hand a technical diagnosis, for instance a redesign of the workplace. It is important to remark that these measures are not exclusive. According to this, different levels of action can be established. That is, from very complex levels to more simple levels such as, for example, reminder panels. In addition, the prevention actions carried out in this module Fig. 1 General scheme for a health continuous vigilance can be conducted at three levels. At the first level, the system reacts automatically. When one of the collected data reaches a condition that the professional wants to be controlled, there is an automatic reaction. This associated reaction can be theThe content of the blocks shown in Figure1 is: activation of an alarm, a protocol in a situation of risk, etc.- Where a group of personal data is collected is the These automatic reactions are achieved using ECA rules-Monitoring Module. Event, Condition, Action. At the second level, health- All these personal data, obtained from the monitoring and a professionals receive the alerts and react to individualgroup of environment variables from several sensors in the workers. The reaction of professionals can be the assignationfactory, are joined together in the Response Medical Center. of a prevention plan developed before, or the assignation of aAs environment variables, one can understand parameters prevention plan modified for the worker situation insuch as, environment temperature or humidity, that is, particular. These ways that define the processes are calledparticular characteristics from the workplaces at which the workflows. The third level is in charge of providingworker can stay during a work journey. knowledge for the other two levels, improving the protocols,The Response Medical Center allows to filter and organize the adapting them to new situations and personalizing thepopulation depending on the changeable rules and on the user recommendations. Innovative intelligent tools are used torole. So, it is in this module where the first amount of data is manage it.collected, creating, as a result, personalized records of theworkers and establishing alerts which make easier the task of - Finally, the Intervention Module is responsible forhealth professionals. performing the particular actuation selected for the problem inFrom this point on, next steps are already focused on getting action line according to the problem detected. Fasys system is considered cyclic and of a continuous learning, in a way that, after the Intervention Module, it starts again- The information stored in the previous module is not enough from the Monitoring make a complete diagnosis. So, data from other sources are Another important aspect to take into account is the personalneeded such as: privacy. As a consequence of this, only a few people will have• Data from a medical base of knowledge (it contains access to the EHR (Electronic Healthcare Record), to the relations among diseases, risks, medical tests, medical personal variables, and to the personal diagnosis. recommendations, etc). From all five main parts, it is going to be emphasized the• Personal data from the health system, which include the Response Medical Center. All collected data in this module previous medical history and it is known as Electronic has to be processed by an application called NOMHAD. In the Healthcare Record (EHR). immediate future, ICT (Information Communication
  4. 4. Technologies) will have an outstanding role in the healthsector. This will allow the improvement of the currentprocesses, making them more accessible and efficient.Important efforts have been performed to extend its use in thehealth sector.This module receives automatically monitored data from allworkers. This information is treated to prioritize and managemore efficiently the attention and the available resources forthe factory population.So far, the options managed by NOMHAD are specifically thefollowing:• To create a patient. The professional will fill the Fig. 2 NOMHAD system administrative worker data and the medical relevant data for a future evaluation. Patients will also be assigned to health professionals. When the general modules and the relation among them are• Reception and Display of Monitoring. The system stores defined, an architecture must be created, that is to say, a way the monitoring data of the person. It stores them into a to guarantee the connection and interoperability among them. To get information from the worker environment and his database related to the personal health record in order to personal parameters, it is necessary to interconnect sensors be used by health professionals in the future. The and services in a fault tolerance and decentralized way. This monitoring data are displayed in the right way, either in process, complex and highly interconnected, can be solved graphical form, numerical, image, etc using Choreography of Services [12-8]. This means that the The data stored in the system are processed on arrival. A choreographied processes are independent and can set of several rules, defined by the doctor and adapted to communicate each other to define execution flows. This the personal profile, are applied. These rules allow the model makes easier the connection and disconnection of services dynamically, and at the same time it is capable of system to detect potential anomalies found in the data, in using different kind of sensors and configurations. This order to take decisions. approach is shown in Figure 3. For the definition of the rules, health professionals will have a tool to help themselves with this task. The use of choreography to interconnect services requires also• To configure alerts: The system will have an alert module the use of a common exchange language to allow the services that, based on the monitoring data and the limits defined to understand each other. This can be performed by an architecture which includes a Semantic layer in the as optimal by a professional, will be able to detect Choreographer. The reason to do that is to improve the whether the data stored are acceptable or not. intercommunication among sensors, actuators and services of• The possibility of assigning questionnaires: The patient the system. mood could be extracted from these questionnaires. Health professional will choose the questionnaire and will The ontologies [12] are a solution to describe concepts have the possibility to personalize it depending on the formally. Concretely, an ontology is a formal and explicit specification of a shared conceptualization. It provides a needs of each worker in particular. common vocabulary that can be used to model the kind of These questionnaires will be available in the future in objects and/or concepts and its properties and relations. The case the professionals want a subsequent consulting or reasoners [12] are software applications allowing the semantic validations. seek in the ontologic description. Using this technology, it is• Monitoring: The measurements can be obtained with possible to describe semantically the sensors and data services, usual external devices, whose information is introduced giving them the ability of having a more complete understanding of the collected data and the services actions. afterwards in the system or it can be used integrated The use of services of Ontologies and Reasoning Systems to elements into the system (controlled, for example, by describe the data coming from the sensors, makes possible to Bluetooth and transmitting the captured data directly to get a more precise interpretation and to detect automatically the system). The design of the system can be extended to the sensors and services available at any time. introduce new devices.The following shows the main screen of the application.
  5. 5. needs of Fasys requirements is being developed. This kind of repositories is owned by the person, who has the option to share it with people he chooses. When an employee goes to work in a factory for the first time, health professionals ask him to download his previous EHR, in order to have the personal file (PHR) more complete for the final diagnosis. In general, current PHR contains a summarized version of EHR ready for patients and, in some cases, home monitoring data. PHR developed by Fasys is based on the following aspects: • It is focused on workplace health. • It allows patient to introduce data (automatically or manually) • It allows an exchange of information with the healthcare system (EHR) • It includes an option to generate summaries to share information with others PHR. One of the advantages, for example, is when a worker goes to work in other factory. If the new factory has the Fasys system, his PHR could be Fig. 3 Fasys Architecture downloaded in the system of the new factory in order to have a more complete file. • Stored Data can also be extracted for consultations in caseIn order to illustrate graphically the action to perform and thestandards describing the flow followed by actions, it is health professionals need to do. Consequently, there mustpossible to use workflows. They are a formalization of the be an Access Control. With this control, it is ensured thatprocess to be automated. Some workflow languages can be these personal data can only be seen by authorizedexecuted automatically. This is known as a workflow people. If the data have to be used for statistical studies, itinterpretation. The automatic interpretation of a workflow is must be made anonymous. So, the results of the studiesdone by a workflow engine, which can complete the actions will not be related to people in particular.explained in a workflow, in the order and with the derivationrules specified in it. Workflows can be employed by people In addition, and with the objective of validate the developedwho are not experts in programming for the health area. For work in the different stages of the project, several meetingsthat reason and thanks to these modules, health professionals with experts have been done. On the one hand, the firstare able to design and modify the protocols to be executed meetings had the objective to clarify the main points to beautomatically. considered for a health vigilance scheme. And on the otherA Services Orchestrator [8] is included in the architecture and hand, the last meetings had the mission to validate themoreover, it is connected to the Choreographer which accepts developed scheme of health vigilance. Their point of view isthe use of Workflows. vital to perform a good scheme of a support decision and a health continuous vigilance, directing it to solve the real needsFinally, the objective of this paper is to show the current that contain each covered area.situation of the health data warehouses related to Fasys project.Nowadays, there is a health system ready to be used by health IV. CONCLUSIONSprofessionals. It stores the medical data of the patient from the According to the project objectives, a scheme of healthpoint of view of the assistance process, and it is owned by the continuous vigilance has been designed. It provides acurrent healthcare system. This repository is called EHR workable solution in order to improve the current healthcare(Electronic Healthcare Record). system in the factories of machining, handling and assemblyWith the purpose of improving the characterization of the operations. It is possible to obtain a more continuousperson and his environment, EHR data have been increased. monitoring of the worker, improving his own health andThis new amount of information is stored, together with the making the factory safer and healthier. To achieve this, it isEHR information, in other repositories. These repositories are necessary to increase the number of variables obtained fromknown as PHR (Personal Health Record) [13] and can collect the environment of the worker, from personal parameters, anddata such as habits, preferences, information about the family, to combine them with the medical knowledge and themoods, customs or nutritional profile. A PHR adapted to the actuation protocols.
  6. 6. Future steps will be focused on the detailed definition of some [10] Fasys: “Fábrica Absolutamente Segura y Saludable”. Available: of the scheme of health vigilance that have to be [11] Himss, (Last Access:completed. The optimal way to fit all input and output data November 2011)should be studied in depth. It is important to remark the proper [12] Carlos Fernández-Llatas-Llatas, Juan B. Mocholí, Agustín Moyano,connection with other modules and smaller subsystems which Teresa Meneu “Semantic Process Choreography for Distributed Sensor Management” International Workshop on Semantic Sensor Web - IC3Kthey are related with. 2010 2010Up to now, the application included into the Response [13] PHR Reviews. Available: Center collects data from personal monitoring. In thefuture, this application will be improved, introducing relevantdata for the project, such as: environment variables (roomtemperature, humidity…) or type of machine used (which isrelated to one kind of strain or another).Besides the introduction of new parameters, other twoinnovations for this application are being studied:• Possibility to carry out videoconferences between the doctor and the worker. This action will improve the continuous monitoring. On the one hand, it will be useful for external consultations, in case the doctor is not in the factory. And on the other hand, it will be useful to raise remote queries to specialists.• Mobility. The goal is to build a little version of the application. It can be used on small devices like a tablet. Thus, the information will be available anywhere, carrying out a supervision of the processes and a management of alerts in real time. REFERENCES[1] International Labour Organization labour-standards/occupational-safety-and-health/lang--en/index.htm (Last Access: November 2011)[2] Balogh I, Orbaek P, Winkel J, Nordander C, Ohlsson K, Ektor- Andersen J, et al. (2001). “Questionnairebased mechanical exposure indices for large population studies-reliability, internal consistency and predictive validity”. Scand J Work Environ Health; 27(1):41–48.[3] Leijon O, Wiktorin C, Harenstam A, Karlqvist L, MOA Research Group (2002). “Validity of a self-administered questionnaire for assessing physical workloads in a general population”. J Occup Environ Med; 44(8):724– 735.[4] J. Stranks, 2006. The managers guide to health & safety at work. London: Kogan Page Limited[5] Segev Wasserkrug, Avigdor Gal, Opher Etzion, and Yulia Turchin. “Complex event processing over uncertain data”. In Proceedings of the second international conference on Distributed event-based systems, DEBS 08, pages 253{264, New York, NY, USA, 2008. ACM.[6] Carlos Fernández, Juan Pablo Lázaro, and Jose Miguel Benedí. “Workfow mining application to ambient intelligence behavior modeling”. In Universal Access in Human-Computer Interaction, volume 5615 of Lecture Notes in Computer Science, pages 160{167. Springer, 2009.[7] E. Behrends, O. Fritzen, W. May, and D. Schubert. “An ECA Engine for Deploying Heterogeneous Component Languages in the Semantic Web”. In Web Reactivity (EDBT Workshop), Springer LNCS 4254, 2006.[8] Carlos Fernández-Llatas, Juan B. Mocholí, Carlos Sánchez, Pilar Sala, Juan Carlos Naranjo “Process choreography for Interaction simulation in Ambient Assisted Living environments” The 12th Mediterranean Conference on Medical and Biological Engineering and Computing MEDICON 2010 2010[9] J.M. Stellman (ed.), 1998. Encyclopaedia of occupational health and safety, Volumen 1;Volumen 5. Geneva: International Labour Office