eduCRATE - A Virtual Hospital Architecture L crimioara - - PDF document

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eduCRATE- A Virtual Hospital Architecture

Lăcrimioara STOICU-TIVADARa, Vasile STOICU-TIVADARa1, Dorin BERIANa, Simona DRĂGANb, Alexandru ŞERBANa, Corina ŞERBANb a Politehnica University Timişoara, Romania b Victor Babeş University of Medicine and Pharmacy Timişoara, Romania 1 vasile.stoicu-tivadar@aut.upt.ro

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Objec&ves

A!new$so'ware$architecture!for!a!3D!immersive environment!–!for!simula1on!of!the!Medical(Prac+ce (student5pa7ent!interac7on)!in!Medical(Educa+on!– improving

• technical!and!func7onal!exper%se
• problem+solving!and!decision5making!skills
• interpersonal!and!communica%ons!skills
• team+based!competencies

but!applying!the!“primum&non&nocere”!principle !

The!suggested!architecture!solves$several!drawbacks!of the!exis7ng!solu7ons

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Medical(Educa+on ! ! ! !

matches(the(current(working style(of(the(young(genera+on whom!it!is!addressed

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Abilities Attitudes Aptitudes SIMULATION CENTER

Medical(Educa+on(.(simula+on

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Simulation - technique for practice and learning

• can replace and amplify real experiences with

guided ones often “immersive” in nature

• evoke or replicate substantial aspects of the real

world in a fully interactive fashion

• may facilitate the development of health

professionals’ knowledge, skills, and attitudes, whilst protecting patients from unnecessary risks

Lateef&F.&Simula.on1based&learning:&Just%like%the%real%thing. Journal&of&Emergencies,&Trauma,&and&Shock.&2010;&3(4):&3481 352. Ziv&A,&Erez&D,&Munz&Y,&Vardi&A,&Barsuk&D,&Levine&I,&et&al.&The Israel&Center&for&Medical&Simula.on:&a&paradigm%for%cultural change%in%medical%educa5on.&Academic&Medicine.&2006; 81(12):&109111097. Ziv&A,&Wolpe&PR,&Small&SD,&Glick&S.&Simula.on1based&medical educa.on:&an%ethical%impera5ve.&Simula.on&in&healthcare. 2006;&1(4):&2521256.

Medical(Educa+on(.(simula+on

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Medical(Educa+on(.(simula+on

Immersive(simula(on!pla,orms!that!replicate!the!clinical!environment promise!to!revolu(onize!medical!educa(on!by!enabling – !!!!an!enhanced!level!of!safety, – !!!!standardiza(on, – !!!!efficiency across!future!services(of(health0care(training Examples:

Imperial College London [Internet]. Game-based Learning for Virtual Patients in Second Life; [updated 2013; cited 2014 Jan 24]. Available from: https://www1.imperial.ac.uk/medicine/elearning/secondlife/ gamebasedlearning. Kuang Y, Jiang J. The Designing of Training Simulation System Based on Unity 3D. International Conference on Intelligent Computation Technology and Automation; 2011 Mar 28-29; Shenzen: China. Lewis J, Brown D, Cranton W, Mason R. Simulating visual impairments using the Unreal Engine 3 game engine. 1st International Conference on Serious Games and Applications for Health; 2011 Nov 16-18; Braga: Portugal. University of Brighton [Internet]. The Virtual Hospital; [updated 2011 Nov 11; cited 2014 Jan 24]. Available from: http://about.brighton.ac.uk/snm/news/2011/111129-virtual- hospital.php. Keele University [Internet]. Virtual Patient - Keele University; [updated 2013; cited 2014 Jan 24]. Available from: http://www.keele.ac.uk/pharmacy/vp.

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Interna'onal*Virtual*Medical*Educa'on

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Medical(Educa+on(–(simula+on

Virtual!Immersive!Environments!(VIEs)!3!advantages

• Prac7cing!real!world!skills!with!rich-feedback-in-a-safe

environment!that!does!not!impact!real!processes!or persons

• Mastering!a!technique,!behavior!or!method!through

guided-rehearsals!again!and!again!as!many!7mes!as!is needed

• Ability!to!prac7ce!in!the!virtual!environment!not

accoun5ng-loca5on-or-5me,!only!having!access!to!a computer

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Medical(Educa+on(–(new(tools

Cloud&compu*ng

scalable,!depending&on&the actual&needs!)!relieving!the ins1tu1ons!from!the burden!of!purchasing!and maintaining!technology

Cogni*ve&systems Internet&of&Things,&etc.

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Drawbacks)of)exis/ng)solu/ons

• Lack of flexibility
• Hard to edit
• No multilingual support (for most of them)
• Dependence on a VR provider
• Need of high speed Internet connection
• No support for expert systems, or other

extensions

• No possibility/hard to implement medical

protocols and guidelines

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To#solve#the#problems#.># a#new#approach:#eduCRATE

• #educa#on&&&HippoCRATEs
• &modern-services-in-educa3on
• &a&virtual&learning&environment

– &to&improve&decision4making capacity-and-associa3ve-logic – &providing&medical&students&the

• pportunity&to&simulate&actual

situa#ons&encountered&in&the medical&prac#ce&and&develop the&abili#es&to&work&safer-and more-efficient-as-future doctors.

#extending!learning(services possibili/es!in!medical educa0on ! #developing!innova/ve(skills in!advanced!technologies!# !cloud!and!mul0media

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Method

• case%based(learning!in!simulated!context

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• !crea1ng!interac1ve!clinical!scenarios!for

which!students!will!find!solu1ons – !for!posi1ve!diagnosis – !therapeu1c!management

based!on!3D(immersive(virtual(environments, Medical(Guidelines,(EHR,((and(Cloud(compu=ng

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Benefits

• the!Virtual!Hospital!(VH)!applica3on!5!framework!for

medical!training – at!the!highest!standards, – for!pa3ent!safety!and – error!management

• facilita3ng!collabora've*thinking
• increases*mo'va'on*and*self5confidence
• Technical*and*func'onal

exper'se!training

• Problem5solving*and!decision5

making!skills

• Interpersonal!and

communica'ons!skills!or!team5 based!competencies

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Technical)challenges

• management!and!development!of!complex

digital-and-interac0ve-content!based!on scenarios!using!avatars!helping!students!to train!on!a!casuis0c-extracted-from-the-real world,!emerging!in!VH

• !avatars-for-student-and-pa0ent,!scenery

elements,!textures,!etc.!for!realis<c representa<on!of!the!interac<ons!between students!and!pa<ents !

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Technical)challenges

(resource(consuming)

• models

provided!for pa0ents, students, consul0ng rooms,!tools, devices,!medical equipment!0!!a virtual!space!for simula4on!of medical!ac4vity

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Clinical'background

• interac(on*in!terms!of

medical!informa0on!1!based

• n
• !content!guidelines*and

medical*scenarios

• !the!electronic*healthcare

record!of!pa0ents!from!the current!clinical!prac0ce

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Novel&es

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• use of medical protocols and guidelines - with

standard representations - Arden, GLIF or Asbru

• performing simulations following a set of scenarios

defined in an external database, according to medical protocols and guidelines

• scenarios may be added or modified anytime, giving to the

project more flexibility compared with previous solutions, and can easily be adapted to any clinical scenario.

• multilingual capacity
• use of real eHR
• synchronisation of these with the 3D immersive

environment and the interaction with the students

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Cloud computing VR applications developing environment (Unity 3d) Guidelines editing and execution environment

(Arden Syntax/ EGADSS/CLIPS -

• pen source, Asbru/ASGAARD,

GLIF etc.)

An integrator development environment (Java)

Technologies

W.#Aigner,#K.#Kaiser,#S.#Miksch,#Visualiza7on#Methods#to#Support Guideline=Based#Care#Management.#Computer)based.Medical Guidelines.and..Protocols:.A.Primer.and.Current.Trends,#2008, pp.#140=159.

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Roles

• medical guidelines developers that implement the

medical scenarios

• editors of virtual reality
• administrators of patient medical data
• administrators of didactical activity

and

• Medical STUDENTS

Based on student activity -> reports in various forms 2D and 3D graphics particularly useful in self-assessment for progressive improvement of knowledge

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Sequence'Diagram'(par0ally)

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Cloud&compu*ng

IBM CloudBurst:

• Hardware
• Storage
• Networking
• Virtualization
• Service management

software

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Indicators+of+success

Short-term

• in terms of technology: the stability of the entire

system, robustness, degree of customization, degree to which avatars can hold the student's personality, speed, ubiquitous access to the databases

• in terms of education and healthcare: the dynamics of

learning, degree in which the system is student-centred (accessibility, usability, responsiveness, accuracy in matching guidelines and scenarios) Medium and long term

• better training expressed in
• better results of evaluation and
• better doctors for the future
• healthcare learning services supporting development
• f a new generation of doctors

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Development

• Medical academic staff defines a virtual interaction

scenario

• Together with a group of engineers, they translate the

scenario into medical guideline representation

• Physicians populate EHR with fictive patients records
• Engineers develop representation models and missing

actions

• Technical testing
• Medical validation
• Using system by a pilot group of medical students
• Conclusions and adjustments
• System uploaded to cloud
• Documenting in order to be used by others.

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Vision&for&the&future:&example &&&3&Cogni6ve&systems&related&to&eduCRATE

• !For!specific!contexts,!if!the!student/resident

encounters!some!issues,!the!system!may!give sugges%ons

• !Big!Data!available!in!hospitals!could!become

useful!scenarios,!automa%cally.generated!by!!the system

• !Guidelines!may!be!automa%cally.improved
• !Offering!an!automated.analysis!of!the!student’s

selecBon!path!and!its!consequences

• !Support!for!expert.systems
• !Cracking!the!language.barriers,!enhancing

accessibility

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CONCLUSIONS

Results:

• a!new)learning)method)and)environment,!with!original!features,!that!uses

technology,!for!a!real!need!to!train!future!doctors,!to!s6mulate!associa6ve thinking!and!decision:making.

• a!new)So4ware)System)Architecture,!based!on!cloud)compu9ng

technologies,!medical)guidelines!representa6on,!3D)immersive)virtual reality,!and!electronic)health)records

– provides!support!required!by!the!younger(genera*on,!cons6tu6ng!itself!as!an innova6ve!way!of!educa6on!in!medicine!:>!student.centred(learning. – the!“primum&non&nocere”!ethical!impera6ve!will!provide!the!framework!for pa6ent!safety!and!error!management.

Novelty:!flexibility!offered!by!integra6ng!the!medical!guidelines!and!the!EHR, in!contrast!with!the!current!rela6vely!inflexible!solu6ons. Advantages:

• From!the)educa9onal!point!of!view:!!new)and)modern)learning

environment

• From!the!medical!point!of!view:!!clinical!prac6ce!training)without

exposing)the)pa9ents)to)any)risk.!This!can!prepare!them!for!future!real clinical!situa6ons.

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Thank&you!

vasile.stoicu,-vadar@aut.upt.ro

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Medical(Logic(Module((MLM)–(Pelvian(Pain((Example)

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Imperial)College)London)[Internet].)Game5based)Learning)for)Virtual)Pa<ents)in)Second)Life;)[updated)2013;)cited)2014)Jan)24]. Available)from:)hJps://www1.imperial.ac.uk/medicine/elearning/secondlife/ gamebasedlearning.