Implementing Real-Time Clinical Decision Support Applications on OpenICE: A Case Study Using the National Early Warning System Algorithm

This paper presents the design and implementation of a software application, called MEWS, that implements the Royal College of Physician's National Early Warning (scoring) System on the OpenICE interoperable platform. The MEWS app, as a real-time clinical decision support (RT-CDS) application, does not require the use of an Electronic Health Record System to support its operation. Instead, it is able to receive patient vital sign measurements from any patient physiological monitoring device connected to OpenICE, irrespective of the device manufacturer. Based on the received vital signs, MEWS calculates an overall score indicating the monitored patient's current status and is intended to direct clinicians to patients showing signs of deteriorating conditions and hence needing immediate intervention. The implementation and deployment of the MEWS app on OpenICE presents a preliminary step to understand the challenge of establishing (data) interface protocols to enable medical device interoperability generally, and for RT-CDS applications in particular, and to establish requirements for bridging the gap of current industrial standardization activities in addressing this challenge.