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Using a multiagent organizational approach to improve knowledge provision for shared decision making in patient-physician relationships: an example from Germany

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Abstract

An integral aspect of sound patient centric healthcare delivery is the notion of shared decision making between patient and provider. This paradigm is well documented in the extant literature. However, what appears to be a stumbling block to date is successfully implementing such an approach within established healthcare processes. This void is causing problems in healthcare delivery in particular in EU countries such as Germany because knowledge sources are distributed and underlie strict privacy policies; while the lack of adequate shared decision making compromises the quality of healthcare delivery and can lead to errors and inefficient workflow. This paper which is based on an extensive research project serves to analyze the provision of personal guidance services for shared decision making in eHealth service networks. By doing so, we address the problem of distributed and privacy-aware knowledge sharing by the formation of agent-based organizations to represent the relationships of patients and physicians and study this problem from the perspective of multiagent systems; i.e., we develop technology enabled collaboration solutions. The efficacy of the proffered decision support system will be demonstrated by a scenario-based evaluation. We contend that such an approach will address the current void.

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Notes

  1. The eHealthMonitor project (contract no. FP7-287509, http://www.ehealthmonitor.eu).

  2. This article expands the following conference paper: M. Schuele, T. Widmer, M. Premm, M. Criegee-Rieck and N. Wickramasinghe, “Improving Knowledge Provision for Shared Decision Making in Patient-Physician Relationships – A Multiagent Organizational Approach”, Proceedings of the 47th Hawaii International Conference on System Sciences, pp. 646–655, 2014.

References

  1. Hartman M, Martin A, McDonnell P, Catlin A. National health spending in 2007: slower drug spending contributes to lowest rate of overall growth since 1998. Health Aff. 2009;28(1):246.

    Article  Google Scholar 

  2. Berwick DM. Disseminating innovations in health care. JAMA. 2003. doi:10.1001/jama.289.15.1969.

    Google Scholar 

  3. Duckett S, Willcox S. The Australian health care system (4th Revised edition.). Oxford University Press, 2011.

  4. Tang PC, Overhage JM, Chan AS, Brown NL, Aghighi B, Entwistle MP, et al. Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial. J Am Med Inform Assoc. 2013;20(3):526–34. doi:10.1136/amiajnl-2012-001263.

    Article  Google Scholar 

  5. Wickramasinghe N, Schaffer J. Realizing value driven e-health solutions. Report for IBM. Washington DC, 2010.

  6. Sulaiman H, Wickramasinghe N. Assimilating healthcare information systems in a Malaysian Hospital. Commun Assoc Inf Syst (CAIS. 2014;34:1291–318.

    Google Scholar 

  7. André B, Inger Ringdal G, Loge JH, Rannestad T, Laerum H, Kaasa S. Experiences with the implementation of computerized tools in health care units: a review article. Int J Hum Comput Interact. 2008;24(8):753–75. doi:10.1080/10447310802205768.

    Article  Google Scholar 

  8. Bernstein ML, McCreless T, Côté MJ. Five constants of information technology adoption in healthcare. Hosp Top. 2007;85(1):17–25. doi:10.3200/HTPS.85.1.17-26.

    Article  Google Scholar 

  9. Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010;10(1):231. doi:10.1186/1472-6963-10-231.

    Article  Google Scholar 

  10. Culnan MP. Armstrong, information privacy concerns, procedural fairness and impersonal trust: an empirical investigation. retrieved from http://citeseer.ist.psu.edu/viewdoc/summary?doi=10.1.1.40.5243, 1997.

  11. HFMA. Overcoming barriers to electronic health record adoption: results of survey and roundtable discussions conducted by the healthcare financial management Association. Retrieved from http://mhcc.maryland.gov/electronichealth/mhitr/EHR%20Links/overcoming_barriers_to_ehr_adoption.pdf, 2006.

  12. Kennedy BL. Exploring the sustainment of health information technology: successful practices for addressing human factors. Prescott Valley: Northcentral University; 2011.

    Google Scholar 

  13. Liu LS, Shih, Hayes GR. Barriers to the adoption and use of personal health record systems. Analysis, 2011; 363–370. doi:10.1145/1940761.1940811

  14. Thweatt EG, Kleiner BH. New developments in health care organisational management. J Health Manag. 2007;9:433–41. doi:10.1177/097206340700900308.

    Article  Google Scholar 

  15. Trudel MC. Challenges to personal information sharing in interorganizational settings: learning from the Quebec health smart card project. London: The University of Western Ontario; 2010.

    Google Scholar 

  16. Deloitte . National E-Health Strategy. Australian Government Department of Health and Ageing. 2008. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/national+Ehealth+strategy

  17. Fiscella K, Geiger HJ. Health information technology and quality improvement for community health centers. Health Aff. 2006;25(2):405–12.

    Article  Google Scholar 

  18. Gill N. The impact of e-Health adoption and investment on health outcomes: a study using secondary analysis. Toronto: University of Toronto; 2010.

    Google Scholar 

  19. Häyrinen K, Saranto K, Nykänen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform. 2008;77(5):291–304. doi:10.1016/j.ijmedinf.2007.09.001.

    Article  Google Scholar 

  20. NHHRC. A Healthier Future for All Australians: National Health and Hospitals Reform Commission - Final Report June 2009. Australian Government Department of Health and Ageing. 2009a. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/nhhrc-report

  21. NHHRC (2009b). Future for all Australians: national health and hospitals reform commission-final report June. Australian Government Department of Health and Ageing 27Jul.

  22. Wiljer D, Urowitz S, Apatu E, DeLenardo C, Eysenbach G, Harth T, et al. Patient accessible electronic health records: exploring recommendations for successful implementation strategies. J Med Internet Res. 2008;10(4):e34. doi:10.2196/jmir.1061.

    Article  Google Scholar 

  23. Elwyn G, Edwards A. Shared decision-making in health care: achieving evidence-based patient choice. 2nd ed. Oxford: Oxford University Press; 2009.

    Google Scholar 

  24. Lyons A, Richardson S. Clinical decision support in critical care nursing. AACN Clin Issues. 2003;14(3):295–301.

    Article  Google Scholar 

  25. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. BMJ. 2005;330(7494):765.

    Article  Google Scholar 

  26. Légaré F, Turcotte S, Stacey D, Ratté S, Kryworuchko J, Graham ID. Patients’perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice. Patient. 2012;5(1):1–19.

    Article  Google Scholar 

  27. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–92.

    Article  Google Scholar 

  28. Jennings N. On agent-based software engineering. Artif Intell. 2000;117:277–96.

    Article  MATH  Google Scholar 

  29. Isern D, nchez, Moreno A. Agents applied in health care: a review, Int J Med Inform. 79, no. 3, Elsevier, Ireland, 2010- pp. 145–166.

  30. Silverman BG, Andonyadis C, Morales A. Web-based health care agents: the case of reminder and todos, too (R2Do2). J Artif Intell Med. 1998;14(3):295–316.

    Article  Google Scholar 

  31. Huang J, Jennings NR, Fox J. Agent-based approach to health care management. Appl Artif Intell Int J. 1995;9(4):401–20.

    Article  Google Scholar 

  32. Kaplan SH, Greenfield S, Ware JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease”. Med Care. 1989;27(3 Suppl):110–27.

    Article  Google Scholar 

  33. Zhang P, Carlsson B, Johansson SJ. Enhance collaboration in diabetic healthcare for children using multi-agent systems. Int J Agent-Oriented Softw Eng. 2010;4(2):155–73.

    Article  Google Scholar 

  34. Author citation (removed for review)

  35. The Oxford Dictonary of English. 2nd edition. OUP Oxford, 2005.

  36. Luhmann N. Organisation und Entscheidung. Opladen, 2000.

  37. Cyert RM, March JG. A behavioral theory of the firm. Blackwell, 1963.

  38. Kirn S, Herzog O, Lockemann P, Spaniol O, editors. Multiagent engineering. Berlin: Springer; 2006.

    Google Scholar 

  39. Ferber J, Gutknecht O, Michel F. From agents to organisations: an organisational view of multi-agent systems. AOSE 2003 (Giorgini, P., Müller, J.P. and Odell, J.J. Eds.). LNCS, vol. 2935, Springer, Heidelberg, 2004, pp. 214–230.

  40. Fuehrer EC, Ashkanasy NM. The virtual organization: defining a weberian ideal type from the inter-organizational perspective. In Proceedings of the annual meeting of the academy of management, 1998.

  41. Barbuceanu M and Fox MS. The information agent: an infrastructure agent supporting collaborative enterprise architectures. In Proc 3rd IEEE workshop on enabling technologies: infrastructure for collaborative enterprises, Morgantown, 1994; pp. 112–116,

  42. Fischer K, Müller J, Heimig I, Scheer A. Intelligent agents in virtual enterprises. In Proceedings of 1st international conference on the practical application of intelligent agents and multi agents technology, 1996; pp. 205–223.

  43. Jain A, Aparicio IV M, Singh MP. Agents for process coherence in virtual enterprises. Commun ACM. 1999;42(3):62–9.

    Article  Google Scholar 

  44. Tambe M, Pynadath DV, Chauvat N. Building dynamic agent organizations in cyberspace. IEEE Internet Comput. 2000;4(2):65–73.

    Article  Google Scholar 

  45. Petersen S, Gruninger M. An agent-based model to support the formation of virtual enterprises. In International ICSC symposium on mobile agents and multi-agents in virtual organisations and E-commerce, 2000.

  46. Petersen SA. Virtual enterprise formation and partner selection: an analysis using case studies. Int J Netw Virtual Organ. 2007;4(2):201–15.

    Article  Google Scholar 

  47. Horling B, Lesser V. A survey of multiagent organizational paradigms. Knowl Eng Rev. 2004;19:281–316.

    Article  Google Scholar 

  48. IOM (Instiute of Medicine) et al. Crossing the quality chasm: a new health system for the 21st centruy. Washington: National Academy Press; 2001.

    Google Scholar 

  49. Duncan E, Best C, Hagen S. Shared decision making interventions for people with mental health conditions. Cochrane Database of Syst Rev. no. 1, 2010.

  50. Greenfield S, Kaplan SH, Ware JE, Yano EM, Frank HJ. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3(5):448–57.

    Article  Google Scholar 

  51. Kaplan SH, Greenfield S. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;110(3 Supp).

  52. Author citation (removed for review), 2012.

  53. Bratman ME, Israel J, Pollack ME. Plans and resource-bounded practical reasoning. Comput Intell. 1988;4:349–55.

    Article  Google Scholar 

  54. W3C: Web Ontology Language (OWL), http://www.w3.org/2004/OWL/

  55. Hevner AR, March ST, Park J, Ram S. Design science in information systems research. MIS Q. 2004;28(1):75–105.

    Google Scholar 

  56. Spiegel R, Brunner C, Ermini-Fünfschilling D, Monsch A, Notter M, Puxty J, et al. A new behavioral assessment scale for geriatric out- and in-patients: the NOSGER (Nurses’ Observation Scale for Geriatric Patients. J Am Geriatr Soc. 1991;39(4):339–47.

    Article  Google Scholar 

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Acknowledgments

This work has been supported by the eHealthMonitor project (http://www.ehealthmonitor.eu) and has been partly funded by the European Commission under contract FP7-287509. Authors Michael Schuele, Tobias Widmer, Marc Premm, and Manfred Criegee-Rieck have received research grants from the eHealthMonitor project. Author Nilmini Wickramasinghe is a member of the advisory board of the eHealthMonitor project.

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Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. University of Hohenheim, Stuttgart, Germany

    Michael Schuele, Tobias Widmer & Marc Premm

  2. Friedrich-Alexander University of Erlangen-Nuernberg, Nuernberg, Germany

    Manfred Criegee-Rieck

  3. Epworth HealthCare & RMIT University, Richmond, Australia

    Nilmini Wickramasinghe

Authors
  1. Michael Schuele
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  2. Tobias Widmer
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  3. Marc Premm
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  4. Manfred Criegee-Rieck
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  5. Nilmini Wickramasinghe
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Correspondence to Michael Schuele.

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Schuele, M., Widmer, T., Premm, M. et al. Using a multiagent organizational approach to improve knowledge provision for shared decision making in patient-physician relationships: an example from Germany. Health Technol. 5, 13–23 (2015). https://doi.org/10.1007/s12553-015-0102-6

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