The conceptual MADE framework for pervasive and knowledge-based decision support in telemedicine

Telemedicine systems are inherently distributed, but, especially in the context of the Internet-of-Things, their complete physical configuration may only be determined after design time by considering, for example, the individual patient's needs. Therefore, to enable pervasive and knowledge-based decision support to be provided in telemedicine, a conceptual framework was developed for modelling and executing clinical knowledge as networks of four types of concurrent processes: Monitoring (M), Analysis (A), Decision (D) and Effectuation (E). In this way, the required decision support functionality can, as presented in this article, be distributed at run-time by mapping different portions of the knowledge across the devices constituting the system. This MADE framework was applied to model a clinical guideline for gestational diabetes mellitus and to derive a prototype knowledge-based system that executes the resulting MADE network. Thus it is shown to support the full development trajectory of a telemedicine system, including analysis, design and implementation.