Capture and Reuse of Knowledge in ICT-based decisional

13 Pages·2009·0.55 MB·English

by  Antoniu Stefan

Informatica Economică vol. 13, no. 4/2009 11
Capture and Reuse of Knowledge in ICT-based Decisional Environments

Ioana Andreea STĂNESCU1, Florin Gheorghe FILIP2
1Advanced Technology Systems, Târgovişte, Romania
2Romanian Academy, Bucharest, Romania
[email protected], [email protected]

Health care practitioners continually confront with a wide range of challenges, seeking to
making difficult diagnoses, avoiding errors, ensuring highest quality, maximizing efficacy and
reducing costs. Information technology has the potential to reduce clinical errors and to im-
prove the decision making in the clinical milieu. This paper presents a pilot development of a
clinical decision support systems (CDSS) entitled MEDIS that was designed to incorporate
knowledge from heterogeneous environments with the purpose of increasing the efficiency
and the quality of the decision making process, and reducing costs based on advances of in-
formation technologies, especially under the impact of the transition towards the mobile
space. The system aims to capture and reuse knowledge in order to provide real-time access
to clinical knowledge for a variety of users, including medical personnel, patients, teachers
and students.
Keywords: Clinical Decision Support Systems, Knowledge Management, Knowledge Interop-
erability, Mobile Interface, Object-relational Mapping

1 Introduction is important because it allows users to under-
Clinical decision support systems (CDSS) stand that even if a system is categorized to
are computer systems designed to impact cli- include decision support capabilities, they
nician decision making about individual pa- might be retrospective type systems that were
tients at the specific point in time when these not designed to assist clinicians at the point
decisions are made [1]. With the increased of care.
focus on the prevention of medical errors, The main characteristics that differentiate
CDSS have the potential to change the way CDSS refer to the timing at which they pro-
medicine has been taught and practiced. vide support (before, during, or after the
CDSS have been shown to improve both pa- clinical decision is made) and how active or
tient outcomes, as well as the cost of care. passive the support is, respectively whether
There are a variety of systems that can poten- the CDSS can actively provide alerts or pas-
tially support clinical decisions and decision sively responds to physician input or patient-
support systems have been incorporated in specific information.
health-care information systems for a long CDSS also vary in terms of how easy a busy
time, but usually these systems have sup- clinician can access it or whether the infor-
ported retrospective analyses of financial and mation provided is general or specialty-
administrative data [2] [3]. They provide based. In this perspective, technology accep-
support for financial decisions, but they do tance models need to be considered. There is
not facilitate knowledge acquisition and re- also a tendency to incorporate CDSS in com-
use. puter-based patient records and physician or-
In the recent years, complex data mining ap- der entry systems.
proaches have been proposed for similar ret- Another categorization scheme for CDSS is
rospective analyses of both administrative whether they are knowledge-based systems,
and clinical data. These retrospective ap- or non-knowledge-based systems that em-
proaches can be used to develop guidelines, ploy machine learning and other statistical
critical pathways or protocols to guide deci- pattern recognition approaches.
sion making at the point of care, but they are
not considered to be CDSS. This distinction
12 Informatica Economică vol. 13, no. 4/2009
2 Knowledge-based Clinical Decision Sup- user.
port Systems The knowledge base contains compiled in-
Organizations are no longer valued solely for formation that, most of the times, is in the
what they have done – but the potential of form of if-then rules. For example, IF a new
what they might be able to do. This, organ- order is made for a particular blood test that
izational managers will be valued for their tends to change very slowly, AND IF that
ability to leverage knowledge to make un- blood test was ordered within the previous 48
parallel advances in their organization’s abil- hours, THEN alert the physician [9]. This
ity to innovate, compete and connect with the rule is designed to prevent duplicate test or-
actors of the environment they activate in so dering.
that they can collaborate in decision-making The inference engine contains the formulas
[4] [5]. The promise and interest in knowl- for combining the rules or associations in the
edge management is not in knowing, but in knowledge base with actual patient data.
being able to act creatively based on what The communication mechanism represents a
you know and you are able to access. Innova- way of entering patient data into the system
tion results from knowledge that it why it is and getting the output of the system to the
important to consider the infrastructure be- user that has the role of the decision maker.
hind knowledge management. The raw goods Based on previous developments, CDSS can
of intellectual property – experience and incorporate data that were already entered in
know-how – must be channeled and made electronic form. Outputs to the clinicians can
available; otherwise innovation can be ham- consist of recommendations or alerts.
pered [6]. This is a very real problem for CDSS can be developed to assist a variety of
many organizations. decisions. For example, diagnostic decision
Many knowledge-based CDSS were devel- support systems can provide a list of poten-
oped within expert systems research [5] [7], tial diagnoses, based on the patient’s signs
as medicine was considered a good domain and symptoms. The knowledge base of the
in which these concepts could be applied. decision support system contains information
The developers of these systems aimed to about diseases and their signs and symptoms.
adapt them in order to use them more easily The inference engine maps the patient signs
to support real-life patient care processes. and symptoms and can provide suggestions
Some of them were diagnostic decision sup- for diagnoses that can help the clinician to
port systems that did not intend just to simu- better his decisions. In most cases, the system
late expert decision making, but to assist the generates alternatives, and the clinician will
clinicians in their own decision making proc- eliminate some of the choices, based on his
ess. The system did not provide the answer to experience and because he usually knows
a problem, but aimed to provide information more about a patient that the system [10].
for the user. It was the user that had to filter Other systems can provide support for medi-
the information and to exclude erroneous or cation orders, which represent a significant
useless information. The user played an ac- cause of medical errors. For example, the pa-
tive role and he was not just a passive recipi- tient’s laboratory test results for the blood
ent of the output the system provided. This level of a prescribed medication can consti-
focus on the interaction of the user with the tute the input for the system. The knowledge
system and also with other users of the sys- base might contain values for therapeutic and
tem is very important in order to set appro- toxic blood concentrations of the medication
priate expectations for the way the system and rules on what should be done when a
will be used. toxic level of the medication is reached. If
CDSS comprise three main components: the medication level is too high, the system
- the knowledge base; can send an alert to the physician and he can
- the inference engine; react accordingly.
- a mechanism to communicate with the Health care practitioners continually confront
Informatica Economică vol. 13, no. 4/2009 13
a wide range of challenges, seeking to make that has been developed as a pilot project in
difficult diagnoses, avoid errors, ensure high- order to explore the potential of computer as-
est quality, maximize efficacy and reduce sisted decision making in clinical environ-
costs. Patients and the public have many ments.
questions and needs in evaluating their health MEDIS addresses the new challenges
and the decision making process also re- brought forth by the need to provide real-
quires help. The array of choices and the time feedback to decision makers, and it has
many factors that affect a decision are more been designed to provide multi-dimensional
complex and require detailed knowledge. assistance to various categories of users, such
Advances of information technologies pro- as medical personnel, patients, teacher or
vide the necessary background for the over- students.
coming these obstacles, yet the prospect of The main objectives of the knowledge-based
using computers in decision support systems CDSS comprise the following:
has turned to be a much harder problem than - to make knowledge easier to capture and
has initially been appreciated. Even the sim- reuse:
ple forms of decision support require large by facilitating real-time, structured access
o
scale efforts to go from an initial implemen- to information and knowledge, in desktop
tation that aimed to show the effectiveness of and mobile environments, regarding pa-
the system in particular application settings tients, diseases and treatments, anytime
to having the ability to provide ongoing man- and anywhere, the decision-making
agement of decision support in the same set- process benefits of an overall improve-
tings. It is also necessary to move from that ment;
capability to wider development beyond a - to foster optimal problem-solving, deci-
single application, within the same or differ- sion-making and action by its users, in
ent institutions. This becomes a greater prob- regard to:
lem when the aim expands to include re- treatment options for clinical problems,
o
gional or national adoption of the system, customized for each patient, assisting
even for limited aspects of health, such as medical personnel in taking the best deci-
appropriate utilization of imaging proce- sion; the system signal incompatibilities
dures. between the patient record and the pre-
Challenges that are manageable with some scribed treatment, reducing the number of
effort in a single environment become much medical errors;
more difficult in a multi-institutional setting learning activities carried out within med-
o
[3]. They relate to maintenance and update of ical educational institutes; teacher and
the knowledge underlying decision support; students can access the knowledge data-
managing the corpus of knowledge, in terms base and they can use it during the learn-
of conflicts, overlaps and gaps; establishing ing process to obtain sustainable qualifi-
the best ways to deploy various forms of de- cations;
cision support [4] [7], in terms of their inte- secured access to clinical data for pa-
o
gration with practice and impact on effi- tients; each patient can access his own
ciency and workflow; and disseminating records and the physician’s recommenda-
knowledge that has been well established so tions.
that it can be reused in multiple sites, making The primary task of the system is to select
such knowledge platform-independent. Ad- knowledge that is pertinent and/ or to process
dressing this last challenge is essential to lev- data to create the pertinent knowledge. This
eraging knowledge and making the financial feature is improved as the system can make
effort worth on a broad scale. the selection based on patient-specific data.
This increases the relevance of the system to
3 The main features of the MEDIS system the individual patient. The selection of
MEDIS is a clinical decision support system knowledge and processing of data involve in-
14 Informatica Economică vol. 13, no. 4/2009
ferencing processes, algorithms, rules or as- dresses the medical personnel, which
sociation methods. The main results of the benefit of access customized by compe-
system are to perform some actions, and usu- tency area. For example, a physician can
ally they refer to making recommendations. access only the data of his patients.
Potential users: - a private section with restricted rights
The user of the clinical decision support sys- that can be used by patients, companies
tem include physicians, nurses, laboratory and other institutions to access own data
technicians, pharmacists, patients, teachers, or by teachers and students in practice-
students or other individuals that are inter- based learning environments. The system
ested in accessing medical information. In provides confidentiality of patient data as
some cases, the user may be another software follows: The data base can be accessed
application. The setting are various and they only by obtaining a username and a pass-
can refer to problems that arose in clinical word. The patient can access only their
practice, a health maintenance/ prevention personal data, while the learning actors
care question of a patient, or a training/ edu- can access exclusively information re-
cational exercise. garding diagnoses, treatments, receipts,
Components etc.
a. authorization - a public section that present general in-
The system provides three different types of formation and medical news, which can
access based on: be accessed directly through the web ap-
- a private section with full rights that ad- plication.

Fig. 1. Authorization in the system

b. The system provides extensive data man- process as the data base stores informa-
agement: tion on medication and the incompatibili-
- patient management that comprises the ties between them and certain diseases
full history of a patient, including treat- (figure 3);
ments, diseases, contraindications, restric- - treatment management based on which
tions, recommendations, etc (figure. 2); the system send automatic alerts to the
- diseases management that contains de- physician in case it identifies incompati-
tailed information, recommendations, bilities between the prescription, the his-
knowledge and reasoning, which can be tory of the patient’s treatments and the
accessed through advanced search options prescribed medication (figure 4);
based on symptoms; - prescription management associated with
- medicine management that support users patient visits to the physician, with allows
in improving their decision making the latter to synchronize the previously
Informatica Economică vol. 13, no. 4/2009 15
prescribed treatments with the patient ject-oriented data bases, increasing accessi-
evolution. bility and lowering costs for knowledge ac-
quisition. As gathering knowledge does not
reach its maximum efficiency unless it is
paired with powerful search options, MEDIS
combines the two components with the pur-
pose of enriching users’ experience when in-
teracting with the system.

Fig. 2. Patient management Fig. 4. Treatment management

One of the most important functionality of
the systems refers to its search options (fig-
ure 5) that facilitate easy access to informa-
tion and knowledge and can provide real-
time support for the system’s users.
- Simple: by word or phrases;
- Advanced: by multiple words, using the
or and no operators.

Fig. 5. Search options

Fig. 3. Medicine management
d. comment options
c. search functions The system provides comment options as
MEDIS collects knowledge generated in het- aims to capture timely contextual generated
erogeneous environments. The database knowledge and facilitate its reuse, by pro-
backend is based on Hibernate, thus the sys- moting a permanently updated set of knowl-
tem can incorporate both relational and ob- edge that support clinical decision making.
16 Informatica Economică vol. 13, no. 4/2009
The comments can be private or public. mobile technologies.
e. statistical functions In order to facilitate quick access for inter-
The system facilitates data extraction and ventions in ambulatory circumstances, the
syntheses, generating statistics and charts by system allows access directly to the patient’s
predefined and customized criteria, which al- medical records by scanning a two dimen-
lows managers, administrators and users to sional barcode printed on the patient’s health
evaluate the system. card.
f. mobile graphical user interface Because the patient’s medical records contain
The system can be accessed on handheld de- sensitive information, the link contained in
vices, such as PDAs, XDAs, smart phones, the 2D bar code can only be accessed by us-
iPhones. This increases accessibility and ers who have already been authenticated in
provides support for decision making in am- the system as users with full access rights.
bulatory environments. Thus, the system As the number of Internet connections and
provides real-time assistance anytime, any- especially of wireless connections increases
where and constitutes an innovative approach rapidly, such a development takes benefits of
to CDSS [11] based on the use of advances in the latest access technologies.

Fig. 6. Mobile interface

4 Delivering web content to mobile devices desktop capabilities, in term of size displays
Given the same URL (Fig.6) used to access and browsing software, if they are accessed
our web application, one can easily observe on a mobile device these results in a poor or
the difference between: unusable experience, as pages are not laid out
- Mobile browser configured in mobile as intended [13]. Because of the limited
view mode; screen size and the limited amount of mate-
- Mobile browser configured in desktop rial that is visible to the user, context and
view mode; overview are lost and the page usually re-
- Mobile browser configured in one column quires considerable scrolling to be visible,
mobile view mode with full screen. especially if the top of the page is occupied
Designing applications or web sites for mo- by images and navigation links. In these
bile phones remains a challenge and the de- cases the user gets no immediate feedback as
velopment of mobile application has to con- to whether their retrieval has resulted in the
sider certain standards and recommendations right content. It is particularly important in
[12]. the mobile context to help the users create a
When Web pages are specially designed for mental image of the site, by adopting a con-
Informatica Economică vol. 13, no. 4/2009 17
sistent style that can be considerably dimin- - Keep the URIs of site entry points short:
ished by an uneven style. The web site should be designed with
Delivery of content to mobile devices re- quick URIs that can take the user to a
quires solid customization in the attempt to specific page based on the content ID. For
encourage users to become mobile. The de- example, the user can access the address
velopers of the MEDIS system have consid- http://news.mobi/45123 and be automati-
ered the following recommendations: cally taken to the article with ID 45123.
- Maintain thematic experience for content - Provide minimal navigation at the top of
accessed from different devices: content the page: The navigation menu should be
should be kept similar, no matter if it is designed to occupy little space; at the
accessed from desktop or mobile devices, same time designers should provide links
so that users can access it easily and feels to the most important pages. It is proba-
comfortable in the mobile virtual space. bly best if content is structured hierarchi-
- Exploit device capabilities for an en- cally to provide the content hierarchy
hanced user experience: mobile devices leading to the current page.
provide different functions, based on the - Provide a balance structure: mobile ap-
market share they target; these functions plication designers should not include a
should be exploited to a maximum in or- large number of links at the top of the
der to provide an enriched experience for mobile web site; users are encouraged to
the mobile user and encourage the user to become mobile when they need to access
assimilate mobile technologies. Thus, de- as much content as possible, as quickly as
velopers should adopt an adaptive design possible.
by detecting device characteristics and - Provide consistent navigation mecha-
tweaking the user interface. By adapting nisms: designers should preserve the same
the system and/or the content to support navigation mechanism across a service to
specific functions of a device or group of allow users to identify them easier and
devices, the users obtain better experi- feel comfortable with the mobile envi-
ences. ronment.
- Provide solutions for deficient implemen- - Assign access keys to links in naviga-
tations: This refers to differences in in- tional menus and frequently accessed
terpretation between browsers and also functionality: easy access is a top priority
deficiencies in implementation caused by in the mobile world; users would enjoy
non-support of mandatory features. The the mobile experience, if they can access
system should be able to adapt itself in information with just ‘a single click’.
case it encounters clients that do not re- - Avoid pop-ups: pop-ups or other informa-
spect defined standards, or lack part of tive windows can affect the quality of the
the standard implementation. Most of the interaction, reducing the attractiveness of
time, there are workarounds that can be the web site.
used in order to obtain the same result as - Use of clear and simple language. Users
in standard browsers. in a mobile environment expect specific
- Test on actual devices: because of the and accurate pieces of information or
vast number of models and of differences knowledge, rather than browsing. They
between mobile devices presents on the usually access mobile knowledge when
market today, it is best to test the website they really would like to find specific in-
on as many different phone models as formation, at a specific moment, maybe
possible, in order to obtain a sustainable even for an urgent matter. Extensive read-
system development. Sometimes the ing will discourage the user and make
browser implementation can differ greatly them give up on the experience. Audio
for the same phone model, depending of options can be provided for extensive
the firmware version installed. texts.
18 Informatica Economică vol. 13, no. 4/2009
- Provide correspondence between size of extra setup at the beginning. It negotiates a
page and device capabilities: the reduced secure channel, and then it sends normal
memory of mobile devices can limit ac- HTTP over that channel (11, 15).
cess to content from a various range of Security objectives in general terms fall into
mobile devices. one or more of the following objectives:
- One direction scrolling: Users can im- - access control: to assure that the person
prove the comprehension of a text and or the computer at the other end of the
eagerness to use mobile browsers, if they session is permitted to do what he/ it asks
don’t have to scroll in all directions and for;
loose coherence. - authentication: to assure that the resource
- Avoid large or high resolution images: (human or machine) at the other end of
As mobile devices present limited storage the session really is what it claims to be;
capacity, images should be resized at the - integrity: to assure that the information
server, to avoid unwelcomed experiences that arrives is the same as when it was
- Avoid using tables or frames: Due to sent;
screen limitation, tables and frames rarely - accountability: to assure that any transac-
fit. To avoid incomprehensible display, it tion that takes place can subsequently be
is better to avoid tables that contain many proved to have taken place. Both the
rows and columns, or frames; otherwise sender and the receiver agree that the ex-
the information cannot be accesses prop- change took place (also called non-
erly. repudiation);
- Error handling: when errors occur, users - privacy: to assure that sensitive informa-
need to be able to understand what has tion is not visible, usually carried out by
happened and also how they deal with the encryption.
problem; otherwise they might get reluc- The security objectives remained the same
tant and give up on the experience. along years, but their environment has ex-
- Avoid free text entry and provide pre- panded with the advanced of technology to
selected default values: To compensate more complex circumstances and interac-
the reduced size of most mobile devices, tions, bringing forth new challenges. Today,
users need to be able to use access keys users expect to be able to access data se-
for an easier navigation in a mobile curely no matter where they are and remote
browser. Also, in designing for small de- connections require extra qualifications. Al-
vices, speech input is a viable alternative though, in recent years, in terms of Internet
for devices too small for extra buttons. access the developments of the mobile tech-
The design and the development of MEDIS nologies have begun to fill the gap between
for the mobile world has required sound ad- mobile devices and the desktop computers,
aptation to the basic environmental condi- there are still many differences between how
tions that restrict wide usage, in order to pro- content is rendered in mobile web browsers
vide enriched user experience. and on desktop computers due to hardware,
software and physical device constraints.
5 Secure mobile World Wide Web connec- With this in mind, the best way to create a
tion friendly web experience for the mobile users
At the core of every web application is the is to create customized context, specially
fact that all of its functionalities are commu- adapted to the device specifications.
nicated using Hypertext Transfer Protocol Mobile content developers have to take into
(HTTP), and its results are typically format- account the wide variety of mobile browsers
ted in HyperText Markup Language and operating systems that are available on
(HTML). The only difference between HTTP the market today. While high-end devices
and Hypertext Transfer Protocol Secure with operating systems such as iPhone OS,
(HTTPS) is that an HTTPS connection has Windows Mobile, Android, and Symbian are
Informatica Economică vol. 13, no. 4/2009 19
better equipped to handle Rich Internet Ap-
App Java EE
plications (RIA), they only comprise a small
number of the mobile device market mostly
JBoss App Java SE
due to the high costs of such devices. In or-
der to make the make the content accessible
Java Runtime Environment
to as many users as possible, designers of
mobile web applications need to maintain a
Java Virtual Machine
delicate balance between the features that
they provide to end users and the features
that they require from the device. Operating System
In order to access data using a mobile web
interface, the developers have used an en-
Central Processing Unit
cryption data connection. In this way, no
third party is able to intercept the communi- Fig. 7. Development platform for MEDIS
cation between the client and the server.
HTTPS is a protocol that encrypts and encap- 7 Hibernate as a persistence solution
sulates normal HTTP traffic using SSL (Se- Most significant development projects in-
cure Sockets Layer). volve a relational database. The mainstay of
Data encryption and client authentication are most application is the large-scale storage of
done through the use of PKI certificates is- information [17] [18]. With the advent of
sued to each client and installed in the SIM World Wide Web, the demand for databases
card of the mobile device. Besides the nor- has increased. While the demand for such
mal data encryption application, issuing self- applications has grown, their creation has not
owned client certificates allows developers to become noticeable simpler. The persistence
embed them into the SIM cards and there- models suffer to a certain degree from the
fore, they can prevent any attempts to copy mismatch between the relational model and
the private key and allows them to easily re- the object-oriented model, making database
voke client certificates in case a mobile de- persistence difficult.
vice is stolen or lost. Computer-based systems used in clinical en-
vironments require a considerable and sus-
6 Development technologies tainable amount of storage. More than this,
MEDIS was developed using Java. Unlike the existing information and knowledge
native applications that access directly the abounds, but they were created in heteroge-
operating systems and the hardware re- neous environments, requiring sound inter-
sources, Java applications are executed by a operability.
virtual machine (JVM - Java Virtual Ma- The developers of MEDIS have used Hiber-
chine). Thus, they are isolated from a direct nate as the database backend because it sup-
exterior contact and they can access only ports inheritance relationships and various
Java libraries or the functions of the virtual other relationships between classes.
machine [16]. The virtual machine contains The use of JDBC requires a substantial body
the Java Runtime Environment that repre- of code and careful observation of various
sents all the standard functions and libraries rules, such as that governing connection
provided by Java. Java desktop applications management, to ensure that the application
(Java SE) are executed directly and function does not leak resources [19].
similar to any desktop application, while Java Hibernate does not require the mapping of
EE Application require an application Server one POJO (Plain Old Java Object) to one ta-
(JBoss) that acts as a Web server (figure 7). ble, as it allows storage of POJOs in the da-
tabase. Figure 8 [20] shows how Hibernate
fits into the application between the client
code and the database.
20 Informatica Economică vol. 13, no. 4/2009
other “POJO friendly” mechanism [23].
Hibernate presents no problems when han-
dling serializable POJOs.
There is a very large body of pre-existing
code. Any Java object capable of being per-
sisted to a database is a candidate for Hiber-
nate persistence [24]. Therefore, Hibernate is
a natural replacement for ad hoc solutions, or
as the persistence engine for an application
that has not yet had database persistence in-
corporated into it. Furthermore, by choosing
Hibernate persistence, developers are not ty-
ing themselves to any particular design deci-
sions for the business objects in their applica-

tion,
Fig. 8. The role of Hibernate in a Java appli-
One of the benefits often presented for Hi-
cation
bernate is that it is a “thin” solution [25].

Thus, Hibernate does not require an applica-
The direct persistence of traditional Java ob-
tion server to operate. It is therefore applica-
jects is object-relational mapping, which re-
ble in client-side applications.
fers to mapping the objects in Java to the re-
Also Hibernate makes use of an inordinate
lational entities in the database. POJOs can
number of supportive libraries. If we are to
be any Java object at all. Hibernate allows
consider the download times and disk space
the developers to persist POJOs with few
of an applet, Hibernate seems to be some-
constraints.
thing large, but in these days of fast connec-
The sole condescension to Hibernate is the
tions and considerable disk space, it is
provision of a private default constructor.
unlikely to be a deciding factor [26] [27].
Hibernate demands that all POJOs to be

stored should provide a default constructor.
8 Value-added in the field of CDSS
A POJO can be constructed out of a selection
MEDIS is a system that provides a practice
of table columns, or several POJOs can be
oriented approach to knowledge interopera-
persisted into a single table.
bility and management. The main advantages
Although there is some performance over-
that the system brings to the decisional envi-
head while Hibernate starts up and processes
ronment translate into the following direc-
its configuration files, it is generally per-
tions:
ceived as being a fast tool. In Hibernate it is
The system proposes an optimized flow that
possible to specify the mappings at develop-
aims to sustain the relationship between the
ment time [21] [22].
decision factor and the expert knowledge, by
Hibernate persistence has no requirement for
the use of information technologies, in terms
a J2EE application server or any other spe-
of knowledge management and interoperabil-
cific environment. It is, therefore, a much
ity and real-time access to knowledge. As it
more suitable solution for stand-alone appli-
is a web-based system, access to knowledge
cations, client-side application storage, and
is facilitated anytime, anywhere. The mobile
other environments in which a J2EE server is
graphical user interface increase access op-
not immediately available.
portunities and expands usage in ambulatory
Hibernate uses POJOs that can be very easily
interventions.
and naturally generalized for the use in other
MEDIS comprises different dimensions of
applications. There is no direct dependency
the decisional process at it addresses both to
upon the Hibernate libraries, so POJOs can
medical personnel, patients and student ac-
be put to any use that does not require persis-
tivities. This approach provides intercon-
tence, or they can be persisted using any