Decision support at home (DS@HOME) - system architectures and requirements

Background: Demographic change with its consequences of an aging society and an increase in the demand for care in the home environment has triggered intensive research activities in sensor devices and smart home technologies. While many advanced technologies are already available, there is still a lack of decision support systems (DSS) for the interpretation of data generated in home environments. The aim of the research for this paper is to present the state-of-the-art in DSS for these data, to define characteristic properties of such systems, and to define the requirements for successful home care DSS implementations. Methods: A literature review was performed along with the analysis of cross-references. Characteristic properties are proposed and requirements are derived from the available body of literature. Results: 79 papers were identified and analyzed, of which 20 describe implementations of decision components. Most authors mention server-based decision support components, but only few papers provide details about the system architecture or the knowledge base. A list of requirements derived from the analysis is presented. Among the primary drawbacks of current systems are the missing integration of DSS in current health information system architectures including interfaces, the missing agreement among developers with regard to the formalization and customization of medical knowledge and a lack of intelligent algorithms to interpret data from multiple sources including clinical application systems. Conclusions: Future research needs to address these issues in order to provide useful information - and not only large amounts of data - for both the patient and the caregiver. Furthermore, there is a need for outcome studies allowing for identifying successful implementation concepts.