The PICASO project will improve cooperation and exchange of knowledge between professional caregivers in health, rehabilitation and social care domains and actively include patients and their relatives in the integrated care settings thus supporting patient empowerment and self-care (the safe hand-off). The project implements blockchain technology to support distributed electronic patient records and cloud service orchestration to support an holistic and integrated care approach

1. PICASO - A Personalised, Integrated Care ApproachPICASO - A Personalised, Integrated Care Approach
Visions
Objectives
Major Innovations
Technological Approach

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Health care costs in EuropeHealth care costs in Europe
Costs of health care relative to GDP in the EU, 2006
Comparison of EU-27 health care expenditure projections

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Deficits in Communication and Information Transfer Between Hospital-Deficits in Communication and Information Transfer Between Hospital-
Based and Primary Care PhysiciansBased and Primary Care Physicians
• Direct communication between hospital physicians and primary care
physicians occurred infrequently (3%-20%).
• The availability of a discharge summary at the first post-discharge visit was
low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the
quality of care in approximately 25% of follow-up visits and contributing to
primary care physician dissatisfaction
• Discharge summaries often lacked important information such as
diagnostic test results (missing from 33%-63%), treatment or hospital
course (7%-22%), discharge medications (2%-40%), test results pending at
discharge (65%), patient or family counselling (90%-92%), and follow-up
plans (2%-43%)
Source: Sunil Kripalani, MD, AMA. 2007;297(8):831-841. doi:10.1001/jama.297.8.831

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Vision – Four Pillars to Better and Cheaper HealthcareVision – Four Pillars to Better and Cheaper Healthcare
• will improve cooperation and exchange of knowledge between
professional caregivers in health, rehabilitation and social care domains
and actively include patients and their relatives in the integrated care
settings thus supporting patient empowerment and self-care (the safe
hand-off);
• will reinforce medical knowledge and create new care models for
management and treatment of patients with multi-morbidity conditions;
• will bring about improvements in health outcomes, daily activities, and
quality of life of older persons with multi-morbidities by personalising care
management programmes to specific characteristics of the patients'
profiles and support adherence to care plans at the point of need;
• will allow more cost-effective care management through increased skills
and collaboration of care professionals and more automated and efficient
workflows, which eventually will lead to better health outcome and a
reduction in hospitals admissions, and thus contributing significantly to the
sustainability of health and social care systems in Europe.

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The PICASO Overall Cloud ConceptThe PICASO Overall Cloud Concept

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Decomposition of Information and Care SpacesDecomposition of Information and Care Spaces

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PICASO – Major Technological InnovationsPICASO – Major Technological Innovations
• Care Plan Execution: Service Formalism and Dynamic Orchestration
• Multi-Morbidity Care Management: Constraint Satisfaction Problem Solving
• Care Integration: Cloud Federation and Data Management
• Data Security: Authentication and Knowledge Discovery

8. PICASO Innovation: Service Orchestration for Care Plan ExecutionPICASO Innovation: Service Orchestration for Care Plan Execution

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Service Formalism and Dynamic OrchestrationService Formalism and Dynamic Orchestration
Create a new approach to integrated care based on the concepts of dynamic
service narratives that define the content and sequence of care services to be
launched in order to perform clinical logistics in care plans that span across a
multi-actor, multidisciplinary environment.
Dynamically orchestrate services for personalised health, therapies and social care
with decision support for multi-actor interaction and enabling patients and
relatives to become active participants.
Create a Care Management system based on dynamic design of complex care
plans guided by narratives using goal-driven heuristic search and with secure
authentication of patients and carers involved.
Develop a Service Orchestration framework that orchestrates and executes care
narratives across a multitude of care platforms providing event detection and
processing and incorporating risk assessment based on risk prediction models and
contextual situation awareness, which can be used for decision support for
professional and non-professional cares.

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Narratives – Computer Aided Healthcare WorkflowsNarratives – Computer Aided Healthcare Workflows
• The aim of ‘narratology’ can be defined as that of producing an in-depth
description of the ‘syntactic/semantic structures’ of the narratives. The
narratologist is in charge of dissecting narratives into their component
parts in order to establish their functions, their purposes and the
relationships among them.

11. PICASO Innovation: Constraint Satisfaction Problem Solving to supportPICASO Innovation: Constraint Satisfaction Problem Solving to support
Multi-Morbidity Care ManagementMulti-Morbidity Care Management

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Constraint Satisfaction Problem SolvingConstraint Satisfaction Problem Solving
Provide multi-actor, multi-disciplinary integration platform with tools for the
interpretation of patients’ health status in their physical care space, with the aim to
dynamically adjust the content and sequence of the delivered care services so it
always is adapted to their personal health and behavioural status.
Create a decision support methodology for analysing conflicts, constraints and
limitations from single-morbidity care plans and patient/physician/therapist
preferences applied to patients with co-morbidities and multi-morbidity conditions
by using the concept of constraint satisfaction problem, to allow the cares to define
new care programmes for the management of co-morbidities in community and
home care settings.

13. PICASO Innovation: Care Integration based on Federated Cloud ServicesPICASO Innovation: Care Integration based on Federated Cloud Services

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Cloud Federation and Data ManagementCloud Federation and Data Management
• Develop new training programmes for the care workforce, new organisational models
and new ways of exchanging medical information to improve the coordination of care
management across silos.
• Develop a robust, privacy compliant, cloud based Resource Management system that
can perform acquisition of physiological and behavioural data in non-clinically controlled
care spaces, taking into account the variability in the population in order to provide
carers with realistic situational awareness.
• Develop a Data Management framework for secure, privacy compliant, and role based
information sharing based on distributed shared memory and tuple object spaces
allowing carers to share patient information and exchange knowledge across care
networks using intuitive, interactive ad-hoc information search.
• Develop TOSCA Service Templates to support interoperability and application
interoperability on cloud environments

15. TOSCA Topology and Orchestration Specification for CloudTOSCA Topology and Orchestration Specification for Cloud
ApplicationsApplications
• How to describe software applications and its dependencies to run in a
cloud.
• Service Templates describes available capabilities
• Application requirements are matched against templates
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16. Basic Tosca PrinciplesBasic Tosca Principles
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17. PICASO Innovation: Data Sharing, Security and Privacy based onPICASO Innovation: Data Sharing, Security and Privacy based on
BlockchainBlockchain

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Authentication and Knowledge DiscoveryAuthentication and Knowledge Discovery
• Provide role based access for carers to distributed shared data and exchange of
knowledge about the patient’s status in an intuitive collaborative platform.
• Develop a Data Management framework for secure, privacy compliant, and role based
information sharing based on distributed shared memory and tuple object spaces
allowing carers to share patient information and exchange knowledge across care
networks using intuitive, interactive ad-hoc information search.
• Develop a log-oriented architecture based om blockchain technology to support
distributed and shared electronic journals

19. Shared & secure access with the BlockchainShared & secure access with the Blockchain
• Originally developed for the Bitcoin system (Nakamoto)
• A distributed (replicated) transaction ledger
– A shared transaction/data log
– Focus on privacy, sharing, identity and ownership
– Replicated, immutable, encrypted IDs
• Now being promoted for various app domains
– Supply chain mgmt, contracts, eHealth, …
• Baseline tech:
– Linux Hyperledger project
• https://www.hyperledger.org/
• Parties: IBM (Open Blockchain), Ethereum,…
• Other refs: CACM Sept 15 and Lamport et al. July 82 (”Byzantine generals
problem”)
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20. Blockchain for PICASOBlockchain for PICASO
• A candidate implementation for the Shared Memory/Tuple Space concept
in the Data Management subset
• Shared patient data ledger(s)
– Care System Private Cloud – Patient Private Cloud
• Issues
– Will it meet security & privacy requirements ?
– Legal & ethical considerations ?
– Open source (Hyperledger)
– …
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21. PICASO BlockchainPICASO Blockchain
03/30/16 Picaso Project Overview 21
Blockchain

22. Blockchain architectureBlockchain architecture
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PICASO PartnersPICASO Partners