Design of ICU medical decision support applications by integrating service oriented applications with a Rule-based system

The ICU of Ghent University Hospital is currently evaluating a Service-Oriented Architecture (SOA) that supports physicians in the follow-up of patients by providing a number of medical support services. The main idea behind SOA is the separation of the functions of the system into well-defined, independent, reusable and distributable services. However, sometimes physicians require a more specific or slightly different functionality than the existing services offer. In these situations the system architecture imposes the time-consuming and error-prone development and testing of a new service. To counter this, a framework was developed that integrates a Rule-based component with the existing SOA platform. This allows users to add new functionalities as easy understandable Rules. This integration can be constructed in two ways. In the database-driven approach the Rule-based system is an extra layer between the database and the services. The service-oriented approach, on the other hand, works with the data provided by the services and does not interact directly with the database. Both approaches are detailed and compared to each other. Both solutions were evaluated with a medical use case, namely detecting Systemic Inflammatory Response Syndrome (SIRS) in patients in the ICU.