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Management of the complex chronically ill patient is highly problematic. This is due to the need to complement recommendations in clinical guidelines with recommendations based on treatments performed on a representative set of patients. It is necessary to identify conflicts between the recommendations of different guidelines designed for handling specific chronic diseases. The PITeS-TIiSS project (code PI15/01213) aims to overcome this problem by designing and deploying an ontology-based personalized clinical decision support tool. This helps to improve personalized decisions and reduces variability in clinical practice in an integrated care environment. This paper describes the methodology followed in developing the ontology used to infer clinical knowledge and to develop and implement the support tool. The tool will access the information provided by the Electronic Health Record of Andalusian Health Public Service, the main healthcare provider in a region in Spain with more than eight million inhabitants.

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The habits and lifestyles are the fundamental factors in the control of cardiovascular risk. Patients who have had a cerebrovascular accident (CVA) have a high risk of having a new event with similar characteristics. The exponentially growing success, penetration and adherence of the new communication technologies, based on applications (APPs), allows to use them to obtain information and influence the risk factors. We propose that empowering patients in their disease can make a more efficient management of it. For this reason, we designed and developed a system which integrates a mobile application and a web application. This system also makes use of peripheral devices to monitor patients and allow the automatic acquisition of information to enable the characterization of this kind of patients in relation to habits and lifestyle. At the same time, the system can also empower these patients with their disease to do secondary prevention.

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Nowadays diseases tend to chronicle, mainly due to the increase in life expectancy and this leads to a state of polypharmacy. More than 1.5% of Spain's GDP is spent on pharmaceuticals and healthcare products. Complex chronic patients (pluripathological and polymedicated) account for most of the expenditure. The "Action Group A1" of the European Innovation Partnership develops in the "Active and Healthy Ageing" programme actions to improve the quality of life and health outcomes of these patients. On the other hand, the PITeS TIiSS project develops decision support tools to improve this scenario. An ontology has been developed as a tool on adherence. The domain of this ontology is mainly focused on medication adherence and measurement methods. This ontology gathers the necessary knowledge about the domain allowing the use of the ontology as part for is possible.

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BACKGROUND: The Platform for Innovation in Medical and Health Technologies (ITEMAS) is a network of 66 healthcare centres focused on fostering innovation in medical and health technologies as an essential tool for increasing the sustainability of the Spanish healthcare system. The present research is focused on defining a formal representation that details the most relevant concepts associated with the creation and adoption of innovative medical technology in the Spanish healthcare system. METHODS: The methodology applied is based on the methontology process, including peer-review identification and selection of concepts from the ITEMAS innovation indicators and innovation management system standards. This stage was followed by an iterative validation process. Concepts were then conceptualised, formalised and implemented in an ontology. RESULTS: The ontology defined describes how relationships between employees, organisations, projects and ideas can be applied to generate results that are transferrable to the market, general public and scientific forums. Overall, we identified 136 concepts, 138 object properties and 30 properties in a five-level hierarchy. The ontology was tested and validated as an appropriate framework for calculating the ITEMAS innovation indicators. CONCLUSIONS: The consensus concepts were expressed in the form of an ontology to be used as a single communication format between the members of the ITEMAS network. Healthcare centres can compare their innovation results and obtain a better understanding of their innovation context based on the reasoning techniques of artificial intelligence. As a result, they can benefit from advanced analytical capabilities to define the most appropriate innovation policies for each centre based on the common experience of the large number of healthcare centres involved. The results can be used to create a map of agents and knowledge to show capabilities, projects and services provided by each of the participating centres. The ontology could also be applied as an instrument to match needs with existing projects and capabilities from the community of organisations working in healthcare technology innovation.

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