title: Autonomic care platform for optimizing query performance.
abstract: BACKGROUND
  As the amount of information in electronic health care systems increases, data operations get more complicated and time-consuming. Intensive Care platforms require a timely processing of data retrievals to guarantee the continuous display of recent data of patients. Physicians and nurses rely on this data for their decision making. Manual optimization of query executions has become difficult to handle due to the increased amount of queries across multiple sources. Hence, a more automated management is necessary to increase the performance of database queries. The autonomic computing paradigm promises an approach in which the system adapts itself and acts as self-managing entity, thereby limiting human interventions and taking actions. Despite the usage of autonomic control loops in network and software systems, this approach has not been applied so far for health information systems.
  
  
  METHODS
  We extend the COSARA architecture, an infection surveillance and antibiotic management service platform for the Intensive Care Unit (ICU), with self-managed components to increase the performance of data retrievals. We used real-life ICU COSARA queries to analyse slow performance and measure the impact of optimizations. Each day more than 2 million COSARA queries are executed. Three control loops, which monitor the executions and take action, have been proposed: reactive, deliberative and reflective control loops. We focus on improvements of the execution time of microbiology queries directly related to the visual displays of patients' data on the bedside screens.
  
  
  RESULTS
  The results show that autonomic control loops are beneficial for the optimizations in the data executions in the ICU. The application of reactive control loop results in a reduction of 8.61% of the average execution time of microbiology results. The combined application of the reactive and deliberative control loop results in an average query time reduction of 10.92% and the combination of reactive, deliberative and reflective control loops provides a reduction of 13.04%.
  
  
  CONCLUSIONS
  We found that by controlled reduction of queries' executions the performance for the end-user can be improved. The implementation of autonomic control loops in an existing health platform, COSARA, has a positive effect on the timely data visualization for the physician and nurse.
authors.forename: Kristof
authors.initials: K
authors.lastname: Steurbaut
authors.affiliation: Department of Mathematics and Computer Science, University of Antwerp - iMinds, Middelheimlaan 1, 2020 Antwerp, Belgium. steven.latre@uantwerpen.be.
authors.forename: Steven
authors.initials: S
authors.lastname: Latré
authors.forename: Johan
authors.initials: J
authors.lastname: Decruyenaere
authors.forename: Filip
authors.initials: F
authors.lastname: De Turck
mesh_terms: D003628:Database Management Systems / Q000592:standards*; D063005:Health Information Systems / Q000592:standards*; D006801:Humans; D016247:Information Storage and Retrieval / Q000592:standards*; D007362:Intensive Care Units / Q000592:standards*