title: Development and validation of a portable platform for deploying decision-support algorithms in prehospital settings.
abstract: BACKGROUND
  Advanced decision-support capabilities for prehospital trauma care may prove effective at improving patient care. Such functionality would be possible if an analysis platform were connected to a transport vital-signs monitor. In practice, there are technical challenges to implementing such a system. Not only must each individual component be reliable, but, in addition, the connectivity between components must be reliable.
  
  
  OBJECTIVE
  We describe the development, validation, and deployment of the Automated Processing of Physiologic Registry for Assessment of Injury Severity (APPRAISE) platform, intended to serve as a test bed to help evaluate the performance of decision-support algorithms in a prehospital environment.
  
  
  METHODS
  We describe the hardware selected and the software implemented, and the procedures used for laboratory and field testing.
  
  
  RESULTS
  The APPRAISE platform met performance goals in both laboratory testing (using a vital-sign data simulator) and initial field testing. After its field testing, the platform has been in use on Boston MedFlight air ambulances since February of 2010.
  
  
  CONCLUSIONS
  These experiences may prove informative to other technology developers and to healthcare stakeholders seeking to invest in connected electronic systems for prehospital as well as in-hospital use. Our experiences illustrate two sets of important questions: are the individual components reliable (e.g., physical integrity, power, core functionality, and end-user interaction) and is the connectivity between components reliable (e.g., communication protocols and the metadata necessary for data interpretation)? While all potential operational issues cannot be fully anticipated and eliminated during development, thoughtful design and phased testing steps can reduce, if not eliminate, technical surprises.
authors.forename: A T
authors.initials: AT
authors.lastname: Reisner
authors.forename: M Y
authors.initials: MY
authors.lastname: Khitrov
authors.forename: L
authors.initials: L
authors.lastname: Chen
authors.forename: A
authors.initials: A
authors.lastname: Blood
authors.forename: K
authors.initials: K
authors.lastname: Wilkins
authors.forename: W
authors.initials: W
authors.lastname: Doyle
authors.forename: S
authors.initials: S
authors.lastname: Wilcox
authors.forename: T
authors.initials: T
authors.lastname: Denison
authors.forename: J
authors.initials: J
authors.lastname: Reifman
mesh_terms: D000465:Algorithms; D020000:Decision Support Systems, Clinical; D006761:Hospitals; D006801:Humans; D012984:Software; D055986:Vital Signs
keywords: Decision-support algorithms; combat casualty care; device connectivity; prehospital care; vital-sign data