title: A clinical decision-making mechanism for context-aware and patient-specific remote monitoring systems using the correlations of multiple vital signs.
abstract: OBJECTIVE
  In home-based context-aware monitoring patient's real-time data of multiple vital signs (e.g. heart rate, blood pressure) are continuously generated from wearable sensors. The changes in such vital parameters are highly correlated. They are also patient-centric and can be either recurrent or can fluctuate. The objective of this study is to develop an intelligent method for personalized monitoring and clinical decision support through early estimation of patient-specific vital sign values, and prediction of anomalies using the interrelation among multiple vital signs.
  
  
  METHODS
  In this paper, multi-label classification algorithms are applied in classifier design to forecast these values and related abnormalities. We proposed a completely new approach of patient-specific vital sign prediction system using their correlations. The developed technique can guide healthcare professionals to make accurate clinical decisions. Moreover, our model can support many patients with various clinical conditions concurrently by utilizing the power of cloud computing technology. The developed method also reduces the rate of false predictions in remote monitoring centres.
  
  
  RESULTS
  In the experimental settings, the statistical features and correlations of six vital signs are formulated as multi-label classification problem. Eight multi-label classification algorithms along with three fundamental machine learning algorithms are used and tested on a public dataset of 85 patients. Different multi-label classification evaluation measures such as Hamming score, F1-micro average, and accuracy are used for interpreting the prediction performance of patient-specific situation classifications. We achieved 90-95% Hamming score values across 24 classifier combinations for 85 different patients used in our experiment. The results are compared with single-label classifiers and without considering the correlations among the vitals. The comparisons show that multi-label method is the best technique for this problem domain.
  
  
  CONCLUSIONS
  The evaluation results reveal that multi-label classification techniques using the correlations among multiple vitals are effective ways for early estimation of future values of those vitals. In context-aware remote monitoring this process can greatly help the doctors in quick diagnostic decision making.
authors.affiliation: School of Science (Computer Science), RMIT University, Melbourne, Victoria 3001, Australia; National ICT Australia (NICTA), Australia. Electronic address: abdur.forkan@rmit.edu.au.
authors.forename: Abdur Rahim Mohammad
authors.initials: ARM
authors.lastname: Forkan
authors.affiliation: School of Science (Computer Science), RMIT University, Melbourne, Victoria 3001, Australia; National ICT Australia (NICTA), Australia.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khalil
mesh_terms: D000465:Algorithms; D001364:Awareness; D000066491:Clinical Decision-Making; D006801:Humans; D008991:Monitoring, Physiologic
keywords: Clinical decision support system; Context-aware monitoring; Multi-label classification; Personalized healthcare; Vital signs