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Proposal AIPHER
Proposal AIPHER
Proposal AIPHER
Pilot
AIPHER
Artificial intelligence to predict hospital emergency readmissions
ASHO CSAPG
https://www.asho.net/ https://www.csapg.cat/
15/11/2022
Spain/Barcelona
www.hosmartai.eu
Open Call 2: Annex 3.1 – Proposal Template
Table of Contents
TABLE OF CONTENTS........................................................................................................................................ 1
LIST OF TABLES ................................................................................................................................................ 1
1. OVERVIEW OF THE PROPOSAL (MAXIMUM 1 PAGE) ............................................................................... 2
1.1 EXECUTIVE SUMMARY .................................................................................................................................... 2
2. EXCELLENCE & INNOVATION (MAXIMUM 3 PAGES + 1 PAGE FOR IMAGE(S)) ......................................... 3
3. IMPACT & EXPLOITATION (MAXIMUM 2 PAGES) .................................................................................... 6
4. EXPERTISE AND EXCELLENCE OF THE TEAM (MAX. 2 PAGES) .................................................................. 8
5. PROJECT PLANNING AND VALUE FOR MONEY (MAXIMUM 3 PAGES) ................................................... 10
5.1 MAIN ACTIVITIES OF THE PROJECT ................................................................................................................... 10
5.2 VALUE FOR MONEY ...................................................................................................................................... 12
APPENDIX A ANNEX: ETHICAL/SECURITY CHECKLIST ............................................................................... 12
List of Tables
TABLE 1: CONSORTIUM COMPOSITION. ............................................................................................................................................... 2
TABLE 3: PROPOSED TEAM ................................................................................................................................................................... 8
TABLE 5: PERSON-MONTH AND PERSONNEL COSTS .......................................................................................................................... 12
TABLE 6: TOTAL BUDGET .................................................................................................................................................................... 12
TABLE 7: ETHICAL ISSUES.................................................................................................................................................................... 13
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Open Call 2: Annex 3.1 – Proposal Template
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Open Call 2: Annex 3.1 – Proposal Template
Current scenario
Currently, a physician discharges a patient when they consider that the patient is out
of danger. The physician is not supported by any specific tool to make this decision, merely
by its own knowledge and the results of the tests performed on the patient. This way to
work results in an average of 5% of patients being readmitted to the Emergency
Department within 72h (own data) and up to 20% within 30 days (literature data).
The availability of a risk marker showing the likelihood of a patient being readmitted
within 30 days would greatly help emergency doctors to reassess certain types of
patients. To date, when a patient is discharged from the hospital, the main
recommendation is to visit the primary care physician. Nonetheless, it is confirmed that this
measure does not work very well as a follow-up of patients. This project aims not only
study the predictive capacity of the algorithm but also the protocol and the most effective
way to present this information in the workflow.
AIPHER will result in a very attractive and promising technology for hospitals, however,
this system must be capable to automatically access all the structured data of the patient
being discharged. Another important barrier that this algorithm will find is the predictive
capability of the algorithm and how the particularization (re-training) to hospital patient
profiles works. These challenges will be taken into account during the project and
effective mitigation measures put in place.
Envisioned scenario
This technology based on artificial intelligence (AI) algorithms will be used as a predictor
in healthcare facilities by assessing the possibilities of patient’s readmissions in hospital.
The end-user, CSAPG, intends to implement the technology developed by ASHO in its
emergency room’s exit. When a patient is admitted into the hospital via the emergency
room, the algorithm will collect patients’ data from the hospital’s Electronic Health Records
(including clinical history but also demographic and socio-economic data (cmbd)) and
monitor its diagnostic and progression. Once a patient is discharged from hospital, the
algorithm will use the patient’s data to predict whether the patient is likely to return to
the emergency room within the next 30 days. This predictive tool will be very helpful to
emergency doctors, allowing to revaluate certain types of patients. When a doctor will
receive a warning that a patient is at risk of readmission, the doctor will have mainly 4
different options: ignore the warning (unlikely if the algorithm is working well), revert the
discharge (a very extreme option), recommend a visit with the primary care physician or
directly make an appointment, and recommend hospital follow-up, by means of calls or
home visits (which could also be done by primary care).
AIPHER will provide a support tool in a scenario where one currently does not exist
but is very much needed: a risk marker for ED patients being discharged.
To achieve this objective, AIPHER will use the storage platform and algorithm service of
ACUMOS AI. A platform that allows to algorithm designers to share their algorithms with
anyone who has access permissions. Thus, hospitals and healthcare facilities could obtain
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Open Call 2: Annex 3.1 – Proposal Template
the technology license and access, benefiting from this technology in their hospitals and
facilities.
Technical approach
AIPHER will be integrated into the ACUMOS AI storage and service platform from
HosmartAI. The minimum required machines for running ACUMOS AI for docker-compose
method on Ubuntu 16.04 are: an application server with docker engine and a DB server
with Marida DB 10.2. To assure the well-functioning of this technology, AIPHER will need
32 CPU Cores (16 CPU Core-VM and 16 CPU DB-VM) with a memory of 64GB and
100GB of disk size each one.
Importantly, AIPHER will have some important challenges and barriers to defeat. An
AI process that follows best practices requires three datasets: train, test and validation.
Therefore, it will be necessary to retrain the algorithm with CSAPG’s EHR and also to fine-
tune the model for the hospital in question, it means, to find the hyperparameters that
work better in this specific case. The different phases will serve to obtain the necessary
datasets to complete the process with best practices. In summary, this system must be
capable to access hospital's data and all the structured data of the patient that is being
discharged.
Access to CSAPG’s patient database and the subsequent retraining will also allow AIPHER
to surmount another challenge: achieving significant accuracy. ASHO has been working
on this algorithm for a long time and to date, has already validated the technology in a
laboratory (TRL4). The algorithm’s accuracy was, however, limited by the scope of the
available data: Our AIPHER is based on Graph Neural Networks (GNN), a design
architecture that tends to work much better with higher quantities of data. ASHO has
achieved an accuracy of 75% working with a limited and partially incomplete database
of 800 patients, as obtaining patient data outside of a specific partnership with a hospital
is quite difficult due to ethical and legal concerns. However, we expect reaching an
accuracy of >85% after retraining in phase I with CSAPG’s database of hundreds of
thousands of patients. Implementing and training the AIPHER algorithm locally in the
hospital will entirely remove most of the legal and ethical concerns, as the patient data
will never leave the hospital’s information system.
CSAPG will significantly benefit from this predictive tool that will allow to reduce the
number of patients that will return to the emergency room in the next 30 days, and
therefore, allowing to reduce health care costs of readmissions.
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Open Call 2: Annex 3.1 – Proposal Template
Gender approach
Sex (as biological aspect) and gender (as socio-cultural aspect) are aspects that are
involved to the health and disease differences among individuals, therefore, must be
considered in any research project in the health domain. HIT has demonstrated the
potential of reducing sex and gender biases by effectively integrating sex and gender
differences during its design and learning processes. AIPHER will avoid gender biases by
considering both sex and gender dimensions, in the design of the algorithm, data collection
and analysis. Thus, the gender dimension approach will be included at all stages of the
project, providing equal opportunities for the equal participation of women and men, and
non-binary in project participants and involved workers. Furthermore, gender-inclusive
language will be used to avoid gender discrimination.
Therefore, human participants and workers of the involved entities will ensure gender/sex
balance and also no discrimination by ethnicity and socio-economic status, giving the same
opportunities for all individuals and assuring inclusiveness.
Images/schemes
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Open Call 2: Annex 3.1 – Proposal Template
Exploitation potential
The success and lasting impact of AIPHER depend on 1) the effective communication of the
benefits/usability of the AIPHER technology to the relevant audience (clinicians, hospital
managers, healthcare facilities…), stakeholders (e.g. public authorities) and general
audience; 2) AIPHER results being tailored and targeted to the specific needs of the
different practitioners and stakeholders, and then delivered in an appropriate, accessible
and easy-to-use format. For that reason, a good communication, dissemination and
exploitation strategy are needed to reach the maximum target audience and obtain the
maximum possible benefits. Exploitation activities will be developed during the evaluation
phase (phase III) with the aim is to provide business support that promotes the exploitation
of project outcomes. This phase will consider a business strategy and exploitation plan,
stakeholder impact, complete market analysis, direct and indirect competitor analysis,
scalability potential and dissemination activities from report. Dissemination strategy will
aim to raise awareness about the project’s ongoing activities, and transfer the knowledge
and results generated to the target audience. All results will be disseminated to the
healthcare sector, stakeholders and general audience via multiple approaches: press
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Open Call 2: Annex 3.1 – Proposal Template
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Open Call 2: Annex 3.1 – Proposal Template
Data analysis
ASHO Gonzalo Algorithm N/A M
Hernández development
Ortega
Data mining
ASHO Jordi García Technical system https://es.linkedin.com/in/j M
Carreras support ordi-garcia-carreras-
49ba83119
ASHO Julio César Technical system https://es.linkedin.com/in/j M
Tortosa support ulio-cesar-tortosa-
Garballo garballo-49376151
CSAPG Alejandro Clinical study design https://www.csapg.cat/pr M
Rodriguez and Principal ofessionals/recerca/equip
Molinero Investigator /1/alejandro-rodriguez
CSAPG Carlos Pérez Data processing https://www.csapg.cat/pr M
López Responsible ofessionals/recerca/equip
/4/carlos-perez
CSAPG Mariano Responsible for the https://www.linkedin.com/i M
Gutiérrez Coello integration of the n/marianogutierrezcoello/
algorithm into the ?originalSubdomain=es
hospital's systems
CSAPG Clarissa Fieldwork N/A F
Catalano coordinator
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Open Call 2: Annex 3.1 – Proposal Template
- Julio César Tortosa Garballo (informatician) is an expert on SQL data access, PHP, and JS
languages, Linux Server (console), TCP/IP Networking, VPN, RDP, Web Server.
ASHO is a national leader in the provision of hospital discharge coding services and automatic
coding of outpatient processes such as Emergency, Outpatient, Day Hospital, in which training,
teamwork and innovation is the core value, with the aim of earning the trust of customers through
a good work.
CSAPG is a public entity created on April 1, 2019, with the aim of responding to the health and
social needs of our reference population, through the implementation of hospital, care,
preventive, rehabilitative, teaching and research activities. CSAPG manage the Alt Penedès
Regional Hospital (headquarters), the Sant Camil Residence Hospital, the Sant Antoni Abat
Hospital and the Rehabilitation Center.
ASHO and CSAPG cover the necessary roles, providing solid partners and the adequate
scientific competences to the level of ambition of the project. In addition, ASHO and CSAPG
have already worked cooperatively in other projects. ASHO will be the technology providers
in this project and CSAPG will have a role of an end-user by implementing in their facilities the
technology developed by ASHO.
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Open Call 2: Annex 3.1 – Proposal Template
Deliverables: D1 Report with a detailed Pilot Plan with a description of the setup
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Open Call 2: Annex 3.1 – Proposal Template
Deliverables: D6 Report of the project’s pilot development results and its operating system,
Task 2: Installation of the algorithm into the Sant Camil Residence Hospital and upload on ML
ACUMOS platform (M3)
ASHO will install the algorithm in one of the CSAPG hospitals to test pilot. CSAPG will bring access
to ASHO to all electronic medical records of the hospital.
Task 3: Retrain the algorithm with real data from incoming patients and implementation (M4-
M5)
The designed algorithm by ASHO will obtain data from incoming patients to emergency department
in Sant Camil Residence Hospital and will adjust the developed model with real incoming patients’
data.
Deliverables: D8 Internal report with all patient’s data to collect, D10 Internal report of algorithm
adjustments with patients’ data
Deliverables: D10 Report with all market associated activities ant the potential scalability of the
product.
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Open Call 2: Annex 3.1 – Proposal Template
will make sure HosmartAI’s contribution to the product’s development is acknowledged at every
point.
Deliverables: D11 Dossier of attended events/meetings (dates, participant, place, contribution). and
scientific papers published.
Impact and Outputs of the 3rd phase
List main Milestones: M.3 Presentation of final dossiers on all communication and dissemination
performed activities.
List main KPIs: 1) Number of scientific articles to be published, 2) Presentations in events (webinar,
online meetings, campaigns, science festivals, conferences...), 3) Audio-visual tools to show results of
the project, 4) Social networks used to disseminate project results, 5) Expected number of visits to
your websites, 6) Participations in radio and television programs, 7) Number of presentations at
outreach events, and 8) Number of press releases.
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Appendix A Annex: Ethical/Security Checklist
Table 5: Ethical issues
YES/NO
Informed Consent
• Does the proposal involve children? YES
• Does the proposal involve patients or persons not able to give consent? YES
• Does the proposal involve adult healthy volunteers? NO
• Does the proposal involve Human Genetic Material? NO
• Does the proposal involve Human biological samples? NO
• Does the proposal involve Human data collection? YES
Research on Human embryo/foetus
• Does the proposal involve Human Embryos? NO
• Does the proposal involve Human Foetal Tissue / Cells? NO
• Does the proposal involve Human Embryonic Stem Cells? NO
Privacy
• Does the proposal involve processing of genetic information or personal data NO
(e.g. health, sexual lifestyle, ethnicity, political opinion, religious or
philosophical conviction)
• Does the proposal involve tracking the location or observation of people? NO
Research on Animals
• Does the proposal involve research on animals? NO
• Are those animals transgenic small laboratory animals? NO
• Are those animals transgenic farm animals? NO
• Are those animals cloned farm animals? NO
• Are those animals nonhuman primates? NO
Research Involving Developing Countries
• Use of local resources (genetic, animal, plant etc) NO
• Benefit to local community (capacity building i.e. access to healthcare, NO
education etc)
Dual Use
• Research having direct military application NO
• Research having the potential for terrorist abuse NO
ICT Implants
• Does the proposal involve clinical trials of ICT implants? NO
I CONFIRM THAT NONE OF THE ABOVE ISSUES APPLY TO MY PROPOSAL YES/NO
Security