George Despotou

George Despotou
The University of Warwick · Institute of Digital Healthcare - Warwick Manufacturing Group

PhD

About

74
Publications
21,507
Reads
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402
Citations
Citations since 2017
38 Research Items
225 Citations
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20172018201920202021202220230102030405060
20172018201920202021202220230102030405060
Additional affiliations
September 2019 - present
The University of Warwick
Position
  • Professor (Associate)
September 2014 - September 2019
The University of Warwick
Position
  • Professor (Assistant)
January 2007 - September 2014
The University of York
Position
  • Research and Teaching Fellow

Publications

Publications (74)
Article
Full-text available
Introduction of IT in the health domain can potentially benefit the quality of the delivered healthcare, also contributing to increase safety. However health IT systems themselves can have safety implications and can result in accidents. Creating a safety case has been in practice in numerous domains and is starting to be adopted in the health IT d...
Article
Full-text available
The paper illustrates how event tree diagrams, used in safety engineering, can be applied to test the design of a healthcare service. Event tree diagrams can be employed to inform quantitative approaches to quality, by providing justification with respect to safety, of operational aspects to be monitored and measured.
Article
Full-text available
Digitally enabled healthcare services combine socio-technical resources to deliver the required outcomes to patients. Unintended operation of these services may result in adverse effects to the patient. Eliminating avoidable harm requires a systematic way of analysing the causal conditions, identifying opportunities for intervention. Operators of s...
Preprint
Full-text available
Background: Digital health applications can improve quality and effectiveness of healthcare, by offering a number of tools to patients, professionals, and the healthcare system. Introduction of new technologies is not without risk, and digital health applications are often considered a medical device. Assuring their safe operation requires, amongst...
Article
Full-text available
Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health...
Conference Paper
Introduction: CAREPATH is an Horizon 2020 funded project aiming to generate a digital health solution, supported by an information and communication technology infrastructure, for care based on the current best practice guidelines, optimizing it for specific regions and health systems, for treatment and management of multimorbid patients with mild...
Article
Full-text available
CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients' independence, quality...
Article
Full-text available
It is typical for many digital health research projects to develop IT architectures that will implement integrated care services that may also deliver interventions. As part of compliance with the requirements of the regulation, the components that are considered as a medical device will need to be classified to a medical device category. This is o...
Chapter
Full-text available
Background: CIGs languages consist of approach specific concepts. More widely used concepts, such as those in UMLS are not typically used. Objective: An evaluation of UMLS concept sufficiency for CIG definition. Method: A popular guideline is mapped to UMLS concepts with NLP. Results are reviewed to evaluate gaps, and appropriateness. Results...
Article
Full-text available
Digital health applications can improve quality and effectiveness of healthcare, by offering a number of new tools to users, which are often considered a medical device. Assuring their safe operation requires, amongst others, clinical validation, needing large datasets to test them in realistic clinical scenarios. Access to datasets is challenging,...
Chapter
Full-text available
Background: Artificial Intelligence (AI) has seen an increased application within digital healthcare interventions (DHIs). DHIs use entails challenges about their safety assurance. Exacerbated by regulatory requirements, in the UK, this places the onus of safety assurance not only on the manufacturer, but also on the operator of a DHI. Clinical Sa...
Chapter
Full-text available
Multimorbid patients are prescribed a number of medications in parallel, which may often interact with each other, resulting in adverse effects. However, clinical guidelines on prescription of medications predominantly focus on individual conditions do not consider the guidance in the context of other guidelines, resulting in conflicts. C3-Cloud is...
Article
Full-text available
Background: C3-Cloud is an integrated care ICT infrastructure offering seamless patient-centered approach to managing multimorbidity, deployed in three European pilot sites. Challenge: The digital delivery of best practice guidelines unified for multimorbidity, customized to local practice, offering the capability to improve patient personalizatio...
Article
Full-text available
Digital health interventions (DHIs) enable improvements in health strategy and address health system challenges. The World Health Organization provides a formal classification for DHIs. However, safety claims, about such interventions, vary in quality and are often vague as to how they are communicated between technical, clinical experts and stakeh...
Article
Full-text available
Background: Assurance of digital health interventions involves, amongst others, clinical validation, which requires large datasets to test the application in realistic clinical scenarios. Development of such datasets is time consuming and challenging in terms of maintaining patient anonymity and consent. Objective: The development of synthetic d...
Article
Full-text available
Background: Increasing numbers of intelligent healthcare applications are developed by analysing big data, on which they are trained. It is necessary to assure that such applications will be safe for patients; this entails validation against datasets. But datasets cannot be shared easily, due to privacy, and consent issues, resulting in delaying i...
Article
Full-text available
Background: New patient-centric integrated care models are enabled by the capability to exchange the patient's data amongst stakeholders, who each specialise in different aspects of the patient's care. This requires a robust, trusted and flexible mechanism for patients to offer consent to share their data. Furthermore, new IT technologies make it...
Article
Full-text available
Objectives: To explore nurses’ attitudes toward Joint Commission International (JCI) accreditation and its perceived impact on patient safety, as well as the perceived degree of implementation of the International Patient Safety Goals (IPSG), in tertiary care in South Korea. Methods: A cross-sectional observational study was conducted consisting of...
Article
Full-text available
Introduction: A growing share of the population in OECD countries is of age 65 and over, expected to reach 22% by 2030 (compared to 15% in 2010). Life expectancy has also significantly increased. People at age of 65 are expected to live for an average of 21 and 17 years for women and men; an almost 40% increase since 1960. The profound success in i...
Article
Full-text available
C3-Cloud is a project aiming to provide an ICT infrastructure, which will allow patient centric and integrated care, based on best practice guideline, for patients with multi-morbidity. Clinical Decision Support, by checking the patient's record for known adverse interactions when the medication changes. The drug interaction advisory service provid...
Article
Full-text available
Execution of multiple computer-interpretable guidelines (CIGs), enables the creation of patient-centered care plans for multimorbidity, which can be monitored by clinical decision support systems. This paper introduces an execution framework to manage multiple, concurrently implemented CIGs, also discussing the approaches used such as constraint sa...
Article
Full-text available
Clinical practice guidelines (CPGs) document evidence-based information and recommendations on treatment and management of conditions. CPGs usually focus on management of a single condition; however, in many cases a patient will be at the centre of multiple health conditions (multimorbidity). Multiple CPGs need to be followed in parallel, each mana...
Article
Full-text available
A Urine Monitoring Device (UMOD) has been designed and implemented for monitoring postoperative urination. This device has been created primarily to assist nurses and doctors monitor patients during their postoperative and recovery period. Furthermore, to reduce the burden of the nursing staff required to regularly monitor and empty the urine bags...
Conference Paper
Full-text available
Drug safety is an important aspect in healthcare, resulting in a number of inadvertent events, which may harm the patients. IT based Clinical Decision Support (CDS), integrated in electronic-prescription or Electronic Health Records (EHR) systems, can provide a means for checking prescriptions for errors. This requires expressing prescription guide...
Conference Paper
Full-text available
Care pathways plan out the expected course of patient treatment. As well as reducing clinical variations their use supports healthcare teams with regard to recognizing and implementing evidence-based key interventions. In this contribution it is proposed that event tree diagrams, an inductive safety analysis technique traditionally used to represen...
Poster
Full-text available
In this contribution it is demonstrated that event tree diagrams, an inductive safety analysis technique that is traditionally used to represent possible accident sequences during the design phase of a process, can also be used to represent the whole or parts of an operational care pathway - especially the critical control and monitoring points wit...
Article
Full-text available
Drug safety is an important aspect in healthcare, resulting in a number of inadvertent events, which may harm the patients. IT based Clinical Decision Support (CDS), integrated in electronic-prescription or Electronic Health Records (EHR) systems, can provide a means for checking prescriptions for errors. This requires expressing prescription guide...
Article
Full-text available
Recent technological advances in electronics, wireless communications and low cost medical sensors generated a plethora of Wearable Medical Devices (WMDs), which are capable of generating considerably large amounts of new, unstructured real-time data. This contribution outlines how this data can be propagated to a healthcare system through the inte...
Conference Paper
Full-text available
The paper examines the feasibility of a cloud-based voice recognition technology, as the means to delivering structured home care, using clinical decision support, to complement more traditional care delivery methods (human caregiver). The feasibility study has used a cloud-based voice recognition service provided by Amazon Echo, on top of which a...
Conference Paper
Full-text available
The paper examines the feasibility of a cloud-based voice recognition technology, as the means to delivering structured home care, using clinical decision support, to complement more traditional care delivery methods (human caregiver). The feasibility study has used a cloud-based voice recognition service provided by Amazon Echo, on top of which a...
Conference Paper
Full-text available
A patellar tendinopathy rehabilitation device has been designed and implemented to allow physical therapists to perform treatment at different inclination angles. The device is now integrated with " motivation and feedback " mechanism based on Gamification, to inform and warn the patient of potential deviations from the prescribed exercise, which m...
Conference Paper
Full-text available
Clinical Decision Support Systems help the delivery of care by supplementing generic clinical guidelines with decision support. This is achieved by encompassing patient-specific recommendations that support the implementation of the computer-interpretable guidelines (CIGs). CIG implementation involves understanding the risks and outcomes of a treat...
Article
Full-text available
Integrated care paradigms depend on multiple sources of data. The quality of data used in decision-making will ultimately affect the delivered care to the patient. Quality includes several dimensions, which may affect the result. This paper presents how data quality dimensions may affect the delivered service, and propose a conceptual framework for...
Article
Full-text available
Recent advances in medical and electronic technologies have introduced the use of Body Area Networks as a part of e-health, for constant and accurate monitoring of patients and the transmission as well as processing of the data to develop a holistic Electronic Health Record. The rising global population, different BAN manufacturers and a variety of...
Article
Full-text available
The Artificial Pancreas is a medical device, currently in development, that aims to provide automatic regulation of blood glucose (BG) levels in ambulatory type 1 diabetes mellitus sufferers. The most popular approach utilises subcutaneous (SC) continuous glucose monitoring (CGM) combined with SC insulin injection controlled by a Model Predictive C...
Article
Full-text available
As patient numbers continue to rise Emergency Department's (ED's) are struggling to not only control patient wait times but also to maintain the quality of patient care. Improving patient flow through the ED has been a priority for many years with techniques such as Lean Six-Sigma being implemented specifically to help alleviate the problem. The In...
Article
Full-text available
Modern Implantable Medical Devices (IMDs), implement capabilities that have contributed significantly to patient outcomes, as well as quality of life. The ever increasing connectivity of IMD's does raise security concerns though there are instances where implemented security measures might impact on patient safety. The paper discusses challenges of...
Article
Full-text available
The paper presents a concise method for transforming textual representations of healthcare services, to a structured, semantically unambiguous modelling language. The method is designed based on literature, as well as trial and error by the authors, using text descriptions of healthcare services. Employing the method can convert textual description...
Article
Full-text available
Root Cause Analysis (RCA) is the most widely used system analysis tool for investigating safety related incidents in healthcare. This contribution reviews RCA techniques, using a Health Informatics example, and discusses barriers to their successful uptake by healthcare organisations. It is concluded that a critical assessment to examine the uptake...
Article
Full-text available
Health IT, in addition to benefits can also have unintended consequences both in terms of operational and business risks. Understanding the dependencies between operator and manufacturer as well as issues that need to be addressed during procurement is essential to increase confidence in the operation of health IT. The paper provides the context, a...
Article
Full-text available
The paper describes safety analysis and justification of a clinical service (accidents and emergencies), using a deviation based approaches.
Article
Full-text available
The paper discusses the motivation behind the safety assurance of health IT, lists pertinent standards and regulation, as well as discussing prominent challenges in the field of health I safety.
Article
Full-text available
The purpose of this paper is to synthesise multiple worldviews of system of systems and introduce sustainability as a prerequisite for the development of the field. Fundamentally, systems of systems provide significantly greater capability than constituent systems. The enhanced capability is achieved through coordination and integration of complex...
Article
Full-text available
Safety cases have been used in the safety domain for a number of years, mostly in the defence, aerospace and energy domains. Their usefulness, as a tool to improving safety, has been appreciated by many practitioners. This has resulted in the core concepts of safety cases to be transferred to other domains (e.g. automotive), and their focus on othe...
Article
Full-text available
Hazards are situations that can result in accidents. This can include loss of lives, injuries and economic or environmental disasters, depending on the domain. For example, a common hazard in the aviation domain is in flight engine shutdown. Hazard analysis is the process of discovering hazards in a system. This activity has been performed for many...
Conference Paper
Full-text available
The use of software intensive systems in healthcare has become increasingly pertinent, aiming to improve the healthcare delivered to patients. Examples of these systems can vary from medical devices offering software enabled functionality; to patient medical record management systems; to applications aimed at the individual and their interaction wi...
Technical Report
Full-text available
Assurance cases refer to the explicit documentation of claims about a system, and explanation of how these claims are convincingly supported by evidence generated during development and testing of that system. The purpose of an assurance case is to capture and communicate the rationale as to why one should have confidence in the operation of a syst...
Chapter
Full-text available
Based on our recent experience, ‘distinguishing fact from fiction’ in relation to System of Systems (SoS) safety has emerged as a pertinent topic in a number of senses. From an analytical perspective, we recognise that it would be a mistake to treat a SoS as ‘just another complex system’. The defining properties of a SoS mean that traditional analy...
Conference Paper
Full-text available
Proceedings of the 2011 Workshop on Dependable Systems of Systems (University of York YCS-2011-472) (G. Despotou Ed.)
Chapter
Full-text available
COTS have increasingly been used by industrial practice as a means of maintaining low development costs of a product, whilst offering significant capability upgrades. COTS are multipurpose products driven by commonly used functionality. However, being general purpose products raises certain challenges regarding their ability to be certified. Previo...
Conference Paper
Full-text available
The term Systems of Systems has increasingly been used to describe classes of systems exhibiting a combination of characteristics such as emergence, autonomy and independent development of their constituent systems. Safety is a system property, the achievement of which has a crucial influence on the system's final acceptance. Due to its importance,...
Conference Paper
Full-text available
A 2 page quick reference card for the Goal Structuring Notation. For a more detailed description of GSN please consult the standard.
Conference Paper
Full-text available
The term Systems of Systems (SoS) has recently been introduced in the systems engineering domain to describe a new class of systems, exhibiting a number of attributes such as complexity, autonomy, and geographic dispersion. The (UK) Ministry of Defence Architectural Framework (MODAF) is a prominent framework used in the defence domain. MODAF is org...
Chapter
The increasing role of Systems of Systems (SoS) in safety-critical applications establishes the need for methods to ensure their safe behaviour. One approach to ensuring this is by means of safety policy — a set of rules that all the system entities must abide by. This paper proposes simulation as a means to evaluate the effectiveness of such a pol...
Conference Paper
Full-text available
The obsolescence problem (component life of 7 years, compared to aircraft life of 30+ years) whilst maintaining high-capability and low–cost upgrades is the holy grail for avionics systems integrators. The use of COTS and getting maximum reuse of existing functionality is key to solving this problem. However, such an approach can compromise the cer...
Conference Paper
Full-text available
Hazards are situations that can result in accidents. Depending on the domain, this can include loss of lives, injuries and economic or environmental disasters. For example, a common hazard in the aviation domain is in flight engine shutdown. Hazard analysis is the process of discovering hazards in a system. This activity has been performed for many...
Conference Paper
Full-text available
Safety cases are now regularly used to communicate the argument about the achievement of acceptable levels of safety for safety critical systems. Increasingly, safety standards such as Defence Standard 00-56 require the scope of the safety case to cover not only the development of the system, but also operating and maintenance through life, includi...
Article
Full-text available
Dependability cases are a concept that has primarily emerged from safety cases. A dependability case constitutes a clear, defensible, and traceable argument that a system is acceptably dependable to operate in a given operational context. This includes any requirements that are crucial to the stakeholders' envisioned system operation. A dependabili...
Thesis
Dependability is a composite property consisting of attributes such as reliability, availability, safety and security. The achievement of these attributes is often essential for the operational success of systems undertaking critical and complex tasks. Assurance that the final system will demonstrate the required dependability qualities, can be cru...
Conference Paper
Full-text available
A system's stakeholders can have requirements involving various non-orthogonal system attributes which can be at odds when implemented. Having to resolve possible conflicts between the different system goals and make trade-offs is an inevitable situation, especially for large-scale systems. In some circumstances trade-offs can be made in a relative...
Conference Paper
Full-text available
In mission critical systems the operational success of the system depends on many aspects of the system's operation such as availability, security, performance and safety. According to the design of the system, dependability attributes can be in conflict or in harmony often resulting in unavoidable trade-offs. Adopting a more flexible approach towa...
Article
Full-text available
Systems of systems (SoS) demonstrate a number of distinguishing characteristics, such as the autonomy of their constituent systems and the resulting emergent behaviour. The elements of SoS are united by a common purpose but, in order to operate in a manner that does not lead to accidents, must also comply with a consistent set of rules. Policy is j...
Conference Paper
Full-text available
Argumentation is an approach which can be used for describing how evidence satisfies requirements and objectives. A structured argumentation notation allows developers to determine the need for individual items of evidence and allows reviewers to determine whether a complete set of evidence satisfies the requirements. This paper introduces an estab...
Article
Full-text available
Argumentation is an approach which can be used for describing how evidence satisfies requirements and objectives. A structured argumentation notation allows developers to determine the need for individual items of evidence and allows reviewers to determine whether a complete set of evidence satisfies the requirements. This paper introduces an estab...
Conference Paper
Full-text available
For many critical systems, in addition to satisfying functional requirements it is important also to address qualities such as performance, availability and safety, which are attributes of dependability. Engineering practice has shown that it is impossible to achieve all dependability requirements without compromise. The satisfaction of requirement...
Conference Paper
Full-text available
A safety case is a well-reasoned argument, supported by evidence that a system is acceptably safe to operate in a particular context. For many, evolving a safety case in step with the design has proved to be an effective means of identifying and addressing safety concerns during a system's lifecycle. However, ultimately safety cases address only on...
Article
Full-text available
A dependability case communicates an argument that a system will acceptably operate with respect to the stakeholders' envisioned dependability requirements. We describe the use of the Goal Structuring Notation (an argumentation notation and methodology) for dependability case development to establish arguments supporting claims of achievement of th...

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