What a trio of unique minds can create

The Mobile Emergency Triage (MET) system came about through the combined efforts of "three very different minds," says University of Ottawa professor Wojtek Michalowski.

Dr. Steven Rubin, a pediatric surgeon with the Children's Hospital of Eastern Ontario, decided he wanted to do something to help patients with abdominal pain.

Notoriously difficult to diagnose and treat, particularly in children, abdominal pain can result from a wide range of problems that often have nothing to do with the stomach. Appendicitis is one well-known culprit and can strike pre-verbal infants. A perforated appendix can cause death. Abdominal pain can also result from gynecologic origins, pneumonia or even strep infections.

Dr. Rubin sought out Mr. Michalowski, a professor of decision and management sciences at the School of Management and adjunct professor in the faculty of medicine at the University of Ottawa. With a master's degree in econometrics and a PhD in operations research from the Warsaw School of Economics, he was a natural to help set in motion the idea behind MET.

Mr. Michalowski had expertise in data mining and knowledge discovery, otherwise known as "rough set theory." This complex analytic methodology allows researchers to describe patients by attributes such as duration of pain and type of pain, and place them into categories of recommended treatment.

Rough set theory ultimately expresses data in the form of decision rules; for doctors using MET, this means recommendations on appropriate treatment paths for young patients with abdominal pain.

Mr. Michalowski and Dr. Rubin used the methodology to develop MET's algorithm, and brought Dr. Ken Farion on board to help with testing. Dr. Farion, an assistant professor in the faculty of medicine and an emergency physician at CHEO, is the group's self-described "techno-geek."

"Our idea together was to shorten the time that patients spend in emergency," Mr. Michalowski said. "Also to lessen tension and stress. It had to be ubiquitous, so it wouldn't be confined to one system."

MET currently runs on Palm personal digital assistants, which allow doctors to use it bedside and operate independently, or as part of a larger hospital operating system. But its creators also want MET to run in a seamless fashion on any computing platform. Researchers are currently working on MET's architecture to make it available at point-of-care.

They say MET will ultimately be accessible in "weak connectivity" or wireless situations on smart cellphones or using any mobile computing device, such as a Palm, iPaq or tablet.

Mr. Michalowski is excited about the possibilities, suggesting MET could be used by paramedics in ambulances, or by nurse practitioners. "Somebody in Inuvik could have a patient, and if they want to use MET, the ability to e-mail will be all that's required."

But, he cautions, work remains to be done. "These small devices (smart phones) are very nice, but they are not very powerful. The work we are doing is technologically ahead of what's available to support it. It's one step shy of artificial intelligence."

The team is also developing other MET-like modules to aid in diagnosis and treatment of hip and scrotal pain, and asthma.

© The Ottawa Citizen 2004