Title page:

The road ahead: Embracing big data for clinical decision support
Ming-Chin Lin, M.D., Ph.D.1,3; Usman Iqbal, Pharm.D., M.B.A, Ph.D2, 3, 4 ;Yu-Chuan (Jack)
Li, M.D., Ph.D.1, 3, 5
1
Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology,
Taipei Medical University, Taipei, Taiwan
2
Master Program in Global Health and Development, College of Public Health, Taipei
Medical University, Taipei, Taiwan
3
International Center for Health Information Technology (ICHIT), Taipei Medical University,
Taipei, Taiwan
4
Health Informatics Unit, COMSATS Institute of Information Technology (CIIT), Islamabad,
Pakistan
5
Chair, Dept. of Dermatology, Wan Fang Hospital, Taipei, Taiwan

Corresponding author:
Yu-Chuan (Jack) Li, M.D., Ph.D., FACMI, FACHI
Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology,
Taipei Medical University, Taiwan
International Center for Health Information Technology (ICHIT), Taiwan
Chair, Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan
E-mail: jack@tmu.edu.tw; jaak88@gmail.com
Tel: +886-2-6636-2530 Ext. 7601
Fax: +886-2-6638-7537
Address: 250- Wuxing Street, Xinyi District, Taipei 11031, Taiwan
 The road ahead: Embracing big data for clinical decision support

Editorial
The era of big data creates new possibilities for clinical decision support. The traditional
approach relies heavily on experts experience to build a clinical decision support engine. The
development of wearable devices, machine learning algorithms, and web platforms open up
new research directions for clinical decision support. This months Editors Choice articles
demonstrate how to embrace big data and accept its use in clinical settings.

The first Editors Choice article, A clinical decision-making mechanism for context-aware
and patient-specific remote monitoring systems using the correlations of multiple vital signs,
demonstrates how to reduce the challenge of collecting time-series data from wearable
devices. Volume, velocity, and variability are major hurdles when using such data for clinical
decision support. Forkan et al. (1) developed a clinical decision support system employing six
vital signs (heart rate, systolic blood pressure, diastolic blood pressure, oxygen saturation,
respiratory rate, and electrocardiograms) to predict abnormal conditions in patients.
Capturing the aforementioned time-series vital sign data and fitting it into a classification
method is a considerable challenge. In this paper, Forkan et al. demonstrate how to use multi-
label classification to process complex time-series data, which is superior to the single-label
method.

Big data and deep learning have a continuous impact on artificial intelligence, particularly in
voice and image recognition. Traditional image recognition uses hand-crafted features, which
are fixed and cannot be improved despite further learning experience. In the second Editors
Choice article, Vessel segmentation and microaneurysm detection using discriminative
dictionary learning and sparse representation, Javidi et al. (2) report using discriminative
dictionary learning to create a classification method for vessel segmentation and
microaneurysm detection. The dictionary learning method creates vessel and non-vessel
dictionaries and compares them to the fixed dictionary method, revealing that discriminative
dictionary learning can continuously optimize descriptive features by updating the dictionary.
Their method can reduce false positive vessels in abnormal retinal images with pathological
regions.

Ubiquity is the optimal goal for clinical decision support. To reach this goal, there is a long
history of debate over whether to choose client or server, centralized or decentralized, or
standalone or web-based systems in healthcare. With the development of web technology,
web-based systems may provide an effective solution in clinical settings. Novo et al. (3)
developed the Hydra web-based system, integrating numerous services, including physical
examination, habits, blood pressure, laboratory data, and electrocardiography. A
cardiovascular risk calculator is also included in Hydra, which was implemented at Santiago
de Compostela University Hospital. Novo et al. report that Hydra can provide accurate,
robust clinical decision support for cardiovascular risk as a standalone system. Furthermore,
it allows users to access this system on any Internet-ready computer without a complicated
installation process.
The aforementioned Editors Choice articles open up new directions in big data by analyzing
wearable-device data, discriminative dictionary learning, and web-base platforms. In the era
of big data, these approaches can facilitate ubiquitous clinical decision support.

References

1. Forkan ARM, Khalil I. A clinical decision-making mechanism for context-aware and

patient-specific remote monitoring systems using the correlations of multiple vital signs.
Computer Methods and Programs in Biomedicine. 2017;139:1-16.

2. Javidi M, Pourreza H-R, Harati A. Vessel segmentation and microaneurysm detection

using discriminative dictionary learning and sparse representation. Computer Methods and
Programs in Biomedicine. 2017;139:93-108.

3. Novo J, Hermida A, Ortega M, Barreira N, Penedo M, Lpez J, et al. Hydra: A web-

based system for cardiovascular analysis, diagnosis and treatment. Computer Methods and
Programs in Biomedicine. 2017;139:61-81.