Arch Clinical Problem and Solutions

AbstractMore than half a million people in Europe live on chronic renal re-placement therapy by hemodialysis (HD). Though arteriovenous fistulas are the preferred vascular access (VA) method of connecting a patients circulation to the artificial kidney, VA dysfunction is the major cause of morbidity and hospitalization in HD patients. The ARCHproject has been initiated to tackle this problem by delivering clinical decision support for VA surgery.In this report we describe the stakeholders and user scenarios for models and tools being developed by the ARCH project, the consolidated requirements for services of software infrastructure, proposed a portfolio of services to be realized. We also summarize the Europeanvascular access clinical guidelines, and describe four different current VA surgery clinical workflows, and propose a number of ways ofintegrating the computational tools developed by the ARCH consortiuminto the current practice.ConclusionsIn this report, we described the stakeholders and user scenarios formodels and tools being developed by the ARCH project, the consolidated requirements for services of software infrastructure, proposed aportfolio of services to be realized.We defined two main user scenario categories: the ARCH researcher category and the clinical practitioner category. The scenarios withinthe ARCH researcher category illustrate the definition of clinical protocols, development, in-vitro and clinical validation of modelingtools for vascular access (VA), while the scenarios in the clinicalpractitioner category illustrate the use of the validated tools in clinical practice. We defined the Research Information Management Infrastructure (RIMI) to support the users in ARCH researcher user scenarios, and the Clinical Information Management Infrastructure (CIMI)to support the users in clinical practitioner user scenarios.An important development has been the adoption of the VPH euHeart project of the ARCH client/server infrastructure design and XML data representation for data collection, along with the actual software appli-cation to be adapted to the projects specific requirements.TheRIMI and the CIMI will provide domain-specific services that willbe tailored to the intended users of the infrastructure. These domain-specific services, will be realized through the ARCH technicalcomputational and data basic services.Most RIMI services are already in place and being used by the project members. These services include: a project Twiki web for documentexchange; an ARCH server for storage of large data sets and an ARCHclient to facilitate data storage and exchange; a GForge server forsoft-ware exchange; an OpenClinica server for managing Case Report Forms.Regarding the proposed CIMI services, we are now in the process of validating our design of the clinical graphical interface (CGI) of the clinical application that will assist the clinicians in performingthe VA function prediction simulations. Some screenshots are shownin this report and initial feedback of the clinicians has been favorable. At the same time, we are creating the basic data and computational technical services that will allow the realization of the clinical application itself.