Patent Publication Number: US-2019180867-A1

Title: Dynamic operating room scheduler using machine learning

Description:
BACKGROUND 
     1. Technical Field 
     Present invention embodiments relate to using natural language processing, video analytics, sensors, IoT devices and machine learning for monitoring progress of a medical procedure in an operating room, updating an operating room schedule, providing notifications to others regarding operating room schedule changes, and updating associated databases. 
     2. Discussion of the Related Art 
     According to a recent study, an estimated 250,000 deaths occur in the United States annually due to medical errors. The actual figure may be higher because residential deaths and deaths in nursing home were not included in the study. Deaths due to medical errors may be the third leading cause of death after cancer and heart disease. Every surgeons&#39; goals includes improving care for their patients. When medical errors are reduced, medical costs for patients will decrease in a number of ways positively impacting overall health for all. 
     SUMMARY 
     A method, a system, and a computer program product are provided for monitoring and updating information related to a medical procedure. A computing system may collect information from a patient related to preparation for the medical procedure and may provide information regarding the medical procedure and a medical condition of the patient to at least one member of a medical procedure team associated with the medical procedure. Data pertaining to performance of the medical procedure in an operating room may be collected from multiple sensors. Progress of the medical procedure being performed in the operating room may be monitored in real time by analyzing the collected data, a procedure reference library, and a physician history to determine a status of the medical procedure, the computing system having been trained to recognize patterns based on a set of training data including one or more of retrospective and real-time data to analyze the collected data and make a recommendation regarding the status. A schedule of the operating room for one or more subsequent medical procedures may be adjusted based on the monitored progress of the medical procedure in real time. Notification of the adjusted schedule may be generated and transmitted to participants of the one or more subsequent medical procedures. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Generally, like reference numerals in the various figures are utilized to designate like components. 
         FIG. 1  illustrates an example environment in which embodiments of the invention may operate. 
         FIG. 2  is a functional block diagram of a computing system that may implement embodiments of the invention. 
         FIG. 3  illustrates multiple layers according to an embodiment of the invention. 
         FIGS. 4 and 5  are flowcharts that illustrate an example process that may be performed according to embodiments of the invention. 
         FIG. 6  is a flowchart of an example process for adjusting a schedule for one or more operating rooms based on either a monitored progress of a medical procedure or a request regarding an unscheduled emergency medical procedure according to embodiments of the invention. 
     
    
    
     DETAILED DESCRIPTION 
     A system, a method and a computer program product are provided for determining whether a patient is properly prepared for a medical procedure, providing a physician with information regarding a medical condition of the patient and the medical procedure to be performed, monitoring a progress of the medical procedure being performed in an operating room, adjusting an operating room schedule as needed and following up with the patient sometime after completion of the medical procedure. Various embodiments may identify physicians associated with the medical procedure and their roles in the medical procedure. Embodiments may further determine whether all required implements are present in the operating room before and after the medical procedure, and may track how the implements are used during the medical procedure. 
       FIG. 1  illustrates an example environment  100  in which present invention embodiments may operate. Example environment  100  may include a network  102 , one or more computing systems  104 , a handheld or other type of computing device  106 , a Global Positioning System (GPS) device  108 , one or more video image capturing devices  110 , one or more microphones  112 , one or more RFID devices  114 , one or more barcode scanners  116  and one or more Internet of Things (IoT) devices  118 . 
     Network  102  may include, but not be limited to, a wide area network, a local area network, a packet switching network, the Internet, a cellular telephone data network, or any combination of the above. One or more computing systems  104 , handheld or other type of computing device  106 , GPS device  108 , one or more video image capturing devices  110 , one or more microphones  112 , one or more RFID devices  114  embedded within, or attached to, medical implements, one or more barcode scanners  116  and one or more Internet of Things (IoT) devices  118  may each be connected to network  102  via a wired or a wireless connection. One or more computing systems  104  may include a server or multiple servers configured as a server farm. Handheld or other type of computing device  106  may include, but not be limited to, a smartphone, a laptop computer, a tablet, a notebook computer, or a desktop computer. GPS device  108  may be a device that obtains location information and reports the location information to one or more computing systems  104  via network  102 . One or more video image capturing devices  110  may include a video camera that provides captured video images to one or more computing systems  104  via network  102 . One or more microphones  112  may capture speech and other audio information and may provide the captured speech and the other audio information to one or more computing systems  104  via the network  102 . RFID devices  114  may provide identifying information regarding respecting devices associated therewith. Barcode scanner  116  may scan barcodes and may provide scanned information to computing system  104  via network  102 . IoT devices  118  may provide information to one or more computing systems  104  via network  102 . 
     In some embodiments, GPS device  108 , handheld or other type of computing device  106  and IoT devices  118  may have wireless connections to network  102 . In other embodiments, others of the above-mentioned devices may be connected to network  102  via either a wireless or a wired connection. 
       FIG. 2  is a functional block diagram of a computing system  200  that may implement one or more computing systems  104  in various embodiments of the invention. Computing system  200  is shown in a form of a general-purpose computing device. Components of computing system  200  may include, but are not limited to, one or more processors or processing units  216 , a system memory  228 , and a bus  218  that couples various system components including system memory  228  to one or more processing units  226 . 
     Bus  218  represents one or more of any of several types of bus structures, including a memory bus or memory controller, a peripheral bus, an accelerated graphics port, and a processor or local bus using any of a variety of bus architectures. By way of example, and not limitation, such architectures include Industry Standard Architecture (ISA) bus, Micro Channel Architecture (MCA) bus, Enhanced ISA (EISA) bus, Video Electronics Standards Association (VESA) local bus, and Peripheral Component Interconnects (PCI) bus. 
     Computing system  200  typically includes a variety of computer system readable media. Such media may be any available media that is accessible by computing system  200 , and may include both volatile and non-volatile media, removable and non-removable media. 
     System memory  228  can include computer system readable media in the form of volatile memory, such as random access memory (RAM)  230  and/or cache memory  232 . Computing system  200  may further include other removable/non-removable, volatile/non-volatile computer system storage media. By way of example only, storage system  234  can be provided for reading from and writing to a non-removable, non-volatile magnetic medium (not shown, which may include a “hard drive” or a Secure Digital (SD) card). Although not shown, a magnetic disk drive for reading from and writing to a removable, non-volatile magnetic disk (e.g., a “floppy disk”), and an optical disk drive for reading from or writing to a removable, non-volatile optical disk such as a CD-ROM, DVD-ROM or other optical media can be provided. In such instances, each can be connected to bus  218  by one or more data media interfaces. As will be further depicted and described below, memory  228  may include at least one program product having a set (e.g., at least one) of program modules that are configured to carry out the functions of embodiments of the invention. 
     Program/utility  240 , having a set (at least one) of program modules  242 , may be stored in memory  228  by way of example, and not limitation, as well as an operating system, one or more application programs, other program modules, and program data. Each of the operating system, the one or more application programs, the other program modules, and the program data or some combination thereof, may include an implementation of a networking environment. Program modules  242  generally carry out the functions and/or methodologies of embodiments of the invention as described herein. 
     Computing system  200  may also communicate with one or more external devices  214  such as a keyboard, a pointing device, one or more displays  224 , one or more devices that enable a user to interact with computing system  200 , and/or any devices (e.g., network card, modem, etc.) that enable computing system  200  to communicate with one or more other computing devices. Such communication can occur via Input/Output (I/O) interfaces  222 . Still yet, computing system  200  can communicate with one or more networks such as a local area network (LAN), a general wide area network (WAN), and/or a public network (e.g., the Internet) via network adapter  220 . As depicted, network adapter  220  communicates with the other components of computing system  200  via bus  218 . It should be understood that, although not shown, other hardware and/or software components could be used in conjunction with computing system  200 . Examples, include, but are not limited to: microcode, device drivers, redundant processing units, external disk drive arrays, RAID systems, tape drives, and data archival storage systems, etc. 
     Invention embodiments may be segmented into three layers, a data acquisition layer, a processing layer and a data persistence layer.  FIG. 3  illustrates the layers of various embodiments. 
     Data acquisition layer  302  may include various devices  304  that collect information and provide the information to data processing layer  306 . Various devices  304  may include, but not be limited to, one or more IoT devices, a GPS device, one or more RFID devices, one or more barcode readers, one or more microphones, one or more video image capturing devices and one or more medical devices or implements. 
     Data processing layer  306  may include an environment awareness subsystem  312  that receives the collected information provided by data acquisition layer  302 . Environment awareness subsystem  312  may include a sound/voice recognition engine  314  and a video analytics engine  316 . Sound/voice recognition engine  314  may perform natural language processing and sentiment analysis as it gathers conversations in an operating room to determine a status of a medical procedure. Hearing a surgeon say, “Thank you team, this was excellent work,” may be interpreted as indicating that the medical procedure is nearing completion. Similarly, hearing the surgeon say, “Apply stitches to the wound,” may also be interpreted as indicating that the medical procedure is nearing completion. Video analytics engine  316  may compare captured video to historical video to determine a status of a medical procedure. Knowing the status of the medical procedure is helpful to environmental awareness subsystem  312  in determining when to prepare and to sanitize the operating room for a next medical procedure. Data processing layer  306  may further include a process queue optimization engine (PQOE)  310  and a notification system  308 . 
     PQOE  310  may include a list of processes to be performed for a given medical procedure. As each medical procedure completes, PQOE  310  may optimize a current schedule for the operating room as well as future schedules for the operating room. 
     Notification system  308  may communicate with external systems  328  as well as internal systems to ensure that nothing delays the readiness, start and completion of a medical procedure. For example, notification system  308  may notify family members of the patient if a medical procedure is delayed such that the family members are aware of the status of the medical procedure and are aware of when to be present for the patient. The notifications may be provided to external systems  328  via email messages, text messages and phone calls, as well as other means. Some external systems  328  may provide feedback from external systems  328 . External systems  328  may include, but not be limited to, a computing system, a handheld computing device, a tablet computing device, a laptop or notebook computing device, a smartphone and a desktop personal computing system. Notification system  308  may further include customized thresholds for determining if, or when, alarms are to be dispatched to various parts of a system. 
     Data persistence layer  318  may store information related to continuous improvement of care in an operating room. Data persistence layer  318  may include, but not be limited to, a medical procedure reference corpus (MPRC)  320 , a physician profile database (PPDB)  322 , a procedure history database (PHDB)  324  and an electronic health record (EHR) database  326 . Each of PPDB  322 , PHDB  324  and EHR  326  may be updated by data processing layer  306 . 
     MPRC  320  may include a list of medical procedures that are performed by a facility. Over time, as new procedures are performed at the facility, the list of medical procedures may be updated. Further, MPRC  320  may ingest external resources  330  such as, for example, medical journals and other external resources, to ensure that medical standards, procedures and best practices are kept up-to-date. 
     PPDB  322  may include a list of physician profiles that describe each physician&#39;s qualifications and specialties. PPDB  322  may also contain a list of procedures in which respective physicians specialize. As a physician acquires new skills and performs or participates in new medical procedures, PPDB  322  may be updated. PPDB  322  further may include information regarding roles that a physician plays in each procedure in which he or she participated. For example, PPDB  322  may include information regarding a medical procedure and whether a physician was a lead, an assistant or an observer. PPDB  322  may further include a list of procedure categories, with physicians assigned to respective procedure categories. 
     While training, testing and validating processes concerning medical procedures, embodiments of the invention may learn patterns based on historical data and real-time data provided by multiple sensors. Further, patterns may be learned based on feedback provided by medical procedure teams performing the medical procedures. 
       FIGS. 4 and 5  are flowcharts that illustrate an example process that may be performed in embodiments of the invention. The process may begin with information, related to preparation for a medical procedure, being collected from a patient (act  402 ). The patient may be contacted, via notification system  308 , by one or more computing systems  104  and prompted to provide the information via an email, a text message, a phone call or other methods. For example, the patient may receive an email message, text message or phone call asking whether the patient fasted that morning, etc. Responses provided by the patient may be received by notification system  308  and provided to PQOE  310 . 
     Information regarding a medical condition of the patient and a medical procedure to be performed on the patient may be collected by one or more computing systems  104  from EHR  326  and may be provided to one or more members of a medical procedure team such as, for example, a physician of the patient using notification system  308  (act  404 ). 
     When members of the medical team meet to discuss their respective roles and the medical procedure to be performed, one or more computing systems  104  may collect video and audio data from corresponding devices and may identify members of the medical team using image analysis and voice signature recognition techniques (act  406 ). The image analysis may further include facial recognition techniques. Natural language processing and voice signature recognition techniques may also be used to determine respective roles of members of the medical team (act  406 ). 
     Next, in an operating room, data may be collected from a number of devices  304  by data acquisition layer and may be provided to one or more computing devices  104  (act  408 ). Thus, data may be collected from, for example, one or more video image capturing devices, a GPS device, one or more RFID devices attached to, or embedded within, medical implements, one or more barcode readers, one or more microphones, etc. The collected data may be processed by environment awareness subsystem  312  to identify people in the operating room including the patient, a location of the operating room, medical implements available in the operating room, etc. 
     One or more computing systems  104  may retrieve medical procedure information from PHDB  324  and MPRC  320 , a physician&#39;s history regarding the medical procedure performed and a place where the procedure was performed from PPDB  322 , and a medical history of the patient from EHR  326  (act  410 ). 
     Data processing layer  306  executing on one or more computing systems  104  may divide the medical procedure into multiple stages (act  412 ). Data pertaining to performance of the medical procedure may continue to be collected (act  414 ) and progress of the medical procedure may be continuously monitored (act  416 ). 
     For example, during the medical procedure, text may be extracted from collected audio information and natural language processing may be applied to the extracted text to determine the progress of the medical procedure. In addition, embodiments of the invention may annotate the text with appropriate International Classification of Diseases, Tenth revision, (ICD-10) codes or other codes. 
     Video analytics engine  316  may use cognitive analytics to determine whether steps included in the medical procedure are effectively executed, and if a determination is made that a stage of the medical procedure is taking longer than expected, embodiments may provide real-time suggestions based on previous successful medical procedures. In addition, video analytics engine  316  may analyze and compare captured video images with previously stored video images from a same type of medical procedure to determine the progress. If the system determines that a wrong patient is to have the medical procedure performed thereon, an unqualified doctor is to lead the medical procedure, or a wrong body part is about to be involved in the medical procedure, an alarm may be generated and a warning distributed via notification system  308 . In some embodiments, a speaker in an operating room may receive an audio warning message which may be played through the speaker. 
     Data processing layer  306  may determine whether all stages of the medical procedure are completed (act  418 ). If all of the stages are determined not to be completed, then data processing layer  306  may determine whether a current stage is completed (act  420 ). If the current stage is determined to be completed, then process queue optimization engine (PQOE)  310  may update a current schedule for one or more operating rooms and may notify affected medical teams of the updated schedule via notification system  308  (act  422 ). A current stage of the medical procedure may be changed to a next stage (act  424 ) and processing may then continue with act  418 . Otherwise, if the current stage is determined to be uncompleted during act  420 , then PQOE  310  may update a current schedule regarding any changes and may notify the affected medical teams whether the medical procedure is running early or late (act  426 ). Processing may then continue with act  418 . 
     If, during act  418 , all stages are determined to be completed, then environment awareness subsystem  312  may account for the instruments used during the procedure, PQOE  310  may update the schedule for one or more operating rooms and notification system  308  may send notifications to affected medical teams as well as one or more family members of the patient (act  428 ). Data processing layer  306  may then update databases in data persistence layer  318  (act  430 ). For example, PHDB  324 , PPDB  322 , EHR  326  and MPRC  320  may be updated. 
     In some embodiments, automatic annotation may be performed based on the monitored progress. For example, a lead physician may comment on a condition of an organ and a record in EHR  326  for the patient may be annotated. Manual annotation of databases also may be enabled. Metadata may be generated and recorded as media files are stored. In some embodiments, the metadata and/or annotations may include diagnostic codes such as, for example, International Classification of Diseases, Tenth Revision (ICD-10) codes. 
       FIG. 5  illustrates example processing in a postoperative phase with respect to the medical procedure. The process may begin, sometime after the procedure is completed, by having notification system  308  contact the patient via a phone call, an email, a text message, or other means to request information regarding a condition of the patient and a status of postoperative care (act  502 ). Notification system  308  may receive a response from the patient (act  504 ) and may analyze the received response using natural language processing (act  506 ). A determination may be made regarding whether a physician of the patient is to be contacted (act  508 ). For example, if the patient is not following instructions for the postoperative care or the condition of the patient has deteriorated, then the determination may be that the physician of the patient should be contacted. 
     If the determination is that the physician of the patient is to be contacted, then notification system  308  may contact the physician and may provide information regarding postoperative care and the condition of the patient (act  510 ). 
     In some embodiments, in an unscheduled emergency, an operating room schedule may be adjusted to accommodate the emergency.  FIG. 6  is a flowchart of an example process for rescheduling an operating room when an unscheduled emergency occurs. The process may begin with the PQOE  310  receiving input related to scheduling an operating room (act  602 ). PQOE  310  may then determine whether the received input is a request related to an unscheduled emergency or is a request to adjust an operating room schedule based on progress of a monitored medical procedure in an operating room (act  604 ). 
     If the received input is a request to adjust an operating room schedule based on the monitored progress of a medical procedure in the operating room, then a schedule for the operating room may be adjusted (act  606 ) and notification system  308  may notify affected medical teams and, possibly, one or more family members of a patient (act  608 ). For example, if the medical procedure took 30 minutes longer than expected to complete and several medical procedures are scheduled for the same operating room, one after another, then the schedule may be adjusted such that each of the several medical procedures may be scheduled to begin 30 minutes later than originally scheduled. Additionally, when a facility has multiple operating rooms, availability of the multiple operating rooms may be taken into consideration when adjusting a schedule for any of the operating rooms. For example, if a medical procedure in one of the operating rooms took 30 minutes longer than expected, one or more subsequent medical procedures may be scheduled for other respective available operating rooms. 
     If, during act  604 , the received input is determined to be related to a request for an operating room due to the unscheduled emergency, then PQOE  310  may make a determination regarding whether an operating room is available (act  610 ). An operating room may be considered to be available if the operating room is not currently being used for a medical procedure. If PQOE  310  determines that an operating room is available, then PQOE  310  may schedule the operating room for the emergency (act  612 ). PPDB  322  may be accessed to select an available physician with proper qualifications for performing an emergency medical procedure related to the unscheduled emergency and may assign a remainder of a medical team for the emergency medical procedure (act  614 ). Various embodiments may select a best qualified available physician to perform the emergency medical procedure. Notification system  308  may then notify medical team regarding the scheduled operating room for the emergency medical procedure and may provide any available medical information about an emergency patient (act  608 ). 
     If, during act  610 , a determination is made that no operating room is available, then PQOE  310  may determine how soon an earliest available operating room may be available based on monitoring progress of one or more ongoing medical procedures and an urgency regarding any next scheduled medical procedure for that operating (act  616 ). PQOE  310  may schedule the emergency medical procedure for the earliest available operating room (act  618 ). If a conflict is determined regarding a scheduled medical procedure for the operating room (act  620 ), then PQOE  310  may resolve the conflict (act  622 ). For example, if a medical procedure with a same level of urgency as the emergency medical procedure is scheduled to use the operating room, the conflict may be resolved by finding another available operating room in a same facility, or, if absolutely necessary, the conflict may be resolved by finding an available operating room in a nearby facility. If the medical procedure has a lower level of urgency than the emergency medical procedure, then the emergency medical procedure may continue to be scheduled to use the operating room and the previously scheduled medical procedure may be scheduled to use another available operating room in a same facility, or may be delayed until an operating room becomes available. 
     As previously discussed, PQOE  310  may assign an available qualified physician for the emergency medical procedure (act  614 ). Notification system  308  may notify the assigned qualified physician as well as members of an emergency medical team and may further notify other medical teams affected by any change in schedule (act  608 ). 
     Historical video data, audio data and annotations pertaining to medical procedures may be used to identify trends and patterns that are used as feedback for machine learning to improve accuracy of progress determinations, validate results and improve future medical procedures. The medical team may be prompted for a checklist and suggestions as a systematic alert and the checklist and suggestions may be adjudicated for relevance to the medical procedure. In addition, an operating room schedule may be personalized based on historical evidence of average medical procedure times and a length of time an attending physician typically takes to perform the medical procedure. 
     It will be appreciated that the embodiments described above and illustrated in the drawings represent only a few of the many ways of implementing embodiments. The environment of the present invention embodiments may include any number of computer or other processing systems and databases or other repositories arranged in any desired fashion, where the present invention embodiments may be applied to any desired type of computing environment (e.g., cloud computing, client-server, network computing, mainframe, stand-alone systems, etc.). The computer or other processing systems employed by the present invention embodiments may be implemented by any number of any personal or other type of computer or processing system (e.g., desktop, laptop, PDA, mobile devices, etc.), and may include any commercially available operating system and any combination of commercially available and custom software (e.g., browser software, communications software, server software, etc.). These systems may include any types of monitors and input devices (e.g., keyboard, mouse, voice recognition, etc.) to enter and/or view information. 
     It is to be understood that the software of the present invention embodiments may be implemented in any desired computer language and could be developed by one of ordinary skill in the computer arts based on the functional descriptions contained in the specification and flowcharts illustrated in the drawings. Further, any references herein of software performing various functions generally refer to computer systems or processors performing those functions under software control. The computer systems of the present invention embodiments may alternatively be implemented by any type of hardware and/or other processing circuitry. 
     The various functions of the computer or other processing systems may be distributed in any manner among any number of software and/or hardware modules or units, processing or computer systems and/or circuitry, where the computer or processing systems may be disposed locally or remotely of each other and communicate via any suitable communications medium (e.g., LAN, WAN, Intranet, Internet, hardwire, modem connection, wireless, etc.). For example, the functions of the present invention embodiments may be distributed in any manner among the various end-user/client and server systems, and/or any other intermediary processing devices. The software and/or algorithms described above and illustrated in the flowcharts may be modified in any manner that accomplishes the functions described herein. In addition, the functions in the flowcharts or description may be performed in any order that accomplishes a desired operation. 
     The software of the present invention embodiments may be available on a non-transitory computer useable medium (e.g., magnetic or optical mediums, magneto-optic mediums, floppy diskettes, CD-ROM, DVD, memory devices, etc.) of a stationary or portable program product apparatus or device for use with stand-alone systems or systems connected by a network or other communications medium. 
     The communication network may be implemented by any number of any type of communications network (e.g., LAN, WAN, Internet, Intranet, VPN, etc.). The computer or other processing systems of the present invention embodiments may include any conventional or other communications devices to communicate over the network via any conventional or other protocols. The computer or other processing systems may utilize any type of connection (e.g., wired, wireless, etc.) for access to the network. Local communication media may be implemented by any suitable communication media (e.g., local area network (LAN), hardwire, wireless link, Intranet, etc.). 
     The system may employ any number of any conventional or other databases, data stores or storage structures (e.g., files, databases, data structures, data or other repositories, etc.) to store information. The database system may be implemented by any number of any conventional or other databases, data stores or storage structures (e.g., files, databases, data structures, data or other repositories, etc.) to store information. The database systems may be included within or coupled to the server and/or client systems. The database systems and/or storage structures may be remote from or local to the computer or other processing systems, and may store any desired data. 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises”, “comprising”, “includes”, “including”, “has”, “have”, “having”, “with” and the like, when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. 
     The corresponding structures, materials, acts, and equivalents of all means or step plus function elements in the claims below are intended to include any structure, material, or act for performing the function in combination with other claimed elements as specifically claimed. The description of the present invention has been presented for purposes of illustration and description, but is not intended to be exhaustive or limited to the invention in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the invention. The embodiment was chosen and described in order to best explain the principles of the invention and the practical application, and to enable others of ordinary skill in the art to understand the invention for various embodiments with various modifications as are suited to the particular use contemplated. 
     The descriptions of the various embodiments of the present invention have been presented for purposes of illustration, but are not intended to be exhaustive or limited to the embodiments disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the described embodiments. The terminology used herein was chosen to best explain the principles of the embodiments, the practical application or technical improvement over technologies found in the marketplace, or to enable others of ordinary skill in the art to understand the embodiments disclosed herein. 
     The present invention may be a system, a method, and/or a computer program product at any possible technical detail level of integration. The computer program product may include a computer readable storage medium (or media) having computer readable program instructions thereon for causing a processor to carry out aspects of the present invention. 
     The computer readable storage medium can be a tangible device that can retain and store instructions for use by an instruction execution device. The computer readable storage medium may be, for example, but is not limited to, an electronic storage device, a magnetic storage device, an optical storage device, an electromagnetic storage device, a semiconductor storage device, or any suitable combination of the foregoing. A non-exhaustive list of more specific examples of the computer readable storage medium includes the following: a portable computer diskette, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), a static random access memory (SRAM), a portable compact disc read-only memory (CD-ROM), a digital versatile disk (DVD), a memory stick, a floppy disk, a mechanically encoded device such as punch-cards or raised structures in a groove having instructions recorded thereon, and any suitable combination of the foregoing. A computer readable storage medium, as used herein, is not to be construed as being transitory signals per se, such as radio waves or other freely propagating electromagnetic waves, electromagnetic waves propagating through a waveguide or other transmission media (e.g., light pulses passing through a fiber-optic cable), or electrical signals transmitted through a wire. 
     Computer readable program instructions described herein can be downloaded to respective computing/processing devices from a computer readable storage medium or to an external computer or external storage device via a network, for example, the Internet, a local area network, a wide area network and/or a wireless network. The network may comprise copper transmission cables, optical transmission fibers, wireless transmission, routers, firewalls, switches, gateway computers and/or edge servers. A network adapter card or network interface in each computing/processing device receives computer readable program instructions from the network and forwards the computer readable program instructions for storage in a computer readable storage medium within the respective computing/processing device. 
     Computer readable program instructions for carrying out operations of the present invention may be assembler instructions, instruction-set-architecture (ISA) instructions, machine instructions, machine dependent instructions, microcode, firmware instructions, state-setting data, configuration data for integrated circuitry, or either source code or object code written in any combination of one or more programming languages, including an object oriented programming language such as Smalltalk, C++, or the like, and procedural programming languages, such as the “C” programming language or similar programming languages. The computer readable program instructions may execute entirely on the user&#39;s computer, partly on the user&#39;s computer, as a stand-alone software package, partly on the user&#39;s computer and partly on a remote computer or entirely on the remote computer or server. In the latter scenario, the remote computer may be connected to the user&#39;s computer through any type of network, including a local area network (LAN) or a wide area network (WAN), or the connection may be made to an external computer (for example, through the Internet using an Internet Service Provider). In some embodiments, electronic circuitry including, for example, programmable logic circuitry, field-programmable gate arrays (FPGA), or programmable logic arrays (PLA) may execute the computer readable program instructions by utilizing state information of the computer readable program instructions to personalize the electronic circuitry, in order to perform aspects of the present invention. 
     Aspects of the present invention are described herein with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems), and computer program products according to embodiments of the invention. It will be understood that each block of the flowchart illustrations and/or block diagrams, and combinations of blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer readable program instructions. 
     These computer readable program instructions may be provided to a processor of a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions/acts specified in the flowchart and/or block diagram block or blocks. These computer readable program instructions may also be stored in a computer readable storage medium that can direct a computer, a programmable data processing apparatus, and/or other devices to function in a particular manner, such that the computer readable storage medium having instructions stored therein comprises an article of manufacture including instructions which implement aspects of the function/act specified in the flowchart and/or block diagram block or blocks. 
     The computer readable program instructions may also be loaded onto a computer, other programmable data processing apparatus, or other device to cause a series of operational steps to be performed on the computer, other programmable apparatus or other device to produce a computer implemented process, such that the instructions which execute on the computer, other programmable apparatus, or other device implement the functions/acts specified in the flowchart and/or block diagram block or blocks. 
     The flowchart and block diagrams in the FIGS. illustrate the architecture, functionality, and operation of possible implementations of systems, methods, and computer program products according to various embodiments of the present invention. In this regard, each block in the flowchart or block diagrams may represent a module, segment, or portion of instructions, which comprises one or more executable instructions for implementing the specified logical function(s). In some alternative implementations, the functions noted in the blocks may occur out of the order noted in the FIGS. For example, two blocks shown in succession may, in fact, be executed substantially concurrently, or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved. It will also be noted that each block of the block diagrams and/or flowchart illustration, and combinations of blocks in the block diagrams and/or flowchart illustration, can be implemented by special purpose hardware-based systems that perform the specified functions or acts or carry out combinations of special purpose hardware and computer instructions.