The technology
Take a look at the technology behind our products and explore how the unique combination of data-mining technology and health informatics allows for extensive customization, tailored to the preferences of your hospital.
The family of TREAT products meet the requirements of a complete antimicrobial stewardship program through the use of several different technologies. In principle, our products take every piece of infection-relevant information into account in order to provide advice with the same intelligent consideration of clinicians. The unique, advanced decision support system of TREAT Steward™ uses cost-benefit calculations to complement its 6000+ node Causal Probabilistic Network model. TREAT Lite™ and TREAT Lab™ use a smaller version of this model. TREAT Steward™ is calibrated to each individual installation site, taking into account individual hospital’s microbiological resistance patterns, antimicrobial policies and preferred treatment strategies. Each TREAT product is adapted to fit the local workflow whether it is used in a clinical or laboratory setting. The user interface is a web-based application, which can be accessed from any computer on the local network. Integration with existing hospital systems is one of the core elements of our products; at Treat Systems, our knowledge and understanding of the mapping of complicated information such as microbiology results ensures a seamless, pain‑free installation. Click on the elements below to learn more about the technology.
Infection relevant information
Intelligent advice presentation
Web technology
Integration
Site specific calibrations
Cost-benefit analysis
Causal probabilistic network
The family of TREAT products takes every available piece of infection-relevant information into account when giving advice and recommendation on the clinical workup. The stochastic models use this information for risk assessment (estimating the probability of bacteremia and/or mortality), diagnosis, and for determining the likely causative pathogens.
For TREAT Steward™, the infection-relevant information is not limited to the test results and examination of the individual patient, it also takes into account physiological factors influencing antimicrobial coverage of pathogens at different infection sites, i.e.:
Other important physiological and biological mechanisms accounted for include renal toxicity, allergies, risk-factors, local prevalence of individual pathogens and the effect of previous antimicrobial treatment. TREAT Steward™ takes all of this information, and more, into account when making its probability calculations. The influence of all parameters included in the TREAT Steward™ reflects a tremendous system which has taken more than 70 man-years to build.
The family of TREAT products integrate seamlessly into a range of existing hospital IT systems, providing an elegant solution to display all infection-relevant information for clinicians, specialists, laboratory technicians and management alike. Integration is typically facilitated through web services or HL7 standards. In current installations, the data model retrieves and understands information concerning:
Furthermore, TREAT products
The family of TREAT products uses standard web technology, avoiding the need to install workstations or programs specifically for using the products. Any device with an internet browser that is connected to the hospital network can be used. The solutions can be fully built into existing electronic health record systems, making single sign-on possible – the user will not even recognize that they are using an external third party software solution.
The cost-benefit analysis performed by TREAT Steward™ balances the costs of antimicrobial treatment (antimicrobial costs, side-effects and ecological costs) with the benefits of the treatment: the life-years and bed-days saved by the treatment. The calculation of the benefit is based on the reduction in mortality (saved life-years) and the shorter time to recovery (saved bed-days) based on the probability that the infection is covered by the selected treatment. The individual cost-benefit analysis makes TREAT Steward™ a perfect tool for personalized treatment. All of the costs are updated during the calibration process to fit local preferences. The ecological costs are adjusted individually to reflect the hospital’s antimicrobial policy. A treatment considered likely to increase bacterial resistance substantially, should be given a higher ecological cost than a treatment considered less likely to cause resistance.
The decision engines behind the family of TREAT products utilize Causal Probabilistic Network (CPN) technology, also called Bayesian networks. A CPN is a probabilistic graphical model that for example can represent the probabilistic relationships between diseases and symptoms. It is an advanced statistical technique that supports decision-making in complex domains based on partial, uncertain or unknown information. The basic units of a CPN, the nodes, are variables represented as probabilities. The full model of TREAT Steward™ is a comprehensive network of more than 6000 nodes. These nodes express, for example, physiological/biological concepts and mechanisms, and along with the causal links between them represent the incorporation of evidence-based knowledge gained from hundreds of studies. The model of TREAT Steward™ represents more than 70 man-years of development work. The risk assessment model in TREAT Lab™ is effectively a sub-model of that used in TREAT Steward™, where the focus is purely on sepsis presentation. The figure illustrates the concept of the model. In this case, the probability of an E. coli urinary tract infection (E_Coli_UTI) is affected by three risk factors; place of infection acquisition, gender and the presence of a urinary catheter. These three risk factors represent knowledge of increased probability of an E. coli UTI infection. Variables may be ‘parent’ or ‘founding’ nodes containing prior probabilities that are not dependent on other variables (e.g. gender). However, most variables are ‘child’ nodes containing conditional probabilities that are dependent on other variables in the CPN (e.g. the probability of “E. coli urinary tract infection” is dependent on the parent variables “gender”, “presence of catheter” and “place of acquisition”). The relationship between nodes in the CPN reflects causality (e.g. urinary tract infection causes leukocyturia).
The main goal for the family of TREAT products is to bring decision support to the critical decision point for the care of the infectious patient. For TREAT Steward™ this means that it provides access to the severity of a possible sepsis and provides the probability of no-, mild-, moderate-, severe-, and critical sepsis: a gradation based on infection-related mortality. Moreover, TREAT Steward™ suggests the most likely diagnosis, choosing between more than 50 different infections, and provides advice showing the most probable pathogen(s) and the associated expected in vivo coverage of different local hospital treatments. As a clinician, you can interactively study and familiarize yourself with the in vivo coverage of various antimicrobials by clicking different treatments in the “recommended treatments” panel.
There are several factors related to infectious diseases that vary significantly from hospital to hospital. To account for these differences, TREAT Steward™ is recalibrated any time it is transferred to a new environment; whether this is at a new hospital or even a new department at the same hospital. The calibration procedure for TREAT Steward™ involves adjusting the probabilities of the factors dependent on the local conditions that are critical to the optimal performance of the system. The most important calibration task for TREAT Steward™ is fitting the system to the local patterns of pathogen susceptibility to antimicrobials. However, the following calibration tasks are among others also necessary:
Following the calibration procedure, the complete system is fine-tuned and validated. During this quality assurance phase, the performance of the model is validated and brought into accordance with local hospital preferences and guidelines. A number of selected standard patients go through an intensive review with respect to the performance of the model’s assessment of sepsis severity, diagnosis and pathogen predictions. Additionally, TREAT Steward’s recommended treatments are reviewed and the coverage and costs analyzed.