1. Decision Support System for Health Continuous
Vigilance in Industrial Environments
María Martínez-Piqueras#1, Carlos Fernández-Llatas#2, Carlos Cebrián*3, Teresa Meneu#4
#
ITACA - Health and Wellbeing Technologies
Universidad Politécnica de Valencia, Spain
1
mamarpi2@itaca.upv.es
2
carfell@itaca.upv.es
4
tmeneu@itaca.upv.es
*
TISSAT, S.A.
Parque Tecnológico de Valencia, Spain
3
ccebrian@tissat.es
Abstract— Several European statistics confirm that a large promotion and development of relevant instruments, and
number of people have fatal accidents every year in the technical assistance [1].
workplace. For this reason, one of the most important European One of the European objectives set for 2020 is the
objectives is to reduce the number of industrial accidents 25%reduction in the number of industrial accidents [2-3]. In
significantly. Fasys Project, focused on factories of machining order to reduce accidents it is essential to pay attention to the
and assembly operations, aims to achieve this improvement workers, their single workplaces and to their working
promoting the use of technologies and giving, at the same time, a conditions. In this way, if workers had a safer environment,
principal role to the worker. From now on, the worker, who has
the number of accidents could be significantly reduced,
represented a neglected element in the factories, will be the
center of attention. The increase of his security, and the implying therefore a reduction in costs. This economic saving
enhancement of his working conditions and health, will be key is very important to the general economy of the company. In
elements for the Factory of the Future performance. addition, these favourable environments make workers feel
In this paper, a health continuous vigilance system is proposed. more comfortable while they are in the factories, and thus the
The system includes both the monitoring to characterize workers efficiency is increased. As a consequence, it is possible to
activity and environment, and aspects related to prevention obtain the maximum efficiency in the factory as a whole,
protocols. To manage it, several systems of collecting data are which also produces economic benefit for the company. From
needed. They can be distributed around the factory and monitor, a healthcare point of view, factories lack normally in an
for example, personal and environment data, or get information,
amount of enough information to allow a holistic care of the
for example, from medical knowledge or previous medical
information of the worker. Besides, due to the big amount of worker. Health data stored by companies are only a small
generated information, intelligent systems for massive data amount of data, usually stored once a year, and referred to the
processing are needed. In this way, the information could be physical condition of a person just in a particular moment [4].
easily managed and classified, in order to obtain data from a
specific situation that could be required. For this reason, the future work has to be oriented on new
technological applications to get a factory safer and to reduce
I. INTRODUCTION significantly the number of accidents. To control the accidents
The International Labour Organization (ILO) estimates that it is necessary to anticipate and estimate what can happen. So,
160 million workers are victims of occupational accidents and prevention will be a key point. To manage it, it is important to
diseases every year [1]. The base of several associations is collect and measure data during a period of time, in order to
that workers should be protected from sickness, disease and evaluate their progress. Consequently, the perfect model
injury arising from their employment. But currently two would be a factory in which the risks and health were
million of people lose their lives every year from work-related controlled at any time.
accidents and diseases. The suffering caused by such
accidents and illnesses to workers and their families is So, this paper describes the objective to turn the punctual
innumerable. The standards on occupational safety and health monitoring into a more frequent and personalized vigilance.
provide necessary tools for governments, employers, and To achieve this goal, it is necessary a continuous and
workers to establish such practices and to provide for full individual monitoring, respectively. Collecting data of many
safety at work. In 2003, ILO assumed a global strategy to people during a long period of time requires collecting a big
improve occupational safety and health, which included the amount of information. People are not able to process so much
introduction of a preventive safety and health culture, the information, so intelligent systems for massive data
processing are needed. Examples of this kind of systems are:
CEP [5], Process Mining [6], ECA [7]. These intelligent

2. systems classify data and generate alarms associated to the specific summaries about the state and evolution of the person.
worker. Thanks to these alerts and all the other environmental This enables a more efficient management of events.
and personal data stored, it is possible to predict health threats.
Thus, it is possible to act in the most appropriate way for each With the purpose of completing the personal data stored in
worker in particular. These preventive actions, adapted for NOMHAD, Fasys project proposes a connection to the current
each worker, are represented by workflows [8]. In order to health system. This connection provides a register about the
configure templates of these prevention actions, it is required health state of the person during his lifetime, which collects
to develop a visual and intuitive interface that allows experts data such as his diseases, surgically interventions or pains.
to directly do it. In addition, the created protocol must be This health system is commonly known as EHR (Electronic
automatically executable in computer systems. To manage it, Health Record) [11].
a specific system has to turn the design of the plan into an
executable format. Finally, once the information has been monitored and
Nowadays, the concept of absolutely safe and healthy classified, the next point is focused on the intervention. With
environments [9] is increasingly used. In order to get the main the aim of representing prevention protocols for this
objective, that is, the reduction of industrial accidents, Fasys intervention, workflows are developed. Given the workers
Project [10] aims to an absolutely safe and healthy factory, singularity, the adaptation of the prevention protocols is
developing knowledge and technology to guarantee both the needed for each one of them. In this way, the elimination of
safety and permanent wellbeing of the worker in the factories the occupational hazard is much more effective.
of machining, handling and assembly operations of the future.
Through this, the workers will become the key factors of III. RESULTS
competitiveness and differentiation of the new productive Several studies confirm that, in European Union,
model. To solve the lack of the continuous and personal approximately 5,500 people per year have fatal accidents in
vigilance and the personalization of the preventive actions, the workplace [1]. These accidents cost a high price for the
Fasys proposes a general scheme of a decision support system EU and affect all sectors of the economy, mainly enterprises
for health continuous vigilance in industrial environments. with less than 50 workers. It has been checked that prevent
This scheme includes blocks focused on monitoring, work accidents has more benefits than just reducing damages
collecting and managing data, creating diagnosis and [1]. In addition, from the European point of view, the
establishing prevention plans. With the purpose of Factories of the Future (FoF) will have fabrication
interrelating this modules, in the project emerges the need to environments highly dynamics, what entails that workers will
develop an architecture which connects and relates all of be involved progressively in more diverse situations [10].
them. The increase in the number of accidents that currently occurs
in factories, added to the European ideas in the factories of the
II. MATERIALS AND METHODS future, makes workers the key roles in the industrial
Nowadays, the number of sensors for monitoring personal environments. The worker health and safety become a central
health data is increasing. In addition, sensors that collect element in the production process, relating it to the
environmental parameters in industrial factories are being performance, productivity and efficiency. Consequently, there
introduced more and more. The problem encountered so far, is a need to generate systems for health continuous vigilance
and intended to be solved in this project, is that these data are of workers.
not connected. The information is only collected in order to The Figure1 presents the scheme, developed in Fasys, for a
produce isolated diagnosis, but not common results, and the health continuous vigilance system. This system is based on
collected data become less relevant if they are not treated five main parts: Monitoring Module; Response Medical
together. The final decision, in a dynamic environment like a Center; Differential Diagnosis Module; Prevention Plans
factory, could be more precise if results came from a study of Module; and Intervention Module. Each of these parts can
a diverse set of parameters. be influenced by a number of external variables and
According to Fasys project, the first step to improve the health parameters such as the Electronic Healthcare Record
and safety in factories is to increase the personal and
environmental monitored data. Consequently, there is a need Given the big amount of generated information in this model,
to develop a system able to store all this information. it is necessary to process all the collected data, since such
Nowadays, NOMHAD system is an application able to stored amount of information would not be easily understandable by
part of this required information: workers' personal parameters health professionals. Services and intelligent devices that have
such as blood pressure, pulse and oxygen saturation. The been generated will provide a classification of the monitored
system performs a prioritization and an intelligent data. Some data will be set inside a normal range, and others
management of alarms. These alarms are based on the rules will be out of the settled limits, generating alarms due to this.
and protocols accepted by health professionals and by the Furthermore, this classification will help the doctor to
health system. This service will combine the information, organize and evaluate all workers’ data and at the same time it
through the prioritized alarm list, with the generation of will be able to act more precisely against a particular
diagnostic.

3. • Trend analyzer data. This system is in charge of detecting
how some parameters of a person are changing during the
pass of time. These parameters can be added to the
absolute values in order to get a more complete
evaluation of the person.
• Evaluation module results. It can be defined as a
“photograph of the person” in a particular moment, with
no need to detect a problem.
These four mentioned sources are the subsystems shown in
the general scheme, Figure 1, which provide important
information to the main blocks. To manage all this
information, Fasys has developed the Differential Diagnosis
Module, shown in Figure1. This module, through intelligent
systems, helps in decision making by health personal.
- The next step is to reach the Prevention Plans Module,
where it is defined how to act. The measures to be taken can
be of two types: on one hand a medical diagnosis and on the
other hand a technical diagnosis, for instance a redesign of the
workplace. It is important to remark that these measures are
not exclusive. According to this, different levels of action can
be established. That is, from very complex levels to more
simple levels such as, for example, reminder panels.
In addition, the prevention actions carried out in this module
Fig. 1 General scheme for a health continuous vigilance can be conducted at three levels. At the first level, the system
reacts automatically. When one of the collected data reaches a
condition that the professional wants to be controlled, there is
an automatic reaction. This associated reaction can be the
The content of the blocks shown in Figure1 is: activation of an alarm, a protocol in a situation of risk, etc.
- Where a group of personal data is collected is the These automatic reactions are achieved using ECA rules-
Monitoring Module. Event, Condition, Action. At the second level, health
- All these personal data, obtained from the monitoring and a professionals receive the alerts and react to individual
group of environment variables from several sensors in the workers. The reaction of professionals can be the assignation
factory, are joined together in the Response Medical Center. of a prevention plan developed before, or the assignation of a
As environment variables, one can understand parameters prevention plan modified for the worker situation in
such as, environment temperature or humidity, that is, particular. These ways that define the processes are called
particular characteristics from the workplaces at which the workflows. The third level is in charge of providing
worker can stay during a work journey. knowledge for the other two levels, improving the protocols,
The Response Medical Center allows to filter and organize the adapting them to new situations and personalizing the
population depending on the changeable rules and on the user recommendations. Innovative intelligent tools are used to
role. So, it is in this module where the first amount of data is manage it.
collected, creating, as a result, personalized records of the
workers and establishing alerts which make easier the task of - Finally, the Intervention Module is responsible for
health professionals. performing the particular actuation selected for the problem in
From this point on, next steps are already focused on getting question.
an action line according to the problem detected. Fasys system is considered cyclic and of a continuous learning,
in a way that, after the Intervention Module, it starts again
- The information stored in the previous module is not enough from the Monitoring Module.
to make a complete diagnosis. So, data from other sources are Another important aspect to take into account is the personal
needed such as: privacy. As a consequence of this, only a few people will have
• Data from a medical base of knowledge (it contains access to the EHR (Electronic Healthcare Record), to the
relations among diseases, risks, medical tests, medical personal variables, and to the personal diagnosis.
recommendations, etc).
From all five main parts, it is going to be emphasized the
• Personal data from the health system, which include the
Response Medical Center. All collected data in this module
previous medical history and it is known as Electronic
has to be processed by an application called NOMHAD. In the
Healthcare Record (EHR).
immediate future, ICT (Information Communication

4. Technologies) will have an outstanding role in the health
sector. This will allow the improvement of the current
processes, making them more accessible and efficient.
Important efforts have been performed to extend its use in the
health sector.
This module receives automatically monitored data from all
workers. This information is treated to prioritize and manage
more efficiently the attention and the available resources for
the factory population.
So far, the options managed by NOMHAD are specifically the
following:
• To create a patient. The professional will fill the
Fig. 2 NOMHAD system
administrative worker data and the medical relevant data
for a future evaluation. Patients will also be assigned to
health professionals. When the general modules and the relation among them are
• Reception and Display of Monitoring. The system stores defined, an architecture must be created, that is to say, a way
the monitoring data of the person. It stores them into a to guarantee the connection and interoperability among them.
To get information from the worker environment and his
database related to the personal health record in order to
personal parameters, it is necessary to interconnect sensors
be used by health professionals in the future. The and services in a fault tolerance and decentralized way. This
monitoring data are displayed in the right way, either in process, complex and highly interconnected, can be solved
graphical form, numerical, image, etc using Choreography of Services [12-8]. This means that the
The data stored in the system are processed on arrival. A choreographied processes are independent and can
set of several rules, defined by the doctor and adapted to communicate each other to define execution flows. This
the personal profile, are applied. These rules allow the model makes easier the connection and disconnection of
services dynamically, and at the same time it is capable of
system to detect potential anomalies found in the data, in using different kind of sensors and configurations. This
order to take decisions. approach is shown in Figure 3.
For the definition of the rules, health professionals will
have a tool to help themselves with this task. The use of choreography to interconnect services requires also
• To configure alerts: The system will have an alert module the use of a common exchange language to allow the services
that, based on the monitoring data and the limits defined to understand each other. This can be performed by an
architecture which includes a Semantic layer in the
as optimal by a professional, will be able to detect
Choreographer. The reason to do that is to improve the
whether the data stored are acceptable or not. intercommunication among sensors, actuators and services of
• The possibility of assigning questionnaires: The patient the system.
mood could be extracted from these questionnaires.
Health professional will choose the questionnaire and will The ontologies [12] are a solution to describe concepts
have the possibility to personalize it depending on the formally. Concretely, an ontology is a formal and explicit
specification of a shared conceptualization. It provides a
needs of each worker in particular.
common vocabulary that can be used to model the kind of
These questionnaires will be available in the future in objects and/or concepts and its properties and relations. The
case the professionals want a subsequent consulting or reasoners [12] are software applications allowing the semantic
validations. seek in the ontologic description. Using this technology, it is
• Monitoring: The measurements can be obtained with possible to describe semantically the sensors and data services,
usual external devices, whose information is introduced giving them the ability of having a more complete
understanding of the collected data and the services actions.
afterwards in the system or it can be used integrated
The use of services of Ontologies and Reasoning Systems to
elements into the system (controlled, for example, by describe the data coming from the sensors, makes possible to
Bluetooth and transmitting the captured data directly to get a more precise interpretation and to detect automatically
the system). The design of the system can be extended to the sensors and services available at any time.
introduce new devices.
The following shows the main screen of the application.

5. needs of Fasys requirements is being developed. This kind of
repositories is owned by the person, who has the option to
share it with people he chooses.
When an employee goes to work in a factory for the first time,
health professionals ask him to download his previous EHR,
in order to have the personal file (PHR) more complete for the
final diagnosis.
In general, current PHR contains a summarized version of
EHR ready for patients and, in some cases, home monitoring
data. PHR developed by Fasys is based on the following
aspects:
• It is focused on workplace health.
• It allows patient to introduce data (automatically or
manually)
• It allows an exchange of information with the healthcare
system (EHR)
• It includes an option to generate summaries to share
information with others PHR. One of the advantages, for
example, is when a worker goes to work in other factory.
If the new factory has the Fasys system, his PHR could be
Fig. 3 Fasys Architecture downloaded in the system of the new factory in order to
have a more complete file.
• Stored Data can also be extracted for consultations in case
In order to illustrate graphically the action to perform and the
standards describing the flow followed by actions, it is health professionals need to do. Consequently, there must
possible to use workflows. They are a formalization of the be an Access Control. With this control, it is ensured that
process to be automated. Some workflow languages can be these personal data can only be seen by authorized
executed automatically. This is known as a workflow people. If the data have to be used for statistical studies, it
interpretation. The automatic interpretation of a workflow is must be made anonymous. So, the results of the studies
done by a workflow engine, which can complete the actions will not be related to people in particular.
explained in a workflow, in the order and with the derivation
rules specified in it. Workflows can be employed by people In addition, and with the objective of validate the developed
who are not experts in programming for the health area. For work in the different stages of the project, several meetings
that reason and thanks to these modules, health professionals with experts have been done. On the one hand, the first
are able to design and modify the protocols to be executed meetings had the objective to clarify the main points to be
automatically. considered for a health vigilance scheme. And on the other
A Services Orchestrator [8] is included in the architecture and hand, the last meetings had the mission to validate the
moreover, it is connected to the Choreographer which accepts developed scheme of health vigilance. Their point of view is
the use of Workflows. vital to perform a good scheme of a support decision and a
health continuous vigilance, directing it to solve the real needs
Finally, the objective of this paper is to show the current that contain each covered area.
situation of the health data warehouses related to Fasys project.
Nowadays, there is a health system ready to be used by health IV. CONCLUSIONS
professionals. It stores the medical data of the patient from the According to the project objectives, a scheme of health
point of view of the assistance process, and it is owned by the continuous vigilance has been designed. It provides a
current healthcare system. This repository is called EHR workable solution in order to improve the current healthcare
(Electronic Healthcare Record). system in the factories of machining, handling and assembly
With the purpose of improving the characterization of the operations. It is possible to obtain a more continuous
person and his environment, EHR data have been increased. monitoring of the worker, improving his own health and
This new amount of information is stored, together with the making the factory safer and healthier. To achieve this, it is
EHR information, in other repositories. These repositories are necessary to increase the number of variables obtained from
known as PHR (Personal Health Record) [13] and can collect the environment of the worker, from personal parameters, and
data such as habits, preferences, information about the family, to combine them with the medical knowledge and the
moods, customs or nutritional profile. A PHR adapted to the actuation protocols.

6. Future steps will be focused on the detailed definition of some [10] Fasys: “Fábrica Absolutamente Segura y Saludable”.
Available:http://www.fasys.es/en/
modules of the scheme of health vigilance that have to be [11] Himss, http://www.himss.org/ASP/topics_ehr.asp (Last Access:
completed. The optimal way to fit all input and output data November 2011)
should be studied in depth. It is important to remark the proper [12] Carlos Fernández-Llatas-Llatas, Juan B. Mocholí, Agustín Moyano,
connection with other modules and smaller subsystems which Teresa Meneu “Semantic Process Choreography for Distributed Sensor
Management” International Workshop on Semantic Sensor Web - IC3K
they are related with. 2010 2010
Up to now, the application included into the Response [13] PHR Reviews. Available: http://www.phrreviews.com/
Medical Center collects data from personal monitoring. In the
future, this application will be improved, introducing relevant
data for the project, such as: environment variables (room
temperature, humidity…) or type of machine used (which is
related to one kind of strain or another).
Besides the introduction of new parameters, other two
innovations for this application are being studied:
• Possibility to carry out videoconferences between the
doctor and the worker. This action will improve the
continuous monitoring. On the one hand, it will be useful
for external consultations, in case the doctor is not in the
factory. And on the other hand, it will be useful to raise
remote queries to specialists.
• Mobility. The goal is to build a little version of the
application. It can be used on small devices like a tablet.
Thus, the information will be available anywhere,
carrying out a supervision of the processes and a
management of alerts in real time.
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