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eHealth and mHealth Pipelines for Clinical Decision Support to Improve Medication Selection and Safety Open Access


Other title
Medical Informatics
Data Analytics
Data storage
Mobile app
Clinical Decision Support Systems
Clinical Decision Support
Big Data
Medication Selection
Oral Chemotherapy
Change Management
Fast and Frugal Trees
3 Tier Architecture
Software Agent
Medication Safety
Type of item
Degree grantor
University of Alberta
Author or creator
van Rooij, Tibor W
Supervisor and department
Marsh, Sharon (Faculty of Pharmacy and Pharmaceutical Sciences)
Examining committee member and department
Stege, Ulrike (Department of Computer Science)
Rix, Serina (Faculty of Pharmacy and Pharmaceutical Sciences)
Hun, Sunwoo (Faculty of Pharmacy and Pharmaceutical Sciences)
Wilson, Donna (Faculty of Nursing)
Mackey, John (Department of Oncology)
Faculty of Pharmacy and Pharmaceutical Sciences
Pharmaceutical Sciences
Date accepted
Graduation date
Doctor of Philosophy
Degree level
Although much work has been done over the past decade on developing personalized and evidence-based medicine, such as diagnostic tests based on genetics to better predict patients' responses to therapy, stumbling blocks remain that have prevented knowledge, tests, and other pertinent patient-centric data from becoming routine in clinical practice. The main problem with uptake and implementation centres on an absence of computational infrastructures to deliver an individualized approach at the point of care. This study focused on the creation of re-usable computer and mobile-based components of clinical decision support systems for patient-centric data. The goal was to develop eHealth and mHealth pipelines to not only create interactive delivery systems for medication selection and medication safety, but also to provide templates that can be re-used on provincial, pan-Canadian, and international scales. Through this research, a novel database structure for storing and analyzing data (CASTOR), augmented fast and frugal decision trees (FFTs), and mobile and web-based applications (AntiC), were developed to improve medication selection and medication safety. These projects were initially based on rationalizing, storing, and interpreting large genomic data sets, filtering the ensuing pharmacogenomically relevant data into automated decision trees for medication selection on a country-specific basis, and developing a work-frame template (BOW) to build clinical decision applications (apps) for smartphones and tablets. As a result of this project, ultimately, community and hospital pharmacists in Canada will be better informed about the safe handling and use of oral chemotherapeutics, preventing adverse drug reactions, and Ministries of Health in developing countries will have access to curated, pharmacogenomics-based decision trees specific to their countries to rationalize medication selection at no extra cost to local healthcare systems. The models we developed (CASTOR, augmented FFTs, and BOW) were deliberately designed and built with re-usable components that can be linked to future projects to generate targeted and focused clinical decision support and mHealth applications wherever needed. This will eventually allow for the implementation of rationalized clinical decision support applications and evidence-based knowledge translation at the point of care.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
T. van Rooij, S. Rix and S. Marsh. AntiC: A practice tool for the safe use of oral chemotherapeutics by community and hospital pharmacists. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada, May/June 2015, 148, 3: 118-124T. van Rooij, SB. Rix, JB. Moore and S. Marsh. A Bridging Opportunities Work-frame to Develop Mobile Applications for Clinical Decision Making. Future Science OA, 2015: FSO8T. van Rooij, M. Roederer, T. Wareham, I. van Rooij, HL. McLeod and S. Marsh. Fast and frugal trees: Translating population-based pharmacogenomics to medication prioritization. Personalized Medicine, 2015, 12, 2: 117-128M. Bouffard, MS. Phillips, AMK. Brown, S. Marsh, J-C. Tardif and T. van Rooij. Damming the flood: genome-wide scale Comprehensive Analysis and STORage (CASTOR). Database 2010; doi: 10.1093/database/baq029

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