AGENT-BASED SIMULATION OF ARTIFICIAL-INTELLIGENCE- ASSISTED TRANSFER OF CARE A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Industrial and Human Factors Engineering by PAUL B STONE B.E., University of Huddersfield, 1999 2019 Wright State University WRIGHT STATE UNIVERSITY GRADUATE SCHOOL April 22, 2019 I HEREBY RECOMMEND THAT THE THESIS PREPARED UNDER MY SUPERVISION BY PAUL B STONE ENTITLED AGENT-BASED SIMULATION OF ARTIFICIAL-INTELLIGENCE-ASSISTED TRANSFER OF CARE, BE ACCEPTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN INDUSTRIAL AND HUMAN FACTORS ENGINEERING. __________________________ Subhashini Ganapathy, Ph.D. Thesis Director __________________________ John C. Gallagher, Ph.D. Chair, Department of Biomedical Industrial and Human Factors Committee on Final Examination: ________________________________ Subhashini Ganapathy, Ph.D. ________________________________ Mary E. Fendley, Ph.D. ________________________________ Xinhui Zhang, Ph.D. ________________________________ Barry Milligan, Ph.D. Interim Dean of the Graduate School ABSTRACT Stone, Paul B., M.S.I.H.E, Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, 2019. Agent-Based Simulation of Artificial- Intelligence-Assisted, Transfer of Care This study demonstrates the application of Agent-Based Simulation as a potential training aid for Transfer of Care (ToC) between EMS and a hospital triage department. The specific aim was to develop a simulation to increase the efficiency and accountability of information communication during ToC to test the suitability of Agent-Based Simulation to address training requirements in complex, health provision settings. This paper focuses on the design of the training simulation, including the development of individual agents within the simulation through the user interface elements and the evaluation and verification of the prototype simulator. The primary objective is for the simulation to generate realistic scenarios including complex and non-repeating patient conditions and outcomes based on real-world data and to provide an interface for trainees to conduct a simulated ToC task. It is hypothesized that an agent-based ToC simulator will provide a representative model of emergency situations both in realism and complexity. The study showed Agent-Based Simulation is capable of producing highly complex representations of healthcare scenarios and the prototype simulator was found to be statistically representative of real-world data. This paper primarily presents the work related to the simulation design and development and an initial validation of some model elements using the NEMESIS database. iii Table of Contents 1. INTRODUCTION ............................................................................................................. 1 Scope ........................................................................................................................ 8 Aim ........................................................................................................................... 9 Objectives ................................................................................................................. 10 2. TASK ANALYSIS ............................................................................................................ 11 Hierarchical Task Analysis ....................................................................................... 11 Analysis of Current Procedures and SOPs ............................................................... 12 User Profiles ............................................................................................................. 12 Use Cases ................................................................................................................. 17 Requirements Definition .......................................................................................... 20 3. AGENT-BASED SIMULATOR DEVELOPMENT ........................................................ 24 Concept ..................................................................................................................... 24 Initial Design ............................................................................................................ 27 4. INITIAL DESIGN REVIEW AND ANALYSIS .............................................................. 40 Model Elements ........................................................................................................ 40 UI Elements .............................................................................................................. 41 Data Requirements ................................................................................................... 43 5. SIMULATOR PROTOTYPE DESIGN DETAIL ............................................................. 45 Architecture .............................................................................................................. 45 Design Definitions .................................................................................................... 48 Patient Agent ............................................................................................................ 50 EMS Agent ............................................................................................................... 57 AI Agent ................................................................................................................... 62 Triage Agent ............................................................................................................. 63 Final User Interface Design ...................................................................................... 66 iv 6. RESULTS .......................................................................................................................... 79 Quantitative Verification ......................................................................................... 79 7. CONCLUSIONS AND DISCUSSION ............................................................................. 81 Conclusions from the Quantitative Verification of Model Utility ........................... 81 Conclusions on the Implementation of Agent-Based Simulation ............................ 82 Discussion ................................................................................................................ 82 8. RECOMMENDATIONS .................................................................................................. 84 Future Work ............................................................................................................. 84 REFERENCES ...................................................................................................................... 86 APPENDIX A: TRANSFER OF CARE PROCEDURE....................................................... 91 APPENDIX B: TASK ANALYSIS ...................................................................................... 92 APPENDIX C: SUPPORTING EVIDENCE FOR SIMULATION RULES ........................ 93 APPENDIX D: STRUCTURED SME REVIEW (POST TASK ANALYSIS) .................... 103 v LIST OF FIGURES Figure Page 1. Suboptimal Generic Information Transfer Process ........................................................25 2. Improved Generic Information Transfer Process ...........................................................26 3. Agent Relationships in the Information Generation Stage .............................................29 4. Scenario Generation Interface ........................................................................................34 5. Existing TCCC card (DoD, 2014) ..................................................................................35 6. Patient Information Transfer Form. ................................................................................37 7. Simulator Architecture Overview. ..................................................................................47 8. Simulator Configuration Overview ................................................................................48 9. Diagram of Patient Agent—States, Behaviors and Connections ...................................54 10. Diagram of Patient Agent—States, Behaviors and Connections .................................55 11. EMS Agent Overview ..................................................................................................59 12. EMS Agent Observation Behavioral Logic ..................................................................60 13. EMS Agent Treatment Behavioral Logic .....................................................................61 14. Introduction and Instruction Screen .............................................................................67 15. Scenario Generation Form—Prior to Scenario Start and Initialization ........................69 16. Scenario Generation Form—Post Initialization ...........................................................70 17. Simulator Treatment Control Panel ..............................................................................71 18. Scenario Generation Form—Displaying Treatment Message. .....................................73 19. Patient Stability Information Display ...........................................................................74 vi 20. Time to Hospital Display..............................................................................................74 21. Transfer of Care Form ..................................................................................................75