I-Wellness: A Hybrid Case-Based Framework for
Personalized Wellness Therapy
Lim Thean Pheng
School Of Computer Sciences
Universiti Sains Malaysia
11800 Minden, Penang, Malaysia.
theanpheng84@hotmail.com
Abstract In todays world, increasing awareness on personal
wellness has shifted the concept of health from treatment of
diseases to prevention of health problems. This is actually
related to complementary and alternative medicine treatment
known as wellness. As defined by the National Wellness
Institute Inc. in United States of America (USA), wellness is an
active process through which people become aware of, and make
choices towards a more successful existence. In typical wellness
approach, the wellness operators namely therapist, masseur,
psychiatrist and wellness specialist are among the experts in
wellness consultation. They are qualified experts in analyzing a
persons wellness condition and matching a suitable wellness
therapy for him/her. This typical consultation approach is time
consuming and inconvenient for consumers and wellness
operators who have hectic daily schedules. Therefore, an
intelligent wellness recommendation system is necessary to
analyze users wellness condition and recommend suitable
wellness therapy for them. One of the solutions to typical
consultation is to apply a knowledge-based approach that enables
quick and reliable decision making process. A hybrid case-based
framework is proposed to solve the recommendation tasks for
personalized wellness therapy recommendation and monitoring.
Keywords-wellness; personalized therapy; knowledge-based;
rule-based and case-based reasoning
I. INTRODUCTION
Nowadays, there are plenty of health and wellness websites
that offer wellness information and solutions for users. The
concept of health is not restricted to heal of illness and
conversely, therapy in prevention of health diseases is very
popular. This is related to complementary and alternative
medicine treatment known as wellness [1]. In United States,
wellness.com is among the popular online wellness community
website that provides information on wellness and offers
service in searching for wellness and health therapy destination
in the country [2]. In Malaysia, wellnessvisit.com is a popular
wellness community portal that offers information about
wellness packages, doctors information, medical tourism
procedures and other useful links about medical and wellness
visit in Malaysia [3]. The website also offers patients
information corner and guideline for overseas clients to come
to Malaysia for health and medical treatment. This indicates
Wahidah Husain
School Of Computer Sciences
Universiti Sains Malaysia
11800 Minden, Penang, Malaysia
wahidah@cs.usm.my
that wellness is a continuous process of awareness about health
care among individual and will frequently seek for more
information and solution to improve their wellness. The
commitment of pursuing wellness begins with individuals
conscious decision and awareness to a healthy lifestyle [4].
Individual can select from variety of therapies according to
their best interest and suitability.
I-Wellness is in the business of commercializing
technology for wellness centres and consumers in wellness
market. Through a unique combination of knowledge based
system and web technologies, I-Wellness offers holistic
solution in wellness management (for wellness centres) and
wellness therapy recommendation (for online users). These
technologies will be incorporated into a wellness community
portal. The wellness community portal will become the
worlds one-stop wellness destination in the near future.
The aim of this study is to enhance services on wellness
community portal in order to ease users in looking for their
desired, personalised wellness therapy on the web. An ideal
wellness community portal should provide total solutions in
order to improve users knowledge and convenience in
adopting wellness therapy as their complementary and
alternative medicine treatment. Therefore, a study on
enhancing web services on wellness community portal has
been carried out to achieve the following objectives:
To find the best technique to match users wellness
concerns with wellness therapy in the internet.
To determine the best web-based wellness
recommendation model that attempts to make reliable
wellness recommendation that is customized towards
individual preferences and needs.
Technique is important to reveal new application that will
enhance services in wellness community portal in order to
support more necessary services such as matching users
wellness needs with suitable wellness therapy. Therefore, the
question on What is/are the best technique/techniques to
match users wellness conditions with suitable wellness
therapy on the web? is developed. Furthermore, new
innovative web-based wellness recommendation model will
help to improve wellness recommendation service for
individual users on the web. It is crucial to study about
necessary model that can provide reliable wellness information
and recommendation to users.
II. LITERATURE REVIEW
Wellness therapy is about treatment in balancing the
harmony of body, emotions, physical fitness, beauty care,
healthy diet, relaxation, mental activity, environmental
sensitivity and social contacts. This is also applied to corporate
employees who experiencing busy working lifestyle. Wellness
therapy will help them to achieve their work-life balance.
Wellness programme is defined as a structural intervention
usually dealing with emotion, psychology, physical and
spiritual matters of illness [5]. Statistic shows that in United
Kingdom, general health practitioners have high interest in
complementary and alternative medicine treatment [6]. In
United States there is one out of three people used
complementary healthcare while in Netherland is one out of
five and lastly in Sweden and Denmark is one out of four
people [7]. In wellness industry, it is a challenge to provide
personalized wellness therapy for customers because individual
needs are different from each other. Therefore, the basic and
vital information that we need to address is to identify
consumers wellness needs. Maslow motivation theory reveals
that individual is highly motivated if their needs and
expectation are met [8]. Failure to meet their needs will create
frustration and fixation among users. Various institutions such
as corporate organization, state libraries and wellness centers
are struggling to match supply and demand in their wellness
initiatives [9]. Therefore, it is important to look for solutions in
meeting users wellness demands and needs in the market.
Rule-based reasoning (RBR) is a knowledge representation
technique with IF-THEN rule statement [10]. The condition
portions of the rule are basically facts and these rules are
patterns. A search engine in the system will look for patterns
rules that match patterns in the data [10]. INTERNIST is a
clinical intelligent system that is used to support diagnosis in
year 1970 [11]. The system is designed using rule-based
expert system and is capable to diagnose complex problems in
general health. It also indicated that some system requires
specific rules but this can be resolved by formulating rules that
are generally applicable. However, problem solving will
become more complex if there are too many pattern rules
required to match the data [10]. RBR is lack in its learning
capabilities because it is difficult to acquire new expertise in
pattering the rules [12]. RBR requires problem solver to take
into account all the domain rules. In real life problem solving,
the pressure of time limit has restricted problem solver to look
into large unmanageable rules in solving problem. RBR needs
to convert knowledge into rules and in problem solving
situation, RBR will repeat the whole process to solve a
problem [12]. This will consume significant time and problem
solving process may reach the bottleneck due to time constrain.
Case-based is a reasoning technique in AI that uses
previous experiences in solving problems [13]. Case-based
reasoning (CBR) technique resembles reasoning model of
human beings. CBR uses experts previous experiences to
solve new problems which are similar to previous problems.
Instead of relying on static and general rule of system, CBR is
capable in utilizing its case database of previous experience
cases to solve new complex cases which are similar to the past
cases. CBR is mainly been used in medical domains which is
applied to diagnostic and healing tasks [14]. CBR is suitable to
use in wellness problem solving situation because it has
learning capabilities which will improve its problem solving
skills when new cases are stored in the case database [10].
In wellness approach, when users enter their wellness
concerns and health condition, the system will be able to match
the conditions with previous cases in case database. The
system will suggest suitable wellness therapy based on solution
in the most similar case in case database. CBR system is a
problem solving system that retrieves prior cases from its case
database and solution in prior case is suggested to solve the
new problem. This technique is similar with experts that tend
to solve problem based on their experiences or have seen from
others experiences. In online wellness recommendation, the
system will use attributes and solution in existing wellness
cases to suggest suitable wellness therapy that matches users
current wellness needs.
Wellness recommendation system will attempt to match
users wellness conditions with suitable wellness therapies
based on cases stored in case database. Users have to provide
information such as personal details, health status, medical
records, personal lifestyle and wellness concerns to the system.
Then, the system will match the information with attributes of
wellness cases in case database. Figure 1 illustrates the case-
based reasoning cycle.
Figure 1: Case-based reasoning cycle [14]
The case-based reasoning cycle consists of four process
steps which are retrieving previous cases from case database,
reuse case to map solution, revise previous solution to target
problem and retain the case after solution has been successfully
adapted to target problem [14]. Case is triggered by matching
its relevant components inserted by the users [15].
III. PROPOSED METHODOLOGY
This research is focusing on the innovation of wellness
recommendation module that is capable to analyze users
wellness conditions and suggests suitable, personalized
wellness solution to them. Figure 2 shows the proposed
research methodology that will be used in this study.
 system in order to develop one stop wellness community portal
that offers convenient, reliable and personalized services to
users. Various wellness community portals are studied to
Phase I
reveal the web technologies used for promoting wellness
Study about wellness services in the portals. Recently, web 2.0 technology is gaining
applications in the its popularity on the web. Social networking is a platform that
internet connects online users together in knowledge sharing and
promotes interaction among users on the web. Popular social
networking service providers such as Facebook, LinkedIn,
MySpace and Bebo.com has gather users attention and
Phase II
Study the web
participation in exchanging ideas and knowledge. Therefore,
technologies & how it can web technologies such as social networking, community portal
be integrated in wellness and wiki are important to attract online users to gather on a
application same network.
Phase III: Review and compare knowledge-based models and
Phase III propose an ideal model for wellness recommendation in the
Review & compare KB proposed system
models & propose an
ideal model for wellness The technology platform is important to develop a capable
recommendation system in recommending personalized wellness solution to
users. Therefore, reviewing on knowledge-based models will
reveal more clues in proposing an ideal model for wellness
Phase IV recommendation in the proposed system. In Literature Review,
Collect & analyze data for a study on two Artificial Intelligence reasoning techniques
system requirement &
transform data to
which are rule-based reasoning (RBR) and case-based
represent knowledge reasoning (CBR) have been done. These are two frequently
used reasoning techniques in medical recommendation,
nutritional recommendation and other health-related
Phase V commendation. This study will compare knowledge-based
Develop a prototype of models and propose an ideal model for wellness
wellness recommendation.
recommendation module
Phase IV: Collect and analyze data for system requirement
and wellness and transform data to represent knowledge

Phase VI To gather data for system requirement, Delphi study will be

Evaluate the module
against performance
criteria
Figure 2. Research Methodology
Phase I: Study about wellness and identify wellness
applications in the internet
This research will begin with a study on wellness
application in the internet. The purpose of this study is to
understand about recent technique and applications offered by
wellness websites as services to users. Research on web-based
wellness applications will help to discover new technology and
application to improve users wellness experience when surfing
for wellness information on the web. Various wellness website
are compared and the features in each websites are thoroughly
studied in order to create new wellness applications to be
included in wellness community portal.
Phase II: Study the web technologies and how it can be
integrated with internet technology in wellness application
Further study on web technologies will help to determine
the feasibility of integrating web technologies and wellness
conducted with wellness consultants from different wellness
centers in selected states in Malaysia. The main purpose of
Delphi study is to gather knowledge and requirement for
wellness consultation. Panel of experts will be invited to
participate in this study. In this Delphi study, expert has been
defined as those with acknowledge expertise and experience in
conducting wellness consultation and recommendation with
customers in wellness industry. The result from Delphi study
will be converted into useful information in designing the
wellness recommendation module.
Phase V: Develop a prototype of wellness recommendation
module
After gathering data, development stage begins with
prototype of wellness recommendation module. This module
will be integrated together with web technologies in order to be
accessed online. To test the prototype, sample of previously
solved wellness cases will be stored in case database. New
problem will be inserted in the recommendation module and
the prototype will be able to suggest appropriate solution to
users.
Phase VI: Evaluate the module against performance criteria
After development of prototype, the wellness
recommendation module will be presented to wellness center
and online users for module testing and evaluation. The
evaluation will be compared against performance criteria
which comprises of issues about convenience, reliability and
user friendly. Necessary revision steps will be taken after
gathering feedbacks from the users.
making wellness recommendation to their customers by using
I-Wellness System in the internet. Figure 3 shows the
proposed framework of the wellness system.
USERS

IV. PROPOSED FRAMEWORK

The unique integration of wellness website, web-based
wellness programme together with web 2.0 technology has
User User Wellness
enhanced users surfing experiences on the web. Nowadays, Database Information Module
various organizations include profit oriented organizations,
non-government organizations (NGOs) and institutions have Reuse same /
developed community portals in the internet [16]. In addition, similar case
wellness community portal provide visible presence on the New case ADVISORY
Wellness
internet and allow organizations to collect knowledge through Case Recommendation PANEL
the internet. Wellness community portal is a website that Database Module
provides information and resources to online users and also
allows users to interact with each other for experience sharing.
This wellness community portal will bring wellness
information together and offer services such as knowledge
dissemination, discussion forums, resource finding and General
information downloading. These features will promote Health Package Selection
Database Module
community activity and interaction among internet users.
Wellness community portal integrates applications and
facilities such as search engines, wellness directories and also
user-generated contents to promote the interest of knowledge Appointment
sharing among communities. Scheduling Module
There are over 70,000 sites health-care related websites that
provide health and wellness information to online users [17]. WELLNESS
Points Allocation CENTRES
Research shows that there are more than 12.5 million internet
searches about health-related issues daily [18]. Therefore, Module
searching for wellness and health information on World Wide User
Web is not a new health information seeking approach for Database
online users. I-Wellness aims to create a wellness community Wellness Monitoring
portal that provides complete web-based applications to Module
enhance users experience and knowledge in wellness issues
In order to improve the quality of wellness Figure 3. Proposed framework for I-Wellness System
recommendation, I-Wellness is proposing a wellness
community portal that integrates web technologies and The proposed framework of the system can be summarized
knowledge-based system for wellness recommendation. into six modules as listed below.
Interactive web application can facilitate users to search for
information, personalization features, getting advice for (i) User Wellness Information Module
problems solving and making assessment based on specific
circumstances [19]. Therefore, an interactive recommendation This module will ask users to input information about
system for wellness is important to ensure users satisfactions users personal health information, wellness records and
when they are searching for wellness information in the preferences. This module will store, retrieve and update
internet. members health history, profile and wellness records before
the information are sent for wellness analysis in wellness
I-Wellness system has capability to match and personalize recommendation module.
users needs for wellness therapies. This system will
personalize users preferences by offering wellness information
and therapies recommendation for customers according to their (ii) Wellness Recommendation Module
needs and requirements. This system will register users and
gathering data about their wellness condition, preferences, and This module attempts to match users wellness concerns
health background. The system will then match users with suitable wellness therapy. After recommendation, this
preferences and wellness condition with a personalized module will provide information about the recommended
wellness programme. The proposed framework is an ideal therapies to users. This module also provides information
innovation to holistic wellness solution for users. On the other about users wellness problems by retrieving related
hand, wellness therapists will be able to make references when information from general health database. Information on
 users wellness concerns such as disease symptoms and desk module will allow administrator to control and use the
consequences will encourage them to take proper prevention appointment system internally. The functions include
steps. Figure 4 shows the proposed hybrid case-based exporting appointment date to calendar software (for example
to Microsoft Outlook), view appointment on mobile phone, and
Retrieve users block their timetable selectively. Functions in client module
information include email appointment notification, SMS appointment
User notification and online booking. With this module, users can
New Problem
User directly book appointments without the intervention of
Database reception desk, which will provide them the flexibility of
scheduling appointments outside office working hours.
Retrieve cases
from case base
database (v) Point Allocation Module
Subjective
guiding rule This module allows allocation and accumulation of reward
Case Rule points collected by customers when they shop in selected
database Calculate similar case database
by using near neighbour wellness centres and in iwellnessonline.com. The point
algorithm allocation sub modules include user point module and point
administrative module. In user point module, customers can
Expert check their accumulated reward points to redeem gifts and
Consultation wellness packages when necessary points are reached. In point
administrative module, administrator can check the status of
Reuse Case Build new case
reward points, approve gift redeem request from users, add or
remove reward scheme and others.

Proposed Solution User (vi)Wellness Monitoring Module

Solved case
This module will monitor users wellness conditions and
will frequently suggest suitable wellness therapies for users.
This module will alert users by emailing them about suitable
Retain Case wellness therapies and remind them to re-consult wellness
Revise case
consultants when needed. This module also allows
administrators to receive feedback from users and allows them
to write in their comments and suggestions to the administrator.
Confirmed solution User This module is important to collect feedback from wellness
Update case
centres and users after they have completed the recommended
wellness therapies. The feedbacks will be used to update the
cases in case database in order to ensure that the cases and
solutions are up to date.
Learned Case

reasoning for wellness recommendation. V. CONCLUSION

Figure 4. Proposed Hybrid Case-based reasoning for wellness
recommendation
(iii) Package Selection Module
This module provides choices of wellness centres and
therapies for users. Users have option to select their desired
wellness destinations according to their budget and
preferences. Packages and wellness centres proposed by the
system are personalised according to users wellness needs.
(iv) Appointment Scheduling Module
This module enables users to schedule appointment with
wellness centres in the internet. Customers can view, book or
cancel their appointments without calling the reception desk.
There are two sub modules in online appointment systems
which are reception desk module and client module. Reception
The proposed framework will feature online wellness
recommendation system that can recommend suitable wellness
therapy for users. This personalization recommendation will
save users time and cost in looking for appropriate wellness
therapy for themselves. The hybrid CBR has ability to store
knowledge from wellness experts that can represent more
reliable and less error prone in making wellness
recommendation. The concept of Hybrid CBR in wellness
recommendation is to retain experts knowledge and
experience together with previously resolved wellness cases in
case database. Users present wellness concerns are solved by
using solution based on same or similar case in case database.
Moreover, I-Wellness system is able to arrange flexible
appointments for customers with wellness centre. The online
appointment system will enable users to register and make
booking via the internet. This service will ease users effort in
calling the reception desk to book for appointment. Moreover,
users can avoid long queue and improper scheduling system in
a wellness center. Customer relationship management is
important to improve services provided to the customers. In
automatic notification system, users can sign up for
membership program and receive updates about their preferred
wellness therapies that match their personal wellness condition.
This matching updates are based on users preferences (such as
wellness condition, budget, etc) and also recommendation from
our panel of wellness advisors.
For wellness community portal, I-Wellness System will
create innovative experiences for users when they are surfing
for wellness information. The combination of web
technologies and knowledge-based system in I-Wellness
System will enable users to search for wellness information,
purchase suitable wellness package proposed by the
recommendation model, participate in wellness discussion,
sharing wellness knowledge and experienced others new
attractive wellness services.
REFERENCES
[1] MacDonald, J. J., 1993, Primary Health Care: Medicine In Its Place,
London: Earthscan Publications.
[2] Wellness.com, 2009, The Healthy Living Community, viewed 24th
October 2009 <http://www.wellness.com>.
[3] Wellnessvisit.com, 2009, Health/Medical Tourism Solutions, viewed
24th October 2009 <http://www.wellnessvisit.com>.
[4] Ardell, D. B., 2000, What is Wellness? Viewed 8th October 2009
<http://www.seekwellness.com/wellness/articles/what_is_wellness.htm>
[5] Verma, S., Forsyth, E. and Flynn, L., 1999, Wellness Programmes
integrating a complementary modality into primary-care medicine,
Disease Management Health Outcomes, Vol. 6(3), pp.141-150.
[6] Wharton, R. and Lewith, G., 1986, Complementary Medicine and the
general practitioner, BMJ, Vol. 292.
[7] Peck, S. M., 1997, The road less travelled and beyond, New York:
Simon and Shuster.. Clerk Maxwell, A Treatise on Electricity and
Magnetism, 3rd ed., vol. 2. Oxford: Clarendon, 1892, pp.6873.
[8] Maslow, A. H., 1970, Motivation and Personality, 2nd ed. Harper &
Row, New York.
[9] Bragg, J., 2008, Survey Says Libraries Struggle to Match Supply,
Demand in Wellness Initiatives, viewed 25th October 2009
< file:///S:/Share/ALAAPA/web%20site/newsletter/vol5no3/worklife.ht
ml>.
[10] Wang, W. M., Cheung, C. F., Lee, W. B. and Kwok, S.K., 2007,
Knowledge-based treatment planning for adolescent early intervention
of mental healthcare: a hybrid case-based reasoning approach, Expert
Systems, Vol. 24, No. 4.
[11] Miller, R. A. et al., 1982, INTERNIST-1: an experimental computer-
based diagnostic consultant for general internal medicine, New England
Journal of Medicine, Vol. 307, pp.468-476.
[12] Lee, M. R., 2002, An exception handling of rule-based reasoning using
case-based reasoning, Journal of intelligent and Robotic System, Vol.
35, pp. 327-338
[13] Wu, D. D., Weber, R. and Abramson, F. D., 2004, A case-based
framework for leveraging nutrigenomics knowledge and personalized
nutrition counselling, paper to be presented in the workshop in CBR in
Health Sciences, European Conference.
[14] Schmidt, R., & Gierl, L., 2001. Case-based reasoning for antibiotics
therapy advice: an investigation of retrieval algorithms and prototypes,
Artificial Intelligence in Medicine, Vol. 23 (2), pp. 171-186.
[15] Jackson, P., 1999, Introduction to Expert Systems, 3rd ed., Addison-
Wesley, The United States of America.
[16] Millen, D. R., 2000, Community portals and collective goods:
conversation archives as an information resource, in Proceesings of the
33rd Hawaii international Conference on System Sciences.
[17] Grandinetti, D. A., 2000, Doctors and the web: Help your patients surf
the Net safely, Medical Economics, 77 (5), pp. 186.
[18] Eysenbach, G., 2003, The Impact of the Internet on Cancer Outcomes,
A Cancer Journal for Clinicians, 53, pp. 356-371.
[19] Song, J., & Zahedi, F. M., 2007, Trust in health infomediaries,
Decision Support Systems, 43, pp. 390-407.