Abstract: A system for monitoring quantitative health data of a user, the system includes a stationary sensor device for monitoring a first set of quantitative health data of the user when the user is resting in bed; and a wearable tracker for monitoring a second set of quantitative health data of the user when the user is resting; wherein the wearable tracker is worn by the user; the first set and second set are sequential in time to obtain around-the-clock monitoring of the quantitative health data of the user.

Abstract: A predictive model can be applied to data representing a history of events for an entity to compute a value indicative of an outcome related to a reference time for that entity. The effect of an event from an entity's history of events on an outcome for the entity at a reference time can vary based on the type of event and relative time of that event with respect to the reference time. The effect of an event from an entity's history of events on an outcome for the entity also can vary due to other characteristics of the entity in combination with the event. These effects are captured as weights. For an entity, functions of sets of events from the history of events are computed for the entity and a set of weights for events. The computed results are inputs to the predictive model.

Abstract: Methods are provided for the surveillance and monitoring of a patient's medical care when the patient is treated at two or more medical organizations having different medical record systems. Patient information is received from a first medical organization and populated into an active risk assessment array that monitors the patient's risk for developing a particular disease or condition. Patient information is then received from a second medical organization and populated into the array. It is determined that actionable criteria have been met, and in response, a notification or alert is sent to the medical organizations indicating that the patient is at risk.

Abstract: A system and method provides a glucose report for determining glycemic risk based on an ambulatory glucose profile of glucose data over a time period, a glucose control assessment based on median and variability of glucose, and indicators of high glucose variability. Time of day periods are shown at which glucose levels can be seen. A median glucose goal and a low glucose line provide coupled with glucose variability provide a view into effects that raising or lowering the median goal would have. Likelihood of low glucose, median glucose compared to goal, and variability of glucose below median provide probabilities based on glucose data. Patterns can be seen and provide guidance for treatment.

Abstract: Patient support apparatuses include a frame, support surface, and a controller. The controller provides notification to a user of a service event relating to the patient support apparatus. The controller limits functionality of a component of the patient support apparatus based upon a severity of the service event. The controller may also, or alternatively, detect when a control is activated by a user and, in response to such activation, determine whether the patient support apparatus has been marked for use or marked for servicing. If marked for use, the controller responds in a first manner, and if marked for service, the controller responds in a different manner. In other embodiments, a method is provided for determining an order in which multiple patient support apparatuses should be service. In still other embodiments, the patient support apparatus automatically changes to an unusable configuration when in need of high priority service.

Abstract: An insulin monitoring system includes one or more processors, one or more computer-readable storage devices, and program instructions stored on at least one of the one or more storage devices for execution by at least one of the one or more processors. The program instructions include: first program instructions to track, in real time, the amount of insulin active in a patient; second program instructions to calculate the amount of insulin need of the patient by tracking the patient's metabolic states; third program instructions to compare the insulin active in the patient with the insulin need of the patient; and fourth program instructions to determine an insulin fault level based on the comparison.

Abstract: A system and method of processing a CT scan includes receiving a plurality of radiographs and determining an axis of rotation per scan from the plurality of radiographs prior to CT reconstruction.

Abstract: A system for utilizing diagnostics for informed vibrant constitutional guidance includes at least a server, a diagnostic engine operating on the at least a server configured to generate a machine learning model trained by a training set, wherein the machine-learning model is configured to receive contextual information as an input and output a diagnostic output wherein the training data set includes a plurality of data entries, each data entry including at least an element of contextual information and at least a correlated diagnostic output, and at least an advisory module, operating on the at least a server configured to generate an advisory output as a function of the diagnostic output, wherein the advisory output comprises textual data identifying the diagnostic output and wherein the textual data identifying the diagnostic output is configured to be displayed on an advisor client device, and transmit the advisory output to the advisor client device.

Abstract: A system for monitoring a fatigue level of an operator of a vehicle includes a sensor configured to generate a signal indicative of a physiological state of the operator; a display for the operator; and a controller to: receive, from the sensor, the signal; determine the fatigue level of the operator by analyzing the received signal using an algorithm developed using operator fatigue statistics; generate a real-time fatigue report for the operator based on the determined fatigue level of the operator; transmit the generated real-time fatigue report to the display for the operator for display to the operator, and a display for a dispatcher for the vehicle for display to the dispatcher; generate an anonymized version of the real-time fatigue report; and transmit the anonymized version of the real-time fatigue report to a cloud for access by remote users.

Abstract: Provided herein is an engagement and care support platform (“ECSP”) computer system including at least one processor in communication with at least one memory device for facilitating senior user engagement. The processor is programmed to: (i) register a user through an application, (ii) register a caregiver associated with the user through the application, (iii) generate a senior profile based upon user personal and scheduling data, (iv) build a daily interactive user interface that reflects the senior profile, (v) display the daily interactive user interface at a first client device associated with the user, (vi) cause the first client device to initiate a daily interaction prompt to the user, (vii) determine whether any user interaction was received in response to the daily interaction prompt, and (viii) transmit a daily update message to a second client device associated with the caregiver, including an indication of whether any user interaction was received.

Abstract: A hand-held device, such as a remote control, is provided for operation of a consumer appliance and is equipped with one or more biometric sensors to capture and report on the health condition of a user of the hand-held device. The data captured by such a hand-held device may be evaluated locally in the hand-held device itself or may be conveyed to a target consumer appliance either for local evaluation by that consumer appliance or for onward transmission to a central off-site monitoring service.

Abstract: Systems, methods and computer-readable media are provided for facilitating clinical decision support and managing patient population health by health-related entities including caregivers, health care administrators, insurance providers, and patients.

Abstract: Methods, systems and compositions that allow for treating a patient according to a patient customized therapeutic regimen are provided. Embodiments of the invention include obtaining dosage administration information from a patient and using the same to tailor a therapeutic regimen for the patient. Embodiments of the invention further include preparing and forwarding to the patient physical pharmaceutical dosages based on the customized therapeutic regimen.

Abstract: A system for patient data exchange is provided and includes a plurality of sensors monitoring a patient according to a default sensor configuration, and a patient data exchange engine that receives a request comprising one or more parameters, identifies at least one applicable sensor from the plurality of sensors based on the one or more parameters, and reconfigures the at least one applicable sensor from the default sensor configuration to a different sensor configuration in accordance with the one or more parameters to generate applicable sensor data responsive to the request. In specific embodiments, the patient data exchange engine further computes a monetary value for the generated sensor data based at least on an attribute of the patient and an attribute of the sensor data.

Abstract: A structured testing method for diagnostic or therapy support of a patient with a chronic disease and devices thereof are disclosed which implement a structured collection procedure based on a medical use case and/or question which provides at least one or more parameters defining entry criterion, a schedule of events, adherence criterion, and exit criterion. The entry criterion establish conditions needed to be met prior to obtaining biomarker data from the patient. Each event can include one or more of a performance time, patient guidance to perform the event, a request for information from the patient a request for patient action, and a request for collection of biomarker data from the patient. The adherence criterion can be used to assess whether an event performed is acceptable to addressing the medical use case and/or question, and the exit criterion establishes conditions needed to be met prior to exiting the collection procedure.

Abstract: A conversation management system provides a conversational computing interface that manages verbal exchanges between a computer (e.g., artificial intelligence) and a human operator. In a medical embodiment, conversational input from the computing system is generated based on medical knowledge, uses deep learning algorithms, and/or intelligently tracks the state of a conversation so as to the most relevant data to the user.

Abstract: A conversation management system provides a conversational computing interface that manages verbal exchanges between a computer (e.g., artificial intelligence) and a human operator. In a medical embodiment, conversational input from the computing system is generated based on medical knowledge, uses deep learning algorithms, and/or intelligently tracks the state of a conversation so as to the most relevant data to the user.

Abstract: A computer apparatus and computer-implemented process for generating a batch record (BR) from a master batch record (MBR) during manufacture of a batch of pharmaceutical product. In the control software, a graphical analysis interface is provided for processing graphs of spectroscopic or chromatographic analysis. A group of fields in the MBR is assigned to the analysis. The operator wears an augmented reality headset and uses this to capture an image of a graph from an instrument display. The graph image is then processed to extract the graph and its metadata, and then further processed to find peaks and assign attribute labels to the peaks, and thus populate the analysis fields. Overlay images are then transmitted to AR headset to present to the operator the populated analysis fields. The operator then accepts or rejects the populated analysis fields by issuing user interface commands.

Abstract: An indication that a patient event occurred may be used to evaluate the efficacy of at least one therapy program and/or adjust therapy delivery to the patient. In some examples, the patient event indication includes patient input that may be received via an event indication button of a programming device. In some examples, therapy delivery may be adjusted by adjusting at least one therapy parameter value, switching therapy programs or therapy program groups or restarting a therapy cycle of a medical device.

Abstract: An apparatus (10) for navigating a hierarchical electronic questionnaire (12) includes at least one electronic processor (20) programmed to: provide (102) a user interface (UI) (27) via which: at least a portion of the hierarchical electronic questionnaire is presented on a display device (24) represented as a tree-based questionnaire map (30) with a plurality of nodes (32) connected by a plurality of branches (34), the nodes of the plurality of nodes corresponding to questions; a user input is received, via at least one user input device (22), indicative of a selection of at least one of the nodes; and the question corresponding to the selected node is displayed and a user input indicative of an answer to the question corresponding to the selected node is received via the at least one user input device; and populate (104) one or more nodes other than the selected node based on the selected node and/or the answer to the question corresponding to the selected node.

Abstract: A patient case may be evaluated whenever new information is received or as scheduled. Evaluation may include resolving a Diagnosis-Related Group (DRG) code and determining a CDI scoring approach based at least in part on a result from the resolving. Resolving a DRG code may include determining whether a DRG code is associated with the patient case. If no DRG code is found, the system may search for an International Classification of Diseases code or ask a user to select or assign a DRG code. Using the determined CDI scoring approach, a first score may be generated and adjusted by at least one of length of stay, documentation accuracy, payer, patient location, documentation novelty, review timing, case size, or documentation sufficiency. The adjusted score may be normalized and presented to a CDI specialist, perhaps with multiple CDI scores in a sorted order.

Abstract: Systems, methods, and apparatuses that provide alerts based on analyte data and acceleration data. An analyte sensor may generate the analyte data. An accelerometer may generate the acceleration data. A transceiver may convert the analyte data into analyte concentration values. The transceiver may convert the acceleration data into activity information. The transceiver may generate an alert based on the analyte concentration values and activity information. The alert may be communicated to a user by a mobile medical application executed on the transceiver and/or a display device (e.g., smartphone) in communication with the transceiver. The mobile medical application may display (e.g., on a display of the display device) a plot or graph of the analyte concentration values and activity information with respect to time.

Abstract: An image processing method is provided for displaying cells from a plurality of pathology images or overall images. A respective overall image represents a respective patient tissue sample or a respective patient cell sample.

Abstract: The MIHIC system in various embodiments described herein helps clinicians predict the risk of maternal mortality by detecting diseases early and identifying possible risks in mothers, fetuses and infants across pre, peri and post-natal stages of pregnancy. The system quantifies risk as a single MIHIC score, which through quantification assigns possible risks to the mother, fetus and infant. The MIHIC score uses a specialized algorithm to derive the individual and overall risk as a value between 0 and 1 and uses the risk scores to stratify the patients into High, Medium and Low risk for preventive intervention and improved pregnancy outcome.

Abstract: A method (100) for generating a textual description of a medical image, comprising: receiving (130) a medical image of an anatomical region, the image comprising one or more abnormalities; segmenting (140) the anatomical region in the received medical image from a remainder of the image; identifying (150) at least one of the one or more abnormalities in the segmented anatomical region; extracting (160) one or more features from the identified abnormality; generating (170), using the extracted features and a trained text generation model, a textual description of the identified abnormality; and reporting (180), via a user interface of the system, the generated textual description of the identified abnormality.

Abstract: The present invention is directed to a secure messaging assistant that provides secure two-way communications between a user device and a server. The user can conduct a natural language conversation with the secure messaging assistant ask medical questions and enter symptoms that the user is experiencing. The secure messaging assistant uses natural language processing to return, in near real-time, medical conditions that are responsive to the user's input and which account for the user's own medical history (e.g., securely stored electronic medical history). The secure messaging assistant prevents the user from disclosing private or sensitive information to an internet based search engine, in the quest for medical advice.

Abstract: The present disclosure related to an apparatus that may be used for taking blood glucose measurements and providing individualized insulin dose recommendations wherein the apparatus is easy to use and facilitates improved diabetes control in patients. Also disclosed are related methods.

Abstract: Introduced here is a method, a system, a device, etc. for displaying health-related data (e.g., blood glucose measurements) relevant to user's selection. The method, the system, the device, etc. can be based on: receiving healthcare-related data from data streams associated with a profile of a patient; identifying, based on a least a subset of the data streams, a time window corresponding to a contextual event indicative of a patient activity that has a potential of affecting metabolism of the patient; determining a graphical representation of the contextual event; generating a graph of blood glucose level over time for display; detecting a user indication of a user interest in a time point along the graph of the blood glucose level; and highlighting the graphical representation of the contextual event in response to the time point falling within the identified time window.

Abstract: State information can be determined for a subject that is robust to different inputs or conditions. For drowsiness, facial landmarks can be determined from captured image data and used to determine a set of blink parameters. These parameters can be used, such as with a temporal network, to estimate a state (e.g., drowsiness) of the subject. To improve robustness, an eye state determination network can determine eye state from the image data, without reliance on intermediate landmarks, that can be used, such as with another temporal network, to estimate the state of the subject. A weighted combination of these values can be used to determine an overall state of the subject. To improve accuracy, individual behavior patterns and context information can be utilized to account for variations in the data due to subject variation or current context rather than changes in state.

Abstract: A method of predicting a blood compound concentration of a target may include receiving, by a system, spectral data associated with a region of the target, using near-infrared (NIR) spectroscopy. The method may include classifying, by the system, each of the plurality of data instances of the spectral data to one of a plurality of labelled classes. The method may include obtaining, by the system, one or more best fit models from a plurality of prediction models based on the classification. The method may include determining, by the system, blood compound concentration values corresponding to each of the one or more best fit models. The method may include predicting, by the system, the blood compound concentration of the target using the blood compound concentration values predicted using the best fit models.

Abstract: Absorbent articles with biodegradable and/or biocompostable elements are disclosed, wherein the absorbent articles include sensors. The sensors detect and determine variables associated with collected fluids, solids, and gases, including a presence of fluids, solids, and gases, a volume of fluids, solids, and gases, and/or a distribution of fluids, solids, and gases. In one embodiment, the sensors and/or connected computing systems are calibrated to capacities and other properties of elements within the articles, including superabsorbent polymers, and are operable to trigger an alert based on detected or determined conditions.

Abstract: A safety-monitoring garment system is used to thoroughly monitor the health and performance of a user. The system includes a garment, at least one health-monitoring sensor, at least one performance-tracking sensor, a microcontroller, a user controller, and a portable power source. The garment is preferably a jacket for the user. The at least one health-monitoring sensor continuously monitors the vitals of the user, and the at least one performance-tracking sensor monitors the performance status of the user. The microcontroller stores, analyzes, and delivers the data from the at least one health-monitoring sensor and the at least one performance-tracking sensor to an external computing device. The user controller manages the at least one health-monitoring sensor and the at least one performance-tracking sensor. The portable power source provides the necessary power for the at least one health-monitoring sensor, the at least one performance-tracking sensor, the microcontroller, and the user controller.

Abstract: A non-invasive method of estimating intra-cranial pressure (ICP). The method including the steps of: a. non-invasively measuring pressure pulses in an upper body artery; b. determining central aortic pressure (CAP) pulses that correspond to these measured pressure pulses; c. identifying features of the ICP wave which denote cardiac ejection and wave reflection from the cranium, including Ejection Duration (ED) and Augmentation Index of Pressure (PAIx); d. non-invasively measuring flow pulses in a central artery which supplies blood to the brain within the cranium; e. identifying features of the measured cerebral flow waves which denote cardiac ejection and wave reflection from the cranium as Flow Augmentation Index (FAIx); f. calculating an ICP flow augmentation index from the measured central flow pulses; g.

Abstract: A method and system for optimizing insulin dosages for diabetic subjects which includes a processor for calculating basal and bolus dosages to be recommended for meal types including breakfast, lunch, dinner, snack, or at miscellaneous times. The bolus calculations are specifically directed to time periods which are taken from either pre-meal, post-meal, bedtime, mid-sleep or miscellaneous times. The processor calculates an optimized bolus for a specific time period and meal type based upon prior basal dosages, prior glucose doses, hypoglycemia thresholds, mid-point of target ranges, and subject insulin sensitivity factors. A display is provided to the subject for sensing the optimized insulin dosage recommended at a specific time period and for a specific meal type.

Abstract: An apparatus comprising a socket insert that is arranged in a receptacle of the apparatus. The socket insert is connected to an operating medium connector. In the receptacle a data interface is covered by the socket insert and inaccessible from outside. To obtain access to the apparatus software or data, the socket insert can be replaced by a service insert that covers the operating medium output but contacts the data plug. The service insert allows communication with the apparatus control to input or output data and/or programs. The arrangement of the service interface covered by socket inserts provides an effective means for access control to the service interface. It impedes or avoids non-authorized access to the interface and damages for persons and material that otherwise could occur due to the missing disruptive discharge proof potential separation between the service interface and particularly the power section of the apparatus control.

Abstract: Systems and methods are provided to provide guidance to a user regarding management of a physiologic condition such as diabetes. The determination may be based upon a patient glucose concentration data sensed by a glucose concentration sensor. A host state change associated with the host glucose concentration data may be determined. A guidance message based at least in part on the host state change may also be determined. The guidance message may be delivered through a user interface.

Abstract: A system for monitoring the movements or other activities of patient. Aspects include a monitoring device with one or more sensors such as a pressure or motion sensors that may be positioned on or near a patient. Alerts may be generated by the monitoring device if the sensor readings fall outside predetermined limits set in a patient profile specific to a particular patient. Sensor readings and/or alerts may be sent by the monitoring device to the central server which may notify nearby caregivers that a patient needs assistance. The server may be configured to analyze sensor readings and alert information to refine patient profiles to reduce or eliminate false alarms.

Abstract: An ultrasound apparatus includes: a display unit configured to display on an ultrasound image a measuring device image including a plurality of measuring points which indicate points on the ultrasound image that are to be measured, and an adjusting portion for adjusting the plurality of measuring points; an input unit configured to receive a touch input for changing a position of the adjusting portion; and a controller configured to adjust a position of at least one of the plurality of measuring points based on the changed position of the adjusting portion, and to obtain a measurement value based on positions of the plurality of measuring points including the at least one measuring point, the position of which is adjusted, wherein the plurality of measuring points are disposed apart from the adjusting portion.

Abstract: A system for measuring blood oxygenation levels and capillary refill time (CRT) of a user includes a camera configured to capture a video stream that includes a series of images representing a process of first squeezing a fingernail of the user to a blanched state, and then releasing to a resting state, and a Convolutional Neural Network (CNN) based processing unit configured to process an input image to create a two-dimensional representation of features, remove spatial relationships in the two-dimensional representation, generate non-spatial metadata, identify the fingernail in the resting state, and regions within a static image of the fingernail, and configured to generate a blood oxygenation value, and a measurement confidence level, and generate a CRT value of the user by applying the blood oxygenation value, and the measurement confidence level to a series of images captured by the camera over time.

Abstract: A method for developing codes and a cross functional set of rules that suggest to a physician, in real-time, potential diagnoses related to diagnostic results or other clinical data entered into the electronic Medical Record (EMR). The method generates a possible diagnosis for consideration and addition to the patient problem list. When the physician selects a suggested diagnosis, the problem list is automatically updated with the diagnosis. In view of the above, the physician has the needed information at the point of care so that the timeliness, safety and quality of care is improved. The generated documentation also assists other physicians throughout the continuum of care for the Patient. The method creates crosswalk from data element to diagnosis to enhance the completeness of documentation. As a result, the Diagnostic Related Group (DRG) is more accurately assigned by coders at discharge to drive more accurate and efficient billing for improved reimbursement and revenue.

Abstract: A method of managing an electronic health record and displaying a patient's medical state can include receiving a first input corresponding to the medical state, including a first plurality of positives that each correspond to a deviation from a healthy state. The method can also include grouping at least some of the first plurality of positives that collectively correlate to at least one of the medical conditions. The method can also include displaying with a display a statgraph having a plurality of objects including a homunculus plane, nodes projecting away from the plane, axes interconnecting the nodes, and a planar bundling object enveloping at least some of the nodes. The method can also include morphing, on the display controlled by the computing device, a first statgraph into a second statgraph.

Abstract: Provided herein is an engagement and care support platform (“ECSP”) computer system including at least one processor in communication with at least one memory device for facilitating senior user engagement. The processor is programmed to: (i) register a user through an application, (ii) register a caregiver associated with the user through the application, (iii) generate a senior profile based upon user personal and scheduling data, (iv) build a daily interactive user interface that reflects the senior profile, (v) display the daily interactive user interface at a first client device associated with the user, (vi) cause the first client device to initiate a daily interaction prompt to the user, (vii) determine whether any user interaction was received in response to the daily interaction prompt, and (viii) transmit a daily update message to a second client device associated with the caregiver, including an indication of whether any user interaction was received.

Abstract: The present invention provides an interactive, electronic, knowledge-based ordering process for specialty/biotech pharmaceuticals (medically coded drugs) which results in less waste, improved procedural efficiencies, and greater cost savings than the current ordering systems. The knowledge-base of the system is based on the health plan's clinical policies as well as the status of the patient and their entitled benefits with the health plan, and it is applied in an interactive manner through a web-enabled system which provides a real-time, prospective examination and control over requests for authorization to dispense the medically coded drugs. The system also includes a feedback loop from the specialty pharmacies to provide information on the medicines that have actually been dispensed. The system also provides to the patient, educational material and adherence reminders to affect therapeutic outcomes.

Abstract: Systems and methods for utilizing machine learning to generate a trans-diagnostic classifier that is operative to concurrently diagnose a plurality of different mental health disorders using a single trans-diagnostic questionnaire that includes a plurality of questions (e.g., 17 questions). Machine learning techniques are used to process labeled training data to build statistical models that include trans-diagnostic item-level questions as features to create a screen to classify groups of subjects as either healthy or as possibly having a mental health disorder. A subset of questions is selected from the multiple self-administered mental health questionnaires and used to autonomously screen subjects across multiple mental health disorders without physician involvement, optionally remotely and repeatedly, in a short amount of time.

Abstract: Techniques for patterned and correlated electrical activity include receiving user data from a device of a user and anonymized data from other devices of other users, the user data and the anonymized data being received based on the device and the other devices having been co-located. The user data is compared to the anonymized data according to an activity. It is determined that an event occurred based on one or more deviations of the user data from the anonymized data according to the activity, the event being related to a health of the user.

Abstract: A medical device system. The system includes a first medical device, a first remote interface, and a second remote interface in communication with the first remote interface and the first medical device, wherein the first medical device sends a command to the first medical device through the second remote interface, and wherein when the second remote interface receives the command, the command must be confirmed by the second remote interface before the command is send by the second remote interface to the first medical device.

Abstract: Generally, methods, devices, and systems related to analyte monitoring and data logging are provided—e.g., as related to in vivo analyte monitoring devices and systems. In some aspects, methods, devices, and systems are provided that relate to enable related settings based on an expected use of an in vivo positioned sensor; logging or otherwise recording analyte levels acquired or derived—e.g., sample analyte levels more frequently than they are logged or otherwise recorded in memory; dynamically adjust the data logging frequency; randomly determine times of acquiring or storing analyte levels from the in-vivo positioned analyte sensors; and enable recording related settings when the system is operable.

Abstract: Generally, methods, devices, and systems related to analyte monitoring and data logging are provided—e.g., as related to in vivo analyte monitoring devices and systems. In some aspects, methods, devices, and systems are provided that relate to enable related settings based on an expected use of an in vivo positioned sensor; logging or otherwise recording analyte levels acquired or derived—e.g., sample analyte levels more frequently than they are logged or otherwise recorded in memory; dynamically adjust the data logging frequency; randomly determine times of acquiring or storing analyte levels from the in-vivo positioned analyte sensors; and enable recording related settings when the system is operable.

Abstract: A patient care system has a medical pump for delivering a medicine to a patient, and a processor in communication with the pump. The pump is configured to receive a first input on whether the medicine is a critical medicine, and a second input on a trigger condition that triggers a fail-operate mode for the critical medicine. The processor controls the medical pump to operate in the fail-operate mode, where the fail-operate mode continues delivery of the critical medicine when the trigger condition is triggered.

Abstract: Systems, methods, and devices, including computer-readable media, for managing operation of devices in complex systems and changing environments. In some implementations, a server system stores data indicating management plans for each of a plurality of different devices, each management plan indicating a device-specific set of program states for programs in a predetermined set of programs. The server system alters the management plans and enforces interdependence of the programs, and the server system generates a customized instruction that alters operation of the device according to the device-specific set of program states assigned in the altered management plan for the device. The server system causes each device to perform one or more operations of the device determined according to the device-specific set of program states assigned in the altered management plan for the device.