A standards-based ICT framework to enable a service-oriented approach to clinical decision support

This research provides evidence that standards based Clinical Decision Support (CDS) at the point of care is an essential ingredient of electronic healthcare service delivery. A Service Oriented Architecture (SOA) based solution is explored, that serves as a task management system to coordinate complex distributed and disparate IT systems, processes and resources (human and computer) to provide standards based CDS. This research offers a solution to the challenges in implementing computerised CDS such as integration with heterogeneous legacy systems. Reuse of components and services to reduce costs and save time. The benefits of a sharable CDS service that can be reused by different healthcare practitioners to provide collaborative patient care is demonstrated. This solution provides orchestration among different services by extracting data from sources like patient databases, clinical knowledge bases and evidence-based clinical guidelines (CGs) in order to facilitate multiple CDS requests coming from different healthcare settings. This architecture aims to aid users at different levels of Healthcare Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and managing services, thus enabling transparency. The research employs the Design Science research methodology (DSRM) combined with The Open Group Architecture Framework (TOGAF), an open source group initiative for Enterprise Architecture Framework (EAF). DSRM’s iterative capability addresses the rapidly evolving nature of workflows in healthcare. This SOA based solution uses standards-based open source technologies and platforms, the latest healthcare standards by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service (RLUS) standard. Combining business process management (BPM) technologies, business rules with SOA ensures the HCO’s capability to manage its processes. This architectural solution is evaluated by successfully implementing evidence based CGs at the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent Referral (Lung Cancer), c) Genome testing and integration with CDS in screening (Lynch’s syndrome). In addition to medical care, the CDS solution can benefit organizational processes for collaborative care delivery by connecting patients, physicians and other associated members. This framework facilitates integration of different types of CDS ideal for the different healthcare processes, enabling sharable CDS capabilities within and across organizations

A Generic Approach and Framework for Managing Complex Information

Several application domains, such as healthcare, incorporate domain knowledge into their day-to-day activities to standardise and enhance their performance. Such incorporation produces complex information, which contains two main clusters (active and passive) of information that have internal connections between them. The active cluster determines the recommended procedure that should be taken as a reaction to specific situations. The passive cluster determines the information that describes these situations and other descriptive information plus the execution history of the complex information. In the healthcare domain, a medical patient plan is an example for complex information produced during the disease management activity from specific clinical guidelines. This thesis investigates the complex information management at an application domain level in order to support the day-to-day organization activities. In this thesis, a unified generic approach and framework, called SIM (Specification, Instantiation and Maintenance), have been developed for computerising the complex information management. The SIM approach aims at providing a conceptual model for the complex information at different abstraction levels (generic and entity-specific). In the SIM approach, the complex information at the generic level is referred to as a skeletal plan from which several entity-specific plans are generated. The SIM framework provides comprehensive management aspects for managing the complex information. In the SIM framework, the complex information goes through three phases, specifying the skeletal plans, instantiating entity-specific plans, and then maintaining these entity-specific plans during their lifespan. In this thesis, a language, called AIM (Advanced Information Management), has been developed to support the main functionalities of the SIM approach and framework. AIM consists of three components: AIMSL, AIM ESPDoc model, and AIMQL. The AIMSL is the AIM specification component that supports the formalisation process of the complex information at a generic level (skeletal plans). The AIM ESPDoc model is a computer-interpretable model for the entity-specific plan. AIMQL is the AIM query component that provides support for manipulating and querying the complex information, and provides special manipulation operations and query capabilities, such as replay query support. The applicability of the SIM approach and framework is demonstrated through developing a proof-of-concept system, called AIMS, using the available technologies, such as XML and DBMS. The thesis evaluates the the AIMS system using a clinical case study, which has applied to a medical test request application

Efficient Decision Support Systems

This series is directed to diverse managerial professionals who are leading the transformation of individual domains by using expert information and domain knowledge to drive decision support systems (DSSs). The series offers a broad range of subjects addressed in specific areas such as health care, business management, banking, agriculture, environmental improvement, natural resource and spatial management, aviation administration, and hybrid applications of information technology aimed to interdisciplinary issues. This book series is composed of three volumes: Volume 1 consists of general concepts and methodology of DSSs; Volume 2 consists of applications of DSSs in the biomedical domain; Volume 3 consists of hybrid applications of DSSs in multidisciplinary domains. The book is shaped decision support strategies in the new infrastructure that assists the readers in full use of the creative technology to manipulate input data and to transform information into useful decisions for decision makers

A comprehensive clinical guideline model and a reasoning mechanism for AAL systems

The progressive ageing of population combined with the need for comfort in situations of disease and disability are pushing healthcare organizations and governments to find new solutions to enable people to live longer in their preferred environment, while having access to quality healthcare services. iGenda is an Ambient Assisted Living platform that provides constant monitoring to people with this type of needs. The use of a Computer-Interpretable Guideline model for decision making is one of the features of this platform. The model used to represent Clinical Practice Guidelines gathers a set of features that make guidelines more dynamic and easily implementable. The model is defined using Ontology Web Language, profiting from the existing constructors provided by this language. It is based on a set of primitive tasks, namely Plans, Actions, Questions and Decisions. Focusing on decision support, a method for dealing with incomplete information about the clinical parameters of a health record is presented. The objective is to keep a continuous flow of information through the decision process and assuring that an outcome is always achieved. The usefulness of the integration of guideline recommendations with a reason mechanism capable of handling incomplete information is demonstrated through a case study about the diagnosis of metabolic syndrome.(undefined

A service oriented architecture to implement clinical guidelines for evidence-based medical practice

Health information technology (HIT) has been identified as the fundamental driver to streamline the healthcare delivery processes to improve care quality and reduce operational costs. Of the many facets of HIT is Clinical Decision Support (CDS) which provides the physician with patient-specific inferences, intelligently filtered and organized, at appropriate times. This research has been conducted to develop an agile solution to Clinical Decision Support at the point of care in a healthcare setting as a potential solution to the challenges of interoperability and the complexity of possible solutions. The capabilities of Business Process Management (BPM) and Workflow Management systems are leveraged to support a Service Oriented Architecture development approach for ensuring evidence based medical practice. The aim of this study is to present an architecture solution that is based on SOA principles and embeds clinical guidelines within a healthcare setting. Since the solution is designed to implement real life healthcare scenarios, it essentially supports evidence-based clinical guidelines that are liable to change over a period of time. The thesis is divided into four parts. The first part consists of an Introduction to the study and a background to existing approaches for development and integration of Clinical Decision Support Systems. The second part focuses on the development of a Clinical Decision Support Framework based on Service Oriented Architecture. The CDS Framework is composed of standards based open source technologies including JBoss SwitchYard (enterprise service bus), rule-based CDS enabled by JBoss Drools, process modelling using Business Process Modelling and Notation. To ensure interoperability among various components, healthcare standards by HL7 and OMG are implemented. The third part provides implementation of this CDS Framework in healthcare scenarios. Two scenarios are concerned with the medical practice for diagnosis and early intervention (Chronic Obstructive Pulmonary Disease and Lung Cancer), one case study for Genetic data enablement of CDS systems (New born screening for Cystic Fibrosis) and the last case study is about using BPM techniques for managing healthcare organizational perspectives including human interaction with automated clinical workflows. The last part concludes the research with contributions in design and architecture of CDS systems. This thesis has primarily adopted the Design Science Research Methodology for Information Systems. Additionally, Business Process Management Life Cycle, Agile Business Rules Development methodology and Pattern-Based Cycle for E-Workflow Design for individual case studies are used. Using evidence-based clinical guidelines published by UK’s National Institute of Health and Care Excellence, the integration of latest research in clinical practice has been employed in the automated workflows. The case studies implemented using the CDS Framework are evaluated against implementation requirements, conformance to SOA principles and response time using load testing strategy. For a healthcare organization to achieve its strategic goals in administrative and clinical practice, this research has provided a standards based integration solution in the field of clinical decision support. A SOA based CDS can serve as a potential solution to complexities in IT interventions as the core data and business logic functions are loosely coupled from the presentation. Additionally, the results of this this research can serve as an exemplar for other industrial domains requiring rapid response to evolving business processes