Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

User-centered visual analysis using a hybrid reasoning architecture for intensive care units

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care

Bridging the gap between therapy research and practice in a person-centered/experiential therapy training program : the Leuven systematic case study research protocol

The goal of the Leuven Systematic Case Study Research Protocol project is to stimulate practice-oriented research in order to bridge the gap between research and practice. In this article we give a progress report of the project, in which a set of Dutch-language research instruments was created and tested with postgraduate trainees in person-centered/experiential therapy at the University Leuven (Belgium). We begin by presenting the general framework for the protocol, including the three major domains of therapy process, therapy outcome, and client/therapist characteristics. Then we give an overview of the quantitative and qualitative instruments used. We explain how the project has been implemented in the postgraduate program. To evaluate the success of the project, we analyzed the answers of our trainees on a questionnaire. We give an overview of the clinical cases involved and the variety of research questions that have been formulated in the individual case studies. Finally we discuss the value of this pilot project

Planning strategically, designing architecturally : a framework for digital library services

In an era of unprecedented technological innovation and evolving user expectations and information seeking behaviour, we are arguably now an online society, with digital services increasingly common and increasingly preferred. As a trusted information provider, libraries are in an advantageous position to respond, but this requires integrated strategic and enterprise architecture planning, for information technology (IT) has evolved from a support role to a strategic role, providing the core management systems, communication networks, and delivery channels of the modern library. Further, IT components do not function in isolation from one another, but are interdependent elements of distributed and multidimensional systems encompassing people, processes, and technologies, which must consider social, economic, legal, organisational, and ergonomic requirements and relationships, as well as being logically sound from a technical perspective. Strategic planning provides direction, while enterprise architecture strategically aligns and holistically integrates business and information system architectures. While challenging, such integrated planning should be regarded as an opportunity for the library to evolve as an enterprise in the digital age, or at minimum, to simply keep pace with societal change and alternative service providers. Without strategy, a library risks being directed by outside forces with independent motivations and inadequate understanding of its broader societal role. Without enterprise architecture, it risks technological disparity, redundancy, and obsolescence. Adopting an interdisciplinary approach, this conceptual paper provides an integrated framework for strategic and architectural planning of digital library services. The concept of the library as an enterprise is also introduced

Project Retrosight. Understanding the returns from cardiovascular and stroke research: Methodology Report

Copyright @ 2011 RAND Europe. All rights reserved. The full text article is available via the link below.This project explores the impacts arising from cardiovascular and stroke research funded 15-20 years ago and attempts to draw out aspects of the research, researcher or environment that are associated with high or low impact. The project is a case study-based review of 29 cardiovascular and stroke research grants, funded in Australia, Canada and UK between 1989 and 1993. The case studies focused on the individual grants but considered the development of the investigators and ideas involved in the research projects from initiation to the present day. Grants were selected through a stratified random selection approach that aimed to include both high- and low-impact grants. The key messages are as follows: 1) The cases reveal that a large and diverse range of impacts arose from the 29 grants studied. 2) There are variations between the impacts derived from basic biomedical and clinical research. 3) There is no correlation between knowledge production and wider impacts 4) The majority of economic impacts identified come from a minority of projects. 5) We identified factors that appear to be associated with high and low impact. This report presents the key observations of the study and an overview of the methods involved. It has been written for funders of biomedical and health research and health services, health researchers, and policy makers in those fields. It will also be of interest to those involved in research and impact evaluation.This study was initiated with internal funding from RAND Europe and HERG, with continuing funding from the UK National Institute for Health Research, the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada and the National Heart Foundation of Australia. The UK Stroke Association and the British Heart Foundation provided support in kind through access to their archives

Handbook for Learning-centred evaluation of Computer-facilitated learning projects in higher education

This handbook supports a project funded by the Australian Government Committee for University Teaching and Staff Development (CUTSD). The amended project title is “Staff Development in Evaluation of Technology-based Teaching Development Projects: An Action Inquiry Approach”. The project is hosted by Murdoch University on behalf of the Australasian Society for Computers in Learning in Tertiary Education (ASCILITE), as a consortium of 11 universities. The rationale of the project is to guide a group of university staff through the evaluation of a Computer-facilitated Learning (CFL1) project by a process of action inquiry and mentoring, supported by the practical and theoretical material contained in this handbook

How can health economics be used in the design and analysis of adaptive clinical trials? A qualitative analysis

Introduction Adaptive designs offer a flexible approach, allowing changes to a trial based on examinations of the data as it progresses. Adaptive clinical trials are becoming a popular choice, as the prudent use of finite research budgets and accurate decision-making are priorities for healthcare providers around the world. The methods of health economics, which aim to maximise the health gained for money spent, could be incorporated into the design and analysis of adaptive clinical trials to make them more efficient. We aimed to understand the perspectives of stakeholders in health technology assessments to inform recommendations for the use of health economics in adaptive clinical trials. Methods A qualitative study explored the attitudes of key stakeholders—including researchers, decision-makers and members of the public—towards the use of health economics in the design and analysis of adaptive clinical trials. Data were collected using interviews and focus groups (29 participants). A framework analysis was used to identify themes in the transcripts. Results It was considered that answering the clinical research question should be the priority in a clinical trial, notwithstanding the importance of cost-effectiveness for decision-making. Concerns raised by participants included handling the volatile nature of cost data at interim analyses; implementing this approach in global trials; resourcing adaptive trials which are designed and adapted based on health economic outcomes; and training stakeholders in these methods so that they can be implemented and appropriately interpreted. Conclusion The use of health economics in the design and analysis of adaptive clinical trials has the potential to increase the efficiency of health technology assessments worldwide. Recommendations are made concerning the development of methods allowing the use of health economics in adaptive clinical trials, and suggestions are given to facilitate their implementation in practice

A Scalable Architecture for Incremental Specification and Maintenance of Procedural and Declarative Clinical Decision-Support Knowledge

Clinical guidelines have been shown to improve the quality of medical care and to reduce its costs. However, most guidelines exist in a free-text representation and, without automation, are not sufficiently accessible to clinicians at the point of care. A prerequisite for automated guideline application is a machine-comprehensible representation of the guidelines. In this study, we designed and implemented a scalable architecture to support medical experts and knowledge engineers in specifying and maintaining the procedural and declarative aspects of clinical guideline knowledge, resulting in a machine comprehensible representation. The new framework significantly extends our previous work on the Digital electronic Guidelines Library (DeGeL) The current study designed and implemented a graphical framework for specification of declarative and procedural clinical knowledge, Gesher. We performed three different experiments to evaluate the functionality and usability of the major aspects of the new framework: Specification of procedural clinical knowledge, specification of declarative clinical knowledge, and exploration of a given clinical guideline. The subjects included clinicians and knowledge engineers (overall, 27 participants). The evaluations indicated high levels of completeness and correctness of the guideline specification process by both the clinicians and the knowledge engineers, although the best results, in the case of declarative-knowledge specification, were achieved by teams including a clinician and a knowledge engineer. The usability scores were high as well, although the clinicians’ assessment was significantly lower than the assessment of the knowledge engineers