Activity-based Access Control Model to Hospital Information

Hospital work is characterized by the need to manage multiple activities simultaneously, constant local mobility, frequently interruptions, and intense collaboration and communication. Hospital employees must handle a large amount of data that is often tied to specific work activities. This calls for a proper access control model. In this paper, we propose a novel approach, Activity-based access Control Model (ACM). Unlike conventional approaches which exploit user identity/role information, ACM leverages user’s activities to determine the access permissions for that user. In ACM, a user is assigned to perform a number of actions if s/he poses a set of satisfactory attributes. Access permissions to hospital information are granted according to user’s actions. By doing this, ACM contributes a number of advantages over conventional models: (1) facilitates user’s work; (2) reduces complexity and cost of access management. Though the design of ACM first aims to support clinical works in hospitals, it can be applied in other activity-centered environments. 1

Modelling the feedback effects of reconfiguring health services

The shift in the balance of health care, bringing services ‘closer to home’, is a well-established trend, which has been motivated by the desire to improve the provision of services. However, these efforts may be undermined by the improvements in access stimulating demand. Existing analyses of this trend have been limited to isolated parts of the system with calls to control demand with stricter clinical guidelines or to meet demand with capacity increases. By failing to appreciate the underlying feedback mechanisms, these interventions may only have a limited effect. We demonstrate the contribution offered by system dynamics modelling by presenting a study of two cases of the shift in cardiac catheterization services in the UK. We hypothesize the effects of the shifts in services and produce model output that is not inconsistent with real world data. Our model encompasses several mechanisms by which demand is stimulated. We use the model to clarify the roles for stricter clinical guidelines and capacity increases, and to demonstrate the potential benefits of changing the goals that drive activity

Simulation analysis of the consequences of shifting the balance of health care: a system dynamics approach

Objectives: The shift in the balance of health care, bringing services 'closer to home', is a well-established trend. This study sought to provide insight into the consequences of this trend, in particular the stimulation of demand, by exploring the underlying feedback structure. Methods: We constructed a simulation model using the system dynamics method, which is specifically designed for the analysis of feedback structure. The model was calibrated to two cases of the shift in cardiac catheterization services in the UK. Data sources included archival data, observations and interviews with senior health care professionals. Key model outputs were the basic trends displayed by waiting lists, average waiting times, cumulative patient referrals, cumulative patient activity and cumulative overall costs. Results: Demand was stimulated in both cases via several different mechanisms. We revealed the roles for clinical guidelines and capacity changes, and the typical responses to imbalances between supply and demand. Our analysis also demonstrated the potential benefits of changing the goals that drive activity by seeking a waiting list goal rather than a waiting time goal. Conclusions: Appreciating the wider consequences of shifting the balance of care is essential if services are to be improved overall. The underlying feedback mechanisms of both intended and unintended effects need to be understood. Using a systemic approach, more effective policies may be designed through coordinated programmes rather than isolated initiatives, which may have only a limited impact

Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication