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

Personalizing Situated Workflows for Pervasive Healthcare Applications

In this paper, we present an approach where a workflow system is combined with a policy-based framework for the specification and enforcement of policies for healthcare applications. In our approach, workflows are used to capture entitiespsila responsibilities and to assist entities in fulfilling them. The policy-based framework allows us to express authorisation policies to define the rights that entities have in the system, and event-condition-action (ECA) policies that are used to adapt the system to the actual situation. Authorisations will often depend on the context in which patientspsila care takes place, and our policies support predicates that reflect the environment. ECA policies capture events that reflect the current state of the environment and can perform actions to accordingly adapt the workflow execution. We show how the approach can be used for the Edema treatment and how fine-grained authorisation and ECA policies are expressed and used

B2B Infrastructures in the Process of Drug Discovery and Healthcare

In this paper we describe a demonstration of an innovative B2B infrastructure which can be used to support collaborations in the pharmaceutical industry to achieve the drug discovery goal. Based on experience gained in a wide range of collaborative projects in the areas of grid technology, semantics and data management we show future work and new topics in B2B infrastructures which arise when considering the use of patient records in the process of drug discovery and in healthcare applications

A Consent-based Workflow System for Healthcare Systems

In this paper, we describe a new framework for healthcare systems where patients are able to control the disclosure of their medical data. In our framework, the patient's consent has a pivotal role in granting or removing access rights to subjects accessing patient's medical data. Depending on the context in which the access is being executed, different consent policies can be applied. Context is expressed in terms of workflows. The execution of a task in a given workflow carries the necessary information to infer whether the consent can be implicitly retrieved or should be explicitly requested from a patient. However, patients are always able to enforce their own decisions and withdraw consent if necessary. Additionally, the use of workflows enables us to apply the need-to-know principle. Even when the patient's consent is obtained, a subject should access medical data only if it is required by the actual situation. For example, if the subject is assigned to the execution of a medical diagnosis workflow requiring access to the patient's medical record. We also provide a complex medical case study to highlight the design principles behind our framework. Finally, the implementation of the framework is outlined

Autonomic care platform for optimizing query performance

Background: As the amount of information in electronic health care systems increases, data operations get more complicated and time-consuming. Intensive Care platforms require a timely processing of data retrievals to guarantee the continuous display of recent data of patients. Physicians and nurses rely on this data for their decision making. Manual optimization of query executions has become difficult to handle due to the increased amount of queries across multiple sources. Hence, a more automated management is necessary to increase the performance of database queries. The autonomic computing paradigm promises an approach in which the system adapts itself and acts as self-managing entity, thereby limiting human interventions and taking actions. Despite the usage of autonomic control loops in network and software systems, this approach has not been applied so far for health information systems. Methods: We extend the COSARA architecture, an infection surveillance and antibiotic management service platform for the Intensive Care Unit (ICU), with self-managed components to increase the performance of data retrievals. We used real-life ICU COSARA queries to analyse slow performance and measure the impact of optimizations. Each day more than 2 million COSARA queries are executed. Three control loops, which monitor the executions and take action, have been proposed: reactive, deliberative and reflective control loops. We focus on improvements of the execution time of microbiology queries directly related to the visual displays of patients' data on the bedside screens. Results: The results show that autonomic control loops are beneficial for the optimizations in the data executions in the ICU. The application of reactive control loop results in a reduction of 8.61% of the average execution time of microbiology results. The combined application of the reactive and deliberative control loop results in an average query time reduction of 10.92% and the combination of reactive, deliberative and reflective control loops provides a reduction of 13.04%. Conclusions: We found that by controlled reduction of queries' executions the performance for the end-user can be improved. The implementation of autonomic control loops in an existing health platform, COSARA, has a positive effect on the timely data visualization for the physician and nurse

Authorization and access control of application data in Workflow systems

Workflow Management Systems (WfMSs) are used to support the modeling and coordinated execution of business processes within an organization or across organizational boundaries. Although some research efforts have addressed requirements for authorization and access control for workflow systems, little attention has been paid to the requirements as they apply to application data accessed or managed by WfMSs. In this paper, we discuss key access control requirements for application data in workflow applications using examples from the healthcare domain, introduce a classification of application data used in workflow systems by analyzing their sources, and then propose a comprehensive data authorization and access control mechanism for WfMSs. This involves four aspects: role, task, process instance-based user group, and data content. For implementation, a predicate-based access control method is used. We believe that the proposed model is applicable to workflow applications and WfMSs with diverse access control requirements

Autonomic Cloud Computing: Open Challenges and Architectural Elements

As Clouds are complex, large-scale, and heterogeneous distributed systems, management of their resources is a challenging task. They need automated and integrated intelligent strategies for provisioning of resources to offer services that are secure, reliable, and cost-efficient. Hence, effective management of services becomes fundamental in software platforms that constitute the fabric of computing Clouds. In this direction, this paper identifies open issues in autonomic resource provisioning and presents innovative management techniques for supporting SaaS applications hosted on Clouds. We present a conceptual architecture and early results evidencing the benefits of autonomic management of Clouds.Comment: 8 pages, 6 figures, conference keynote pape