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

Behavior change interventions: the potential of ontologies for advancing science and practice

A central goal of behavioral medicine is the creation of evidence-based interventions for promoting behavior change. Scientific knowledge about behavior change could be more effectively accumulated using "ontologies." In information science, an ontology is a systematic method for articulating a "controlled vocabulary" of agreed-upon terms and their inter-relationships. It involves three core elements: (1) a controlled vocabulary specifying and defining existing classes; (2) specification of the inter-relationships between classes; and (3) codification in a computer-readable format to enable knowledge generation, organization, reuse, integration, and analysis. This paper introduces ontologies, provides a review of current efforts to create ontologies related to behavior change interventions and suggests future work. This paper was written by behavioral medicine and information science experts and was developed in partnership between the Society of Behavioral Medicine's Technology Special Interest Group (SIG) and the Theories and Techniques of Behavior Change Interventions SIG. In recent years significant progress has been made in the foundational work needed to develop ontologies of behavior change. Ontologies of behavior change could facilitate a transformation of behavioral science from a field in which data from different experiments are siloed into one in which data across experiments could be compared and/or integrated. This could facilitate new approaches to hypothesis generation and knowledge discovery in behavioral science

Standards for Scalable Clinical Decision Support: Need, Current and Emerging Standards, Gaps, and Proposal for Progress

Despite their potential to significantly improve health care, advanced clinical decision support (CDS) capabilities are not widely available in the clinical setting. An important reason for this limited availability of CDS capabilities is the application-specific and institution-specific nature of most current CDS implementations. Thus, a critical need for enabling CDS capabilities on a much larger scale is the development and adoption of standards that enable current and emerging CDS resources to be more effectively leveraged across multiple applications and care settings. Standards required for such effective scaling of CDS include (i) standard terminologies and information models to represent and communicate about health care data; (ii) standard approaches to representing clinical knowledge in both human-readable and machine-executable formats; and (iii) standard approaches for leveraging these knowledge resources to provide CDS capabilities across various applications and care settings. A number of standards do exist or are under development to meet these needs. However, many gaps and challenges remain, including the excessive complexity of many standards; the limited availability of easily accessible knowledge resources implemented using standard approaches; and the lack of tooling and other practical resources to enable the efficient adoption of existing standards. Thus, the future development and widespread adoption of current CDS standards will depend critically on the availability of tooling, knowledge bases, and other resources that make the adoption of CDS standards not only the right approach to take, but the cost-effective path to follow given the alternative of using a traditional, ad hoc approach to implementing CDS

Proposal for an IMLS Collection Registry and Metadata Repository

The University of Illinois at Urbana-Champaign proposes to design, implement, and research a collection-level registry and item-level metadata repository service that will aggregate information about digital collections and items of digital content created using funds from Institute of Museum and Library Services (IMLS) National Leadership Grants. This work will be a collaboration by the University Library and the Graduate School of Library and Information Science. All extant digital collections initiated or augmented under IMLS aegis from 1998 through September 30, 2005 will be included in the proposed collection registry. Item-level metadata will be harvested from collections making such content available using the Open Archives Initiative Protocol for Metadata Harvesting (OAI PMH). As part of this work, project personnel, in cooperation with IMLS staff and grantees, will define and document appropriate metadata schemas, help create and maintain collection-level metadata records, assist in implementing OAI compliant metadata provider services for dissemination of item-level metadata records, and research potential benefits and issues associated with these activities. The immediate outcomes of this work will be the practical demonstration of technologies that have the potential to enhance the visibility of IMLS funded online exhibits and digital library collections and improve discoverability of items contained in these resources. Experience gained and research conducted during this project will make clearer both the costs and the potential benefits associated with such services. Metadata provider and harvesting service implementations will be appropriately instrumented (e.g., customized anonymous transaction logs, online questionnaires for targeted user groups, performance monitors). At the conclusion of this project we will submit a final report that discusses tasks performed and lessons learned, presents business plans for sustaining registry and repository services, enumerates and summarizes potential benefits of these services, and makes recommendations regarding future implementations of these and related intermediary and end user interoperability services by IMLS projects.unpublishednot peer reviewe

Outside The Box: Building a Digital Asset Management Ecosystem for Preservation and Access

The University of Houston (UH) Libraries made an institutional commitment in late 2015 to migrate the data for its digitized cultural heritage collections to open source systems for preservation and access: Hydra-in-a-Box, Archivematica, and ArchivesSpace. This article describes the work that the UH Libraries implementation team has completed to date, including open source tools for streamlining digital curation workflows, minting and resolving identifiers, and managing SKOS vocabularies. These systems, workflows, and tools, collectively known as the Bayou City Digital Asset Management System (BCDAMS), represent a novel effort to solve common issues in the digital curation lifecycle and may serve as a model for other institutions seeking to implement flexible and comprehensive systems for digital preservation and access.Librarie

Bayesian nonparametric dependent model for partially replicated data: the influence of fuel spills on species diversity

We introduce a dependent Bayesian nonparametric model for the probabilistic modeling of membership of subgroups in a community based on partially replicated data. The focus here is on species-by-site data, i.e. community data where observations at different sites are classified in distinct species. Our aim is to study the impact of additional covariates, for instance environmental variables, on the data structure, and in particular on the community diversity. To that purpose, we introduce dependence a priori across the covariates, and show that it improves posterior inference. We use a dependent version of the Griffiths-Engen-McCloskey distribution defined via the stick-breaking construction. This distribution is obtained by transforming a Gaussian process whose covariance function controls the desired dependence. The resulting posterior distribution is sampled by Markov chain Monte Carlo. We illustrate the application of our model to a soil microbial dataset acquired across a hydrocarbon contamination gradient at the site of a fuel spill in Antarctica. This method allows for inference on a number of quantities of interest in ecotoxicology, such as diversity or effective concentrations, and is broadly applicable to the general problem of communities response to environmental variables.Comment: Main Paper: 22 pages, 6 figures. Supplementary Material: 11 pages, 1 figur

Learning Object Metadata and its application

A number of international efforts have been initiated during the past few years leading to the evolvement of various educational metadata specifications for the commonly agreed description of educational resources. Educational metadata can significantly enhance the effective description, search and retrieval of learning objects resulting in efficient organization of educational resources for technology supported instruction. As more and more applications are implemented using educational metadata, it becomes obvious that it would be difficult for a single metadata model to accommodate the functional requirements of all applications. This paper focuses on different existing educational metadata standards with the relative merits of each one, it will also examine the fundamental elements or basic structure of each one of the existing standards, and discuss the interoperability issues. Because of the various E-learning metadata standards that exist, interoperability is a major issue. A major barrier limiting system’s interoperability is the use of different specifications that define the structure and content of learning objects

Development and implementation of clinical guidelines : an artificial intelligence perspective

Clinical practice guidelines in paper format are still the preferred form of delivery of medical knowledge and recommendations to healthcare professionals. Their current support and development process have well identified limitations to which the healthcare community has been continuously searching solutions. Artificial intelligence may create the conditions and provide the tools to address many, if not all, of these limitations.. This paper presents a comprehensive and up to date review of computer-interpretable guideline approaches, namely Arden Syntax, GLIF, PROforma, Asbru, GLARE and SAGE. It also provides an assessment of how well these approaches respond to the challenges posed by paper-based guidelines and addresses topics of Artificial intelligence that could provide a solution to the shortcomings of clinical guidelines. Among the topics addressed by this paper are expert systems, case-based reasoning, medical ontologies and reasoning under uncertainty, with a special focus on methodologies for assessing quality of information when managing incomplete information. Finally, an analysis is made of the fundamental requirements of a guideline model and the importance that standard terminologies and models for clinical data have in the semantic and syntactic interoperability between a guideline execution engine and the software tools used in clinical settings. It is also proposed a line of research that includes the development of an ontology for clinical practice guidelines and a decision model for a guideline-based expert system that manages non-compliance with clinical guidelines and uncertainty.This work is funded by national funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project PEst-OE/EEI/UI0752/2011"

The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions : a review

Clinical practice guidelines (CPGs) document evidence-based information and recommendations on treatment and management of conditions. CPGs usually focus on management of a single condition; however, in many cases a patient will be at the centre of multiple health conditions (multimorbidity). Multiple CPGs need to be followed in parallel, each managing a separate condition, which often results in instructions that may interact with each other, such as conflicts in medication. Furthermore, the impetus to deliver customised care based on patient-specific information, results in the need to be able to offer guidelines in an integrated manner, identifying and managing their interactions. In recent years, CPGs have been formatted as computer-interpretable guidelines (CIGs). This enables developing CIG-driven clinical decision support systems (CDSSs), which allow the development of IT applications that contribute to the systematic and reliable management of multiple guidelines. This study focuses on understanding the use of CIG-based CDSSs, in order to manage care complexities of patients with multimorbidity. The literature between 2011 and 2017 is reviewed, which covers: (a) the challenges and barriers in the care of multimorbid patients, (b) the role of CIGs in CDSS augmented delivery of care, and (c) the approaches to alleviating care complexities of multimorbid patients. Generating integrated care plans, detecting and resolving adverse interactions between treatments and medications, dealing with temporal constraints in care steps, supporting patient-caregiver shared decision making and maintaining the continuity of care are some of the approaches that are enabled using a CIG-based CDSS