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

Towards an aspect weaving BPEL engine

This position paper proposes the use of dynamic aspects and the visitor design pattern to obtain a highly configurable and extensible BPEL engine. Using these two techniques, the core of this infrastructural software can be customised to meet new requirements and add features such as debugging, execution monitoring, or changing to another Web Service selection policy. Additionally, it can easily be extended to cope with customer-specific BPEL extensions. We propose the use of dynamic aspects not only on the engine itself but also on the workflow in order to tackle the problems of Web Service hot deployment and hot fixes to long running processes. In this way, composing aWeb Service "on-the-fly" means weaving its choreography interface into the workflow

Innovation Of, In, On Infrastructures: Articulating the Role of Architecture in Information Infrastructure Evolution

In this paper, we address the question: “which conditions enable successful information infrastructure innovation?”. Information infrastructures are characterized by nonlinear evolutionary dynamics. Based on a case study that examines the design, development, and initial use of a web-based solution for patient-hospital communication at a Norwegian hospital over a ten-year period, we trace the evolution of a new II. This longitudinal analysis takes installed base cultivation as its conceptual basis. Specifically, we draw on three aspects of a cultivation strategy: growth process, user mobilization, and learning to cultivate. The analysis shows how the solution started as a bottom-up initiative of a small and motivated team at the hospital IT department, and how it grew gradually in a flexible and evolutionary way. Our findings support the argument that successful infrastructure innovations are based on a cultivation strategy addressing specific users’ needs, usefulness, and evolutionary growth. We make three key contributions to information infrastructure research. First, we expose the role architecture plays in the growth of IIs. Second, we provide insights about cultivating IIs, especially in their bootstrap phase. Third, we identify three different but interrelated types of innovation—in, of, on infrastructure—that articulate the critical role of IIs architecture in enabling successful innovation

Accountable-eHealth Systems: the Next Step Forward for Privacy

EHealth systems promise enviable benefits and capabilities for healthcare, yet the technologies that make these capabilities possible brings with them undesirable drawback such as information security related threats which need to be appropriately addressed. Lurking in these threats are patient privacy concerns. Resolving these privacy concerns have proven to be difficult since they often conflict with information requirements of healthcare providers. It is important to achieve a proper balance between these requirements. We believe that information accountability can achieve this balance. In this paper we introduce accountable-eHealth systems. We will discuss how our designed protocols can successfully address the aforementioned requirement. We will also compare characteristics of AeH systems with Australia’s PCEHR system and identify similarities and highlight the differences and the impact those differences would have to the eHealth domain

Incorporating an Element of Negotiation into a Service-Oriented Broker Application

The Software as a Service (SaaS) model is a service-based model in which a desired service is assembled, delivered and consumed on demand. The IBHIS broker is a ‘proof of concept’ demonstration of SaaS which is based on services that deliver data. IBHIS has addressed a number of challenges for several aspects of servicebased software, especially the concept of a ‘broker service’ and service negotiation that is only used in establishing end-user access authorizations. This thesis investigates and develops an extended form of service-based broker, called CAPTAIN (Care Planning Through Auction-based Information Negotiation). It extends the concepts and role of the broker as used in IBHIS, and in particular, it extends the service negotiation function in order to demonstrate a full range of service characteristics. CAPTAIN uses the idea of the integrated care plan from healthcare to provide a case study. A care planner acting on behalf of a patient uses the broker to negotiate with providers to produce the integrated care plan for the patient with the broker and the providers agreeing on the terms and conditions relating to the supply of the services. We have developed a ‘proof of concept’ service-oriented broker architecture for CAPTAIN that includes planning, negotiation and service-based software models to provide a flexible care planning system. The CAPTAIN application has been evaluated that focuses on three features: functions, data access and negotiation. The CAPTAIN broker performs as planned, to produce the integrated care plan. The providers’ data sources are accessed to read and write data records during and after service negotiation. The negotiation model permits the broker to interact with the providers to produce an adaptable plan, based on the client’s needs. The primary outcome is an extendable service-oriented broker architecture that can enable more scalable and flexible distributed information management by adding interaction with the data sources

A framework and tool to manage Cloud Computing service quality

Cloud Computing has generated considerable interest in both companies specialized in Information and Communication Technology and business context in general. The Sourcing Capability Maturity Model for service (e-SCM) is a capability model for offshore outsourcing services between clients and providers that offers appropriate strategies to enhance Cloud Computing implementation. It intends to achieve the required quality of service and develop an effective working relationship between clients and providers. Moreover, quality evaluation framework is a framework to control the quality of any product and/or process. It offers a tool support that can generate software artifacts to manage any type of product and service efficiently and effectively. Thus, the aim of this paper was to make this framework and tool support available to manage Cloud Computing service quality between clients and providers by means of e-SCM.Ministerio de Ciencia e Innovación TIN2013-46928-C3-3-RJunta de Andalucía TIC-578

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

Knowledge Management for Public Administrations: Technical Realizations of an Enterprise Attention Management System

The improvement of governments’ efficiency has gained great importance and validity especially in the current times of economic downturn. E-Government constitutes the most contemporary techno-managerial proposition in the track of possible interventions. The paper addresses, more specifically, empowerments necessitated by Public Administration (PA) organizations. Anchored on the needs of three real-life cases, the paper describes the conception and the realization of an IT artefact together with its methodological appeals aiming at improving information access and delivery and thus PAs’ decision making capacity. Our proposition constitutes a novel approach for managing users’ attention in knowledge intensive organizations which goes beyond informing a user about changes in relevant information towards proactively supporting the user to react on changes. The approach is based on an expressive attention model, which is realized by combining ECA (Event-Condition-Action) rules with ontologies. The technical realizations described in the paper constitute the underlying infrastructure of an Enterprise Attention Management System