Clinical Process Management: A model-driven & tool-based proposal

In healthcare institutions it is important to define methodologies and management strategies in order to define, maintain and execute Healthcare Processes (HP) in a simple and effective manner. These needs are necessary because this kind of processes involve many people (software engineer, healthcare teams, and doctors, among others) and must also comply with lots of international clinical standards (such as ISO-EN 13606 or ISO/DIS 13940). This paper presents a formal demonstration of our proposal which is based on the Model-Driven paradigm in order to support modeling, deploying and executing HP. Our tool-based proposal allows reducing costs, improving quality and optimizing HP taking into account the Model-Driven paradigm advantages

Special topic interoperability and EHR: Combining openEHR, SNOMED, IHE, and continua as approaches to interoperability on national ehealth

SummaryObjectives: The main aims of the paper comprise the characterization and examination of the potential approaches regarding interoperability. This includes openEHR, SNOMED, IHE, and Continua as combined interoperability approaches, possibilities for their incorporation into the eHealth environment, and identification of the main success factors in the field, which are necessary for achieving required interoperability, and consequently, for the successful implementation of eHealth projects in general.Methods: The paper represents an in-depth analysis regarding the potential application of openEHR, SNOMED, IHE and Continua approaches in the development and implementation process of eHealth in Slovenia. The research method used is both exploratory and deductive in nature. The methodological framework is grounded on information retrieval with a special focus on research and charting of existing experience in the field, and sources, both electronic and written, which include interoperability concepts and related implementation issues.Results: The paper will try to answer the following inquiries that are complementing each other:1. Scrutiny of the potential approaches, which could alleviate the pertinent interoperability issues in the Slovenian eHealth context.2. Analyzing the possibilities (requirements) for their inclusion in the construction process for individual eHealth solutions.3. Identification and charting the main success factors in the interoperability field that critically influence development and implementation of eHealth projects in an efficient manner.Conclusions: Provided insights and identified success factors could serve as a constituent of the strategic starting points for continuous integration of interoperability principles into the healthcare domain. Moreover, the general implementation of the identified success factors could facilitate better penetration of ICT into the healthcare environment and enable the eHealth-based transformation of the health system especially in the countries which are still in an early phase of eHealth planning and development and are often confronted with differing interests, requirements, and contending strategies.Citation: Beštek M, Stanimirovic D. Special Topic Interoperability and EHR: Combining openEHR, SNOMED, IHE, and Continua as approaches to interoperability on national eHealth. Appl Clin Inform 2017; 8: 810–825 https://doi.org/10.4338/ACI-2017-01-RA-0011 </jats:p

Data Modeling Challenges of Advanced Interoperability

Progressive health paradigms, involving many different disciplines and combining multiple policy domains, requires advanced interoperability solutions. This results in special challenges for modeling health systems. The paper discusses classification systems for data models and enterprise business architectures and compares them with the ISO Reference Architecture. On that basis, existing definitions, specifications and standards of data models for interoperability are evaluated and their limitations are discussed. Amendments to correctly use those models and to better meet the aforementioned challenges are offered

Solving the Modeling Dilemma as a Foundation for Interoperability

Introduction: Progressive health paradigms, involving many different disciplines and combining multiple policy domains, requires advanced interoperability solutions. This results in special challenges for modeling health systems. Methods: The paper discusses classification systems for data models and enterprise business architectures and compares them with the ISO Reference Architecture. Results and Conclusions: Existing definitions, specifications and standards for data models enabling interoperability are analyzed, and their limitations are evaluated. Amendments to correctly use those models and to better meet the aforementioned challenges are offered

Interoperable EHR Systems – Challenges, Standards and Solutions

Background: Electronic Health Record Systems (EHRS) and Personal Health Record Systems (PHRS) are core components of infrastructure needed to run any health system. Objectives: As health systems undergo paradigm changes, EHRS and PHRS have to advance as well to meet the related interoperability challenges. Methods: The paper discusses EHR types, implementations and standards, starting with different requirements specifications, systems and systems architectures, standards and solutions. Results: Existing standards and specifications are compared with changing requirements, presenting weaknesses and defining the advancement of EHRS, architectures and related services, embedded in advanced infrastructure systems. Conclusion: Future EHR systems are components in a layered architecture with open interfaces. The need of verifying data models at business domains level is specifically highlighted. Such approach is enabled by the ISO Interoperability Reference Architecture of a systemoriented, architecture-centric, ontology-based, policy- driven approach, meeting good modeling best practices

A Two-Level Identity Model To Support Interoperability of Identity Information in Electronic Health Record Systems.

The sharing and retrieval of health information for an electronic health record (EHR) across distributed systems involves a range of identified entities that are possible subjects of documentation (e.g., specimen, clinical analyser). Contemporary EHR specifications limit the types of entities that can be the subject of a record to health professionals and patients, thus limiting the use of two level models in healthcare information systems that contribute information to the EHR. The literature describes several information modelling approaches for EHRs, including so called “two level models”. These models differ in the amount of structure imposed on the information to be recorded, but they generally require the health documentation process for the EHR to focus exclusively on the patient as the subject of care and this definition is often a fixed one. In this thesis, the author introduces a new identity modelling approach to create a generalised reference model for sharing archetype-constrained identity information between diverse identity domains, models and services, while permitting reuse of published standard-based archetypes. The author evaluates its use for expressing the major types of existing demographic reference models in an extensible way, and show its application for standards-compliant two-level modelling alongside heterogeneous demographics models. This thesis demonstrates how the two-level modelling approach that is used for EHRs could be adapted and reapplied to provide a highly-flexible and expressive means for representing subjects of information in allied health settings that support the healthcare process, such as the laboratory domain. By relying on the two level modelling approach for representing identity, the proposed design facilitates cross-referencing and disambiguation of certain demographics standards and information models. The work also demonstrates how it can also be used to represent additional clinical identified entities such as specimen and order as subjects of clinical documentation

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

Incorporating business process management, business ontology and business architecture in medication management quality

Managers and care providers in the health sector are expected to deliver safe, efficient and effective services within a resource constrained, complex system. Services are provided through execution of multiple processes. Healthcare organizations tend to be structured in functional based silos with process improvement efforts often focused on individual processes within the discrete silos. This silo based improvement approach fails to take into account upstream and downstream processes executed and managed in other silos. A patient’s journey will typically include processes from multiple silos and therefore, improvement efforts need to focus on end-to-end processes if the goal is to deliver a positive patient experience. In order to optimize processes in a complex adaptive system like healthcare and to effect meaningful change a combination of management disciplines is required. This research explored the use of Business Process Management (BPM), Business Architecture (BA) and Business Process Management Ontology (BPMO) as a comprehensive, integrated approach to design, redesign, evaluate, improve and monitor the safety, efficiency and effectiveness of medication management processes in a multi-site healthcare organization. The contribution of the research was threefold. First, identified benefits of applying BPM, BPMO and BA to increase organization capacity and improve the end-to-end process of medication management; second, demonstrated the application of an ontology and the business layer of enterprise architecture used in other sectors could be successfully utilized in the healthcare sector; and third, developed a process reference model for medication management processes in acute care and long term care facilities.Business Process ManagementBusiness ArchitectureBusiness Ontologymedication managementquality improvemen