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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 āchallengeā themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying āchallengeā 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
Resolving Architectural Mismatches of COTS Through Architectural Reconciliation
The integration of COTS components into a system under development entails architectural mismatches. These have been tackled, so far, at the component level, through component adaptation techniques, but they also must be tackled at an architectural level of abstraction. In this paper we propose an approach for resolving architectural mismatches, with the aid of architectural reconciliation. The approach consists of designing and subsequently reconciling two architectural models, one that is forward-engineered from the requirements and another that is reverse-engineered from the COTS-based implementation. The final reconciled model is optimally adapted both to the requirements and to the actual COTS-based implementation. The contribution of this paper lies in the application of architectural reconciliation in the context of COTS-based software development. Architectural modeling is based upon the UML 2.0 standard, while the reconciliation is performed by transforming the two models, with the help of architectural design decisions.
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