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

Supporting the clinical trial recruitment process through the grid

Patient recruitment for clinical trials and studies is a large-scale task. To test a given drug for example, it is desirable that as large a pool of suitable candidates is used as possible to support reliable assessment of often moderate effects of the drugs. To make such a recruitment campaign successful, it is necessary to efficiently target the petitioning of these potential subjects. Because of the necessarily large numbers involved in such campaigns, this is a problem that naturally lends itself to the paradigm of Grid technology. However the accumulation and linkage of data sets across clinical domain boundaries poses challenges due to the sensitivity of the data involved that are atypical of other Grid domains. This includes handling the privacy and integrity of data, and importantly the process by which data can be collected and used, and ensuring for example that patient involvement and consent is dealt with appropriately throughout the clinical trials process. This paper describes a Grid infrastructure developed as part of the MRC funded VOTES project (Virtual Organisations for Trials and Epidemiological Studies) at the National e-Science Centre in Glasgow that supports these processes and the different security requirements specific to this domain

A Web/Grid Services Approach for Integration of Virtual Clinical & Research Environments

Clinicans have responsibilities for audit and research, often participating in projects with basic scientist colleagues. Our work in a regional teaching hospital setting involves collaboration with the medical school computer services and builds upon work developed in computer science department as part of the Collaborative Orthopaedic Research Environment (CORE) project[1]. This has established a pilot study for proof of concept work. Users are mapped to a personal profile implemented using XML and a service oriented architecture (SOA)[2,3]. This bridges the e-Health and e-Science domains, addressing some of the basic questions of security and uptake

A service oriented architecture to implement clinical guidelines for evidence-based medical practice

Health information technology (HIT) has been identified as the fundamental driver to streamline the healthcare delivery processes to improve care quality and reduce operational costs. Of the many facets of HIT is Clinical Decision Support (CDS) which provides the physician with patient-specific inferences, intelligently filtered and organized, at appropriate times. This research has been conducted to develop an agile solution to Clinical Decision Support at the point of care in a healthcare setting as a potential solution to the challenges of interoperability and the complexity of possible solutions. The capabilities of Business Process Management (BPM) and Workflow Management systems are leveraged to support a Service Oriented Architecture development approach for ensuring evidence based medical practice. The aim of this study is to present an architecture solution that is based on SOA principles and embeds clinical guidelines within a healthcare setting. Since the solution is designed to implement real life healthcare scenarios, it essentially supports evidence-based clinical guidelines that are liable to change over a period of time. The thesis is divided into four parts. The first part consists of an Introduction to the study and a background to existing approaches for development and integration of Clinical Decision Support Systems. The second part focuses on the development of a Clinical Decision Support Framework based on Service Oriented Architecture. The CDS Framework is composed of standards based open source technologies including JBoss SwitchYard (enterprise service bus), rule-based CDS enabled by JBoss Drools, process modelling using Business Process Modelling and Notation. To ensure interoperability among various components, healthcare standards by HL7 and OMG are implemented. The third part provides implementation of this CDS Framework in healthcare scenarios. Two scenarios are concerned with the medical practice for diagnosis and early intervention (Chronic Obstructive Pulmonary Disease and Lung Cancer), one case study for Genetic data enablement of CDS systems (New born screening for Cystic Fibrosis) and the last case study is about using BPM techniques for managing healthcare organizational perspectives including human interaction with automated clinical workflows. The last part concludes the research with contributions in design and architecture of CDS systems. This thesis has primarily adopted the Design Science Research Methodology for Information Systems. Additionally, Business Process Management Life Cycle, Agile Business Rules Development methodology and Pattern-Based Cycle for E-Workflow Design for individual case studies are used. Using evidence-based clinical guidelines published by UK’s National Institute of Health and Care Excellence, the integration of latest research in clinical practice has been employed in the automated workflows. The case studies implemented using the CDS Framework are evaluated against implementation requirements, conformance to SOA principles and response time using load testing strategy. For a healthcare organization to achieve its strategic goals in administrative and clinical practice, this research has provided a standards based integration solution in the field of clinical decision support. A SOA based CDS can serve as a potential solution to complexities in IT interventions as the core data and business logic functions are loosely coupled from the presentation. Additionally, the results of this this research can serve as an exemplar for other industrial domains requiring rapid response to evolving business processes

A standards-based ICT framework to enable a service-oriented approach to clinical decision support

This research provides evidence that standards based Clinical Decision Support (CDS) at the point of care is an essential ingredient of electronic healthcare service delivery. A Service Oriented Architecture (SOA) based solution is explored, that serves as a task management system to coordinate complex distributed and disparate IT systems, processes and resources (human and computer) to provide standards based CDS. This research offers a solution to the challenges in implementing computerised CDS such as integration with heterogeneous legacy systems. Reuse of components and services to reduce costs and save time. The benefits of a sharable CDS service that can be reused by different healthcare practitioners to provide collaborative patient care is demonstrated. This solution provides orchestration among different services by extracting data from sources like patient databases, clinical knowledge bases and evidence-based clinical guidelines (CGs) in order to facilitate multiple CDS requests coming from different healthcare settings. This architecture aims to aid users at different levels of Healthcare Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and managing services, thus enabling transparency. The research employs the Design Science research methodology (DSRM) combined with The Open Group Architecture Framework (TOGAF), an open source group initiative for Enterprise Architecture Framework (EAF). DSRM’s iterative capability addresses the rapidly evolving nature of workflows in healthcare. This SOA based solution uses standards-based open source technologies and platforms, the latest healthcare standards by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service (RLUS) standard. Combining business process management (BPM) technologies, business rules with SOA ensures the HCO’s capability to manage its processes. This architectural solution is evaluated by successfully implementing evidence based CGs at the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent Referral (Lung Cancer), c) Genome testing and integration with CDS in screening (Lynch’s syndrome). In addition to medical care, the CDS solution can benefit organizational processes for collaborative care delivery by connecting patients, physicians and other associated members. This framework facilitates integration of different types of CDS ideal for the different healthcare processes, enabling sharable CDS capabilities within and across organizations

Workflow Activity Task Controller: an Approach to Distribute Knowledge and Information in Collaborative Product Development

This paper presents a theoretical approach to workflow process management using well established PDM functions for controlling knowledge and information to support collaborative product development processes within the WWW. The new methodology is called Workflow Activity Task Controller (WATC) that can securely distribute design and manufacturing knowledge to support process planning with information exchange during the early stages of the product development phases. Most specifically, WATC uses the methods described herein to link the workflow management of a PDM system with a knowledge-based system and a process planning system. In addition, this framework is flexible and adaptive and can be extended to adapt to a specific company’s needs. The objective and the intention of the development are to improve information flows, promote sharing of design and manufacturing knowledge and subsequently to maximise effectiveness of product development activities and task efficiency

Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

<p>Abstract</p> <p>Background</p> <p>The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS.</p> <p>Methods</p> <p>The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing.</p> <p>Results</p> <p>Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters.</p> <p>Conclusion</p> <p>It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability.</p

A FRAMEWORK FOR BIOPROFILE ANALYSIS OVER GRID

An important trend in modern medicine is towards individualisation of healthcare to tailor care to the needs of the individual. This makes it possible, for example, to personalise diagnosis and treatment to improve outcome. However, the benefits of this can only be fully realised if healthcare and ICT resources are exploited (e.g. to provide access to relevant data, analysis algorithms, knowledge and expertise). Potentially, grid can play an important role in this by allowing sharing of resources and expertise to improve the quality of care. The integration of grid and the new concept of bioprofile represents a new topic in the healthgrid for individualisation of healthcare. A bioprofile represents a personal dynamic "fingerprint" that fuses together a person's current and past bio-history, biopatterns and prognosis. It combines not just data, but also analysis and predictions of future or likely susceptibility to disease, such as brain diseases and cancer. The creation and use of bioprofile require the support of a number of healthcare and ICT technologies and techniques, such as medical imaging and electrophysiology and related facilities, analysis tools, data storage and computation clusters. The need to share clinical data, storage and computation resources between different bioprofile centres creates not only local problems, but also global problems. Existing ICT technologies are inappropriate for bioprofiling because of the difficulties in the use and management of heterogeneous IT resources at different bioprofile centres. Grid as an emerging resource sharing concept fulfils the needs of bioprofile in several aspects, including discovery, access, monitoring and allocation of distributed bioprofile databases, computation resoiuces, bioprofile knowledge bases, etc. However, the challenge of how to integrate the grid and bioprofile technologies together in order to offer an advanced distributed bioprofile environment to support individualized healthcare remains. The aim of this project is to develop a framework for one of the key meta-level bioprofile applications: bioprofile analysis over grid to support individualised healthcare. Bioprofile analysis is a critical part of bioprofiling (i.e. the creation, use and update of bioprofiles). Analysis makes it possible, for example, to extract markers from data for diagnosis and to assess individual's health status. The framework provides a basis for a "grid-based" solution to the challenge of "distributed bioprofile analysis" in bioprofiling. The main contributions of the thesis are fourfold: A. An architecture for bioprofile analysis over grid. The design of a suitable aichitecture is fundamental to the development of any ICT systems. The architecture creates a meaiis for categorisation, determination and organisation of core grid components to support the development and use of grid for bioprofile analysis; B. A service model for bioprofile analysis over grid. The service model proposes a service design principle, a service architecture for bioprofile analysis over grid, and a distributed EEG analysis service model. The service design principle addresses the main service design considerations behind the service model, in the aspects of usability, flexibility, extensibility, reusability, etc. The service architecture identifies the main categories of services and outlines an approach in organising services to realise certain functionalities required by distributed bioprofile analysis applications. The EEG analysis service model demonstrates the utilisation and development of services to enable bioprofile analysis over grid; C. Two grid test-beds and a practical implementation of EEG analysis over grid. The two grid test-beds: the BIOPATTERN grid and PlymGRID are built based on existing grid middleware tools. They provide essential experimental platforms for research in bioprofiling over grid. The work here demonstrates how resources, grid middleware and services can be utilised, organised and implemented to support distributed EEG analysis for early detection of dementia. The distributed Electroencephalography (EEG) analysis environment can be used to support a variety of research activities in EEG analysis; D. A scheme for organising multiple (heterogeneous) descriptions of individual grid entities for knowledge representation of grid. The scheme solves the compatibility and adaptability problems in managing heterogeneous descriptions (i.e. descriptions using different languages and schemas/ontologies) for collaborated representation of a grid environment in different scales. It underpins the concept of bioprofile analysis over grid in the aspect of knowledge-based global coordination between components of bioprofile analysis over grid