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The chaotic nature of healthcare information systems: The need for transdisciplinary collaboration
Copyright @ 2013 EMCIS.This paper demonstrates one of the challenges of the healthcare information systems development, namely the chaotic nature of healthcare systems. Although the reliable evidence demonstrating the positive effects of health information systems on safety and quality remains inconclusive (a growing body of research revealing the unintended consequences and potentially error producing effects of health information systems’ implementation. Different arguments from the literature concerning the chaotic nature of healthcare, including but not limited to the nature of patients and disease have been presented. The requirements of new ways of systems design and the need for transdisciplinary dynamic teams within the requirements engineering phase as a start has been discussed. These arguments have been investigated in the context of an exploratory case addressing one of the advanced oncology centres in the US. This paper concludes that there is an important need to rethink healthcare information systems development method, which has to be in a dynamic ongoing manner for some major issues
User-centered visual analysis using a hybrid reasoning architecture for intensive care units
One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care
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Description and Experience of the Clinical Testbeds
This deliverable describes the up-to-date technical environment at three clinical testbed demonstrator sites of
the 6WINIT Project, including the adapted clinical applications, project components and network transition technologies
in use at these sites after 18 months of the Project. It also provides an interim description of early experiences with
deployment and usage of these applications, components and technologies, and their clinical service impact
Using System Analysis and Personas for e-Health Interaction Design
Today, designers obtain more central roles in product and service development (Perks, Cooper, & Jones, 2005). They have to deal with increasingly complicated problems, like integrating the needs of various stakeholders while taking care about social, ethical and ecological consequences of their designs. To deal with this demanding design situation, they need to apply new methods to organize the available information and to negotiate the stakeholder’s perspectives.
This paper describes how systems analysis supports the design process in a complex environment. In a case study, we demonstrate how this method enables designers to describe user requirements for complex design environments while considering the perspectives of various stakeholders. We present a design research project applying cybernetic systems analysis using the software ''System-Tools'' (Vester, 2002). Results from the analysis were taken to inform the design of an electronic patient record (EPR), considering the particularities of the German health care system. Based on the analysis, we developed a set of requirements for every stakeholder group, detailing the patients' perspective with persona descriptions. We then picked a main persona as reference for the EPR design. We describe the resulting design sketch and discuss the value of cybernetic systems analysis as a tool to deal with complex social environments. The result shows how the method helps designers to structure and organize information about the context and identify fruitful intervention opportunities for design.
Keywords:
E-Health; System Analysis, Cybernetics; Personas.</p
The organizational implications of medical imaging in the context of Malaysian hospitals
This research investigated the implementation and use of medical imaging in the
context of Malaysian hospitals. In this report medical imaging refers to PACS,
RIS/HIS and imaging modalities which are linked through a computer network. The
study examined how the internal context of a hospital and its external context
together influenced the implementation of medical imaging, and how this in turn
shaped organizational roles and relationships within the hospital itself. It further
investigated how the implementation of the technology in one hospital affected its
implementation in another hospital. The research used systems theory as the
theoretical framework for the study. Methodologically, the study used a case-based
approach and multiple methods to obtain data. The case studies included two
hospital-based radiology departments in Malaysia.
The outcomes of the research suggest that the implementation of medical imaging in
community hospitals is shaped by the external context particularly the role played by
the Ministry of Health. Furthermore, influences from both the internal and external
contexts have a substantial impact on the process of implementing medical imaging
and the extent of the benefits that the organization can gain. In the context of roles
and social relationships, the findings revealed that the routine use of medical
imaging has substantially affected radiographers’ roles, and the social relationships
between non clinical personnel and clinicians. This study found no change in the
relationship between radiographers and radiologists. Finally, the approaches to
implementation taken in the hospitals studied were found to influence those taken by
other hospitals.
Overall, this study makes three important contributions. Firstly, it extends Barley’s
(1986, 1990) research by explicitly demonstrating that the organization’s internal and
external contexts together shape the implementation and use of technology, that the
processes of implementing and using technology impact upon roles, relationships
and networks and that a role-based approach alone is inadequate to examine the
outcomes of deploying an advanced technology. Secondly, this study contends that
scalability of technology in the context of developing countries is not necessarily
linear. Finally, this study offers practical contributions that can benefit healthcare
organizations in Malaysia
Consolidated List of Requirements
This document is a consolidated catalogue of requirements for the Electronic
Health Care Record (EHCR) and Electronic Health Care Record Architecture
(EHCRA), gleaned largely from work done in the EU Framework III and IV
programmes and CEN, but also including input from other sources including world-wide
standardisation initiatives. The document brings together the relevant work done into a
classified inventory of requirements to inform the on-going standardisation process as
well as act as a guide to future implementation of EHCRA-based systems. It is meant as
a contribution both to understanding of the standard and to the work that is being
considered to improve the standard. Major features include the classification into issues
affecting the Health Care Record, the EHCR, EHCR processing, EHCR interchange and
the sharing of health care information and EHCR systems. The principal information
sources are described briefly. It is offered as documentation that is complementary to the
four documents of the ENV 13606 Parts I-IV produced by CEN Pts 26,27,28,29. The
requirements identified and classified in this deliverable are referenced in other
deliverables
Electronic Medical Record Adoption in New Zealand Primary Care Physician Offices
Describes EMR adoption in New Zealand's primary healthcare system, including how government investment was secured and data protection laws, unique patient identifiers, and standards and certification were established, with lessons for the United States
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