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

Steps towards interoperability in healthcare environment

Tese doutoramento - Programa Doutoral em Engenharia Biomédica, Informática MédicaHealthcare units have complex Information Systems (IS) made up from heterogeneous data sources, which speak di erent languages and with di erent objectives. Nevertheless, all these sources have indeed important information that can contribute in an active way to provide a healthcare system of excellence. The evolution that has been noticed in Health IS has promoted the development of new methodologies and tools that are intended to solve this complicated problem. In this manner, one of the main paradigms that arises is the interoperability among systems and its capability to allow a general and simpli ed access to relevant information. Another aspect that should be kept in mind, given the constrains of the global economic situation, is the reduction in the investment in national healthcare systems. This thesis is based on a set of studies performed at the Centro Hospitalar do T^amega e Sousa (CHTS) in which the main goals are promoting an improvement in the relation patient-hospital, having in consideration the reduction of implementation costs, but preserving the quality of information. The last one should be accessible everywhere and at anytime to help with clinical decision and, in the future, be available for clinical studies through data computationally interpretable. To do so, an Electronic Semantic Health Record was formalized and implemented, with the help of the clinical sta , which collects all the information considered important and relevant. This Health Record was delivered through a platform for the distribution and archive of clinical information, named Agency for the Integration, Di usion and Archive (AIDA), which is supported by intelligent agents that treat data in an ex-haustive and structured way. To test the proposed model and system and in order to strengthen the relation between the patient and the hospital, an appointment alert system based on SMS and electronic mail was developed, which allowed the reduction of non-programmed misses and that provided a decrease of costs by better re-distributed appointment schedules, and allocate human resources and physical spaces in a more e ective manner. Finally, to reduce stopping periods of systems and to promote the user's con dence on Information Systems, an open-source tool was developed that enables the scheduling of preventive actions according to a mathematical model. These tools allowed for a continuous improvement of systems and are currently well accepted by clinicians and Information Technologies (IT) specialists inside the healthcare unit, proving in real clinical situation the e ectiveness and usability of the model.As unidades de saúde possuem Sistemas de Informação (SI) complexos, compostos por fontes de dados heterogéneas com objectivos distintos. Por em, toda a informação e importante e pode contribuir de forma ativa para a prestação de cuidados de saúde de excelência. Com a evolução dos SI na Saúde novas metodologias têm sido desenvolvidas com o intuito de solucionar este problema complicado. Nesta perspectiva, um dos principais paradigmas que se coloca e a interoperabilidade entre sistemas e a sua capacidade para permitir um acesso simples a informação relevante. Outro factor relevante relaciona-se com os constrangimentos financeiros que toda a economia global atravessa e que se reflete numa diminuição no investimento nos servi cos nacionais de saúde. Esta tese tem como base um conjunto de estudos realizados no Centro Hospitalar do Tâmega e Sousa cujos principais objetivos se prendem com um esforço orientado para a melhoria da relação paciente-hospital, tendo em conta a redução de custos de implementação, mas garantindo sobretudo a qualidade de informação. Esta dever a estar disponível em qualquer lugar e a qualquer altura para o auxílio a decisão clinica e, em última instancia, disponível para estudos cl nicos através de dados interpretáveis computacionalmente. Para tal, recorreu-se a ajuda de pessoal clinico para a implementação de um Processo Clínico Eletrónico Semântico que recolhe toda a informação considerada relevante. Este Processo Clínico foi potenciado através de uma plataforma para a distribuição e arquivo de informação clinica, denominada de Agencia para a Interoperação, Difusão e Arquivo (AIDA), baseada em agentes inteligentes que tratam os dados de forma estruturada. Para testar o modelo e de forma a fortalecer a relação paciente-hospital foi desenvolvido um sistema de alertas para consulta via mensagens escritas e e-mail, que diminuiu o numero de faltas não programadas, proporcionando uma redução de custos através de uma redistribuição dos tempos de consulta alocando recursos humanos e físicos de forma mais eficaz. Por fim, com vista a redução dos tempos de paragem de sistemas, e potenciar a confiança dos utilizadores nos mesmos, foi desenvolvida uma ferramenta baseada em tecnologia open-source que permite o agendamento de intervenções preventivas de acordo com um modelo matemático. Esta ferramenta proporcionou uma melhoria contínua dos sistemas e está globalmente aceite por cl nicos e especialistas de Tecnologias de Informação (TI), provando em situações clínicas reais a usabilidade e eficácia do modelo

Architectural Design of the National Health Information System for Rwanda

The use of information technology in healthcare services can improve the quality of care. The large amount of research has demonstrated the role of the use of Information and communication technology (ICT) solutions to overcome the challenges in patient information management. One of the challenges is the healthcare information sharing between providers. In high income countries, the challenge of exchanging information is almost solved. Nearly all high income countries have implemented a national healthcare network which connects healthcare providers in the whole country. Furthermore, European Union (EU) aims at the point of cross-border healthcare information exchange which supports the mobility of EU citizens. However, in developing countries, they are not yet ready to take the full advantage of ICT in their healthcare systems. The main objective of the thesis was to design the architecture of a national health information system for Rwanda, which is a developing country with limited resources. The research was based on three main issues: One was to determine existing health IT solutions in the healthcare system of Rwanda. The second one was to explore how other countries have developed their national health information systems (NHISs). The third was to find out how open source solutions can build a national network for a country. From the research, the components of the architecture have been defined and finally the architecture was designed. The research started by examining the current situation of ICT solutions in the healthcare system of Rwanda. This showed the progress in implementing certain electronic medical record systems in certain health facilities. However, there is no single hospital with a fully functional system. This step was followed by exploring how other countries implemented their NHIS and it showed that the process varies country by country. It was clear that in developing countries, open source solutions got a large market share contrary to developed countries where proprietary systems are the most used. Finally, open source solutions proved the capability to build a NHIS with different examples of robust open source solutions available in health IT nowadays. Although it would have been interesting, the thesis does not estimate the financial resources needed for the implementation of the architecture. It is possible to implement the NHIS for Rwanda by using both proprietary and open source solutions. However, the interoperability issue can be mitigated by minimizing different types of electronic medical records in healthcare facilities

Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care

<p>Abstract</p> <p>Background</p> <p>Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable.</p> <p>Discussion</p> <p>While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders.</p> <p>Summary</p> <p>Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be moved from concept to practical application? Would a coordinating body expedite this progress? How can existing initiatives and policy levers serve as catalysts to advance integrated PHRs?</p

An Integrated and Distributed Framework for a Malaysian Telemedicine System (MyTel)

The overall aim of the research was to produce a validated framework for a Malaysian integrated and distributed telemedicine system. The framework was constructed so that it was capable of being useful in retrieving and storing a patient's lifetime health record continuously and seamlessly during the downtime of the computer system and the unavailability of a landline telecommunication network. The research methodology suitable for this research was identified including the verification and validation strategies. A case study approach was selected for facilitating the processes and development of this research. The empirical data regarding the Malaysian health system and telemedicine context were gathered through a case study carried out at the Ministry of Health Malaysia (MOHM). The telemedicine approach in other countries was also analysed through a literature review and was compared and contrasted with that in the Malaysian context. A critical appraisal of the collated data resulted in the development of the proposed framework (MyTel) a flexible telemedicine framework for the continuous upkeep o f patients' lifetime health records. Further data were collected through another case study (by way of a structured interview in the outpatient clinics/departments of MOHM) for developing and proposing a lifetime health record (LHR) dataset for supporting the implementation of the MyTel framework. The LHR dataset was developed after having conducted a critical analysis of the findings of the clinical consultation workflow and the usage o f patients' demographic and clinical records in the outpatient clinics. At the end of the analysis, the LHR components, LHR structures and LHR messages were created and proposed. A common LHR dataset may assist in making the proposed framework more flexible and interoperable. The first draft of the framework was validated in the three divisions of MOHM that were involved directly in the development of the National Health JCT project. The division includes the Telehealth Division, Public and Family Health Division and Planning and Development Division. The three divisions are directly involved in managing and developing the telehealth application, the teleprimary care application and the total hospital information system respectively. The feedback and responses from the validation process were analysed. The observations and suggestions made and experiences gained advocated that some modifications were essential for making the MyTel framework more functional, resulting in a revised/ final framework. The proposed framework may assist in achieving continual access to a patient's lifetime health record and for the provision of seamless and continuous care. The lifetime health record, which correlates each episode of care of an individual into a continuous health record, is the central key to delivery of the Malaysian integrated telehealth application. The important consideration, however, is that the lifetime health record should contain not only longitudinal health summary information but also the possibility of on-line retrieval of all of the patient's health history whenever required, even during the computer system's downtime and the unavailability of the landline telecommunication network

Implementation of e-health interoperability in developing country contexts : the case of Zimbabwe

The provision of information technology-enabled healthcare services (e-health) has been adopted by numerous public and private facilities in both developing nations and advanced nations. However, one of the obstacles to the adoption of health information systems has been cited as their lack of interoperability resulting in their reduced effectiveness. In view of this, the study sought to explore the interoperability of health information systems employed in the country and then propose a framework to direct the process of implementing e-health interoperability. The study’s methodology was qualitative and a case study was undertaken. Semi-structured interviews were employed to gather data from e-health stakeholders in state-owned institutions and private enterprises. Document review was also conducted to substantiate findings from interviews. Data was analysed using thematic analysis and NVivo 12 software. The study’s findings revealed that several health information systems were implemented and their interoperability was low. Technological, terminology, organizational as well as regulatory and legal barriers were identified as hindrances to interoperability. The enablers for implementing e-health interoperability also revealed by this study include: development of re-usable software components, train the trainer approach to transfer of skills and regional conformance testing. The consequences of lack of interoperability among health information systems reported by this study include: burden on the worker, wastage of resources and high cost. The study also proposed a dual framework to guide the implementation of e-health interoperability. The study’s recommendations include the development of an e-health policy, an e-health strategy and the upgrade of ICT and telecommunication infrastructure to facilitate health information exchange.School of ComputingD. Phil. (Information Systems

A framework for development of android mobile electronic prescription transfer applications in compliance with security requirements mandated by the Australian healthcare industry

This thesis investigates mobile electronic transfer of prescription (ETP) in compliance with the security requirements mandated by the Australian healthcare industry and proposes a framework for the development of an Android mobile electronic prescription transfer application. Furthermore, and based upon the findings and knowledge from constructing this framework, another framework is also derived for assessing Android mobile ETP applications for their security compliance. The centralised exchange model-based ETP solution currently used in the Australian healthcare industry is an expensive solution for on-going use. With challenges such as an aging population and the rising burden of chronic disease, the cost of the current ETP solution’s operational infrastructure is certain to rise in the future. In an environment where it is increasingly beneficial for patients to engage in and manage their own information and subsequent care, this current solution fails to offer the patient direct access to their electronic prescription information. The current system also fails to incorporate certain features that would dramatically improve the quality of the patient’s care and safety, i.e. alerts for the patient’s drug allergies, harmful dosage and script expiration. Over a decade old, the current ETP solution was essentially designed and built to meet legislation and regulatory requirements, with change-averting its highest priority. With little, if any, provision for future growth and innovation, it was not designed to cater to the needs of the ETP process. This research identifies the gap within the current ETP implementation (i.e. dependency on infrastructure, significant on-going cost and limited availability of the patient’s medication history) and proposes a framework for building a secure mobile ETP solution on the Android mobile operating system platform which will address the identified gap. The literature review part of this thesis examined the significance of ETP for the nation’s larger initiative to provide an improved and better maintainable healthcare system. The literature review also revealed the stance of each jurisdiction, from legislative and regulatory perspectives, in transitioning to the use of a fully electronic ETP solution. It identified the regulatory mandates of each jurisdiction for ETP as well as the security standards by which the current ETP implementation is iii governed so as to conform to those regulatory mandates. The literature review part of the thesis essentially identified and established how the Australian healthcare industry’s various prescription-related legislations and regulations are constructed, and the complexity of this construction for eTP. The jurisdictional regulatory mandates identified in the literature review translate into a set of security requirements. These requirements establish the basis of the guiding framework for the development of a security-compliant Android mobile ETP application. A number of experimentations were conducted focusing on the native security features of the Android operating system, as well as wireless communication technologies such as NFC and Bluetooth, in order to propose an alternative mobile ETP solution with security assurance comparable to the current ETP implementation. The employment of a proof-of-concept prototype such as this alongside / coupled with a series of iterative experimentations strengthens the validity and practicality of the proposed framework. The first experiment successfully proved that the Android operating system has sufficient encryption capabilities, in compliance with the security mandates, to secure the electronic prescription information from the data at rest perspective. The second experiment indicated that the use of NFC technology to implement the alternative transfer mechanism for exchanging electronic prescription information between ETP participating devices is not practical. The next iteration of the experimentation using Bluetooth technology proved that it can be utilised as an alternative electronic prescription transfer mechanism to the current approach using the Internet. These experiment outcomes concluded the partial but sufficient proofof- concept prototype for this research. Extensive document analysis and iterative experimentations showed that the framework constructed by this research can guide the development of an alternative mobile ETP solution with both comparable security assurance to and better access to the patient’s medication history than the current solution. This alternative solution would present no operational dependence upon infrastructure and its associated, ongoing cost to the nation’s healthcare expenditure. In addition, use of this mobile ETP alternative has the potential to change the public’s perception (i.e. acceptance from regulatory and security perspectives) of mobile healthcare solutions, thereby paving the way for further innovation and future enhancements in eHealth

Designing an architecture for secure sharing of personal health records : a case of developing countries

Includes bibliographical references.While there has been an increase in the design and development of Personal Health Record (PHR) systems in the developed world, little has been done to explore the utility of these systems in the developing world. Despite the usual problems of poor infrastructure, PHR systems designed for the developing world need to conform to users with different models of security and literacy than those designed for developed world. This study investigated a PHR system distributed across mobile devices with a security model and an interface that supports the usage and concerns of low literacy users in developing countries. The main question addressed in this study is: “Can personal health records be stored securely and usefully on mobile phones?” In this study, mobile phones were integrated into the PHR architecture that we/I designed because the literature reveals that the majority of the population in developing countries possess mobile phones. Additionally, mobile phones are very flexible and cost efficient devices that offer adequate storage and computing capabilities to users for typically communication operations. However, it is also worth noting that, mobile phones generally do not provide sufficient security mechanisms to protect the user data from unauthorized access

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe