Using Building Data Models to Represent Workflows and a Contextual Dimension

The context-workflow relationship is often poorly defined or forgotten entirely. In workflow systems and applications context is either omitted, defined by the workflow or defined based on a single aspect of a contextual dimension. In complex environments this can be problematic as the definition of context is useful in determining the set of possible workflows. Context provides the envelope that surrounds the workflow and determines what is or is not possible. The relationship between workflow and context is also poorly defined. That context can exist independently of workflow is often ignored, and workflow does not exist independently of context. Workflow representations void of context violate this stipulation. In order for a workflow representation to exist in a contextual dimension it must possess the same dimensions as the context. In this thesis we selected one contextual dimension to study, in this case the spatial dimension, and developed a comprehensive definition using building data models. Building data models are an advanced form of representation that build geometric data models into an ob ject-oriented representation consisting of common building elements. The building data model used was the Industry Foundation Classes (IFC) as it is the leading standard in this emerging field. IFC was created for the construction of facilities and not the use of facilities at a later time. In order to incorporate workflows into IFC models, a zoning technique was developed in order to represent the workflow in IFC. The zoning concept was derived from multi-criteria layout for facilities layout and was adapted for IFC and workflow. Based on the above work a zoning extension was created to explore the combination of IFC, workflow and simulation. The extension is a proof of concept and is not intended to represent a robust formalized system. The results indicate that the use of a comprehensive definition of a contextual dimension may prove valuable to future expert systems

Improving Antibiotic Resistant Infection Transmission Situational Awareness in Enclosed Facilities with a Novel Graphical User Interface for Tactical Biosurveillance

Serious challenges associated with antibiotic resistant infections (ABRIs) force healthcare practitioners (HCP) to seek innovative approaches that will slow the emergence of new ABRIs and prevent their spread. It was realized that traditional approaches to infection prevention based on education, retrospective reports, and biosurveillance often fail to ensure reliable compliance with infection prevention guidelines and real-time problem solving. The objective of this original research was to develop and test the conceptual design of a situational awareness (SA)-oriented information system for coping with healthcare-associated infection transmission. Constantly changing patterns in spatial distribution of patients, prevalence of infectious cases, clustering of contacts, and frequency of contacts may compromise the effectiveness of infection prevention and control in hospitals. It was hypothesized that providing HCPs with a graphical user interface (GUI) to visualize spatial information on the risks of exposure to ABRIs would effectively increase HCPs’ SA. Increased SA may enhance biosurveillance and result in tactical decisions leading to better patient outcomes. The study employed a mixed qualitative-quantitative research method encompassing conceptualization of GUI content, transcription of electronic health record and biosurveillance data into GUI visual artifacts, and evaluation of the GUI’s impact on HCPs’ perception and comprehension of the conditions that increase the risk of ABRI transmission. The study provided pilot evidence that visualization of spatial disease distribution and spatially-linked exposures and interventions significantly increases HCPs’ SA when compared to current practice. The research demonstrates that the SA-oriented GUI enables the HCPs to promptly answer the question, “At a given location, what are the risks of infection transmission there?” This research provides a new form of medical knowledge representation for spatial population-based decision-making within enclosed environments. The next steps include rapid application development and further hypothesis testing concerning the impact of this GUI on decsion-making

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606

Outils et modèles collaboratifs pour la gestion des tensions dans les services des urgences pédiatriques

In the healthcare production management systems, the control of the patient flows and the anticipation of the tensions are major issues. Due to the increasing the crowding situations and their consequences, there is an ever increasing emphasis on the ability of the actors in hospital and healthcare pathways to manage the patient health care process. They must be able to control the crowding (peaks of activities, congestion of services) that are related to patient and healthcare processes flows. However, decision makers do not have sufficient methodologies and decision support tools adapted for controlling the patient flows.This thesis aims to investigate and develop modeling, optimization and implementation of a Support System to improve the care of patients in normal situation and crowding situation in Services Pediatric Emergencies (SUP) of the Lille University Hospital. The objective of this thesis is to propose appropriate solutions to the SUP to improve care for patients in terms of wait times. We therefore modeled the process of care for patients by Workflow approach to identify malfunctions in the SUP near the modeling phase; we proposed a resolution of agent-based architecture to optimize scheduling patient flow and significantly decrease their waiting time during periods of tension. Then we studied a dynamic process orchestration workflow by agents to reduce the expectations of patients running time. This thesis is conducted under the ANR HOST project in collaboration with the Lille University Hospital SUP. The simulation results highlight the contribution of the alliance between the multi-agent systems and optimization for decision supportDans la gestion des systèmes de production de soins, la maîtrise des flux hospitaliers et l'anticipation des tensions sont des enjeux majeurs. Les acteurs du secteur hospitalier et des filières de soins doivent maîtriser des tensions telles les pics d'activités et les engorgements de services qui sont liées aux flux des patients et aux flux des processus de soins. Ils sont toutefois démunis en méthodologies et outils d'aide à la décision et de pilotage adaptés. Cette thèse a pour but d’étudier et de développer la modélisation, l'optimisation et la mise en œuvre d'un Système d’Aide à l’amélioration de la prise en charge des patients en mode normal et en mode tension dans les Services des Urgences Pédiatriques (SUP) du CHRU de Lille. L’objectif de cette thèse est de proposer des solutions appropriées au SUP permettant d’améliorer la prise en charge des patients en termes de temps d’attente. Nous avons donc modélisé le processus de prise en charge des patients par l’approche Workflow afin d’identifier les dysfonctionnements au SUP près cette phase de modélisation, nous avons proposé une architecture de résolution à base d’agents afin d’optimiser l’ordonnancement des flux patients et diminuer considérablement leur temps d’attente en périodes des tensions. Ensuite nous avons étudié une démarche d’orchestration dynamique du Workflow par les agents afin de réduire les temps d’attentes des patients en cours d’exécution. Cette these est menée dans le cadre du projet ANR HOST avec la collaboration du SUP de CHRU de Lille. Les résultats des simulations mettent en exergue l’apport de l’alliance entre les systèmes multi-agent et l’optimisation pour l’aide à la décision

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement