Evaluating information flow in medication management process in Australian acute care facilities: A multi-professional perspective

Over the years, various interventions have been introduced to improve the medication management process. While these interventions have addressed some aspects predisposing the process to inefficiencies, significant gaps are still prevalent across the process. Studies have suggested that the goal of optimal medication therapy is achievable when information flow integrates across the various medication management process phases, stakeholders and departments involved as the patient moves through the process. To provide a cross-sectional view of the process, this study utilised a systemic philosophy to evaluate the information flow integration across the process. The research approach adopted for this study takes a positivist paradigm, which is guided by the cause and effect (causality) belief. It explored numeric measures to evaluate the relationship between constructs that assessed information flow principles (accessibility, timeliness, granularity and transparency) within the medication process and the information integration. The research design was cross-sectional and analytical, and this ensures that findings are relevant to current situations across the Australian healthcare system. Data for this research was collected using an online self-administered survey and the data assessed information flow principles and technologies used in the medication management process. There were 88 participants in this study, including doctors, nurses and pharmacists. The questions and responses were coded for analysis and data analysis techniques used were frequency analysis, Pearson’s chi-square test and multivariate analysis. Findings from this study indicates that the constructs evaluating accessibility, transparency and granularity had moderate associations with the information integration in the medication management process. Further analysis highlighted accessibility as a significant principle in explaining an increase or decrease in information integration in the medication management process. The accessibility construct referring to information retrieval was significant across the two tests conducted. Accessibility is directly related to information sharing and the assessment and monitoring and evaluation phases in the medication management process were identified as having the highest challenges with information sharing. Furthermore, the hybrid (electronic and paper) channel was preferred to support information integration in the medication management process by the participants. Among the technologies evaluated for the medication process, computer-provider-order-entry was found to be statistically significant in explaining an increase in information integration. Overall, results from this study suggest that interventions for the medication management process in Australian acute care facilities should be directed towards improving accessibility, specifically information retrieval and the sharing of information with emphasis on the assessment and monitoring phases. Implementing strategies to address the gaps identified from this research can improve information integration across the process and thereby reducing medication errors, and improving patient care management. Furthermore, the technology adoption across the process highlights that technology adoption across participants’ facilities remains a challenge in Australia

Modeling Clinicians’ Cognitive and Collaborative Work in Post-Operative Hospital Care

abstract: Clinicians confront formidable challenges with information management and coordination activities. When not properly integrated into clinical workflow, technologies can further burden clinicians’ cognitive resources, which is associated with medical errors and risks to patient safety. An understanding of workflow is necessary to redesign information technologies (IT) that better support clinical processes. This is particularly important in surgical care, which is among the most clinical and resource intensive settings in healthcare, and is associated with a high rate of adverse events. There are a growing number of tools to study workflow; however, few produce the kinds of in-depth analyses needed to understand health IT-mediated workflow. The goals of this research are to: (1) investigate and model workflow and communication processes across technologies and care team members in post-operative hospital care; (2) introduce a mixed-method framework, and (3) demonstrate the framework by examining two health IT-mediated tasks. This research draws on distributed cognition and cognitive engineering theories to develop a micro-analytic strategy in which workflow is broken down into constituent people, artifacts, information, and the interactions between them. It models the interactions that enable information flow across people and artifacts, and identifies dependencies between them. This research found that clinicians manage information in particular ways to facilitate planned and emergent decision-making and coordination processes. Barriers to information flow include frequent information transfers, clinical reasoning absent in documents, conflicting and redundant data across documents and applications, and that clinicians are burdened as information managers. This research also shows there is enormous variation in how clinicians interact with electronic health records (EHRs) to complete routine tasks. Variation is best evidenced by patterns that occur for only one patient case and patterns that contain repeated events. Variation is associated with the users’ experience (EHR and clinical), patient case complexity, and a lack of cognitive support provided by the system to help the user find and synthesize information. The methodology is used to assess how health IT can be improved to better support clinicians’ information management and coordination processes (e.g., context-sensitive design), and to inform how resources can best be allocated for clinician observation and training.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201

Modelling information flow for organisations delivering microsystems technology

Motivated by recent growth and applications of microsystems technology (MST), companies within the MST domain are beginning to explore avenues for understanding, maintaining and improving information flow, within their organisations and to/from customers, with a view to enhancing delivery performance. Delivery for organisations is the flow of goods from sellers to buyers and a classic approach to understanding information flow is via the use of modelling techniques. Cont/d

Development of Use Cases, Part I

For determining requirements and constructs appropriate for a Web query language, or in fact any language, use cases are of essence. The W3C has published two sets of use cases for XML and RDF query languages. In this article, solutions for these use cases are presented using Xcerpt. a novel Web and Semantic Web query language that combines access to standard Web data such as XML documents with access to Semantic Web metadata such as RDF resource descriptions with reasoning abilities and rules familiar from logicprogramming. To the best knowledge of the authors, this is the first in depth study of how to solve use cases for accessing XML and RDF in a single language: Integrated access to data and metadata has been recognized by industry and academia as one of the key challenges in data processing for the next decade. This article is a contribution towards addressing this challenge by demonstrating along practical and recognized use cases the usefulness of reasoning abilities, rules, and semistructured query languages for accessing both data (XML) and metadata (RDF)

Eliciting Security Requirements and Tracing them to Design: An Integration of Common Criteria, Heuristics, and UMLsec

Building secure systems is difficult for many reasons. This paper deals with two of the main challenges: (i) the lack of security expertise in development teams, and (ii) the inadequacy of existing methodologies to support developers who are not security experts. The security standard ISO 14508 (Common Criteria) together with secure design techniques such as UMLsec can provide the security expertise, knowledge, and guidelines that are needed. However, security expertise and guidelines are not stated explicitly in the Common Criteria. They are rather phrased in security domain terminology and difficult to understand for developers. This means that some general security and secure design expertise are required to fully take advantage of the Common Criteria and UMLsec. In addition, there is the problem of tracing security requirements and objectives into solution design,which is needed for proof of requirements fulfilment. This paper describes a security requirements engineering methodology called SecReq. SecReq combines three techniques: the Common Criteria, the heuristic requirements editorHeRA, andUMLsec. SecReqmakes systematic use of the security engineering knowledge contained in the Common Criteria and UMLsec, as well as security-related heuristics in the HeRA tool. The integrated SecReq method supports early detection of security-related issues (HeRA), their systematic refinement guided by the Common Criteria, and the ability to trace security requirements into UML design models. A feedback loop helps reusing experiencewithin SecReq and turns the approach into an iterative process for the secure system life-cycle, also in the presence of system evolution

Usability in healthcare : overcoming the mismatch between information systems and clinical work

Usability of clinical information technology (IT) systems is an ongoing topic of discussion. The systems should support healthcare professionals in their daily work with patients. However, critics indicate the prevalence of negative experiences and use related problems. The overall goal of the thesis is to examine the usability of current clinical IT systems from the viewpoint of physicians and nurses for the purposes of further user-centred system development. The thesis includes three empirical studies: a digital dictation study, evaluation of nursing documentation systems, and a national usability questionnaire study with physicians. The research was carried out utilizing contextual inquiry, interaction sequence illustration analysis, and tailored usability questionnaire methods. The research resulted in the following findings and conclusions. Currently used IT systems do not support the daily work and clinical tasks of clinicians well. This is due to numerous usability problems, and lack of computer support for multi-professional and cross-organizational collaboration between clinicians. Major improvements are needed to achieve the potential benefits clinical information and communication technology systems offer. Based on empirical studies, themes for potential improvements are: development of efficient and mobile documentation solutions, redesign of system user interfaces, solutions to support communication and collaboration, customisable and context-specific clinical IT systems, and conceptual redesign of nursing documentation system. In the field of health informatics, a need exists to broaden the scope of usability work. Usability is closely associated with evaluation and testing activities instead of design activities. Hence, the scope of usability is more restricted than it is in user-centred design and usability research fields. In order to overcome the current mismatch between IT systems and clinical work, it is important to understand that usability is extremely context-sensitive by nature. The study results indicated shortcomings in user-centred healthcare IT systems design and end-users' abilities to contribute to development work. User-centred design methods provide a variety of means to analyse, design, and evaluate information and communication systems for clinical purposes. However, the characteristics of the clinical context (e.g. privacy and data security issues, and the wide range of IT systems in use) need to be taken into account when applying the methods and performing research in real-life clinical surroundings

Pre-conference proceedings of the 3rd IFIP TC 13.6 HWID working conference

The committees under IFIP include the Technical Committee TC13 on Human – Computer Interaction within which the work of this volume has been conducted. TC 13 on Human-Computer Interaction has as its aim to encourage theoretical and empirical human science research to promote the design and evaluation of human-oriented ICT. Within TC 13 there are different Working Groups concerned with different aspects of Human-Computer Interaction. The flagship event of TC13 is the bi-annual international conference called INTERACT at which both invited and contributed papers are presented. Contributed papers are rigorously refereed and the rejection rate is high. Publications arising from these TC13 events are published as conference proceedings such as the INTERACT proceedings or as collections of selected and edited papers from working conferences and workshops. See http://www.ifip.org/ for aims and scopes of TC13 and its associated Working Group

Efficiency and Automation in Threat Analysis of Software Systems

Context: Security is a growing concern in many organizations. Industries developing software systems plan for security early-on to minimize expensive code refactorings after deployment. In the design phase, teams of experts routinely analyze the system architecture and design to find potential security threats and flaws. After the system is implemented, the source code is often inspected to determine its compliance with the intended functionalities. Objective: The goal of this thesis is to improve on the performance of security design analysis techniques (in the design and implementation phases) and support practitioners with automation and tool support.Method: We conducted empirical studies for building an in-depth understanding of existing threat analysis techniques (Systematic Literature Review, controlled experiments). We also conducted empirical case studies with industrial participants to validate our attempt at improving the performance of one technique. Further, we validated our proposal for automating the inspection of security design flaws by organizing workshops with participants (under controlled conditions) and subsequent performance analysis. Finally, we relied on a series of experimental evaluations for assessing the quality of the proposed approach for automating security compliance checks. Findings: We found that the eSTRIDE approach can help focus the analysis and produce twice as many high-priority threats in the same time frame. We also found that reasoning about security in an automated fashion requires extending the existing notations with more precise security information. In a formal setting, minimal model extensions for doing so include security contracts for system nodes handling sensitive information. The formally-based analysis can to some extent provide completeness guarantees. For a graph-based detection of flaws, minimal required model extensions include data types and security solutions. In such a setting, the automated analysis can help in reducing the number of overlooked security flaws. Finally, we suggested to define a correspondence mapping between the design model elements and implemented constructs. We found that such a mapping is a key enabler for automatically checking the security compliance of the implemented system with the intended design. The key for achieving this is two-fold. First, a heuristics-based search is paramount to limit the manual effort that is required to define the mapping. Second, it is important to analyze implemented data flows and compare them to the data flows stipulated by the design