A service oriented approach for guidelines-based clinical decision support using BPMN

Evidence-based medical practice requires that clinical guidelines need to be documented in such a way that they represent a clinical workflow in its most accessible form. In order to optimize clinical processes to improve clinical outcomes, we propose a Service Oriented Architecture (SOA) based approach for implementing clinical guidelines that can be accessed from an Electronic Health Record (EHR) application with a Web Services enabled communication mechanism with the Enterprise Service Bus. We have used Business Process Modelling Notation (BPMN) for modelling and presenting the clinical pathway in the form of a workflow. The aim of this study is to produce spontaneous alerts in the healthcare workflow in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The use of BPMN as a tool to automate clinical guidelines has not been previously employed for providing Clinical Decision Support (CDS)

London SynEx Demonstrator Site: Impact Assessment Report

The key ingredients of the SynEx-UCL software components are: 1. A comprehensive and federated electronic healthcare record that can be used to reference or to store all of the necessary healthcare information acquired from a diverse range of clinical databases and patient-held devices. 2. A directory service component to provide a core persons demographic database to search for and authenticate staff users of the system and to anchor patient identification and connection to their federated healthcare record. 3. A clinical record schema management tool (Object Dictionary Client) that enables clinicians or engineers to define and export the data sets mapping to individual feeder systems. 4. An expansible set of clinical management algorithms that provide prompts to the patient or clinician to assist in the management of patient care. CHIME has built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multiprofessional electronic healthcare records. The resulting architecture models have influenced new European standards in this area, and CHIME has designed and built prototype EHCR components based on these models. The demonstrator systems described here utilise a directory service and object-oriented engineering approach, and support the secure, mobile and distributed access to federated healthcare records via web-based services. The design and implementation of these software components has been founded on a thorough analysis of the clinical, technical and ethico-legal requirements for comprehensive EHCR systems, published through previous project deliverables and in future planned papers. The clinical demonstrator site described in this report has provided the solid basis from which to establish "proof of concept" verification of the design approach, and a valuable opportunity to install, test and evaluate the results of the component engineering undertaken during the EC funded project. Inevitably, a number of practical implementation and deployment obstacles have been overcome through this journey, each of those having contributed to the time taken to deliver the components but also to the richness of the end products. UCL is fortunate that the Whittington Hospital, and the department of cardiovascular medicine in particular, is committed to a long-term vision built around this work. That vision, outlined within this report, is shared by the Camden and Islington Health Authority and by many other purchaser and provider organisations in the area, and by a number of industrial parties. They are collectively determined to support the Demonstrator Site as an ongoing project well beyond the life of the EC SynEx Project. This report, although a final report as far as the EC project is concerned, is really a description of the first phase in establishing a centre of healthcare excellence. New EC Fifth Framework project funding has already been approved to enable new and innovative technology solutions to be added to the work already established in north London

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A Jini-Based Solution for Electronic Prescriptions

In most countries today, handwritten, paper-based medical prescriptions are the norm.While efforts have been made in the past and are being made at present to migrate toward electronic dispensation of prescriptions, these have generally omitted to incorporate ubiquitous computing technology in their proposed solutions. In this paper, we focus on this issue and describe a Jini-based prototypical solution for electronic prescriptions, which allows for their wireless transmission to in-range pharmacies and the augmentation of the service levels rendered to the user, with, for instance, information about queue lengths and estimated waiting times being provided to the patients. Clinical and user evaluation revealed that there were high levels of agreement as regards the prototype’s effectiveness, ease of use, and usefulness

A Query Integrator and Manager for the Query Web

We introduce two concepts: the Query Web as a layer of interconnected queries over the document web and the semantic web, and a Query Web Integrator and Manager (QI) that enables the Query Web to evolve. QI permits users to write, save and reuse queries over any web accessible source, including other queries saved in other installations of QI. The saved queries may be in any language (e.g. SPARQL, XQuery); the only condition for interconnection is that the queries return their results in some form of XML. This condition allows queries to chain off each other, and to be written in whatever language is appropriate for the task. We illustrate the potential use of QI for several biomedical use cases, including ontology view generation using a combination of graph-based and logical approaches, value set generation for clinical data management, image annotation using terminology obtained from an ontology web service, ontology-driven brain imaging data integration, small-scale clinical data integration, and wider-scale clinical data integration. Such use cases illustrate the current range of applications of QI and lead us to speculate about the potential evolution from smaller groups of interconnected queries into a larger query network that layers over the document and semantic web. The resulting Query Web could greatly aid researchers and others who now have to manually navigate through multiple information sources in order to answer specific questions

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

Desenvolvimento de uma Infraestrutura baseada em HL7® FHIR® para Interoperabilidade Clínica

Throughout the years, the healthcare business knowledge, requirements, and the number of patients seeking medical attention has grown tremendously to a point where sensitive cases needed the input from multiple healthcare institutions in order to track the patient’s medical history and make the most adequate decisions for each situation. Technology and digital information fulfils a great role in addressing these problems and improving healthcare provision. However, due to the immense number of organizations and systems in this business, sharing a patient’s clinical information can be a major problem if the systems are not capable of understanding the data sent to each other. Ensuring interoperability between systems is crucial to guarantee the continuous flow of a patient’s clinical history transmission and to improve the health professionals’ work. As a company working in the field of healthcare, ALERT’s main goal is to help organizations improve in their health business and to help prolong life, by providing the necessary technology that is capable of benefiting the health professional’s work management and sharing the necessary information with other organizations. Thus, the company seeks to constantly improve its product suite, ALERT®, by meeting the worldwide organizations requirements and assuring interoperability based on the existing health standards in the market. This way, the company wants to add in the ALERT suite the latest standard, Fast Healthcare Interoperability Resources (FHIR ® ), which brings great technological innovations for interoperability’s improvement, provided by the standards developing organization, Health Level Seven International (HL7), being also considered to be a suitable standard for mobile applications thanks to its capabilities and ease of implementation. Herewith, thisthesis presents a development and architectural approach to apply FHIR features in the product suite, along with the problem and solution analysis, including the evaluation of suitable frameworks for the implementation phase. Considering the experiments’ results, the implemented FHIR services actually improved the product’s performance, and thanks to the standard’s specification, the implementation of its core features proved to be simple and straightforward while respecting the key criteria for some of the developed services.Ao longo dos anos, o conhecimento, as exigências, e o número de pacientes à procura de cuidados médicos na área de negócio de cuidados de saúde, tem vindo a aumentar drasticamente ao ponto de ser necessária a opinião de outras instituições para casos de maior sensibilidade, de modo a que o historial médico do paciente fosse acompanhado e que servisse para tomar as decisões mais adequadas para o problema em questão. A tecnologia e a informação digital representam um grande papel na resolução de problemas e promoção de entrega de cuidados de saúde. No entanto, devido à imensa quantidade de organizações e sistemas nesta área de negócio, a partilha de informação clínica relativa a um paciente pode vir a ser um grave problema caso os sistemas não sejam capazes de compreender os dados que estão a ser transmitidos entre eles. Deste modo, assegurar interoperabilidade entre sistemas é crucial para garantir um fluxo contínuo de transmissão de informação relativa ao historial clínico de um paciente, e para melhorar o trabalho dos profissionais de saúde. Sendo uma empresa que trabalha na área de cuidados de saúde, a ALERT tem como principal objetivo ajudar as organizações a melhorar o seu negócio de saúde e ajudar a prolongar a vida, fornecendo a tecnologia necessária que beneficie a gestão de trabalho dos profissionais de saúde e que partilhe informação com outras organizações. Portanto, a empresa procura constantemente melhorar o seu produto ALERT®, procurando cumprir com os requisitos de organizações globais e garantindo interoperabilidade baseada nos standards de saúde existentes no mercado. Assim, a empresa pretende adotar o último standard lançado, Fast Healthcare Interoperability Resources (FHIR®), que traz grandes inovações tecnológicas para o aperfeiçoamento da interoperabilidade, fornecida pela organização de desenvolvimento de standards, Health Level Seven International (HL7), sendo também considerado um standard adequado para aplicações móveis graças às suas capacidades e facilidade de implementação. Com isto, esta tese apresenta uma abordagem arquitetural e de desenvolvimento para a aplicação de funcionalidades FHIR no produto, juntamente com a análise do problema e da solução, incluindo a avaliação de ferramentas adequadas para a fase de implementação. Os resultados de teste obtidos para os serviços FHIR implementados, demonstraram uma melhoria na performance do produto, e graças à especificação do standard, a implementação das principais funcionalidades provou ser simples e direta, respeitando os principais critérios para os serviços desenvolvidos

On-site customer analytics and reporting (OSCAR):a portable clinical data warehouse for the in-house linking of hospital and telehealth data

This document conveys the results of the On-Site Customer Analytics and Reporting (OSCAR) project. This nine-month project started on January 2014 and was conducted at Philips Research in the Chronic Disease Management group as part of the H2H Analytics Project. Philips has access to telehealth data from their Philips Motiva tele-monitoring and other services. Previous projects within Philips Re-search provided a data warehouse for Motiva data and a proof-of-concept (DACTyL) solution that demonstrated the linking of hospital and Motiva data and subsequent reporting. Severe limitations with the DACTyL solution resulted in the initiation of OSCAR. A very important one was the unwillingness of hospitals to share personal patient data outside their premises due to stringent privacy policies, while at the same time patient personal data is required in order to link the hospital data with the Motiva data. Equally important is the fact that DACTyL considered the use of only Motiva as a telehealth source and only a single input interface for the hospitals. OSCAR was initiated to propose a suitable architecture and develop a prototype solution, in contrast to the proof-of-concept DACTyL, with the twofold aim to overcome the limitations of DACTyL in order to be deployed in a real-life hospital environment and to expand the scope to an extensible solution that can be used in the future for multiple telehealth services and multiple hospital environments. In the course of the project, a software solution was designed and consequently deployed in the form of a virtual machine. The solution implements a data warehouse that links and hosts the collected hospital and telehealth data. Hospital data are collected with the use of a modular service oriented data collection component by exposing web services described in WSDL that accept configurable XML data messages. ETL processes propagate the data, link, and load it on the OS-CAR data warehouse. Automated reporting is achieved using dash-boards that provide insight into the data stored in the data warehouse. Furthermore, the linked data is available for export to Philips Re-search in de-identified format