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

A standards-based ICT framework to enable a service-oriented approach to clinical decision support

This research provides evidence that standards based Clinical Decision Support (CDS) at the point of care is an essential ingredient of electronic healthcare service delivery. A Service Oriented Architecture (SOA) based solution is explored, that serves as a task management system to coordinate complex distributed and disparate IT systems, processes and resources (human and computer) to provide standards based CDS. This research offers a solution to the challenges in implementing computerised CDS such as integration with heterogeneous legacy systems. Reuse of components and services to reduce costs and save time. The benefits of a sharable CDS service that can be reused by different healthcare practitioners to provide collaborative patient care is demonstrated. This solution provides orchestration among different services by extracting data from sources like patient databases, clinical knowledge bases and evidence-based clinical guidelines (CGs) in order to facilitate multiple CDS requests coming from different healthcare settings. This architecture aims to aid users at different levels of Healthcare Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and managing services, thus enabling transparency. The research employs the Design Science research methodology (DSRM) combined with The Open Group Architecture Framework (TOGAF), an open source group initiative for Enterprise Architecture Framework (EAF). DSRM’s iterative capability addresses the rapidly evolving nature of workflows in healthcare. This SOA based solution uses standards-based open source technologies and platforms, the latest healthcare standards by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service (RLUS) standard. Combining business process management (BPM) technologies, business rules with SOA ensures the HCO’s capability to manage its processes. This architectural solution is evaluated by successfully implementing evidence based CGs at the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent Referral (Lung Cancer), c) Genome testing and integration with CDS in screening (Lynch’s syndrome). In addition to medical care, the CDS solution can benefit organizational processes for collaborative care delivery by connecting patients, physicians and other associated members. This framework facilitates integration of different types of CDS ideal for the different healthcare processes, enabling sharable CDS capabilities within and across organizations

How the internet of things technology enhances emergency response operations

The Internet of Things (IoT) is a novel paradigm that connects the pervasive presence around us of a variety of things or objects to the Internet by using wireless/wired technologies to reach desired goals. Since the concept of the IoT was introduced in 2005, we see the deployment of a new generation of networked smart objects with communication, sensory and action capabilities for numerous applications, mainly in global supply chain management, environment monitoring and other non-stress environments. This paper introduces the IoT technology for use in the emergency management community. Considering the information required for supporting three sequential and distinct rhythms in emergency response operations: mobilization rhythm, preliminary situation assessment rhythm, and intervention rhythm, the paper proposes a modified task-technology fit approach that is used to investigate how the IoT technology can be incorporated into the three rhythms and enhance emergency response operations. The findings from our research support our two hypotheses: H1: IoT technology fits the identified information requirements; and H2: IoT technology provides added value to emergency response operations in terms of obtaining efficient cooperation, accurate situational awareness, and complete visibility of resources. © 2012 Elsevier Inc

A prototype and demonstrator of Akogrimo’s architecture: An approach of merging grids, SOA, and the mobile Internet

The trend of merging telecommunication infrastructures with traditional Information Technology (IT) infrastructures is ongoing and important for commercial service providers. The driver behind this development is, on one hand, the strong need for enhanced services and on the other hand, the need of telecommunication operators aiming at value-added service provisioning to a wide variety of customers. In the telecommunications sector, the IP Multimedia Subsystem (IMS) is a promising service platform, which may become a ''standard'' for supporting added-value services on top of the next generation network infrastructure. However, since its range of applicability is bound to SIP- enabled services, IMS extensions are being proposed by ''SIPifying'' applications. In parallel to these developments within the traditional IT sector, the notion of Virtual Organizations (VO) enabling collaborative businesses across organizational boundaries is addressed in the framework of Web Services (WS) standards implementing a Service-oriented Architecture (SOA). Here, concepts for controlled resource and service sharing based on WS and Semantic Technologies have been consolidated. Since the telecommunications sector has become, in the meantime ''mobile'', all concepts brought into this infrastructure must cope with the dynamics mobility brings in. Therefore, within the Akogrimo project the VO concept has been extended towards a Mobile Dynamic Virtual Organization (MDVO) concept, additionally considering key requirements of mobile users and resources. Especial attention is given to ensure the duality of the merge of both, SOA and IMS approaches to holistically support SOA-enabled mobile added-value services and their users. This work describes major results of the Akogrimo project, paying special attention to the overall Akogrimo architecture, the prototype implemented, and the key scenario in which the instantiated Akogrimo architecture shows a very clear picture of applicability, use, and an additional functional evaluation

The Management of Manufacturing-Oriented Informatics Systems Using Efficient and Flexible Architectures

Industry and in particular the manufacturing-oriented sector has always been researched and innovated as a result of technological progress, diversification and differentiation among consumers' demands. A company that provides to its customers products matching perfectly their demands at competitive prices has a great advantage over its competitors. Manufacturing-oriented information systems are becoming more flexible and configurable and they require integration with the entire organization. This can be done using efficient software architectures that will allow the coexistence between commercial solutions and open source components while sharing computing resources organized in grid infrastructures and under the governance of powerful management tools.Manufacturing-Oriented Informatics Systems, Open Source, Software Architectures, Grid Computing, Web-Based Management Systems

Rfid-based business process and workflow management in healthcare:design and implementation

The healthcare system in the United States is considered one of the most complex systems and has encountered challenges related to patient safety concerns, escalating costs, and unpredictable outcomes. Many of these problems share a common cause - a lack of efficient business process management and visibility into the real-time location, status, and condition of medical resources. The goal of this research is to propose a newly integrated system to model, automate, and monitor healthcare business processes using an automatic data collection technology to record the timing and location of activities and identify their various resources. This dissertation makes several contributions to the design and implementation of RFID-based business process and workflow management in healthcare. First, I propose a road map to implement RFID in hospitals with performance matrixes for technology evaluation, key criteria for resolution level setting, and business rules for information extraction. Second, RFID-based business process management (BPM) concepts and workflow technologies are used to transform the reprocessing procedures in a Sterile Processing Department (SPD) for the purpose of reducing infections caused by unclean reusable medical equipment. In the proposed pattern for healthcare business process management, the importance of execution status control is emphasized as a key component to handle complex and dynamic healthcare processes. A five-level framework for service-oriented business process management is designed for SPDs to share information, integrate distributed systems, and manage heterogeneous resources among multiple stakeholders. This research proposes a healthcare workflow system as a deliverable solution to manage the execution phase of reprocessing procedures, which supports the design, execution, monitoring, and automation of services supplied in SPDs. RFID techniques are adopted to collect relative real-time data for SPD performance management. Finally, by identifying key architectural requirements, the subsystems of a service-oriented architecture for the SPD workflow prototyping system, SPDFLOW, are discussed in detail. This research is the first attempt to explore healthcare workflow technologies in the SPD domain to improve the quality of reusable medical equipment and ensure patient safety

Reconfigurable and transportable container-integrated production system

In this paper, the concept and the prototype realization of a novel reconfigurable small-footprint manufacturing system in a transportable container is presented. The containerized format enables transportation of the system to provide on-site manufacturing, enabling the benefits of localized service delivery without duplication of equipment at multiple locations. Three industrial product use cases with varying manufacturing and performance requirements were analyzed. All of the use cases demanded highly customized products with high quality in low production volumes. Based on their requirements, a general system specification was derived and used to develop a concept for the container-integrated factory. A reconfigurable, modular manufacturing system is integral to the overall container concept. Production equipment was integrated in the form of interchangeable process modules, which can be quickly connected by standard utility supply and control interfaces. A modular and self-configuring control system provides assisted production workflow programming, while a modular process chain combining Additive Manufacturing, milling, precision assembly and cleaning processes has been developed. A prototype of the container-integrated factory with reconfigurable process modules and control system has been established, with full functionality and feasibility of the system demonstrated

On Line Service Composition in the Integrated Clinical Environment for eHealth and Medical Systems

Medical and eHealth systems are progressively realized in the context of standardized architectures that support safety and ease the integration of the heterogeneous (and often proprietary) medical devices and sensors. The Integrated Clinical Environment (ICE) architecture appeared recently with the goal of becoming a common framework for defining the structure of the medical applications as concerns the safe integration of medical devices and sensors.This research was partly supported by iLand (EU ARTEMIS-1-00026) granted by the ARTEMIS JUand the Spanish Ministry of Industry, Commerce and Tourism. It has also been partly funded by the REM4VSS (TIN2011-28339) project grant of the Spanish Ministry of Economy and Competitiveness and by Universidad Carlos III de Madrid. The authors would also like to mention the large development team of the iLand reference implementation that performed an outstanding role to achieve a software proven also on commercial applications, and they thank them for their valuable efforts and work.Publicad