Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

The Value of Information Technology-Enabled Diabetes Management

Reviews different technologies used in diabetes disease management, as well as the costs, benefits, and quality implications of technology-enabled diabetes management programs in the United States

Model-driven design of context-aware applications

In many cases, in order to be effective, software applications need to allow sensitivity to context changes. This implies however additional complexity associated with the need for applications’ adaptability (being capable of capturing context, interpreting it and reacting on it). Hence, we envision 3 ‘musts’ that, in combination, are especially relevant to the design of context-aware applications. Firstly, at the business modeling level, it is considered crucial that the different possible context states can be properly captured and modeled, states that correspond to certain desirable behaviors. Secondly, it must be known what are the dependencies between the two, namely between states and behaviors. And finally, what is valid for application design in general, business needs are to be aligned to application solutions. In this work, we address the mentioned challenges, by approaching the notion of context and extending from this perspective a previously proposed business-software alignment approach. We illustrate our achieved results by means of a small example. It is expected that this research contribution will be useful as an additional result concerning the alignment between business modeling and software design

Reinsurance in State Health Reform

Based on the experiences of three states, formal modeling, quantitative estimates, and qualitative assessments, explores the impact of and issues involved in publicly funding reinsurance for insurers as a way to expand or maintain private coverage

Bending the Curve: Options for Achieving Savings and Improving Value in Health Spending

Analyzes the potential of fifteen federal health policy options to lower spending over the next ten years and yield higher value on investments in health care