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

Effects of the Interactions Between LPS and BIM on Workflow in Two Building Design Projects

Variability in design workflow causes delays and undermines the performance of building projects. As lean processes, the Last Planner System (LPS) and Building Information Modeling (BIM) can improve workflow in building projects through features that reduce waste. Since its introduction, BIM has had significant positive influence on workflow in building design projects, but these have been rarely considered in combination with LPS. This paper is part of a postgraduate research focusing on the implementation of LPS weekly work plans in two BIM-based building design projects to achieve better workflow. It reports on the interactions between lean principles of LPS and BIM functionalities in two building design projects that, from the perspective of an interaction matrix developed by Sacks et al. (2010a), promote workflow

Coordination approaches and systems - part I : a strategic perspective

This is the first part of a two-part paper presenting a fundamental review and summary of research of design coordination and cooperation technologies. The theme of this review is aimed at the research conducted within the decision management aspect of design coordination. The focus is therefore on the strategies involved in making decisions and how these strategies are used to satisfy design requirements. The paper reviews research within collaborative and coordinated design, project and workflow management, and, task and organization models. The research reviewed has attempted to identify fundamental coordination mechanisms from different domains, however it is concluded that domain independent mechanisms need to be augmented with domain specific mechanisms to facilitate coordination. Part II is a review of design coordination from an operational perspective

A Specification Language for the WIDE Workflow Model

This paper presents a workflow specification language developed in the WIDE project. The language provides a rich organisation model, an information model including presentation details, and a sophisticated process model. Workflow application developers should find the language a useful and compact means to capture and investigate design details. Workflow system developers would discover the language a good vehicle to study the interaction between different features as well as facilitate the development of more advanced features. Others would attain a better understanding of the workflow paradigm and could use the language ms a basis of evaluation for the functionality of workflow systems

Automated Diagnosis of Clinic Workflows

Outpatient clinics often run behind schedule due to patients who arrive late or appointments that run longer than expected. We sought to develop a generalizable method that would allow healthcare providers to diagnose problems in workflow that disrupt the schedule on any given provider clinic day. We use a constraint optimization problem to identify the least number of appointment modifications that make the rest of the schedule run on-time. We apply this method to an outpatient clinic at Vanderbilt. For patient seen in this clinic between March 27, 2017 and April 21, 2017, long cycle times tended to affect the overall schedule more than late patients. Results from this workflow diagnosis method could be used to inform interventions to help clinics run smoothly, thus decreasing patient wait times and increasing provider utilization