21 research outputs found
Automatic Generation of Personalized Recommendations in eCoaching
Denne avhandlingen omhandler eCoaching for personlig livsstilsstøtte i sanntid ved bruk av informasjons- og kommunikasjonsteknologi. Utfordringen er å designe, utvikle og teknisk evaluere en prototyp av en intelligent eCoach som automatisk genererer personlige og evidensbaserte anbefalinger til en bedre livsstil. Den utviklede løsningen er fokusert på forbedring av fysisk aktivitet. Prototypen bruker bærbare medisinske aktivitetssensorer. De innsamlede data blir semantisk representert og kunstig intelligente algoritmer genererer automatisk meningsfulle, personlige og kontekstbaserte anbefalinger for mindre stillesittende tid. Oppgaven bruker den veletablerte designvitenskapelige forskningsmetodikken for å utvikle teoretiske grunnlag og praktiske implementeringer. Samlet sett fokuserer denne forskningen på teknologisk verifisering snarere enn klinisk evaluering.publishedVersio
Towards the interoperability of spontaneous reporting systems in pharmacovigilance : a maturity model approach with a sociotechnical system focus
Thesis (PhD)--Stellenbosch University, 2020.ENGLISH ABSTRACT: It is universally accepted that all medicines have the potential to cause adverse
drug reactions (ADRs) during the course of their normal therapeutic use. Drug safety surveillance during the post-marketing authorisation phase generates the
majority of drug safety data, even more so than the clinical trials during the drug development process. Pharmacovigilance (PV), is based on the medical assessment of ADRs or drug-related problems, collected within organised health programmes.
PV systems, by nature, are complex. The large number, fragmentation, and complexity of existing PV systems, the equally large number of stakeholders within
such systems (i.e. pharmaceutical companies, government regulatory authorities, national and international clinical regulatory bodies, healthcare workers, etc.), as well as the significant number of dimensions along which the effectiveness and
efficiency could be in uenced and also measured, adds to this complexity.
The primary goal of any PV system is to improve and protect patient safety by enabling health care professionals to make more informed therapeutic decisions.
Achieving this goal is dependent on the successful communication of relevant ADR information from the patient to the relevant PV authority. One such method of
communication is the spontaneous reporting of ADRs, which is widely regarded as the cornerstone of data generation in PV during post-marketing authorisation
safety surveillance.
Currently, spontaneous reporting systems (SRSs) are faced with problems such as under-reporting and the communication of incomplete, unrepresentative, and
uncontrolled data. The lack of standardisation and interoperability among these systems results in a reduced capability to detect and characterise new adverse drug
interactions and ADRs.
The primary obstacle to achieving interoperability between SRSs is the fundamental difference in the purpose of the existing SRSs. Stakeholders in the PV system operate SRSs with different goals and perspectives such as maintaining regulatory
compliance, mitigating financial risk, and for the protection and promotion of patient safety in public health programmes. The aim of this study is to contribute towards the interoperability of SRSs in the PV
landscape through the development of a novel maturity model with a sociotechnical system focus. The aim of the model is to promote and improve interoperability
by addressing the degree of integration of systems involved, provide guidance on which system components need to be improved, as well as provide a means for
measuring interoperability progress across the community of SRSs in the global PV landscape.
A multidisciplinary literature review covering PV, capability maturity models, interoperability,
and sociotechnical systems served as a theoretical foundation for the development of the model. The development of the model followed an adaptation
of the 8-phase procedural model for developing maturity models, proposed by Becker et al. (2009).
A comparison of 18 existing maturity models in the fields of: (i) PV; (ii) eHealth; (iii) eHealth/interoperability; (iv) interoperability; and (v) IT infrastructure, was
conducted. The model is made up of three domains, seven subdomains, and thirty dimensions which were identified as a result of the preceding literature review and comparison of existing models.
Through a combination of verification and validation processes involving subject matter experts, the maturity model was refined. The resulting maturity model
was implemented in a case study within a national regulatory authority context, to determine the generalisability and empirical validity of the model. The model was deemed a useful, unique, and valuable contribution to organisations operating SRSs, having achieved the stated aim.AFRIKAANSE OPSOMMING: Oor die algemeen word dit aanvaar dat alle medisyne die potensiaal het om
negatiewe geneesmiddelreaksies te veroorsaak tydens hul normale terapeutiese gebruik. Dwelmveiligheidswaarneming tydens die na-bemarkingsmagtigingsfase genereer die meerderheid van dwelmveiligheidsdata, selfs meer as die kliniese proewe
tydens die dwelmontwikkelingsproses. Pharmacovigilance (PV), is gebaseer op die mediese evaluering van geneesmiddelreaksies of dwelmverwante probleme, wat
binne georganiseerde gesondheidsprogramme ingesamel word.
PV-stelsels is inherent kompleks. Die groot aantal, fragmentasie en kompleksiteit van bestaande PV-stelsels, die ewe groot aantal belanghebbendes binne hierdie
stelsels (d.w.s. farmaseutiese maatskappye, staatsregulerende owerhede, nasionale
en internasionale kliniese reguleringsliggame, gesondheidswerkers, ens.), sowel as die beduidende aantal dimensies waarlangs die effektiwiteit en doeltreffendheid beinvloed kan word en ook gemeet word, dra by tot hierdie kompleksiteit.
Die primeere doel van enige PV-stelsel is om pasieentveiligheid te verbeter en te beskerm deur gesondheidsorgwerkers in staat te stel om meer ingeligte terapeutiese besluite te neem. Die bereiking van hierdie doelwit is afhanklik van die suksesvolle
kommunikasie van relevante geneesmiddelreaksie-inligting van die pasient na die betrokke PV-owerheid. Een sodanige kommunikasiemetode is die spontane rapportering van geneesmiddelreaksies, wat algemeen beskou word as die hoeksteen van data-opwekking in PV tydens die veiligheidswaarneming na bemarking.
Tans word spontane rapporteringstelsels (SRSe) gekonfronteer met probleme soos onder-rapportering en die kommunikasie van onvolledige, nie-verteenwoordigende en onbeheerde data. Die gebrek aan standardisering en interoperabiliteit tussen
hierdie stelsels lei tot 'n verminderde vermoe om nuwe geneesmiddelsinteraksies en geneesmiddelreaksies na te spoor en te karakteriseer.
Die primere struikelblok vir die bereiking van interoperabiliteit tussen SRSe is die fundamentele verskil in die doel van die bestaande SRSe. Belanghebbendes in die PV-stelsel bedryf SRSe met verskillende doelwitte en perspektiewe, insluitende: die handhawing van regulatoriese vereistes; die vermindering van finansiele risiko; en die beskerming en bevordering van pasientveiligheid in openbare gesondheidsorgprogramme.
Die doel van hierdie studie is om by te dra tot die interoperabiliteit van SRSe in die PV-landskap deur die ontwikkeling van 'n nuwe en oorspronklike volwassenheidsmodel met 'n sosiotegniese stelselfokus. Die doel van die model is om interoperabiliteit
te bevorder en te verbeter deur die mate van integrasie van betrokke stelsels aan te spreek, leiding te gee oor watter stelselkomponente verbeter moet
word, asook om die interoperabiliteitsprogressies in die wereldwye gemeenskap van SRSe te meet.
'n Multidissiplinere literatuuroorsig oor PV, volwassenheidsmodelle, interoperabiliteit
en sosiotegniese-stelsels het gedien as 'n teoretiese grondslag vir die ontwikkeling van die model. Die ontwikkeling van die model het gevolg op 'n aanpassing van die 8-fase prosedure model vir die ontwikkeling van volwassenheidsmodelle, voorgestel deur Becker et al. (2009).
'n Vergelyking van 18 bestaande volwassenheidsmodelle in die velde van: (i) PV; (ii) eHealth; (iii) eHealth/interoperabiliteit; (iv) interoperabiliteit; en (v)
IT-infrastruktuur, is uitgevoer. Die model bestaan uit drie domeine, sewe subdomeine en dertig dimensies wat geidentifiseer is as gevolg van die voorafgaande
literatuuroorsig en vergelyking van bestaande modelle.
Die volwassenheidsmodel is deur 'n kombinasie van verifierings- en valideringsprosesse, waar vakkundiges betrokke was, verfyn. Om die veralgemeenbaarheid en empiriese geldigheid van die model te bepaal, is die gevolglike volwassenheidsmodel in 'n gevallestudie, binne die nasionale konteks van 'n regulerende owerheid, geimplementeer. Die gestelde doel van die model is bereik en die model word geag as 'n nuttige, unieke en waardevolle bydrae tot organisasies wat SRS'e bedryf.Doctora
Strategies Used in eHealth Systems Adoption
Failure to adopt an interoperable eHealth system limits the accurate communication exchange of pertinent health-care-related data for diagnosis and treatment. Patient data are located in disparate health information systems, and the adoption of an interoperable eHealth system is complex and requires strategic planning by senior health care IT leaders. Grounded in DeLone and McLeanâs information system success model, the purpose of this qualitative case study was to explore strategies used by some senior information technology (IT) health care leaders in the successful adoption of an eHealth system. The participants were 8 senior health care IT leaders in the eastern United States who successfully adopted an interoperable eHealth system. Data were collected using semistructured interviews following Kallioâs five phase interview guide and analyzed using thematic analysis. Six themes emerged: eHealth ecosystem, implementation approach, quality, strategy, use/intent to use, and user satisfaction. A key recommendation from results indicates that further identification and development of strategies based on the DeLone and McLean IS success model might benefit successful eHealth adoption and implementation. Positive social change implications include the potential for senior health care IT leaders to identify a framework to enhance accuracy among eHealth systems to reduce medical errors and improve patient care
Institutional perspective on introducing enterprise architecture : The case of the Norwegian hospital sector
Paper I, II, and III are not available as a part of the dissertation due to the copyright.The findings from this thesis point to the incongruence between the characteristics of EA and the healthcare domain as specific tensions among the EA logic and different professional logics as a source of deviation. The incongruence comes from the long-term plan-driven EA approach versus healthcare traditions and needs for ad-hoc initiatives. Other themes stem from the EA logic of process standardisation, which poses challenges in gaining acceptance and trust that the processes dinscribe appropriate clinical knowledge and provide support for local variations. Moreover, the EA vision of data integration across organisational units and across IS has implications for concerns about privacy and protection of sensitive data, but this can collide with the healthcare view on patient safety and the need for mission-critical data.
This dissertation makes several contributions to research and practice. First, it augments the EA research stream by offering rich insights and specific implications related to challenges of EA institutionalisation in healthcare. A description of the enterprise architects’ logics and the EA logic supplements the EA knowledge base. Likewise, it presents a model of a predicted evolution of the EA initiatives through the phases of optimism, resistance, decline and finally, reconsolidation of the most persistent ones, unless firm mandates are established from the start. Furthermore, the study provides a model that illustrates how coexisting institutional logics maintain their distinct character while allowing compromises that shape EA operationalisation. The model shows a set of scenarios for settling tensions in project decisions. In these scenarios, EA is foregrounded, blended with other available institutional logics or suppressed.
Second, this dissertation contributes to an enhanced theoretical and empirical understanding of EA institutionalisation, where regulative, normative and culturalcognitive elements create and maintain EA as an institution, and unsurprisingly, the organisational response impedes the institutionalisation process. The organisational response can be explained by selective activated institutional logics among the actors. However, with targeted institutional work from the actors that want EA to be institutionalised, the process can be reinforced.
This thesis also offers some practical suggestions at the national policy level. First, financial arrangements should be assessed to encourage broader involvement from the sub-organisations. Second, through active ownership, they can address the need for enhanced EA understanding and should secure the education of the actors, not the least at the executive level, together with the targeted hires. Furthermore, the need for organisational changes related to EA is under-communicated. The thesis also makes practical suggestions to deal with the challenges, the incongruence and the consequent tensions, mainly by finding solutions that balance between the institutional logics of EA and of healthcare.publishedVersio
Políticas de Copyright de Publicações Científicas em Repositórios Institucionais: O Caso do INESC TEC
A progressiva transformação das práticas científicas, impulsionada pelo desenvolvimento das novas Tecnologias de Informação e Comunicação (TIC), têm possibilitado aumentar o acesso à informação, caminhando gradualmente para uma abertura do ciclo de pesquisa. Isto permitirá resolver a longo prazo uma adversidade que se tem colocado aos investigadores, que passa pela existência de barreiras que limitam as condições de acesso, sejam estas geográficas ou financeiras. Apesar da produção científica ser dominada, maioritariamente, por grandes editoras comerciais, estando sujeita às regras por estas impostas, o Movimento do Acesso Aberto cuja primeira declaração pública, a Declaração de Budapeste (BOAI), é de 2002, vem propor alterações significativas que beneficiam os autores e os leitores. Este Movimento vem a ganhar importância em Portugal desde 2003, com a constituição do primeiro repositório institucional a nível nacional. Os repositórios institucionais surgiram como uma ferramenta de divulgação da produção científica de uma instituição, com o intuito de permitir abrir aos resultados da investigação, quer antes da publicação e do próprio processo de arbitragem (preprint), quer depois (postprint), e, consequentemente, aumentar a visibilidade do trabalho desenvolvido por um investigador e a respetiva instituição. O estudo apresentado, que passou por uma análise das políticas de copyright das publicações científicas mais relevantes do INESC TEC, permitiu não só perceber que as editoras adotam cada vez mais políticas que possibilitam o auto-arquivo das publicações em repositórios institucionais, como também que existe todo um trabalho de sensibilização a percorrer, não só para os investigadores, como para a instituição e toda a sociedade. A produção de um conjunto de recomendações, que passam pela implementação de uma política institucional que incentive o auto-arquivo das publicações desenvolvidas no âmbito institucional no repositório, serve como mote para uma maior valorização da produção científica do INESC TEC.The progressive transformation of scientific practices, driven by the development of new Information and Communication Technologies (ICT), which made it possible to increase access to information, gradually moving towards an opening of the research cycle. This opening makes it possible to resolve, in the long term, the adversity that has been placed on researchers, which involves the existence of barriers that limit access conditions, whether geographical or financial. Although large commercial publishers predominantly dominate scientific production and subject it to the rules imposed by them, the Open Access movement whose first public declaration, the Budapest Declaration (BOAI), was in 2002, proposes significant changes that benefit the authors and the readers. This Movement has gained importance in Portugal since 2003, with the constitution of the first institutional repository at the national level. Institutional repositories have emerged as a tool for disseminating the scientific production of an institution to open the results of the research, both before publication and the preprint process and postprint, increase the visibility of work done by an investigator and his or her institution. The present study, which underwent an analysis of the copyright policies of INESC TEC most relevant scientific publications, allowed not only to realize that publishers are increasingly adopting policies that make it possible to self-archive publications in institutional repositories, all the work of raising awareness, not only for researchers but also for the institution and the whole society. The production of a set of recommendations, which go through the implementation of an institutional policy that encourages the self-archiving of the publications developed in the institutional scope in the repository, serves as a motto for a greater appreciation of the scientific production of INESC TEC
Usability analysis of contending electronic health record systems
In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe