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

Estimating the prevalence of unpaid adult care over time

To help fulfil their responsibilities towards unpaid carers, service providers need some idea of the carer’s situation and how many might require support. This paper argues that estimating the prevalence of unpaid care across service planning and budgeting cycles provides a better indication of the size and composition of the carer population than estimates at a point in time. The number of adults providing care at any time during a year is estimated for typical catchments or organisational settings, including social services and primary health care. As well as focusing on carers who are heavily involved in their caring activities, variations in their psychological well-being are assessed to provide an indication of unmet needs for support

Summarisation and visualisation of e-Health data repositories

At the centre of the Clinical e-Science Framework (CLEF) project is a repository of well organised, detailed clinical histories, encoded as data that will be available for use in clinical care and in-silico medical experiments. We describe a system that we have developed as part of the CLEF project, to perform the task of generating a diverse range of textual and graphical summaries of a patient’s clinical history from a data-encoded model, a chronicle, representing the record of the patient’s medical history. Although the focus of our current work is on cancer patients, the approach we describe is generalisable to a wide range of medical areas

Searching Data: A Review of Observational Data Retrieval Practices in Selected Disciplines

A cross-disciplinary examination of the user behaviours involved in seeking and evaluating data is surprisingly absent from the research data discussion. This review explores the data retrieval literature to identify commonalities in how users search for and evaluate observational research data. Two analytical frameworks rooted in information retrieval and science technology studies are used to identify key similarities in practices as a first step toward developing a model describing data retrieval

Optimized Time Management for Declarative Workflows

Declarative process models are increasingly used since they fit better with the nature of flexible process-aware information systems and the requirements of the stakeholders involved. When managing business processes, in addition, support for representing time and reasoning about it becomes crucial. Given a declarative process model, users may choose among different ways to execute it, i.e., there exist numerous possible enactment plans, each one presenting specific values for the given objective functions (e.g., overall completion time). This paper suggests a method for generating optimized enactment plans (e.g., plans minimizing overall completion time) from declarative process models with explicit temporal constraints. The latter covers a number of well-known workflow time patterns. The generated plans can be used for different purposes like providing personal schedules to users, facilitating early detection of critical situations, or predicting execution times for process activities. The proposed approach is applied to a range of test models of varying complexity. Although the optimization of process execution is a highly constrained problem, results indicate that our approach produces a satisfactory number of suitable solutions, i.e., solutions optimal in many cases

What can we learn from exploring cognitive appraisal, coping styles and perceived stress in UK undergraduate dissertation students?

Undergraduate dissertation students’ cognitive appraisal, coping styles and perceived stress were examined at three time points during their undergraduate dissertation projects (UDP), observing whether cognitive appraisal and coping styles predicted perceived stress and their temporal changes. Sixty-four dissertation students completed the Perceived Stress Scale, an adapted Cognitive Appraisal of Health Scale, the Brief COPE and explorative open-ended questions. Linear Regression models for each time-point showed coping styles and cognitive appraisal predicted perceived stress, but single coping styles and primary appraisal harm/loss predicted stress levels inconsistently over time. Analyses indicated significant effects of time-point on primary appraisals benign/irrelevance, harm/loss and challenge but none for secondary appraisal,coping styles or perceived stress. Content Analysis showed perceived stressors and coping styles to be a function of the UDP’s stages and their tasks and challenges. Implications and recommendations for students and supervisors are discussed

Responsibility modelling for civil emergency planning

This paper presents a new approach to analysing and understanding civil emergency planning based on the notion of responsibility modelling combined with HAZOPS-style analysis of information requirements. Our goal is to represent complex contingency plans so that they can be more readily understood, so that inconsistencies can be highlighted and vulnerabilities discovered. In this paper, we outline the framework for contingency planning in the United Kingdom and introduce the notion of responsibility models as a means of representing the key features of contingency plans. Using a case study of a flooding emergency, we illustrate our approach to responsibility modelling and suggest how it adds value to current textual contingency plans