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

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

An overview of artificial intelligence and robotics. Volume 1: Artificial intelligence. Part B: Applications

Artificial Intelligence (AI) is an emerging technology that has recently attracted considerable attention. Many applications are now under development. This report, Part B of a three part report on AI, presents overviews of the key application areas: Expert Systems, Computer Vision, Natural Language Processing, Speech Interfaces, and Problem Solving and Planning. The basic approaches to such systems, the state-of-the-art, existing systems and future trends and expectations are covered

Modelling evolving clinical practice guidelines: a case of Malawi

Electronic medical record (EMR) systems are increasingly being adopted in low- and middle-income countries. This provides an opportunity to support task-shifted health workers with guideline-based clinical decision support to improve the quality of healthcare delivery. However, the formalization of clinical practice guidelines (CPGs) into computer-interpretable guidelines (CIGs) for clinical decision support in such a setting is a very challenging task due to the evolving nature of CPGs and limited healthcare budgets. This study proposed that a CIG modelling language that considers CPG change requirements in their representation models could enable semi-automated support of CPG change operations thereby reducing the burden of maintaining CIGs. Characteristics of CPG changes were investigated to elucidate CPG change requirements using CPG documents from Malawi where EMR systems are routinely used. Thereafter, a model-driven engineering approach was taken to design a CIG modelling framework that has a novel domain-specific modelling language called FCIG for the modelling of evolving CIGs. The CIG modelling framework was implemented using the Xtext framework. The national antiretroviral therapy EMR system for Malawi was extended into a prototype with FCIG support for experimentation. Further studies were conducted with CIG modellers. The evaluations were conducted to answer the following research questions: i) What are the CPG change requirements for modelling an evolving CIG? ii) Can a model-driven engineering approach adequately support the modelling of an evolving CIG? iii) What is the effect of modelling an evolving CIG using FCIG in comparison with the Health Level Seven (HL7) standard for modelling CIGs? Data was collected using questionnaires, logs and observations. The results indicated that finegrained components of a CPG are affected by CPG changes and that those components are not included explicitly in current executable CIG language models. The results also showed that by including explicit semantics for elements that are affected by CPG changes in a language model, smart-editing features for supporting CPG change operations can be enabled in a language-aware code editor. The results further showed that both experienced and CIG modellers perceived FCIG as highly usable. Furthermore, the results suggested that FCIG performs significantly better at CIG modelling tasks as compared to the HL7 standard, Arden Syntax. This study provides empirical evidence that a model-driven engineering approach to clinical guideline formalization supports the authoring and maintenance of evolving CIGs to provide up-to-date clinical decision support in low- and middle-income countries

Automated Injection of Curated Knowledge Into Real-Time Clinical Systems: CDS Architecture for the 21st Century

abstract: Clinical Decision Support (CDS) is primarily associated with alerts, reminders, order entry, rule-based invocation, diagnostic aids, and on-demand information retrieval. While valuable, these foci have been in production use for decades, and do not provide a broader, interoperable means of plugging structured clinical knowledge into live electronic health record (EHR) ecosystems for purposes of orchestrating the user experiences of patients and clinicians. To date, the gap between knowledge representation and user-facing EHR integration has been considered an “implementation concern” requiring unscalable manual human efforts and governance coordination. Drafting a questionnaire engineered to meet the specifications of the HL7 CDS Knowledge Artifact specification, for example, carries no reasonable expectation that it may be imported and deployed into a live system without significant burdens. Dramatic reduction of the time and effort gap in the research and application cycle could be revolutionary. Doing so, however, requires both a floor-to-ceiling precoordination of functional boundaries in the knowledge management lifecycle, as well as formalization of the human processes by which this occurs. This research introduces ARTAKA: Architecture for Real-Time Application of Knowledge Artifacts, as a concrete floor-to-ceiling technological blueprint for both provider heath IT (HIT) and vendor organizations to incrementally introduce value into existing systems dynamically. This is made possible by service-ization of curated knowledge artifacts, then injected into a highly scalable backend infrastructure by automated orchestration through public marketplaces. Supplementary examples of client app integration are also provided. Compilation of knowledge into platform-specific form has been left flexible, in so far as implementations comply with ARTAKA’s Context Event Service (CES) communication and Health Services Platform (HSP) Marketplace service packaging standards. Towards the goal of interoperable human processes, ARTAKA’s treatment of knowledge artifacts as a specialized form of software allows knowledge engineers to operate as a type of software engineering practice. Thus, nearly a century of software development processes, tools, policies, and lessons offer immediate benefit: in some cases, with remarkable parity. Analyses of experimentation is provided with guidelines in how choice aspects of software development life cycles (SDLCs) apply to knowledge artifact development in an ARTAKA environment. Portions of this culminating document have been further initiated with Standards Developing Organizations (SDOs) intended to ultimately produce normative standards, as have active relationships with other bodies.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201

A Companion to J.R.R. Tolkien, ed. Stuart D. Lee, reviewed by Andrew Higgins

Book review of A Companion to J.R.R. Tolkien (2014), edited by Stuart D. Le

The Challenge of Spoken Language Systems: Research Directions for the Nineties

A spoken language system combines speech recognition, natural language processing and human interface technology. It functions by recognizing the person's words, interpreting the sequence of words to obtain a meaning in terms of the application, and providing an appropriate response back to the user. Potential applications of spoken language systems range from simple tasks, such as retrieving information from an existing database (traffic reports, airline schedules), to interactive problem solving tasks involving complex planning and reasoning (travel planning, traffic routing), to support for multilingual interactions. We examine eight key areas in which basic research is needed to produce spoken language systems: (1) robust speech recognition; (2) automatic training and adaptation; (3) spontaneous speech; (4) dialogue models; (5) natural language response generation; (6) speech synthesis and speech generation; (7) multilingual systems; and (8) interactive multimodal systems. In each area, we identify key research challenges, the infrastructure needed to support research, and the expected benefits. We conclude by reviewing the need for multidisciplinary research, for development of shared corpora and related resources, for computational support and far rapid communication among researchers. The successful development of this technology will increase accessibility of computers to a wide range of users, will facilitate multinational communication and trade, and will create new research specialties and jobs in this rapidly expanding area

The Challenge of Spoken Language Systems: Research Directions for the Nineties

A spoken language system combines speech recognition, natural language processing and human interface technology. It functions by recognizing the person's words, interpreting the sequence of words to obtain a meaning in terms of the application, and providing an appropriate response back to the user. Potential applications of spoken language systems range from simple tasks, such as retrieving information from an existing database (traffic reports, airline schedules), to interactive problem solving tasks involving complex planning and reasoning (travel planning, traffic routing), to support for multilingual interactions. We examine eight key areas in which basic research is needed to produce spoken language systems: (1) robust speech recognition; (2) automatic training and adaptation; (3) spontaneous speech; (4) dialogue models; (5) natural language response generation; (6) speech synthesis and speech generation; (7) multilingual systems; and (8) interactive multimodal systems. In each area, we identify key research challenges, the infrastructure needed to support research, and the expected benefits. We conclude by reviewing the need for multidisciplinary research, for development of shared corpora and related resources, for computational support and far rapid communication among researchers. The successful development of this technology will increase accessibility of computers to a wide range of users, will facilitate multinational communication and trade, and will create new research specialties and jobs in this rapidly expanding area

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe