Transforming Healthcare Quality through Information Tehnology

Information and information exchange are crucial to the delivery of care on all levels of the health care delivery system—the patient, the care team, the health care organization, and the encompassing political-economic environment. To diagnose and treat individual patients effectively, individual care providers and care teams must have access to at least three major types of clinical information—the patient’s health record, the rapidly changing medical-evidence base, and provider orders guiding the process of patient care. In this frame, Information Technology can help healthcare organizations improve the quality of care that they provide, improve patient safety, improve cost-effectiveness, accelerate the translation of research findings into practice, improve care for the medically underserved, increase consumer involvement, improve accuracy and privacy, and increase their ability to monitor health nationally. Consequently, in the present article are presented some implementations of Information and Communication Technologies in the Health Care field.Healthcare; Quality; Information and Communication Technologies

Decentralised Clinical Guidelines Modelling with Lightweight Coordination Calculus

Background: Clinical protocols and guidelines have been considered as a major means to ensure that cost-effective services are provided at the point of care. Recently, the computerisation of clinical guidelines has attracted extensive research interest. Many languages and frameworks have been developed. Thus far, however,an enactment mechanism to facilitate decentralised guideline execution has been a largely neglected line of research. It is our contention that decentralisation is essential to maintain a high-performance system in pervasive health care scenarios. In this paper, we propose the use of Lightweight Coordination Calculus (LCC) as a feasible solution. LCC is a light-weight and executable process calculus that has been used successfully in multi-agent systems, peer-to-peer (p2p) computer networks, etc. In light of an envisaged pervasive health care scenario, LCC, which represents clinical protocols and guidelines as message-based interaction models, allows information exchange among software agents distributed across different departments and/or hospitals. Results: We outlined the syntax and semantics of LCC; proposed a list of refined criteria against which the appropriateness of candidate clinical guideline modelling languages are evaluated; and presented two LCC interaction models of real life clinical guidelines. Conclusions: We demonstrated that LCC is particularly useful in modelling clinical guidelines. It specifies the exact partition of a workflow of events or tasks that should be observed by multiple "players" as well as the interactions among these "players". LCC presents the strength of both process calculi and Horn clauses pair of which can provide a close resemblance of logic programming and the flexibility of practical implementation

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

Body + Power + Justice: Movement-Based Workshops for Critical Tutor Education

In this participatory article (with suggested activities, check-ins with the body, and freewriting), we use collaborative narrative inquiry to unpack considerations that underlie the planning, facilitation, and processing of a series of movement-based workshops. Critiquing liberal multiculturalist approaches in writing centers, we argue against the all-too-common flattening of differences and think through how embodiment helps us work the hyphens (Fine, 1998) or find third ways (Soja, 1996) that break open new possibilities for working and learning together toward equity and racial justice. In contrast to role-playing scenarios that characterize many tutor education practices, we suggest that centering the body through movement allows for an alternative and more generative way to interrogate and restructure racial power. In total, we argue for attention to the body and embodied practice to engage tutors (and all writing center staff, directors included) in developing critical praxis for racial justice. For us, praxis comes in the form we call critical tutor education, which is essential for writing centers committed to more equitable relations and practices, as we continue to strive for the ought to be (Horton as cited in Branch, 2007)

A realistic evaluation : the case of protocol-based care

Background 'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways. Methods Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances. Results In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs). Conclusions As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice

Expressions of Emancipatory Knowing in Undergraduate Nursing Service- Learning

Emancipatory nurses recognize social and political problems of injustice or inequity and participate in social and political change to improve people’s lives. The recent spotlight on relationships among health, health inequity, social determinants of health, and structural institutional barriers, has led to demands that nurse educators integrate innovative curricular and pedagogical strategies to analyze and address social justice issues in today’s healthcare system. A mixed-method, qualitative study was conducted to elicit expressions of emancipatory knowing during and after a service- learning experience. Interpretive description was used to analyze data from 15 written reflections and eight semi-structured interviews. Nine expressions of emancipatory knowing were derived from reflection and subsequent interview data. The expressions expanded what is known about emancipatory knowing in undergraduate nursing students and suggested an early emancipatory knowing domain that extends the current emancipatory knowing model. The results of this study provided insight into how emancipatory knowing was expressed in undergraduate nursing students during and after a service-learning experience. Nurse educators might utilize the expressions of emancipatory knowing reported in this study to develop curricular and service-learning clinical experiences that ensure health and social equity is an outcome of nursing education and emancipatory nursing praxis a professional competency

Guideline-based decision support in medicine : modeling guidelines for the development and application of clinical decision support systems

Guideline-based Decision Support in Medicine Modeling Guidelines for the Development and Application of Clinical Decision Support Systems The number and use of decision support systems that incorporate guidelines with the goal of improving care is rapidly increasing. Although developing systems that are both effective in supporting clinicians and accepted by them has proven to be a difficult task, of the systems that were evaluated by a controlled trial, the majority showed impact. The work, described in this thesis, aims at developing a methodology and framework that facilitates all stages in the guideline development process, ranging from the definition of models that represent guidelines to the implementation of run-time systems that provide decision support, based on the guidelines that were developed during the previous stages. The framework consists of 1) a guideline representation formalism that uses the concepts of primitives, Problem-Solving Methods (PSMs) and ontologies to represent guidelines of various complexity and granularity and different application domains, 2) a guideline authoring environment that enables guideline authors to define guidelines, based on the newly developed guideline representation formalism, and 3) a guideline execution environment that translates defined guidelines into a more efficient symbol-level representation, which can be read in and processed by an execution-time engine. The described methodology and framework were used to develop and validate a number of guidelines and decision support systems in various clinical domains such as Intensive Care, Family Practice, Psychiatry and the areas of Diabetes and Hypertension control