Redesign of technical systems

The paper describes a systematic approach to support the redesign process. Redesign is the adaptation of a technical system in order to meet new specifications. The approach presented is based on techniques developed in model-based diagnosis research. The essence of the approach is to find the part of the system which causes the discrepancy between a formal specification of the system to be designed and the description of the existing technical system. Furthermore, new specifications are generated, describing the new behaviour for the `faulty¿ part. These specifications guide the actual design of this part. Both the specification and design description are based on YMIR, an ontology for structuring engineering design knowledge

Improving the Efficiency of Primary Care in Safety Net Clinics: San Mateo County's System Redesign

Outlines the impact of a countywide redesign of six primary care clinics - including the implementation of electronic health records, team-based care, chronic disease management, and advanced access scheduling - on quality of care and costs

Model compilation: An approach to automated model derivation

An approach is introduced to automated model derivation for knowledge based systems. The approach, model compilation, involves procedurally generating the set of domain models used by a knowledge based system. With an implemented example, how this approach can be used to derive models of different precision and abstraction is illustrated, and models are tailored to different tasks, from a given set of base domain models. In particular, two implemented model compilers are described, each of which takes as input a base model that describes the structure and behavior of a simple electromechanical device, the Reaction Wheel Assembly of NASA's Hubble Space Telescope. The compilers transform this relatively general base model into simple task specific models for troubleshooting and redesign, respectively, by applying a sequence of model transformations. Each transformation in this sequence produces an increasingly more specialized model. The compilation approach lessens the burden of updating and maintaining consistency among models by enabling their automatic regeneration

Unleashing the Effectiveness of Process-oriented Information Systems: Problem Analysis, Critical Success Factors, Implications

Process-oriented information systems (IS) aim at the computerized support of business processes. So far, contemporary IS have often fail to meet this goal. To better understand this drawback, to systematically identify its rationales, and to derive critical success factors for business process support, we conducted three empirical studies: an exploratory case study in the automotive domain, an online survey among 79 IT professionals, and another online survey among 70 business process management (BPM) experts. This paper summarizes the findings of these studies, puts them in relation with each other, and uses them to show that "process-orientation" is scarce and "process-awareness" is needed in IS engineering

Perceptions of a service redesign by adults living with type 2 diabetes

<b>Aim:</b> This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. <b>Background:</b> Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. <b>Method:</b> An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. <b>Findings:</b> Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. <b>Conclusion:</b> People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care

Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/78267/1/1748-5908-5-26.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/2/1748-5908-5-26.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/3/1748-5908-5-26-S3.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/4/1748-5908-5-26-S2.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/5/1748-5908-5-26-S1.TIFFPeer Reviewe

Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting

A Survey on Evaluation Factors for Business Process Management Technology

Estimating the value of business process management (BPM) technology is a difficult task to accomplish. Computerized business processes have a strong impact on an organization, and BPM projects have a long-term cost amortization. To systematically analyze BPM technology from an economic-driven perspective, we are currently developing an evaluation framework in the EcoPOST project. In order to empirically validate the relevance of assumed evaluation factors (e.g., process knowledge, business process redesign, end user fears, and communication) we have conducted an online survey among 70 BPM experts from more than 50 industrial and academic organizations. This paper summarizes the results of this survey. Our results help both researchers and practitioners to better understand the evaluation factors that determine the value of BPM technology

A managerial modernization model in crisis conditions

The improvement of the economic performances of Romanian enterprises facing crisis conditions could be achieved by means of promoting and implementing a range of managerial modernization methods. Among them we mention several factors pertaining to strategic management: redesigning the managerial system, implementing methodological management – with an emphasis on profit center management and other managerial tools which ensure process and organizational flexibility – and professionalizing the management and managers. Based on the aforementioned factors, the model we put forth aims at increasing the management’s role in achieving reasonable levels of efficiency and effectiveness.managerial modernization, managerial redesign, methodological management, strategic management, profit center management, performance.