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

Supporting Collaborative Health Tracking in the Hospital: Patients' Perspectives

The hospital setting creates a high-stakes environment where patients' lives depend on accurate tracking of health data. Despite recent work emphasizing the importance of patients' engagement in their own health care, less is known about how patients track their health and care in the hospital. Through interviews and design probes, we investigated hospitalized patients' tracking activity and analyzed our results using the stage-based personal informatics model. We used this model to understand how to support the tracking needs of hospitalized patients at each stage. In this paper, we discuss hospitalized patients' needs for collaboratively tracking their health with their care team. We suggest future extensions of the stage-based model to accommodate collaborative tracking situations, such as hospitals, where data is collected, analyzed, and acted on by multiple people. Our findings uncover new directions for HCI research and highlight ways to support patients in tracking their care and improving patient safety

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

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Collaborative Documentation for Behavioral Healthcare Providers: An Emerging Practice

This article considers the practice of collaborative documentation (CD) for behavioral healthcare providers; the legislative, technological, and philosophical milieu in which it developed; the attributed benefits for providers and clients; and the peer-reviewed research supporting its use. Collaborative documentation has emerged following significant legislative and technological changes in healthcare delivery and shifts toward client-centered healthcare practices including more shared decision-making between clients and practitioners

MOSAIC roadmap for mobile collaborative work related to health and wellbeing.

The objective of the MOSAIC project is to accelerate innovation in Mobile Worker Support Environments. For that purpose MOSAIC develops visions and illustrative scenarios for future collaborative workspaces involving mobile and location-aware working. Analysis of the scenarios is input to the process of road mapping with the purpose of developing strategies for R&D leading to deployment of innovative mobile work technologies and applications across different domains. One of the application domains where MOSAIC is active is health and wellbeing. This paper builds on another paper submitted to this same conference, which presents and discusses health care and wellbeing specific scenarios. The aim is to present an early form of a roadmap for validation

Library purchasing consortia in the UK: activity, benefits and good practice.

Following a brief introduction in Section 1, Section 2 sets out the operational context of library purchasing consortia. A range of key factors have shaped recent developments in the four LIS sectors under consideration (FE, HE, health and public libraries); some have exerted a common influence over all (e.g. information technology, European Commission purchasing directives, new central government, decline in bookfunds); some are sector-specific (e.g. purchasing arrangements, regional administrative frameworks, collaborative partnerships). The structure and markets of the book and periodical publishing industry in the UK are reviewed, with attention paid to historical as well as more recent practice that has had an impact on library supply. Although each component of the LIS purchasing consortia jigsaw displays individual characteristics that have evolved as a response to its own environment, the thread that links them together is constant change. Section 3 presents the results of a survey of identified library purchasing consortia in the four library sectors. It treats common themes of relevance to all consortia arising from information gathered by seminar input, questionnaire and interview. These include models of consortium operation, membership and governance, ‘typical’ composition of consortia in each sector, and links to analogous practice in other library sectors. Common features of the tendering and contract management process are elicited and attention paid to any contribution of procurement professionals. Finally, levels of consortium expenditure and cost savings are estimated from the published statistical record, which readily demonstrate in financial terms the efficiency of the consortial purchase model for all types of library in the United Kingdom. Section 4 presents the results of a survey of suppliers to libraries in the United Kingdom of books and periodicals, the two sectors most commonly represented in current contracts of library purchasing consortia. It sets out in some detail the operating context governing the highly segmented activities of library booksellers, as well as that pertaining to periodicals suppliers (also known as subscription agents). Detailed responses to questions on the effects of library purchasing consortia on suppliers of both materials have been gathered by questionnaire survey and selected follow-up interviews. Results are presented and analysed according to supply sector with attention given to the tendering process, current contracts under way, cross-sectoral clientele, and advantages and inhibitors of consortia supply. Further responses are reported on issues of how consortia have affected suppliers’ volume of trade, operating margins and market stability as perceived in their own business, the library supply sector and the publishing industry. Finally, overall conclusions are drawn and projections made as to future implications for both types of library suppliers. Section 5 synthesises findings, details enabling and inhibiting factors for consortia formation and models of best practice amongst consortia. The scope for cross-sectoral collaboration is discussed and found to be limited at present. Pointers are given for future activity

PDP4Life: personal development planning for lifelong learning. Final Report.

Many HEIs have developed electronic Personal Development Planning (e-PDP) systems that support the learner through the processes of personal development planning, however, little attention appeared to have been paid to developing frameworks within these systems to enable learners to merge formal and informal records of learning into a single database, to transfer records from one institutional learning environment to another, and to access and manipulate their learner records when not registered within a place of study. PDP4Life attempted to address these issues. This final project report outlines the outcomes of this JISC project

Critical success factors for e-tendering implementation in construction collaborative environments : people and process issues

The construction industry is increasingly engulfed by globalisation where clients, business partners and customers are found in virtually every corner of the world. Communicating, reaching and supporting them are no longer optional but are imperative for continued business growth and success. A key component of enterprise communication reach is collaborative environments (for the construction industry) which allows customers, suppliers, partners and other project team members secure access to project information, products or services they need at any given moment. Implementation of the stated critical success factors of the project is essential to ensure optimal performance and benefits from the system to all parties involved. This paper presents critical success factors for the implementation of e-tendering in collaborative environments with particular considerations given to the people issues and process factors