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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
Visual Exploration and Cohort Identification of Acute Patient Histories Aggregated from Heterogeneous Sources
How can we use information visualization to support retrospective, exploratory analysis of collections of histories for patients admitted to acute care? This paper describes a novel design for visual cohort identification and exploration. We have developed a tool that integrates multiple, heterogeneous clinical data sources and allows alignment, querying and abstraction in a common workbench.
This paper presents results from two projects and a review
of related work in the field of information visualization including both presentation and interactive navigation of the information.
We have developed an interactive prototype and present the
visualization aspect of this prototype and a brief demonstration of its use in a research project with a large cohort of patients.
The prototype represents and reasons with patient events in different OWL-formalizations according to the perspective and use: One for integration and alignment of patient records and observations; Another for visual presentation of individual or cohort trajectories.
Health researchers have successfully analyzed large cohorts (over 100,000 individuals) using the tool. We have also used the tool to produce interactive personal health time-lines (for more than 10,000 individuals) on the web. Utility, usability and effect have been tested extensively and the results so far are promising.
We envision that clinicians who want to learn more about
groups of patients and their treatment processes will find the tool valuable. In addition, we believe that the visualization can be useful to researchers looking at data to be statistically evaluated, in order to discover new hypotheses or get ideas for the best analysis strategies. Our main conclusion is that the tool is usable, but it can be challenging to use for large data sets.Postprint version. © 2016 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works
Utilization of automated location tracking for clinical workflow analytics and visualization
abstract: The analysis of clinical workflow offers many challenges to clinical stakeholders and researchers, especially in environments characterized by dynamic and concurrent processes. Workflow analysis in such environments is essential for monitoring performance and finding bottlenecks and sources of error. Clinical workflow analysis has been enhanced with the inclusion of modern technologies. One such intervention is automated location tracking which is a system that detects the movement of clinicians and equipment. Utilizing the data produced from automated location tracking technologies can lead to the development of novel workflow analytics that can be used to complement more traditional approaches such as ethnography and grounded-theory based qualitative methods. The goals of this research are to: (i) develop a series of analytic techniques to derive deeper workflow-related insight in an emergency department setting, (ii) overlay data from disparate sources (quantitative and qualitative) to develop strategies that facilitate workflow redesign, and (iii) incorporate visual analytics methods to improve the targeted visual feedback received by providers based on the findings. The overarching purpose is to create a framework to demonstrate the utility of automated location tracking data used in conjunction with clinical data like EHR logs and its vital role in the future of clinical workflow analysis/analytics. This document is categorized based on two primary aims of the research. The first aim deals with the use of automated location tracking data to develop a novel methodological/exploratory framework for clinical workflow. The second aim is to overlay the quantitative data generated from the previous aim on data from qualitative observation and shadowing studies (mixed methods) to develop a deeper view of clinical workflow that can be used to facilitate workflow redesign. The final sections of the document speculate on the direction of this work where the potential of this research in the creation of fully integrated clinical environments i.e. environments with state-of-the-art location tracking and other data collection mechanisms, is discussed. The main purpose of this research is to demonstrate ways by which clinical processes can be continuously monitored allowing for proactive adaptations in the face of technological and process changes to minimize any negative impact on the quality of patient care and provider satisfaction.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201
Portinari: A Data Exploration Tool to Personalize Cervical Cancer Screening
Socio-technical systems play an important role in public health screening
programs to prevent cancer. Cervical cancer incidence has significantly
decreased in countries that developed systems for organized screening engaging
medical practitioners, laboratories and patients. The system automatically
identifies individuals at risk of developing the disease and invites them for a
screening exam or a follow-up exam conducted by medical professionals. A triage
algorithm in the system aims to reduce unnecessary screening exams for
individuals at low-risk while detecting and treating individuals at high-risk.
Despite the general success of screening, the triage algorithm is a
one-size-fits all approach that is not personalized to a patient. This can
easily be observed in historical data from screening exams. Often patients rely
on personal factors to determine that they are either at high risk or not at
risk at all and take action at their own discretion. Can exploring patient
trajectories help hypothesize personal factors leading to their decisions? We
present Portinari, a data exploration tool to query and visualize future
trajectories of patients who have undergone a specific sequence of screening
exams. The web-based tool contains (a) a visual query interface (b) a backend
graph database of events in patients' lives (c) trajectory visualization using
sankey diagrams. We use Portinari to explore diverse trajectories of patients
following the Norwegian triage algorithm. The trajectories demonstrated
variable degrees of adherence to the triage algorithm and allowed
epidemiologists to hypothesize about the possible causes.Comment: Conference paper published at ICSE 2017 Buenos Aires, at the Software
Engineering in Society Track. 10 pages, 5 figure
Ambient-aware continuous care through semantic context dissemination
Background: The ultimate ambient-intelligent care room contains numerous sensors and devices to monitor the patient, sense and adjust the environment and support the staff. This sensor-based approach results in a large amount of data, which can be processed by current and future applications, e. g., task management and alerting systems. Today, nurses are responsible for coordinating all these applications and supplied information, which reduces the added value and slows down the adoption rate. The aim of the presented research is the design of a pervasive and scalable framework that is able to optimize continuous care processes by intelligently reasoning on the large amount of heterogeneous care data.
Methods: The developed Ontology-based Care Platform (OCarePlatform) consists of modular components that perform a specific reasoning task. Consequently, they can easily be replicated and distributed. Complex reasoning is achieved by combining the results of different components. To ensure that the components only receive information, which is of interest to them at that time, they are able to dynamically generate and register filter rules with a Semantic Communication Bus (SCB). This SCB semantically filters all the heterogeneous care data according to the registered rules by using a continuous care ontology. The SCB can be distributed and a cache can be employed to ensure scalability.
Results: A prototype implementation is presented consisting of a new-generation nurse call system supported by a localization and a home automation component. The amount of data that is filtered and the performance of the SCB are evaluated by testing the prototype in a living lab. The delay introduced by processing the filter rules is negligible when 10 or fewer rules are registered.
Conclusions: The OCarePlatform allows disseminating relevant care data for the different applications and additionally supports composing complex applications from a set of smaller independent components. This way, the platform significantly reduces the amount of information that needs to be processed by the nurses. The delay resulting from processing the filter rules is linear in the amount of rules. Distributed deployment of the SCB and using a cache allows further improvement of these performance results
Knowledge-based Biomedical Data Science 2019
Knowledge-based biomedical data science (KBDS) involves the design and
implementation of computer systems that act as if they knew about biomedicine.
Such systems depend on formally represented knowledge in computer systems,
often in the form of knowledge graphs. Here we survey the progress in the last
year in systems that use formally represented knowledge to address data science
problems in both clinical and biological domains, as well as on approaches for
creating knowledge graphs. Major themes include the relationships between
knowledge graphs and machine learning, the use of natural language processing,
and the expansion of knowledge-based approaches to novel domains, such as
Chinese Traditional Medicine and biodiversity.Comment: Manuscript 43 pages with 3 tables; Supplemental material 43 pages
with 3 table
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