A standards-based ICT framework to enable a service-oriented approach to clinical decision support

This research provides evidence that standards based Clinical Decision Support (CDS) at the point of care is an essential ingredient of electronic healthcare service delivery. A Service Oriented Architecture (SOA) based solution is explored, that serves as a task management system to coordinate complex distributed and disparate IT systems, processes and resources (human and computer) to provide standards based CDS. This research offers a solution to the challenges in implementing computerised CDS such as integration with heterogeneous legacy systems. Reuse of components and services to reduce costs and save time. The benefits of a sharable CDS service that can be reused by different healthcare practitioners to provide collaborative patient care is demonstrated. This solution provides orchestration among different services by extracting data from sources like patient databases, clinical knowledge bases and evidence-based clinical guidelines (CGs) in order to facilitate multiple CDS requests coming from different healthcare settings. This architecture aims to aid users at different levels of Healthcare Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and managing services, thus enabling transparency. The research employs the Design Science research methodology (DSRM) combined with The Open Group Architecture Framework (TOGAF), an open source group initiative for Enterprise Architecture Framework (EAF). DSRM’s iterative capability addresses the rapidly evolving nature of workflows in healthcare. This SOA based solution uses standards-based open source technologies and platforms, the latest healthcare standards by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service (RLUS) standard. Combining business process management (BPM) technologies, business rules with SOA ensures the HCO’s capability to manage its processes. This architectural solution is evaluated by successfully implementing evidence based CGs at the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent Referral (Lung Cancer), c) Genome testing and integration with CDS in screening (Lynch’s syndrome). In addition to medical care, the CDS solution can benefit organizational processes for collaborative care delivery by connecting patients, physicians and other associated members. This framework facilitates integration of different types of CDS ideal for the different healthcare processes, enabling sharable CDS capabilities within and across organizations

Implementation of workflow engine technology to deliver basic clinical decision support functionality

BACKGROUND: Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. RESULTS: We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. CONCLUSIONS: We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform

Investigations into the model driven design of distribution patterns for web service compositions

Increasingly, distributed systems are being used to provide enterprise level solutions with high scalability and fault tolerance These solutins are often built using Web servces that are composed to perform useful business functions Acceptance of these composed systems is often constrained by a number of non-functional properties of the system such as availability, scalability and performance There are a number of drstribution patterns that each exhibit different non-functional charactmstics These patterns are re-occuring distribution schemes that express how a system is to be assembled and subsequently deployed. Traditional approaches to development of Web service compositions exhibit a number of Issues Firstly, Web service composition development is often ad-hoc and requires considerable low level coding effort for realisatlon Such systems often exhibit fixed architectures, making maintenance difficult and error prone Additionally, a number of the non-funchonal reqwements cannot be easily assessed by exammng low level code. In this thesis we explicitly model the compositional aspects of Web service compositions usmg UML Activity diagrams Ths approach uses a modehng and transformation framework, based on Model Dnven Software Development (MDSD), going from high level models to an executable system The framework is guided by a methodological framework whose primary artifact is a distribution pattern model, chosen from the supplied catalog. Our modelling and transfomation framework improves the development process of Web service compositions, with respect to a number of criteria, when compared to the traditional handcrafted approach Specifically, we negate the coding effort traditionally associated with Web service composition development Maintenance overheads of the solution are also slgnificantly reduced, while improved mutability 1s achieved through a flexible architecture when compared with existing tools We also improve the product output from the development process by exposing the non-functional runtime properties of Web service compositlons using distribution patterns

Internet collaboration and service composition as a loose form of teamwork

This paper describes Web service composition as a form of teamwork, where the Web services are team members in a loose collaboration. We argue that newer hierarchical teamwork models are more appropriate for Web service composition than the traditional models involving joint beliefs and joint intentions. We describe our system for developing and executing Web service compositions as team plans in JACK Teams,((TM) 1) and discuss the relationships between this approach and service orchestration languages such as Business Process Execution Language for Web Services (BPEL4WS). We discuss briefly how the use of Al planning can also be incorporated into this model, and identify some of the research issues involved. Incorporating Web service compositions into a mature Belief Desire Intention (BDI) agent team framework allows for integration of Web services seamlessly into a powerful application execution paradigm that supports sophisticated reasoning

Engineering framework for service-oriented automation systems

Tese de doutoramento. Engenharia Informática. Universidade do Porto. Faculdade de Engenharia. 201

A service oriented architecture to implement clinical guidelines for evidence-based medical practice

Health information technology (HIT) has been identified as the fundamental driver to streamline the healthcare delivery processes to improve care quality and reduce operational costs. Of the many facets of HIT is Clinical Decision Support (CDS) which provides the physician with patient-specific inferences, intelligently filtered and organized, at appropriate times. This research has been conducted to develop an agile solution to Clinical Decision Support at the point of care in a healthcare setting as a potential solution to the challenges of interoperability and the complexity of possible solutions. The capabilities of Business Process Management (BPM) and Workflow Management systems are leveraged to support a Service Oriented Architecture development approach for ensuring evidence based medical practice. The aim of this study is to present an architecture solution that is based on SOA principles and embeds clinical guidelines within a healthcare setting. Since the solution is designed to implement real life healthcare scenarios, it essentially supports evidence-based clinical guidelines that are liable to change over a period of time. The thesis is divided into four parts. The first part consists of an Introduction to the study and a background to existing approaches for development and integration of Clinical Decision Support Systems. The second part focuses on the development of a Clinical Decision Support Framework based on Service Oriented Architecture. The CDS Framework is composed of standards based open source technologies including JBoss SwitchYard (enterprise service bus), rule-based CDS enabled by JBoss Drools, process modelling using Business Process Modelling and Notation. To ensure interoperability among various components, healthcare standards by HL7 and OMG are implemented. The third part provides implementation of this CDS Framework in healthcare scenarios. Two scenarios are concerned with the medical practice for diagnosis and early intervention (Chronic Obstructive Pulmonary Disease and Lung Cancer), one case study for Genetic data enablement of CDS systems (New born screening for Cystic Fibrosis) and the last case study is about using BPM techniques for managing healthcare organizational perspectives including human interaction with automated clinical workflows. The last part concludes the research with contributions in design and architecture of CDS systems. This thesis has primarily adopted the Design Science Research Methodology for Information Systems. Additionally, Business Process Management Life Cycle, Agile Business Rules Development methodology and Pattern-Based Cycle for E-Workflow Design for individual case studies are used. Using evidence-based clinical guidelines published by UK’s National Institute of Health and Care Excellence, the integration of latest research in clinical practice has been employed in the automated workflows. The case studies implemented using the CDS Framework are evaluated against implementation requirements, conformance to SOA principles and response time using load testing strategy. For a healthcare organization to achieve its strategic goals in administrative and clinical practice, this research has provided a standards based integration solution in the field of clinical decision support. A SOA based CDS can serve as a potential solution to complexities in IT interventions as the core data and business logic functions are loosely coupled from the presentation. Additionally, the results of this this research can serve as an exemplar for other industrial domains requiring rapid response to evolving business processes

Verification and Analysis of Web Service Composition

Ph.DDOCTOR OF PHILOSOPH

A programming system for process coordination in virtual organisations

PhD thesisDistributed business applications are increasingly being constructed by composing them from services provided by various online businesses. Typically, this leads to trading partners coming together to form virtual organizations (VOs). Each member of a VO maintains their autonomy, except with respect to their agreed goals. The structure of the Virtual Organisation may contain one dominant organisation who dictates the method of achieving the goals or the members may be considered peers of equal importance. The goals of VOs can be defined by the shared global business processes they contain. To be able to execute these business processes, VOs require a flexible enactment model as there may be no single ‘owner’ of the business process and therefore no natural place to enact the business processes. One solution is centralised enactment using a trusted third party, but in some cases this may not be acceptable (for instance because of security reasons). This thesis will present a programming system that allows centralised as well as distributed enactment where each organisation enacts part of the business process. To achieve distributed enactment we must address the problem of specifying the business process in a manner that is amenable to distribution. The first contribution of this thesis is the presentation of the Task Model, a set of languages and notations for describing workflows that can be enacted in a centralised or decentralised manner. The business processes that we specify will coordinate the services that each organisation owns. The second contribution of this thesis is the presentation of a method of describing the observable behaviour of these services. The language we present, SSDL, provides a flexible and extensible way of describing the messaging behaviour of Web Services. We present a method for checking that a set of services described in SSDL are compatible with each other and also that a workflow interacts with a service in the desired manner. The final contribution of this thesis is the presentation of an abstract architecture and prototype implementation of a decentralised workflow engine. The prototype is able to enact workflows described in the Task Model notation in either a centralised or decentralised scenario

Generic access to symbolic computing services

Symbolic computation is one of the computational domains that requires large computational resources. Computer Algebra Systems (CAS), the main tools used for symbolic computations, are mainly designed to be used as software tools installed on standalone machines that do not provide the required resources for solving large symbolic computation problems. In order to support symbolic computations an infrastructure built upon massively distributed computational environments must be developed. Building an infrastructure for symbolic computations requires a thorough analysis of the most important requirements raised by the symbolic computation world and must be built based on the most suitable architectural styles and technologies. The architecture that we propose is composed of several main components: the Computer Algebra System (CAS) Server that exposes the functionality implemented by one or more supporting CASs through generic interfaces of Grid Services; the Architecture for Grid Symbolic Services Orchestration (AGSSO) Server that allows seamless composition of CAS Server capabilities; and client side libraries to assist the users in describing workflows for symbolic computations directly within the CAS environment. We have also designed and developed a framework for automatic data management of mathematical content that relies on OpenMath encoding. To support the validation and fine tuning of the system we have developed a simulation platform that mimics the environment on which the architecture is deployed

FORMAL ANALYSIS OF WEB SERVICE COMPOSITION

Ph.DDOCTOR OF PHILOSOPH