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

Team Learning, Development, and Adaptation

[Excerpt] Our purpose is to explore conceptually these themes centered on team learning, development, and adaptation. We note at the onset that this chapter is not a comprehensive review of the literature. Indeed, solid conceptual and empirical work on these themes are sparse relative to the vast amount of work on team effectiveness more generally, and therefore a thematic set of topics that are ripe for conceptual development and integration. We draw on an ongoing stream of theory development and research in these areas to integrate and sculpt a distinct perspective on team learning, development, and adaptation

Healthcare Process Support: Achievements, Challenges, Current Research

Healthcare organizations are facing the challenge of delivering high-quality services to their patients at affordable costs. To tackle this challenge, the Medical Informatics community targets at formalisms for developing decision-support systems (DSSs) based on clinical guidelines. At the same time, business process management (BPM) enables IT support for healthcare processes, e.g., based on workflow technology. By integrating aspects from these two fields, promising perspectives for achieving better healthcare process support arise. The perspectives and limitations of IT support for healthcare processes provided the focus of three Workshops on Process-oriented Information Systems (ProHealth). These were held in conjunction with the International Conference on Business Process Management in 2007-2009. The ProHealth workshops provided a forum wherein challenges, paradigms, and tools for optimized process support in healthcare were debated. Following the success of these workshops, this special issue on process support in healthcare provides extended papers by research groups who contributed multiple times to the ProHealth workshop series. These works address issues pertaining to healthcare process modeling, process-aware healthcare information system, workflow management in healthcare, IT support for guideline implementation and medical decision support, flexibility in healthcare processes, process interoperability in healthcare and healthcare standards, clinical semantics of healthcare processes, healthcare process patterns, best practices for designing healthcare processes, and healthcare process validation, verification, and evaluation

Adaptive Workflow Design Based on Blockchain

Increasingly, organizational processes have become more complex. There is a need for the design of workflows to focus on how organizations adapt to emergent processes while balancing the need for decentralization and centralization goal. The advancement in new technologies especially blockchain provides organizations with the opportunity to achieve the goal. Using blockchain technology (i.e. smart contract and blocks of specified consensus for deferred action), we leverage the theory of deferred action and a coordination framework to conceptually design a workflow management system that addresses organizational emergence (e-WfMS). Our artifact helps managers to predict and store the impact of deferred actions. We evaluated the effectiveness of our system against a complex adaptive system for utility assessment

What's next? : operational support for business process execution

In the last decade flexibility has become an increasingly important in the area of business process management. Information systems that support the execution of the process are required to work in a dynamic environment that imposes changing demands on the execution of the process. In academia and industry a variety of paradigms and implementations has been developed to support flexibility. While on the one hand these approaches address the industry demands in flexibility, on the other hand, they result in confronting the user with many choices between different alternatives. As a consequence, methods to support users in selecting the best alternative during execution have become essential. In this thesis we introduce a formal framework for providing support to users based on historical evidence available in the execution log of the process. This thesis focuses on support by means of (1) recommendations that provide the user an ordered list of execution alternatives based on estimated utilities and (2) predictions that provide the user general statistics for each execution alternative. Typically, estimations are not an average over all observations, but they are based on observations for "similar" situations. The main question is what similarity means in the context of business process execution. We introduce abstractions on execution traces to capture similarity between execution traces in the log. A trace abstraction considers some trace characteristics rather than the exact trace. Traces that have identical abstraction values are said to be similar. The challenge is to determine those abstractions (characteristics) that are good predictors for the parameter to be estimated in the recommendation or prediction. We analyse the dependency between values of an abstraction and the mean of the parameter to be estimated by means of regression analysis. With regression we obtain a set of abstractions that explain the parameter to be estimated. Dependencies do not only play a role in providing predictions and recommendations to instances at run-time, but they are also essential for simulating the effect of changes in the environment on the processes, both locally and globally. We use stochastic simulation models to simulate the effect of changes in the environment, in particular changed probability distribution caused by recommendations. The novelty of these models is that they include dependencies between abstraction values and simulation parameters, which are estimated from log data. We demonstrate that these models give better approximations of reality than traditional models. A framework for offering operational support has been implemented in the context of the process mining framework ProM

A Comprehensive Workflow for General-Purpose Neural Modeling with Highly Configurable Neuromorphic Hardware Systems

In this paper we present a methodological framework that meets novel requirements emerging from upcoming types of accelerated and highly configurable neuromorphic hardware systems. We describe in detail a device with 45 million programmable and dynamic synapses that is currently under development, and we sketch the conceptual challenges that arise from taking this platform into operation. More specifically, we aim at the establishment of this neuromorphic system as a flexible and neuroscientifically valuable modeling tool that can be used by non-hardware-experts. We consider various functional aspects to be crucial for this purpose, and we introduce a consistent workflow with detailed descriptions of all involved modules that implement the suggested steps: The integration of the hardware interface into the simulator-independent model description language PyNN; a fully automated translation between the PyNN domain and appropriate hardware configurations; an executable specification of the future neuromorphic system that can be seamlessly integrated into this biology-to-hardware mapping process as a test bench for all software layers and possible hardware design modifications; an evaluation scheme that deploys models from a dedicated benchmark library, compares the results generated by virtual or prototype hardware devices with reference software simulations and analyzes the differences. The integration of these components into one hardware-software workflow provides an ecosystem for ongoing preparative studies that support the hardware design process and represents the basis for the maturity of the model-to-hardware mapping software. The functionality and flexibility of the latter is proven with a variety of experimental results