Health Technology Assessment: An Essential Approach to Guide Clinical Governance Choices on Risk Management

A large part of academic literature, business literature as well as practices in real life are resting on the assumption that uncertainty and risk does not exist. We all know that this is not true, yet, a whole variety of methods, tools and practices are not attuned to the fact that the future is uncertain and that risks are all around us. However, despite risk management entering the agenda some decades ago, it has introduced risks on its own as illustrated by the financial crisis. Here is a book that goes beyond risk management as it is today and tries to discuss what needs to be improved further. The book also offers some cases

Process Mining Dashboard in Operating Rooms: Analysis of Staff Expectations with Analytic Hierarchy Process

[EN] The widespread adoption of real-time location systems is boosting the development of software applications to track persons and assets in hospitals. Among the vast amount of applications, real-time location systems in operating rooms have the advantage of grounding advanced data analysis techniques to improve surgical processes, such as process mining. However, such applications still find entrance barriers in the clinical context. In this paper, we aim to evaluate the preferred features of a process mining-based dashboard deployed in the operating rooms of a hospital equipped with a real-time location system. The dashboard allows to discover and enhance flows of patients based on the location data of patients undergoing an intervention. Analytic hierarchy process was applied to quantify the prioritization of the dashboard features (filtering data, enhancement, node selection, statistics, etc.), distinguishing the priorities that each of the different roles in the operating room service assigned to each feature. The staff in the operating rooms (n = 10) was classified into three groups: Technical, clinical, and managerial staff according to their responsibilities. Results showed different weights for the features in the process mining dashboard for each group, suggesting that a flexible process mining dashboard is needed to boost its potential in the management of clinical interventions in operating rooms. This paper is an extension of a communication presented in the Process-Oriented Data Science for Health Workshop in the Business Process Management Conference 2018.This project received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 812386.Martinez-Millana, A.; Lizondo, A.; Gatta, R.; Vera, S.; Traver Salcedo, V.; Fernández Llatas, C. (2019). Process Mining Dashboard in Operating Rooms: Analysis of Staff Expectations with Analytic Hierarchy Process. International Journal of Environmental research and Public Health. 16(2):1-14. https://doi.org/10.3390/ijerph16020199S114162Agnoletti, V., Buccioli, M., Padovani, E., Corso, R. M., Perger, P., Piraccini, E., … Gambale, G. (2013). Operating room data management: improving efficiency and safety in a surgical block. BMC Surgery, 13(1). doi:10.1186/1471-2482-13-7Marques, I., Captivo, M. E., & Vaz Pato, M. (2011). An integer programming approach to elective surgery scheduling. OR Spectrum, 34(2), 407-427. doi:10.1007/s00291-011-0279-7Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A.-H. S., Dellinger, E. P., … Gawande, A. A. (2009). A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine, 360(5), 491-499. doi:10.1056/nejmsa0810119Dexter, F., Epstein, R. H., Traub, R. D., Xiao, Y., & Warltier, D. C. (2004). Making Management Decisions on the Day of Surgery Based on Operating Room Efficiency and Patient Waiting Times. Anesthesiology, 101(6), 1444-1453. doi:10.1097/00000542-200412000-00027Fernández-Llatas, C., Meneu, T., Traver, V., & Benedi, J.-M. (2013). Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation. International Journal of Environmental Research and Public Health, 10(11), 5671-5682. doi:10.3390/ijerph10115671Westbrook, J. I., & Braithwaite, J. (2010). Will information and communication technology disrupt the health system and deliver on its promise? Medical Journal of Australia, 193(7), 399-400. doi:10.5694/j.1326-5377.2010.tb03968.xFisher, J. A., & Monahan, T. (2012). Evaluation of real-time location systems in their hospital contexts. International Journal of Medical Informatics, 81(10), 705-712. doi:10.1016/j.ijmedinf.2012.07.001Bath, P. A., Pendleton, N., Bracale, M., & Pecchia, L. (2011). Analytic Hierarchy Process (AHP) for Examining Healthcare Professionals’ Assessments of Risk Factors. Methods of Information in Medicine, 50(05), 435-444. doi:10.3414/me10-01-0028Lee, V. S., Kawamoto, K., Hess, R., Park, C., Young, J., Hunter, C., … Pendleton, R. C. (2016). Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality. JAMA, 316(10), 1061. doi:10.1001/jama.2016.12226Sloane, E. B., Liberatore, M. J., Nydick, R. L., Luo, W., & Chung, Q. B. (2003). Using the analytic hierarchy process as a clinical engineering tool to facilitate an iterative, multidisciplinary, microeconomic health technology assessment. Computers & Operations Research, 30(10), 1447-1465. doi:10.1016/s0305-0548(02)00187-9Saaty, T. L. (1977). A scaling method for priorities in hierarchical structures. Journal of Mathematical Psychology, 15(3), 234-281. doi:10.1016/0022-2496(77)90033-5Bridges, J. F. P., Hauber, A. B., Marshall, D., Lloyd, A., Prosser, L. A., Regier, D. A., … Mauskopf, J. (2011). Conjoint Analysis Applications in Health—a Checklist: A Report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. Value in Health, 14(4), 403-413. doi:10.1016/j.jval.2010.11.013Proceedings of the 2011 annual conference on Human factors in computing systems - CHI ’11. (2011). doi:10.1145/1978942Anual Report 2014http://chguv.san.gva.es/documents/10184/81032/Informe_anual2014.pdf/713c6559-0e29-4838-967c-93380c24eff9Ratwani, R. M., Fairbanks, R. J., Hettinger, A. Z., & Benda, N. C. (2015). Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors. Journal of the American Medical Informatics Association, 22(6), 1179-1182. doi:10.1093/jamia/ocv050Van der Aalst, W. M. P., Reijers, H. A., Weijters, A. J. M. M., van Dongen, B. F., Alves de Medeiros, A. K., Song, M., & Verbeek, H. M. W. (2007). Business process mining: An industrial application. Information Systems, 32(5), 713-732. doi:10.1016/j.is.2006.05.00

Automation Factors Influencing the Operation of IoT in Health Institutions: A Decision Support Methodology

Health institutions are adopting new technologies for their processes through automation by means of the concept of "Internet of Things" (IoT). Hence, offering innovative tools, applications and technology for the collection of key data and information, which is then integrated and consolidated, covering the different systems and their collaborators. The necessity of receiving quality medical services is essential in the public Policy of any country. The increasing demand for having an adequate number of medical specialists, pharmacies and medications stock, dental and mental health coverage and other, together with the minimization of the waiting list and patient care time have been a crucial concern. Under this context, it is valuable to redesign the processes planning and its coordination through the use of Information & Communications Technology (ICT) and IoT that unifies the systems. Based on previous research, the general purpose is to generate a system model to examine healthcare quality of service and corroborate its effectiveness in a real environment. The aim of this paper focus on the development of a decision support model to define key areas where the inclusion of IoT would sustain the efficiency in health care service. The research methodology is based on case study, integrating planning processes, data analysis, scoring method that interacts with multicriteria approach. A pilot case study is pursued in health institutions in Chile, determining critical factors and the current automation level system appraisal to generate actions of improvement in processes that show poor service quality. The results give rise to the development of an investment plan that can be converted into action plans for a health institution

Clinical Decision-Making: Developing a 4 C Model Using Graph Theoretic Approach

The purpose of this paper is to propose a graph-theoretic mathematical model to measure how conducive the environment of a hospital is for decision-making. We propose a 4-C model, developed from four interacting factors: confidence, complexity, capability, and customer. In this graph-theoretic model, abstract information regarding the system is represented by the directed edges of a graph (or digraph), which together depict how one factor affects another. The digraph yields a matrix model useful for computer processing. The net effect of different factors and their interdependencies on the hospital's decision-making environment is quantified and a single numerical index is generated. This paper categorizes all the major factors that influence clinical decision-making and attempts to provide a tool to study and measure their interactions with each other. Each factor and each interaction among factors are to be quantified by healthcare experts according to their best judgment of the magnitude of its effect in a local hospital environment.A hospital case study is used to demonstrate how the 4-C model works. The graph-theoretic approach allows for the inclusion of new factors and generation of alternative environments by a combination of both qualitative and quantitative modeling. The 4-C model can be used to create both a database and a simple numerical scale that help a hospital set customized guidelines, ranging from patient admittance procedures to diagnostic and treatment processes, according to its specific situation. Implementing this methodology systematically can allow a hospital to identify factors that will lead to improved decision-making as well as identifying operational factors that present roadblocks

Forecasting of emerging therapeutic monoclonal antibodies patents based on a decision model

Therapeutic monoclonal antibodies (mAbs) market is strongly contributing to the rising growth of the biotechnology industry. Despite the increasing number of inventions over time, a few therapeutic mAbs are currently marketed. This paper focuses on developing an emerging score to select/rank promising therapeutic mAbs patents, based on a hierarchical decision model using expert's opinion. Six attributes related to each factor concerning patent status, patent owner's profile and mAbs medical relevance were analyzed. The desirability levels of each attribute were also assessed. Our data shows the medical relevance factor as the most important, contributing 50% of the emerging score. Among the attributes, the most important under patent status was proper geographic coverage and wider patent scope; for organization's profile was the preexistence of approved drugs; and for medical relevance, the clinical phase performance. A group of 1053 patents related to therapeutic mAb were scored, and the most promising were concerning combination therapy using immune checkpoint inhibitors. The study has managerial implications related to patent portfolio management and patent valuation, and provides instructions to rank mAbs patents according to the emerging score defined by attribute's importance in order to improve the identification of future innovations pathways

Higher Sustainability and Lower Opportunistic Behaviour in Healthcare: A New Framework for Performing Hospital-Based Health Technology Assessment. Sustainability

Innovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing procedures increase the risk to adopt technologies that are not value for money. As a consequence, Health Technology Assessment (HTA) is a critical process at each level of the National Health System. Focusing on the organisational level, this paper explores the current practices of Hospital-Based HTA (HB-HTA) in terms of management, control and behaviours of various actors involved. Among several tasks, decision-makers are appointed at managing the conflict of interest around health technology development, that could pave the way for corruption or other misleading behaviours. Accordingly, the purpose of the study is proposing a new strategic framework, named Health Technology Balanced Assessment (HTBA), to foster hospital-based health technology management aimed to align strategy and actions. The conceptual model is developed on three perspectives (clinical, economic and organisational) to make the actors involved in the assessment (clinicians, health professionals, hospital managers and patients) aware of the impact of new technology on the value chain. Besides supporting the decision-making process, such a tool represents support for the internal control system as a whole. By promoting structured evaluation, it increases transparency and accountability of public health organisations. Moreover, in the long run, the framework proposed will be useful to reach selected United Nations Sustainable Development Goals (UN SDGs) to enhance the quality of healthcare in the future

Exploring new factors and the question of 'which' in user acceptance studies of healthcare software

The importance of user acceptance of technology is critical for the success of technology implementation in the health-care sector. Spending on the procurement of new technology is growing in the hope of improving patient care as well as providing better services to the public, thus it is important that the technology is used to achieve its intended purpose. Success or failure of technology implementation depends upon the acceptance of the user and this is evident through the growing number of studies on evaluation particularly on user acceptance of the technology. While various models and frameworks have been developed to address factors associated with technology acceptance, they provide little understanding on the reasons for discrepancies in acceptance of the same system among different users. In response to this issue, this thesis proposes a theoretical model which suggests the role of ‘fit’ between user, technology and organization as an antecedent of user acceptance factors. This model was suggested based on a review of the literature and was empirically investigated on medical students’ intention to use medically related software. The proposed model in this thesis integrates three very well known existing models namely the Unified Theory of Acceptance and Use of Technology (UTAUT), the DeLone McLean IS Success Model and the Task-Technology Fit Model. The model is examined as a single model, which investigates (1) the effect of perceived fit between user, technology and organization on factors defined by UTAUT and the IS Success Model; (2) the effect of perceived fit between user, technology and organization on management support and information security expectancy construct; and (3) the effect of management support and information security expectancy on intention to use. In particular, this thesis seeks to investigate the role of ‘fit’ between user, technology and organization variable as an antecedent of performance expectancy, effort expectancy, social influence, facilitating conditions, software quality, service quality, information quality, management support and information security expectancy. This thesis also investigates the role of management support and information security expectancy constructs on intention to use which, to the best of researcher’s knowledge, have not been investigated together with an integrated model, as proposed in this thesis. Further, it presents and discusses empirical findings from the Internet survey and Drop-off approaches of 113 respondents which examined students’ intention to use medically related software using the Partial Least Square (PLS) approach to Structural Equation Modeling (SEM). WarpPLS version 3.0 software was used to analyze the empirical data in this thesis. The findings of this thesis support the hypothesized relationship proposed in the theoretical model. Specifically, the results revealed that perceived user-technology-organization fit has a significant effect on all the factors defined in the model except for social influence. The results also provide strong evidence of the relationships between the management support and information security expectancy constructs with the intention to use construct. This thesis contributes to theoretical and practical knowledge by providing, for the first time, evidence about the relationship between perceived user-technology-organization fit with constructs defined by both UTAUT and the IS Success Model. Further, the relationships between perceived user-technology-organization fit with management support and information security constructs are shown. Additionally this thesis provides empirical support on the relationship between the management support and information security expectancy constructs with the intention to use construct. The introduction and inclusion of organization fit with user and technology fit contributes to the body of knowledge in evaluation studies and provides a more complete model within user acceptance studies to help to understand the reasons for different acceptance among users of the same system or technology. Further, this thesis investigates the applicability of the multi-criteria decision analysis (MCDA) techniques to answer the question of ‘which’ in evaluation studies particularly within user acceptance studies. Existing evaluation studies provide the means to answer the question of what, why, who, when and how, but not explicitly the question of ‘which’. The question of ‘which’ needs to be explicitly addressed and specifically recognized in user acceptance studies. Although various studies implicitly provide the answer to the question of ‘which’, the importance of ‘which’ as the most critical factor or the most influential factor should be addressed explicitly in user acceptance studies. This thesis examined three well used methods which are classical AHP, Fuzzy AHP Changs’ method and Fuzzy AHP a and l method, to assign weights between various factors and subfactors of user acceptance. Acceptance factors of two different types of software were computed using each of these methods. The empirical data were collected from medical students for medically-related software and from research students for research-related software. The approaches examined, in this second part of thesis, are not intended to show which is the best method or techniques to evaluate user acceptance, but rather to illustrate the various options which are available within MCDA approaches to derive weights among evaluation items and subsequently provide an answer to address the question of ‘which’ explicitly within user acceptance studies. The results of assigning weights to factors and sub-factors using three different methods provide strong justification on the applicability of the MCDA methods as a decision support tool. The results show that these methods produced the same ranking of the factors which influence user acceptance (with slight variation using Fuzzy Chang’s method on medical software acceptance). The inclusion of the ‘which’ question can enhance evaluation studies in the health informatics research and findings related to user acceptance of health-care technology

Exploring new factors and the question of 'which' in user acceptance studies of healthcare software

The importance of user acceptance of technology is critical for the success of technology implementation in the health-care sector. Spending on the procurement of new technology is growing in the hope of improving patient care as well as providing better services to the public, thus it is important that the technology is used to achieve its intended purpose. Success or failure of technology implementation depends upon the acceptance of the user and this is evident through the growing number of studies on evaluation particularly on user acceptance of the technology. While various models and frameworks have been developed to address factors associated with technology acceptance, they provide little understanding on the reasons for discrepancies in acceptance of the same system among different users. In response to this issue, this thesis proposes a theoretical model which suggests the role of ‘fit’ between user, technology and organization as an antecedent of user acceptance factors. This model was suggested based on a review of the literature and was empirically investigated on medical students’ intention to use medically related software. The proposed model in this thesis integrates three very well known existing models namely the Unified Theory of Acceptance and Use of Technology (UTAUT), the DeLone McLean IS Success Model and the Task-Technology Fit Model. The model is examined as a single model, which investigates (1) the effect of perceived fit between user, technology and organization on factors defined by UTAUT and the IS Success Model; (2) the effect of perceived fit between user, technology and organization on management support and information security expectancy construct; and (3) the effect of management support and information security expectancy on intention to use. In particular, this thesis seeks to investigate the role of ‘fit’ between user, technology and organization variable as an antecedent of performance expectancy, effort expectancy, social influence, facilitating conditions, software quality, service quality, information quality, management support and information security expectancy. This thesis also investigates the role of management support and information security expectancy constructs on intention to use which, to the best of researcher’s knowledge, have not been investigated together with an integrated model, as proposed in this thesis. Further, it presents and discusses empirical findings from the Internet survey and Drop-off approaches of 113 respondents which examined students’ intention to use medically related software using the Partial Least Square (PLS) approach to Structural Equation Modeling (SEM). WarpPLS version 3.0 software was used to analyze the empirical data in this thesis. The findings of this thesis support the hypothesized relationship proposed in the theoretical model. Specifically, the results revealed that perceived user-technology-organization fit has a significant effect on all the factors defined in the model except for social influence. The results also provide strong evidence of the relationships between the management support and information security expectancy constructs with the intention to use construct. This thesis contributes to theoretical and practical knowledge by providing, for the first time, evidence about the relationship between perceived user-technology-organization fit with constructs defined by both UTAUT and the IS Success Model. Further, the relationships between perceived user-technology-organization fit with management support and information security constructs are shown. Additionally this thesis provides empirical support on the relationship between the management support and information security expectancy constructs with the intention to use construct. The introduction and inclusion of organization fit with user and technology fit contributes to the body of knowledge in evaluation studies and provides a more complete model within user acceptance studies to help to understand the reasons for different acceptance among users of the same system or technology. Further, this thesis investigates the applicability of the multi-criteria decision analysis (MCDA) techniques to answer the question of ‘which’ in evaluation studies particularly within user acceptance studies. Existing evaluation studies provide the means to answer the question of what, why, who, when and how, but not explicitly the question of ‘which’. The question of ‘which’ needs to be explicitly addressed and specifically recognized in user acceptance studies. Although various studies implicitly provide the answer to the question of ‘which’, the importance of ‘which’ as the most critical factor or the most influential factor should be addressed explicitly in user acceptance studies. This thesis examined three well used methods which are classical AHP, Fuzzy AHP Changs’ method and Fuzzy AHP a and l method, to assign weights between various factors and subfactors of user acceptance. Acceptance factors of two different types of software were computed using each of these methods. The empirical data were collected from medical students for medically-related software and from research students for research-related software. The approaches examined, in this second part of thesis, are not intended to show which is the best method or techniques to evaluate user acceptance, but rather to illustrate the various options which are available within MCDA approaches to derive weights among evaluation items and subsequently provide an answer to address the question of ‘which’ explicitly within user acceptance studies. The results of assigning weights to factors and sub-factors using three different methods provide strong justification on the applicability of the MCDA methods as a decision support tool. The results show that these methods produced the same ranking of the factors which influence user acceptance (with slight variation using Fuzzy Chang’s method on medical software acceptance). The inclusion of the ‘which’ question can enhance evaluation studies in the health informatics research and findings related to user acceptance of health-care technology

An integrated framework for multi-project planning and control.

The area of project management has been the focus of intensive research for the last three decades. There are a number of studies which have focused on multi-project management, but very few have tackled the need for a tracking system to control and monitor the project in an integrated environment. Some of these studies have covered the multi-project management from the contractor's perspective; or they have tackled one or two of its aspects, such as priority selection, resource allocation, or risk management. The researcher has attempted to show the need for multi-project management systems in which an integrated framework for multi-project planning and control tracking systems (from the owner's perspective rather than the contractors' perspective) is developed; to planning and control under conditions of uncertainty and change. Analytical hierarchy process, mathematical modelling and computer simulation techniques are applied to develop the proposed framework. In multi-project management, each project has its own objective(s) that should be optimised. The analytical hierarchy process is applied to prioritise projects that are received from the applicant accordingly; so that decisions can be made on which project(s) should be launched first. The Mathematical modelling is another method used to solve complex problems, when many projects are running simultaneously. Goal programming is used to minimise the cost and manpower required in a multi-project environment which is usually subject to different constraints. Then simulation is used to manage and control the risk expected in running these projects. In addition, simulation allows project managers to obtain a wide spectrum system on the effects of local changes on the project