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

Designing Traceability into Big Data Systems

Providing an appropriate level of accessibility and traceability to data or process elements (so-called Items) in large volumes of data, often Cloud-resident, is an essential requirement in the Big Data era. Enterprise-wide data systems need to be designed from the outset to support usage of such Items across the spectrum of business use rather than from any specific application view. The design philosophy advocated in this paper is to drive the design process using a so-called description-driven approach which enriches models with meta-data and description and focuses the design process on Item re-use, thereby promoting traceability. Details are given of the description-driven design of big data systems at CERN, in health informatics and in business process management. Evidence is presented that the approach leads to design simplicity and consequent ease of management thanks to loose typing and the adoption of a unified approach to Item management and usage.Comment: 10 pages; 6 figures in Proceedings of the 5th Annual International Conference on ICT: Big Data, Cloud and Security (ICT-BDCS 2015), Singapore July 2015. arXiv admin note: text overlap with arXiv:1402.5764, arXiv:1402.575

Information Accountability Framework for a Trusted Health Care System

Trusted health care outcomes are patient centric. Requirements to ensure both the quality and sharing of patients’ health records are a key for better clinical decision making. In the context of maintaining quality health, the sharing of data and information between professionals and patients is paramount. This information sharing is a challenge and costly if patients’ trust and institutional accountability are not established. Establishment of an Information Accountability Framework (IAF) is one of the approaches in this paper. The concept behind the IAF requirements are: transparent responsibilities, relevance of the information being used, and the establishment and evidence of accountability that all lead to the desired outcome of a Trusted Health Care System. Upon completion of this IAF framework the trust component between the public and professionals will be constructed. Preservation of the confidentiality and integrity of patients’ information will lead to trusted health care outcomes

Neuroimaging study designs, computational analyses and data provenance using the LONI pipeline.

Modern computational neuroscience employs diverse software tools and multidisciplinary expertise to analyze heterogeneous brain data. The classical problems of gathering meaningful data, fitting specific models, and discovering appropriate analysis and visualization tools give way to a new class of computational challenges--management of large and incongruous data, integration and interoperability of computational resources, and data provenance. We designed, implemented and validated a new paradigm for addressing these challenges in the neuroimaging field. Our solution is based on the LONI Pipeline environment [3], [4], a graphical workflow environment for constructing and executing complex data processing protocols. We developed study-design, database and visual language programming functionalities within the LONI Pipeline that enable the construction of complete, elaborate and robust graphical workflows for analyzing neuroimaging and other data. These workflows facilitate open sharing and communication of data and metadata, concrete processing protocols, result validation, and study replication among different investigators and research groups. The LONI Pipeline features include distributed grid-enabled infrastructure, virtualized execution environment, efficient integration, data provenance, validation and distribution of new computational tools, automated data format conversion, and an intuitive graphical user interface. We demonstrate the new LONI Pipeline features using large scale neuroimaging studies based on data from the International Consortium for Brain Mapping [5] and the Alzheimer's Disease Neuroimaging Initiative [6]. User guides, forums, instructions and downloads of the LONI Pipeline environment are available at http://pipeline.loni.ucla.edu

How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study

ObjectiveThe United States faces an opioid crisis. Integrating prescription drug monitoring programs into electronic health records offers promise to improve opioid prescribing practices. This study aimed to evaluate 2 different user interface designs for prescription drug monitoring program and electronic health record integration.Materials and MethodsTwenty-four resident physicians participated in a randomized controlled experiment using 4 simulated patient cases. In the conventional condition, prescription opioid histories were presented in tabular format, and computerized clinical decision support (CDS) was provided via interruptive modal dialogs (ie, pop-ups). The alternative condition featured a graphical opioid history, a cue to visit that history, and noninterruptive CDS. Two attending pain specialists judged prescription appropriateness.ResultsParticipants in the alternative condition wrote more appropriate prescriptions. When asked after the experiment, most participants stated that they preferred the alternative design to the conventional design.ConclusionsHow patient information and CDS are presented appears to have a significant influence on opioid prescribing behavior

Notebook-as-a-VRE (NaaVRE): From private notebooks to a collaborative cloud virtual research environment

Virtual Research Environments (VREs) provide user-centric support in the lifecycle of research activities, e.g., discovering and accessing research assets, or composing and executing application workflows. A typical VRE is often implemented as an integrated environment, which includes a catalog of research assets, a workflow management system, a data management framework, and tools for enabling collaboration among users. Notebook environments, such as Jupyter, allow researchers to rapidly prototype scientific code and share their experiments as online accessible notebooks. Jupyter can support several popular languages that are used by data scientists, such as Python, R, and Julia. However, such notebook environments do not have seamless support for running heavy computations on remote infrastructure or finding and accessing software code inside notebooks. This paper investigates the gap between a notebook environment and a VRE and proposes an embedded VRE solution for the Jupyter environment called Notebook-as-a-VRE (NaaVRE). The NaaVRE solution provides functional components via a component marketplace and allows users to create a customized VRE on top of the Jupyter environment. From the VRE, a user can search research assets (data, software, and algorithms), compose workflows, manage the lifecycle of an experiment, and share the results among users in the community. We demonstrate how such a solution can enhance a legacy workflow that uses Light Detection and Ranging (LiDAR) data from country-wide airborne laser scanning surveys for deriving geospatial data products of ecosystem structure at high resolution over broad spatial extents. This enables users to scale out the processing of multi-terabyte LiDAR point clouds for ecological applications to more data sources in a distributed cloud environment.Comment: A revised version has been published in the journal software practice and experienc

Underestimated effect of intragenic HIV-1 DNA methylation on viral transcription in infected individuals

Background: The HIV-1 proviral genome harbors multiple CpG islands (CpGIs), both in the promoter and intragenic regions. DNA methylation in the promoter region has been shown to be heavily involved in HIV-1 latency regulation in cultured cells. However, its exact role in proviral transcriptional regulation in infected individuals is poorly understood or characterized. Moreover, methylation at intragenic CpGIs has never been studied in depth. Results: A large, well-characterized HIV-1 patient cohort (n = 72), consisting of 17 long-term non-progressors and 8 recent seroconverters (SRCV) without combination antiretroviral therapy (cART), 15 early cART-treated, and 32 late cART-treated patients, was analyzed using a next-generation bisulfite sequencing DNA methylation method. In general, we observed low level of promoter methylation and higher levels of intragenic methylation. Additionally, SRCV showed increased promoter methylation and decreased intragenic methylation compared with the other patient groups. This data indicates that increased intragenic methylation could be involved in proviral transcriptional regulation. Conclusions: Contrasting in vitro studies, our results indicate that intragenic hypermethylation of HIV-1 proviral DNA is an underestimated factor in viral control in HIV-1-infected individuals, showing the importance of analyzing the complete proviral genome in future DNA methylation studies