Integrated Clinical Pathways: A Model-based Holistic Method

Against the background of increasing multidisciplinarity as well as the focus on quality, transparency and economic efficiency of medical services, clinical pathways (CPs) have been established as a promising tool at the organizational level in recent years. They are primarily intended to ensure an adequate description of the care processes and to manage the balance between best treatment practice and economic viability. CPs standardize the internal care services by explicating the institution-specific knowledge with regard to recommendations for action, service portfolio, organizational structures, infrastructure, etc. of a specific service provider. The development of hospital information systems (HIS) has so far been characterized by an evolutionary development of modules in the field of laboratory, radiology, nursing and picture archiving systems as well as in the area of administrative systems. As one result of this development, the HIS usually comprises a heterogeneous network of software systems of different types and manufacturers. However, the actual control of patients by means of evidence-based processes and integration of CPs into HIS was not addressed until the recent years, when HIS manufacturers started developing modules for CP modeling and workflow support. The objective of this thesis is to provide a holistic methodical support for the description of clinical pathways and their integration into a hospital information system to finally improve the compliance of daily care to standard process definitions. Therefore, conceptual models provide an adequate mean to describe and communicate complex matters in a comprehensible form as well as to configure IT systems due to their semi-formal nature. Hence, a first research thread investigates the question, how clinical pathways can be described adequately using conceptual models. This results in an iterative design of adequate modeling languages for clinical pathways. A second research thread further investigates the question, how conceptual models of clinical pathways can be used to configure process-oriented application systems in health care. This thread therefore describes the design of a model-based method, that enables a consecutive transformation of CPs into technical (workflow) specifications, based on the principles of the Model-Driven Architecture.:A. Synopsis of the Doctoral Dissertation B. Agility in Medical Treatment Processes C. Domain Specific Modeling Language - CPmod D. BPMN4CP - Version 1.0 E. BPMN4CP - Version 2.0 F. BPMN4CP - Version 2.1 G. MDA in Health Care IS Development H. Transforming Clinical Pathways into Care Workflows I. CDA Templates - Utilizing the MediCUB

ISO 11354-2 FOR THE EVALUATION OF EHEALTH PLATFORMS

Open software platforms are a recent innovation in the healthcare sector to foster integrated care scenarios. An important quality feature to facilitate innovation and to create an active platform ecosystem is openness. The openness is strongly influenced by the interoperability potential of the platforms. Hence, the assessment of the interoperability potential is a crucial task for evaluating the quality of platforms. However, there is a need for methodological support fostering the evaluation of eHealth platforms. Based on a design science research approach, the article shows, how the Maturity Model for Enterprise Interoperability (ISO 11353-2) can be instantiated in the healthcare domain. We describe a quantitative evaluation model which operationalizes the evaluation process of eHealth platforms. The contribution purposes to improve the transparency and reliability of the evaluation process. Furthermore, the introduced approach reduces the dependence on an evaluation team and facilitates the implementation of assessments

PathwAI Systems in Healthcare – a Framework for Coupling AI and Pathway-based Health Information Systems

Pathway-based Health Information Systems (HIS) enable planning, execution and improvement of standardized care processes. Adaptive behavior and learning effects are taken to a new level by advances in Artificial Intelligence (AI). Yet, design support to unlock synergies from coupling pathway-based HIS with AI is lacking. This Umbrella Review identifies applied purposes of AI in healthcare, describes the relation to pathway-based HIS, and derives a PathwAI Framework as design support for future research and development activities. Previous findings already provide a large base of approaches to realize personalized care pathways and improve coordination and business operations. Furthermore, potentials for designing learning health systems at micro, meso, and macro levels are formulated, but there is still greater opportunity for future research and design. Pathway-based HIS in this context can not only provide interpretable and interoperable data input, but can be conceptual as well as operational receivers of artificially generated knowledge

Towards Model Driven Architecture in Health Care Information System Development

Failed software projects are often the result of an unsystematic transfer of business requirements to the implementation. This deficit led to the specification of the Model Driven Architecture (MDA). It claims a consistent use of conceptual models for the software development process from requirement analysis to technical specification of software. The MDA reduces the gap between the business level and the information technology (IT) level by defining a methodological framework to link these levels (Business-IT alignment). We will present the use of an MDA in health care domain. For this purpose, we show how the paradigm of MDA can be configured to implement medical application software based on a telemedical IT platform (telehealth platform). Additionally to the conceptual structure of the developed approach and the domain-specific alignment, lessons learned from the experiences gathered during design process will be formulated as assistance for similar projects and substantiated with an exemplary application

Modeling Clinical Pathways - Design and Application of a Domain-Specific Modeling Language

Networking and collaboration in clinical care are increasingly entailing new requirements on supporting medical processes. The information technology (IT) in public health accordingly earns strategic relevance and encounters new potentials as well as challenging demands. The application of conceptual models in health care domain is almost entirely restricted to documentation tasks. Approaches like Model-Driven-Architectures or Workflow Management Systems have shown that the application of models, e.g. transformation, execution and formal interpretation, has huge potential. This article presents a modeling language for modeling clinical pathways. Three scenarios show the potential of conceptual models in health care domain and provide foundations for language requirements. Presenting a state-of-the-art of modeling languages for clinical domain and evaluating existing approaches to the requirements provide the gap to develop a domain-specific language. The potentials of the language and the use of corresponding models in medical treatment are demonstrated exemplarily including a discussion on model-driven management

Extending a Business Process Modeling Language for Domain-Specific Adaptation in Healthcare

It is often required to provide a modeling language that enables the representation of domain-specific problems and concepts. Domain-specific modeling approaches can be applied for that. However, these approaches usually suffer from low dissemination, missing tool support and high design costs. Thus, it might be more reasonable to adapt and extend common standard modeling languages. This research article presents an extension of the common process modeling language BPMN for modeling clinical pathways in the healthcare sector. The extension is designed methodically by application of the extension design method of Stroppi et al. (2011), which was extended regarding to a deeper domain analysis. The domain analysis considers the design of a domain ontology, requirements analysis as well as an equivalence check between domain concept and BPMN concepts. Finally, the evolved extension is compared with the CPmod modeling language of Burwitz et al. (2013) in order to discuss strengths and limitations

Terminology for Evolving Design Artifacts

Many design researchers evolve artifacts in succeeding projects. Yet, these researchers lack a terminology to describe how their artifacts evolve. We provide such a terminology by paralleling concepts from evolution with design artifacts using examples from conceptual modeling. We found seven concepts from evolution that we think are useful to describe evolving design artifacts. Evaluating whether these concepts have been addressed, we identified six conceptual modeling design studies, whose authors have addressed some of the concepts with their own words. Using two of these studies, we explain how terminology from evolution can be used to describe evolving design artifacts. We hope that our results are useful to be integrated in design science procedure models to help researchers increasing rigor and relevance of their research, e.g.by allowing to clarify how the artifact at hand has evolved or to describe the evolutionary distance to preceding artifacts

Patientenintegration durch Pfadsysteme

Die aktive Integration eines Patienten in seinen Behandlungsverlauf besitzt große Potentiale zur Verbesserung der Behandlungsqualität. Als Ansatz zur besseren Patientenintegration werden häufig Patientenportale genannt. Die bestehenden Lösungen fokussieren jedoch vornehmlich auf die Zugänglichkeit elektronischer Patientenakten aber nicht auf die Integration von einrichtungsübergreifenden Informationen zum Behandlungsverlauf, auch Patientenpfad genannt. Der Beitrag schlägt daher eine Referenzarchitektur zur Integration von Pfadsystemen in Patientenportale vor. Ihre Anwendbarkeit wird anhand der Gestaltungeines Patientenportals für die Multiple Sklerose Behandlung demonstriert

A deep Large Binocular Telescope view of the Canes Venatici I dwarf galaxy

We present the first deep color-magnitude diagram of the Canes Venatici I (CVnI) dwarf galaxy from observations with the wide field Large Binocular Camera on the Large Binocular Telescope. Reaching down to the main-sequence turnoff of the oldest stars, it reveals a dichotomy in the stellar populations of CVnI: it harbors an old (> 10 Gyr), metal-poor ([Fe/H] ~ -2.0) and spatially extended population along with a much younger (~ 1.4-2.0 Gyr), 0.5 dex more metal-rich, and spatially more concentrated population. These young stars are also offset by 64_{-20}^{+40} pc to the East of the galaxy center. The data suggest that this young population, which represent ~ 3-5 % of the stellar mass of the galaxy within its half-light radius, should be identified with the kinematically cold stellar component found by Ibata et al. (2006). CVnI therefore follows the behavior of the other remote MW dwarf spheroidals which all contain intermediate age and/or young populations: a complex star formation history is possible in extremely low-mass galaxies.Comment: 4 pages, 3 figures, accepted for publication in ApJL. Minor changes, conclusions unchange

XIPE: the X-ray Imaging Polarimetry Explorer

X-ray polarimetry, sometimes alone, and sometimes coupled to spectral and temporal variability measurements and to imaging, allows a wealth of physical phenomena in astrophysics to be studied. X-ray polarimetry investigates the acceleration process, for example, including those typical of magnetic reconnection in solar flares, but also emission in the strong magnetic fields of neutron stars and white dwarfs. It detects scattering in asymmetric structures such as accretion disks and columns, and in the so-called molecular torus and ionization cones. In addition, it allows fundamental physics in regimes of gravity and of magnetic field intensity not accessible to experiments on the Earth to be probed. Finally, models that describe fundamental interactions (e.g. quantum gravity and the extension of the Standard Model) can be tested. We describe in this paper the X-ray Imaging Polarimetry Explorer (XIPE), proposed in June 2012 to the first ESA call for a small mission with a launch in 2017 but not selected. XIPE is composed of two out of the three existing JET-X telescopes with two Gas Pixel Detectors (GPD) filled with a He-DME mixture at their focus and two additional GPDs filled with pressurized Ar-DME facing the sun. The Minimum Detectable Polarization is 14 % at 1 mCrab in 10E5 s (2-10 keV) and 0.6 % for an X10 class flare. The Half Energy Width, measured at PANTER X-ray test facility (MPE, Germany) with JET-X optics is 24 arcsec. XIPE takes advantage of a low-earth equatorial orbit with Malindi as down-link station and of a Mission Operation Center (MOC) at INPE (Brazil).Comment: 49 pages, 14 figures, 6 tables. Paper published in Experimental Astronomy http://link.springer.com/journal/1068