No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Sharing Personal Health Information Via Service-Oriented Computing: A Case of Long-Term Care
Abstract
Sharing personal health information among healthcare providers is a crucial business process not only for saving limited healthcare resources but also for increasing patient's healthcare quality. Building an effective personal health information sharing process from established healthcare systems is a challenge in terms of coordination different business operations among healthcare providers and restructuring technical details existed in different healthcare information systems. This study responds this challenge with a service-oriented approach and develops a business software application to describe how the challenge can be alleviated from both managerial and technical perspectives. The software application in this study depicts personal health information sharing process among different providers in a long-term care setting. The information sharing scenario is based on an industrial initiative, such as Integrating the Healthcare Enterprise (IHE) from healthcare domain and the technologies for implementing the scenario are Web Service technologies from Service-oriented computing paradigm. The implementation in this study can inform healthcare researchers and practitioners applying technologies from service-oriented computing to design and develop healthcare collaborative systems to meet the increasing need for personal health information sharing.
... Among them, Web Services is now the standard of service oriented computing for implementing a dynamic and flexible business process. Based on XML, Web Service were founded upon three standards: the Simple Object Access Protocol (SOAP), which is a communication protocol describing the format of a message exchanged among Web Services operational participants; the Universal Description, Discovery, and Integration (UDDI), which is a standard providing business information description in relation to Web Service registration and searching by service providers and requesters; and the Web Service Description Language (WSDL), which is a service description language defining details of operational interfaces and message exchanges between Web services and business software application (Bultan, Su, & Fu, 2006;Lin, Chen, Guo, Chiang, & Chang, 2012). Web Service is now being used by most organizations to share information or functions across systems or platforms, especially using in the intranet as a transport medium for saving their development cost. ...
Purpose–The caring approach for long-term care is different with the general care because it emphasizes comprehensive health care. If the system establishment lacks integrated concepts, the system will then be unsuitable. This study aims to develop an innovative system project based on the whole person concept and provides the experience for applying the concept of Service-Oriented Architecture (SOA) to integrate different operations of the system which called U-care project. Method–This involves substituting the function module of the original system architecture with a service-based approach to provide a service interface. In addition, there must be a connection between the well-defined interface for the services and the formation of comprehensively integrated system architecture. Evaluations were conducted both on the programmers of the U-care project and on end user experience form using the system.Results–The results describe our resulting functional design of the system. The implanted experience based on SOA was also presented and the services were success practice in a long term care institution. Conclusion–The contribution of this paper is the project functional design and practical feasibility. It also showed the SOA platform with a set of reusable domain function service is suitable for the long term care institution. It can support the actual improvement on the project development schedule and operational performance of personnel.Recommendations–Further work on emphasizing the establishment of domain knowledge by developers when developing long-term care related software to reduce difficulties in communication with users, refining the process applied to the SOA is recommended to improve the efficiency of the project. Research Implications–Service-oriented computing promotes the approach of assembling application components into a network of services that can be loosely coupled to create flexible, dynamic business processes and agile applications. Therefore, the architecture of service oriented uses services to support development teams can achieve rapid, low cost, interoperable, evolvable and massively distributed long term care system.
... Decision making in health care organizations especially hospitals is generally based on data and evidence generated by knowledge management, knowledge sharing and knowledge systems. In health care sector, knowledge sharing and management are being developed mainly in the domain of electronic medical record management and healthcare management [6][7][8]. Generally, most evidence medical decisions and evidence based practice depend on experience and knowledge of existing options and knowledge sharing in health care organizations [9,10]. ...
This study was based on knowledge sharing barriers about attitudes of physicians in Turkish health care system. The present study aims to determine whether the knowledge sharing barriers about attitudes of physicians vary depending on gender, position, departments at hospitals, and hospital ownership status. This study was planned and conducted on physicians at one public hospital, one university hospital, and one private hospital in Turkey. 209 physicians were reached for data collection. The study was conducted in June-September 2014. The questionnaire (developed by A. Riege, (J. Knowl. Manag. 9(3):18-35, 2005)), five point Likert-type scale including 39 items having the potential of the physicians' knowledge- sharing attitudes and behaviors, was used in the study for data collection. Descriptive statistics, reliability analysis, student t test and ANOVA were used for data analysis. According to results of this study, there was medium level of knowledge sharing barriers within hospitals. In general, physicians had perceptions about the lowest level individual barriers, intermediate level organizational barriers and the highest level technological barriers perceptions, respectively. This study revealed that some knowledge sharing barriers about attitudes of physicians were significantly difference according to hospital ownership status, gender, position and departments. Most evidence medical decisions and evidence based practice depend on experience and knowledge of existing options and knowledge sharing in health care organizations. Physicians are knowledge and information-intensive and principal professional group in health care context.
... The current research on electronic communication in general medical practice has speculated on overcoming the isolation of current HIS by enabling EMR sharing in a seamless manner over geographically scattered areas. EMR exchange and HIS integration are characterized by event driven information exchange patterns [12], where messages are sent based on the occurrence of a given event within one of the integrated HIS. Electronic mail (e-mail) is emerging as an alternative way of exchanging clinical documents within the healthcare domain [13]. ...
Data sharing is pivotal in current medical practice so as to better treat patients by taking the best medical decisions, and to optimize healthcare costs by reducing the need to repeat unnecessary medical tests and by better managing healthcare structures. To improve the delivery of treatment outcomes and test results, the request-triggered retrieval of clinical documents provided by current Health Information Systems is not sufficient. The addition of a notification solution is necessary to inform users as soon as their clinical documents of interest have been produced so that they can retrieve them by means of the traditional Health Information Systems. In addition, this notification solution also has to implement the event-based information exchange patterns, which characterize the current attempts at integrating heterogeneous Health Information Systems in a seamless manner.
This paper proposes an architecture for an effective asynchronous notification of clinical documents. Our intention is to bridge the gap between primary and secondary care, and between the clinical personnel and the administrators. The proposed solution is based on a publish/subscribe service, properly extended to allow us to jointly notify collections of correlated documents. Moreover, it has been implemented by means of a web service-based platform in accordance with the Web Service Notification specification so as to obtain a solution easy to integrate and manage. A systematic analysis has been carried out to assess the suitability of the implemented solution to satisfy the requirements for notifying medical documents, and to evaluate the notification latency in different use conditions.
A number of recent studies have showed that early and specialized pre-hospital patient management contributes significantly to emergency case survival. Along with the deployment and availability of appropriate emergency care resources, this also requires the availability of timely and relevant patient information to emergency medical service professionals. However, current healthcare information systems are characterized by heterogeneity and fragmentation, hindering emergency care professionals to have access to holistic or integrated patient information from the various organizations that participate in emergency care processes where and when needed. At the same time, many e-health programs have been undertaken worldwide in the area of emergency and unscheduled care with the objective to facilitate sharing of electronic patient information that may be considered important for the delivery of high quality emergency care and, hence, need to be readily available. In this vein, this paper takes a holistic view of the information needed in emergency healthcare and focuses on developing an appropriate tool for providing timely access to holistic care information by authorized users while retaining existing investments. Thus, a special purpose document management mechanism (DMM) is proposed that facilitates creating standardized XML documents from existing healthcare systems and that enables access to such documents at the point of care. For illustrative purposes, the mechanism has been incorporated into a prototype, cloud-based holistic EMS system.
A number of recent studies have showed that early and specialized pre-hospital patient management contributes
significantly to emergency case survival. Along with the deployment and availability of appropriate emergency
care resources, this also requires the availability of timely and relevant patient information to emergency medical
service professionals. However, current healthcare information systems are characterized by heterogeneity
and fragmentation, hindering emergency care professionals to have access to holistic or integrated patient
information from the various organizations that participate in emergency care processes where and when
needed. At the same time, many e-health programs have been undertaken worldwide in the area of emergency
and unscheduled care with the objective to facilitate sharing of electronic patient information that may be
considered important for the delivery of high quality emergency care and, hence, need to be readily available.
In this vein, this paper takes a holistic view of the information needed in emergency healthcare and focuses
on developing an appropriate tool for providing timely access to holistic care information by authorized users
while retaining existing investments. Thus, a special purpose document management mechanism (DMM)
is proposed that facilitates creating standardized XML documents from existing healthcare systems and that
enables access to such documents at the point of care. For illustrative purposes, the mechanism has been
incorporated into a prototype, cloud-based holistic EMS system.
n this paper, the authors present a framework for information sharing with privacy and priority control in long-term care designed to promote appropriate information sharing among the people who are involved in long-term care for provision of better care service. The authors' framework includes four agents (user agent, local information system access agent, authentication/access control agent and priority control agent) and two databases (user database and care record index database). The LIS (local information system) access agent creates and updates the care record index database, which act as an index when user agents try to access to care recipient's record, based on the Open Authentication protocol. It also acts as a query interface from each user agent. The authentication/access control agent allows sensitive information to be shared in accordance with the policy defined by care recipient. The priority control agent judges the urgency of the information for either periodic or immediate notification. The authors also propose an implementation of this framework using the Resource Description Framework Site Summary, and demonstrate how our framework works with the scenario of care recipient's unexpected injury. In summary, this framework is designed to help people who require long-term care and provides an effective system for each staff that is in charge of administering long-term care services. The authors' information sharing system incorporates a multi-agent architecture to facilitate information sharing and privacy/priority control. The authors believe that this research provides an important first step for researchers who intend to build a prototype to automate the processes of information sharing for long-term health care.
Degenerative aortic stenosis (AS) is a common valvular pathology in developed nations. Secondary to advanced age and often multiple co-morbidities, a significant percentage of patients are not considered surgical candidates. For these high-risk patients, transcatheter aortic valve replacement (TAVR) is a rapidly emerging less-invasive treatment alternative. Because of the lack of direct exposure and visualization of the operative field, pre-procedural planning and intra-procedural guidance relies on imaging. Large 3-dimensional data files are acquired, which are reconstructed on advanced workstations during review and interpretation. Optimally, the imaging data is organized into a comprehensive digital file as an integral part of the electronic health record (EHR) following the patient. This manuscript will discuss the role of image data management in the context of TAVR.
Most medical information systems store clinical informa-tion about patients in proprietary format. To address the resulting interoperability problems, several electronic health record (EHR) standards that enable structured clini-cal content for the purpose of exchange are currently under development. In this article, we present a brief overview of the most relevant EHR standards, examine the level of interoperability they provide and assess their functionality in terms of content structure, access services, multimedia support and security.
Business Process Management (BPM) includes methods, techniques, and tools to support the design, enactment, management, and analysis of operational business processes. It can be considered as an extension of classical Workflow Management (WFM) systems and approaches. Although the practical relevance of BPM is undisputed, a clear definition of BPM and related acronyms such as BAM, BPA, and STP are missing. Moreover, a clear scientific foundation is missing. In this paper, we try to demystify the acronyms in this domain, describe the state-of-the-art technology, and argue that BPM could benefit from formal methods/languages (cf. Petri nets, process algebras, etc.).
Integrating personal health information management (PHIM), which helps people manage their lives and actively participate in their own health care is discussed. Many health care services are delivered in outpatient settings, where patients receive care, patients assume significant responsibility for monitoring their own health status, managing their recovery, and communicating with clinicians from their home. This arises the necessity that the patients must store, maintain, and retrieve many kinds of health information, ranging from medication schedules to information researched online. Patients need tools that address the challenges and enable them to be involved in their health care, as well as to meet the responsibilities of their daily lives. These tools might allow patients to group together related information to support specific decisions. The tools include Web-based interfaces that grant them secure Internet access to portions of their electronic medical records.
The openEHR community has developed a specification that has been taken up by the standards community and has this year been adopted as ISO 13606. The specification offers an engineering and semantic framework for implementing an electronic health record (EHR) service within a service-oriented architecture. The semantic framework provides the means of agreeing the clinical and other content of the EHR independently of the implementation infrastructure. The clinical content is expressed using a formal language, itself part of the ISO standard, which ensures the content specifications provide a single computable source for many key artifacts required for semantic interoperability.
Traditional approaches to software development - the ones embodied in CASE tools and modeling frameworks - are appropriate for building individual software components, but they are not designed to face the challenges of open environments. Service-oriented computing provides a way to create a new architecture that reflects components' trends toward autonomy and heterogeneity. We thus emphasize SOC concepts instead of how to deploy Web services in accord with current standards. To begin the series, we describe the key concepts and abstractions of SOC and the elements of a corresponding engineering methodology.
This analysis investigates what patients and practitioners can do to improve their interactive communications to achieve optimal patient-centric (PC) care. One goal of this clinical practice approach is to improve patient satisfaction, compliance, and outcomes. The mutual responsibilities required of both the patients and practitioners to attain PC care are discussed. Innovative, information technology techniques in the healthcare environment in general and in care delivery in particular are explored. Practitioner-to-patient encouragement vis-a-vis self education on their conditions is also provided.
Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals.
We surveyed all acute care hospitals that are members of the American Hospital Association for the presence of specific electronic-record functionalities. Using a definition of electronic health records based on expert consensus, we determined the proportion of hospitals that had such systems in their clinical areas. We also examined the relationship of adoption of electronic health records to specific hospital characteristics and factors that were reported to be barriers to or facilitators of adoption.
On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems.
The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.
Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable.
While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders.
Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be moved from concept to practical application? Would a coordinating body expedite this progress? How can existing initiatives and policy levers serve as catalysts to advance integrated PHRs?
This paper considers the standardization of an Electronic Health Record (EHR). Relations between several distinct medical datasets and information systems are mapped in order to derive a more precise definition of the EHR. Two international efforts to establish standards for the EHR are presented and critiqued. Strategies for standardizing the EHR are analyzed and recommendations are provided for approaching the standardization process.
Personalized medicine: is it hype or revolution? In any case, there is not only real demand for it, but it also has a history. As it is, the personal aspects of health care have been partly neglected in the current era of evidence-based, scientific medicine. We now know that a 'one fits all' type of treatment has its limits. Medicine needs to be (re-)personalized. The time is right: the post-genomic era provides the necessary molecular tools, but does it provide for the risks involved? Privacy, protection of minorities, and prevention of discrimination are at stake. Regulations are required. The health-care process needs redesigning to render personalized medicine effective. Information and communication management is challenged to handle the wealth of personal information and link to global medical knowledge. But the goal is magnificent: personal health planning, early diagnosis, the right drug for the right patient, and predictable side effects.
This paper seeks to provide an overview of the initiatives that are proceeding internationally to develop standards for the exchange of electronic health record (EHR) information between EHR systems.
The paper reviews the clinical and ethico-legal requirements and research background on the representation and communication of EHR data, which primarily originates from Europe through a series of EU funded Health Telematics projects over the past thirteen years. The major concepts that underpin the information models and knowledge models are summarised. These provide the requirements and the best evidential basis from which HER communications standards should be developed.
The main focus of EHR communications standardisation is presently occurring at a European level, through the Committee for European Normalisation (CEN). The major constructs of the CEN 13606 model are outlined. Complementary activity is taking place in ISO and in HL7, and some of these efforts are also summarised.
There is a strong prospect that a generic EHR interoperability standard can be agreed at a European (and hopefully international) level. Parts of the challenge of EHR interoperability cannot yet be standardised, because good solutions to the preservation of clinical meaning across heterogeneous systems remain to be explored. Further research and empirical projects are therefore also needed.
Optimized workflows and communication between institutions involved in a patient's treatment process can lead to improved quality and efficiency in the healthcare sector. Electronic Health Records (EHRs) provide a patient-centered access to clinical data across institutional boundaries supporting the above mentioned aspects. Interoperability is regarded as vital success factor. However a clear definition of interoperability does not exist. The aim of this work is to define and to assess interoperability criteria as required for EHRs.
The definition and assessment of interoperability criteria is supported by the analysis of existing literature and personal experience as well as by discussions with several domain experts.
Criteria for interoperability addresses the following aspects: Interfaces, Semantics, Legal and organizational aspects and Security. The Integrating the Healthcare Enterprises initiative (IHE) profiles make a major contribution to these aspects, but they also arise new problems. Flexibility for adoption to different organizational/regional or other specific conditions is missing. Regional or national initiatives should get a possibility to realize their specific needs within the boundaries of IHE profiles. Security so far is an optional element which is one of IHE greatest omissions. An integrated security approach seems to be preferable.
Irrespective of the so far practical significance of the IHE profiles it appears to be of great importance, that the profiles are constantly checked against practical experiences and are continuously adapted.
Today information is considered to be a valuable company resource that has to be planned, coordinated and documented. Business processes need to be treated in the same way. Moreover, significant potential for improvement may lie in optimizing these processes. As a consequence information should be collected and suitably modelled and business processes need to be analyzed and redesigned. Business modelling usually deals with different views of a company. The data view is concerned with information structures, the functional view analyzes tasks and procedures, the process view links different functions by analyzing workflows and events triggering them, while the organizational view is concerned with the structure of the company under investigation. These views should not however be treated in an isolated manner. The key to success is to deal with the interaction between them. Hence, business modelling should provide an integrated view of all relevant informational, functional, organizational and workflow issues. One of the most significant problems results from the complexity of the modelling task. Modelling tools are required and are to be used in combination with other close methodologies and applications. Suitable generalizations and/or new methodologies need to be developed.
Technological advances in and convergence of the World Wide Web with Electronic Data Interchange and standard middleware such as CORBA have given rise to a new computing paradigm based on a loosely coupled service-oriented architecture called Web Services. Direct machine to machine interactions that were hitherto deemed infeasible are now possible due to the rapid technological advances in XML and SOAP technologies. There is, however, an unprecedented hype surrounding this new paradigm. In reality, the Web services paradigm lacks a precise definition. Furthermore, the use-case scenarios for Web services and its pros and cons compared to existing, well-defined middleware technologies such as CORBA are not well understood.
“This book clearly shows how today's industry pressures and business challenges mandate renewal of the contract between organizations and their IT assets and peopleï¾and it illustrates how a service-oriented approach to IT can help organizations go through the necessary transformation. The role of governance in bringing IT and business closer together is particularly well explained, and the book is worth reading for that alone.” ï¾Neil Ward-Dutton, Research Director, Macehiter Ward-Dutton “It's easy to pay lip service to the concept of business/IT alignment, but in The New Language of Business, Sandy Carter walks the walk. Few treatments of SOA ground this admittedly difficult topic in the world of business as thoroughly as Sandy has here. I'd recommend this book to any business reader who wants to leverage IT to make their business more agile and innovative, and to any technical reader who wishes to understand how to place SOA in the business context where it belongs.” ï¾Jason Bloomberg, Senior Analyst and Principal, ZapThink LLC “A very valuable read. In today's globally connected marketplace profitable growth requires business flexibility and continuous innovation, both of which are increasingly proving to be impossible without business modularity and the new table-stakes technology SOA.” ï¾Ron Williams, Professor, Kenan-Flagler Business School, University of North Carolina at Chapel Hill “Sandy has provided a pragmatic and holistic perspective on Service Oriented Architectures. She adds credibility by sharing IBM's in-depth customer research as well as case studies to support the findings. The book is a strong source book for those wanting to get started with SOA.” ï¾Judith Hurwitz, President & CEO, Hurwitz & Associates, coauthor, Service Oriented Architectures for Dummies “Few people have thought as long or as hard about SOA as Sandy Carter. This book embodies her invaluable work and the work of many at IBM to research, define, deploy and make SOA happen. Useful not just from a SOA perspective, but also as a concise articulation of the contemporary concepts fundamental to understanding where business and IT are heading.” ï¾Carol Baroudi, coauthor Service Oriented Architecture For Dummies, Senior Analyst, Aberdeen Group “The New Language of Business: SOA & Web 2.0 is based on the collective feedback from industry leaders at organizations of all sizes, in more than 50 countries, who shared their views, experiences, and challenges of aligning technology with business goals.” ï¾From the foreword by Steve Mills, Senior Vice President and Group Executive,ï¾ IBM Software Group There is now a direct, provable link between an organization's flexibility and business performance. To optimize flexibility, companies must achieve unprecedented levels of integration and automation of key processes and infrastructure, both internally and externally. At the same time, they must learn to manage their processes far more dynamically and responsively. They must become flex-pon-sive*. Until recently, technology stood in the way of achieving these goals. Thanks to the emergence of service oriented architecture (SOA), Web 2.0, and open standards, technology now enables companies to achieve those goals. In The New Language of Business, one of IBM's top SOA strategist demonstrates how business leaders can use innovations in technology to drive dramatic process improvements and support accelerating change. Sandy Carter shows how to deconstruct your business into a “componentized” business model, then support that model with linked, repeatable IT services that can adapt quickly, easily, and economically. These techniques will help both IT professionals and business leaders reach new levels of operational excellence to deliver the market-focused innovations that matter most. Drive competitive advantage through Service Oriented Architecture Leverage the value of business process components and IT services Achieve one version of the truthï¾finally! Use information as a service to improve business insight and reduce risk Master SOA governance and the service lifecycle Manage IT infrastructure for business results, both short-term and long-term Start fast: choose from three winning approaches Get quick wins with business process management, collaboration or information Implement on demand: what worksï¾and what doesn't Discover key success factorsï¾and ten critical mistakes to avoid Create the flex-pon-sive* business! ·Learn the secrets of success from industry leaders at organizations of all sizes, from over 50 countriesï¾and why SOA was unanimously chosen as the best way to address their challenges ·Leverage the IBM roadmap for SOA and Web 2.0 deployment, plus proven best practices learned in the field ·Understand what it means to be flex-pon-sive*ï¾and how your organization can get there In The New Language of Business, senior IBM executive Sandy Carter demonstrates how to leverage SOA, Web 2.0, and related technologies to drive new levels of operational excellence and business innovation. Writing for executives and business leaders inside and outside IT, Carter explains why flexibility and responsiveness are now even more crucial to successï¾and why services-based strategies offer the greatest promise for achieving them. You'll learn how to organize your business into reusable process componentsï¾and support them with cost-effective IT services that adapt quickly and easily to change. Then, using extensive examplesï¾including a detailed case study describing IBM's own experienceï¾Carter identifies best practices, pitfalls, and practical starting points for success. Build the flex-pon-sive* business * Flex-pon-sive* companies respond with lightning speed and agility to rapidly changing business needs. Flex-pon-sive* companies are focused on processes that are enabled for change through IT. Part I: Start at the Beginningï¾The Business
Is important, so there needs to be a national strategy to ensure it
Information in Practice pp 263, 264
Leaflets and other information packages (video and audio tapes, computer programs, and websites) have long been seen as integral to educational strategies designed to promote health, persuade people to adopt healthy lifestyles, and increase uptake of screening. They have also been developed to educate patients in self care of such chronic conditions as arthritis, hypertension, stress related psychological problems, gastrointestinal diseases, and back pain, and how to take medicines correctly. There is now growing interest in providing information to support patients' participation in choosing treatments and deciding on strategies for managing their health problems.1 Much well intentioned effort goes into developing such material, but good intentions are not enough to guarantee quality and usefulness, as two papers in this week's issue show (pp 263, 264). 23 If patients …
The current growth of the service sector in global economies is unparalleled in human history—by scale and speed of labor migration. Even large manufacturing firms are seeing dramatic shifts in percent revenue derived from services. The need for service innovations to fuel further economic growth and to raise the quality and productivity levels of services has never been greater. Services are moving to center stage in the global arena, especially knowledge-intensive business services aimed at business performance transformation. One challenge to systematic service innovation is the interdisciplinary nature of service, integrating technology, business, social, and client (demand) innovations. This paper describes the emergence of service science, a new interdisciplinary area of study that aims to address the challenge of becoming more systematic about innovating in service.
In this paper, we describe an approach to business processes and services which views work practices as recurrent patterns of communication called genres. Although defining work practices in this way is unorthodox, it provides two major advantages. First, the communication resources employed by the parties engaging in a service transaction can be clearly described, understood, and communicated. Business processes and services can be differentiated on the basis of the structural and functional arrangement of their constituent genres. This provides a view of a business process or service that is technology-independent. Second, using this approach means that work practices are defined contextually—an important consideration when trying to understand how business processes and services will influence organizations. Because genres are represented using directed graphs, prototypes can be developed to assist during the analysis of existing services and the design of new ones. Structural and functional change of genres can be used to reveal how a specific service is evolving within an organization. This enables us to determine if business demands have changed, something that is difficult to achieve using conventional service engineering approaches.
The designing of IT support for the management of inter-organizational service processes inherits the full complexity of aspects dealt with in approaches altering, automating, and supporting these processes in general—and it needs to go beyond. As customer concerns, especially in long-lasting processes, may change over time, support has to provide flexible service, adjustments among different providers, and opportunities to care for the customer. With serviceflow management (SFM) we argue in favor of putting these service-related aspects in the center of modeling, design and architectures. Its conceptual distinction between the serviceflow (as the portion of the process where the customer's concern is evaluated and cared for) and background processes enables SFM (1) to guide providers as well as designers to focus on service design and delivery, (2) to provide support for serviceflows with enhanced flexibility and service configuration, and (3) to suggest the design of service points where service workers and customers “meet”. Thus the original workflow metaphor, which directs the design of process support from a mass production point of view, is questioned and replaced by a more suitable concept, which considers social and quality aspects in service delivery. Instance-based XML process representations, generic components and architectures for their exchange as well as for the provision of service tasks are presented and discussed, exemplified by an e-health process.
Health care providers and governments are under pressure to maintain and improve the quality of care to an increasing volume
of critical care patients at either end of the life cycle, namely premature and ill term babies together with the elderly.
The provision of a service of critical care utilizing real time service-oriented architectures has the potential to enable
clinicians to be supported in the care of a greater number patients that are, perhaps more importantly, located elsewhere
to their intensive care units. This paper presents a review of recent research in the application of computing and IT to support
the service of critical care and determines the trends and challenges for the application of real time service-oriented architectures
within the domain. It then presents some case study–based research on the design of a service-oriented architecture-based
approach to support two aspects of critical care namely elderly care and neonatal intensive care to provide further context
to trends and opportunities.
A composite Web service consists of a set of individual services (or peers), which interact with each other via messages. A conversation is a global sequence of messages exchanged among peers participating in a composite Web service. Interestingly, conversation behavior differs significantly for synchronous and asynchronous communication, even if peers' local behaviors remain the same. The authors use synchronizability and realizability analysis techniques to analyze conversations in the presence of asynchronous communication. With these analyses, they can use model checking to automatically verify conversation behavior for bottom-up and top-down Web service specifications.
Some of the issues that led to the downfall of Common Object Request Broker Architecture (CORBA) are discussed. The most important factor that led to the downfall of CORBA is that specification. The specification was large and complex and much of it had never been implemented, not even as a proof of concept. The platform had a steep learning curve and was complex and hard to use correctly, leading to long development times and high defect rates. Many of the CORBA's APIs are far largest than necessary. CORBA's object adapter requires more than 200 lines of interface definitions, even though the same functionality can be provided in about 30 lines, the other 170 lines severely complicate program interactions with the CORBA runtime. CORBA provides quite rich functionality , but fails to provide two core features that include security and versioning. Technical problem is one of the most important factor that led to CORBA's decline.
Depending on exactly when one starts counting, CORBA is about 10-15 years old. During its lifetime, CORBA has moved from being a bleeding-edge technology for early adopters, to being a popular middleware, to being a niche technology that exists in relative obscurity. It is instructive to examine why CORBA—despite once being heralded as the “next-generation technology for e-commerce”—suffered this fate. CORBA’s history is one that the computing industry has seen many times, and it seems likely that current middleware efforts, specificallyWeb services, will reenact a similar history.
This article presents descriptive data from surveys that probed the use of health information by Internet users in Australia and New Zealand. Using this data, the article also contributes to understanding of factors associated with a series of Internet health information use outcomes. Four hundred six respondents (151 Australians; 255 New Zealanders) had used the Internet for health information and were asked about emailing doctors, Internet searching, taking Internet information to the doctor and perceptions of Internet information reliability. Regression analyses were conducted to examine associations between key outcomes and independent variables. A bootstrap procedure was performed to select variables used in logistic regression models. Fifty-two percent of health Internet users had emailed their doctor. Few significant differences between Australian and New Zealand responses were found. Internet use for health information was below levels found in North American and European studies, but there was similar prevalence of emailing and presenting Internet information to doctors. Emailers were more likely to believe this improved communication with doctors (OR = 3.59; 95%CI 1.95, 6.61). Frequent Internet searchers were more likely to take Internet information to their doctor (OR = 2.41; 1.47, 3.92), and believe the Internet to be a more useful information source (OR = 2.47; 1.22, 5.03). Females were less likely to email their doctor (OR = 0.47; 0.26, 0.85). More educated respondents were more likely to email their doctor (OR = 1.99; 1.16, 3.39) and to check website credentials (OR = 2.61; 1.53, 4.43). This study suggests that there is a digital divide among health care Internet users. It shows that, for males, email could have health care advantages. Doctors may need to develop strategies to deal with patients presenting with Internet information, including how to source information and check its credibility.
EHR systems are core applications in any eHealth/pHealth environment and represent basic services for health telematics platforms. Standards Developing Organizations as well as national programs define EHR architectures as well as related design, implementation, and deployment processes. Claiming to meet the challenge for semantic interoperability and to offer a sustainable pathway, the resulting documents and specifications are sometimes controversial and even inconsistent.
Based on long-term experiences from national and international EHR projects, inputs from related academic groups, and active involvement at CEN, ISO, HL7, an analysis and evaluation study has been performed. Using the Generic Component Model (GCM) reference architecture, the characteristics for advanced and sustainable EHR architectures have been investigated. The dimensions of such an architectural reference model have been described, including basic principles of the underlying formal logical framework.
Strengths and weaknesses of the different standards, specifications, and approaches have been studied and summarized. Migration pathways for re-using and harmonizing the available materials as well as for formally defining standards development roadmaps can be derived.
For providing interoperable and sustainable EHR systems, an EHR architecture reflecting all paradigms of the GCM is absolutely necessary. The resulting EHR solution represents a services architecture of distributed components. The development process shall be completely model-driven and tool-based with formalized specifications of all domains' aspects.
Unlabelled:
There is a very clear need for the expanded application of information technology (IT) in healthcare. Clinical workflow still depends largely on manual, paper-based medical record systems in an activity that is economically inefficient and produces significant variances in medical outcomes. IT spend currently represents around 1.3% of total healthcare spend on average. As shown in Table ES.1, this equates to a global market for healthcare information products and services of 74.5 billion in 2007. As may be expected, the US dominates the market, taking just under 50% of the 2002 global revenues, but will marginally fall back to take under 49% of the total by 2007. During this period, the US market is forecast to grow by an average of 8.9% per annum from 48.7 billion in 2007. In contrast, the European market will grow at an average of 10.1% per annum, Japan by 8.5% per annum, but the rest of the world, which is currently under-provided with IT, by 10.5% per annum. Table ES.1. World healthcare IT market by region, 2002 and 2007. Year 2002 2007 Region Revenues ( billion) Total (%) Average per annum growth (%)
Source:
Author's estimates. US 23.7 49.9 36.3 48.7 8.9 Europe 14.3 30.1 23.2 31.1 10.1 Japan 3.9 8.2 5.9 7.9 8.5 Rest of the world 5.6 11.8 9.2 12.4 10.5 World total 47.5 100.0 74.6 100.0 9.4.
Recently there has been a remarkable upsurge in activity surrounding the adoption of personal health record (PHR) systems for patients and consumers. The biomedical literature does not yet adequately describe the potential capabilities and utility of PHR systems. In addition, the lack of a proven business case for widespread deployment hinders PHR adoption. In a 2005 working symposium, the American Medical Informatics Association's College of Medical Informatics discussed the issues surrounding personal health record systems and developed recommendations for PHR-promoting activities. Personal health record systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care. When PHRs are integrated with electronic health record systems, they provide greater benefits than would stand-alone systems for consumers. This paper summarizes the College Symposium discussions on PHR systems and provides definitions, system characteristics, technical architectures, benefits, barriers to adoption, and strategies for increasing adoption.
EHR systems are core applications in any eHealth/pHealth environment and represent basic services for health telematics platforms. Many projects are performed at the level of Standards Developing Organizations or national programs, respectively, for defining EHR architectures as well as related design, implementation, and deployment processes. Claiming to meet the challenge for semantic interoperability and offering the right pathway, the resulting documents and specifications are sometimes controversial and even inconsistent. Based on a long tradition in the EHR domain, on the collective experience of academic groups such as the EFMI EHR Working Group, and on an active involvement at CEN, ISO, HL7 and several national projects around the globe, an analysis and evaluation study has been performed using the Generic Component Model reference architecture. Strengths and weaknesses of the different approaches as well as migration pathways for re-using and harmonizing the available materials are offered.
Electronic Personal Health Records (PHRs) has been perceived as the tool to empower consumers to become active decision-makers of their healthcare instead of leaving the decision to providers. However, there has been the lack of enthusiasm and adoption of PHRs. This paper examines the current healthcare climate and attempts to understand the major challenges associated with PHRs adoption. The paper-based and fragmented healthcare system is no longer appropriate for the digital economy of the 21st century. The integrated health information technology system is the solution to transform clinical practice to consumer centric and information driven. Tools such as PHRs are means to an end that provide better, safer and more affordable healthcare for consumers. However, there has been little research conducted to demonstrate PHR's tangible value, despite the widespread perceived value of these technologies. Although survey data reveals that there is a lack of awareness among the public, consumers are receptive to this concept, especially when a physician recommends it. Key issues in adopting PHRs and strategies for successful implementation of PHRs are discussed.
First generation enterprise application integration (hereinafter, "EAl") focused on data integration and stressed on converting data between disparate formats. Then enterprises looked for integrating packages at the application level. That led to brittle and point-to-point connections between the applications allowing them to share information with other systems inside or outside of the organization. This information oriented point-to-point application integration has been quite popular for some time before the enterprises understood the importance of business processes to sustain continuous growth and profit in extremely tough market conditions. To align the business vision of an organization with the business processes, software architects are looking at the application integration at a higher level of abstraction called enterprises business process integration. This model allows the exchange of information between the applications as a part of a business process which is controlled by a business process management (hereinafter, "BPM") package. This paper discusses about the issues involved with traditional EAI approaches and how business process integration (hereinafter, "BPI") can overcome these issues. It presents an architectural approach to the business process integration that highlights the ideal integration methodologies for applications both inside and outside of the organization leveraging the latest technologies like Web services and XML messaging.
Solutions based on service-oriented architectures are promising in that they leverage common services and enable collaborative business processes that cross organizational boundaries. However, because Web services applications can span multiple hosts, operating systems, languages, and enterprises, it's problematic to measure, control, and manage application availability and performance. In addition to discussing the relationship of Web services management to traditional distributed systems management, this survey explores various Web services management approaches and their underlying architectural concepts.
This paper presents a set of tools and techniques for analyzing interactions of composite web services which are specified in BPEL and communicate through asynchronous XML messages. We model the interactions of composite web services as conversations, the global sequence of messages exchanged by the web services. As opposed to earlier work, our tool-set handles rich data manipulation via XPath expressions. This allows us to verify designs at a more detailed level and check properties about message content. We present a framework where BPEL specifications of web services are translated to an intermediate representation, followed by the translation of the intermediate representation to a verification language. As an intermediate representation we use guarded automata augmented with unbounded queues for incoming messages, where the guards are expressed as XPath expressions. As the target verification language we use Promela, input language of the model checker SPIN. Since SPIN model checker is a finite-state verification tool we can only achieve partial verification by fixing the sizes of the input queues in the translation. We propose the concept of synchronizability to address this problem. We show that if a composite web service is synchronizable, then its conversation set remains same when asynchronous communication is replaced with synchronous communication. We give a set of su#cient conditions that guarantee synchronizability and that can be checked statically. Based on our synchronizability results, we show that a large class of composite web services with unbounded input queues can be completely verified using a finite state model checker such as SPIN.
Business Process Management (BPM) includes methods, techniques, and tools to support the design, enactment, management, and analysis of operational business processes. It can be considered as an extension of classical Workflow Management (WFM) systems and approaches. Although the practical relevance of BPM is undisputed, a clear definition of BPM and related acronyms such as BAM, BPA, and STP are missing. Moreover, a clear scientific foundation is missing. In this paper, we try to demystify the acronyms in this domain, describe the state-of-the-art technology, and argue that BPM could benefit from formal methods/languages (cf. Petri nets, process algebras, etc.).
IHE based interoperability -benefits and chal-lenges. The XXIst International Congress of the European Feder-ation for
- F Wozak
- E Ammenwerth
- A Horbst
- P Sogner
- R Mair
- T Schabetsberger
Wozak, F., Ammenwerth, E., Horbst, A., Sogner, P., Mair, R., and Schabetsberger, T. IHE based interoperability -benefits and chal-lenges. The XXIst International Congress of the European Feder-ation for Medical Informatics (MIE 2008); 2008 May 25–28;
Retrieve Information for Display (RID)
- Ihe
eHealth in 2010: realising a knowledge-based approach to healthcare in the EU. European Commission Directorate-General Joint Research Centre
- M Cabrera
- J Burgelmen
- M Boden
- O Da Costa
- C Rodriguez
Digital imaging and communication in medicine
- Dicom
Connecting for Health (2003) The personal health working group final report
- M Foundation
Patient Care Coordination - Cross-Enterprise Sharing of Medical Summaries (XDS-MS) Technical Framework Supplement
- Ihe
Personal health records: key adoption issues and implications for management
- M S Raisinghani
- MS Raisinghani
Patient Care Coordination Technical Framwork (PCC-TF)
- Ihe