Integrated Digital Health Systems Design

2011 ◽  
pp. 585-604
Author(s):  
Wullianallur Raghupathi ◽  
Amjad Umar
Keyword(s):  
Health Systems ◽  
Service Oriented Architecture ◽  
Digital Health ◽  
Healthcare Delivery ◽  
Systems Design ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Soft Systems Methodology ◽  
Soft Systems ◽  
Service Oriented

The application of information technology in healthcare has focused primarily on the implementation of specific systems such as electronic health records (EHRs) and clinical decision support systems (CDSSs), mainly for intra-enterprise use. However, for the integrated health system (IHS) to function effectively in a complex inter-enterprise healthcare delivery environment, designers must focus on approaches such as soft systems methodology (SSM) to enable the design of robust integrated digital health systems (IDHSs). A service-oriented architecture (SOA) offers a flexible framework for IDHSs to become de-centralized, fully functional and modular systems with interoperability. This article identifies the design issues in IDHS and explores the potential of an SSM methodology-based SOA for the development of interoperable IDHSs. In the process we compare and contrast the functionalist socio-technical approach to the interpretive SSM. We also describe a prototype SOA application for an IDHS setting and discuss challenges in the application of SOA to healthcare.

DESIGN OF DECOUPLED CLINICAL DECISION SUPPORT FOR SERVICE-ORIENTED ARCHITECTURES

2009 ◽  
Vol 19 (02) ◽  
pp. 159-183 ◽  
Author(s):  
JENS WEBER-JAHNKE
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Service Oriented Architecture ◽  
Empirical Evaluation ◽  
Cost Savings ◽  
Clinical Decision ◽  
Service Oriented Architectures ◽  
Distributed Services ◽  
Service Oriented ◽  
Computer Based

Computer-based clinical decision support (CDS) contributes to cost savings, increased patient safety and quality of medical care. Most existing CDS systems are stand-alone products (first generation) or part of complete electronic medical record packages (second generation). Experience shows that creating and maintaining CDS systems is expensive and requires effort that should be economized by sharing them among multiple users. It makes good economic sense to share CDS service installations among a larger set of client systems. The paradigm of a service-oriented architecture (SOA) embraces this idea of sharing distributed services. Some attempts making CDS services available to distributed health information systems exist. However, these approaches have not gained much adoption. We argue that they do not provide a sufficient level of decoupling between client and CDS in order to be broadly reusable in SOAs. In this paper, we present a new CDS service component called EGADSS, which has been designed and implemented with the declared objective to minimize the coupling between client and CDS server. We present our key design decisions, which are guided by empirical research in SOA development. We evaluate our result theoretically by measuring the level of decoupling achieved compared to existing CDS approaches. Furthermore, we report on an empirical evaluation of the resulting design, integrating the EGADSS service with an example client system.

scholarly journals Analysis of Legal and Regulatory Frameworks in Digital Health: A Comparison of Guidelines and Approaches in the European Union and United States

2020 ◽  
Vol 8 ◽  
Author(s):  
Fara Aninha Fernandes ◽  
Georgi V Chaltikyan
Keyword(s):  
United States ◽  
European Union ◽  
Digital Health ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
The European Union ◽  
Regulatory Pathways ◽  
Regulatory Frameworks ◽  
The Impact ◽  
Regulatory Landscape

The advent of digital technology in healthcare presents opportunities for the improvement of healthcare systems around the world and the move towards value-based treatment. However, this move must be accompanied by strong legal and regulatory frameworks that will not only facilitate but encourage the good use of technology. The goal of the study was to assess the amenability and furtherance of regulatory frameworks in digital health by evaluating and comparing the processes, effectiveness and outcomes of these frameworks in the European Union and United States. Methods: This study incorporated two research methodologies. The first was a research of current legal and regulatory frameworks in digital health in the European Union and United States. A comprehensive online search for publications was carried out which included laws, regulations, policies, green papers, guidelines and recommendations. This research was complemented with interviews of five purposively sampled key informants in the legal and regulatory landscape. Results: Mind-maps revealed key features and challenges of the digital health field in the topics of the current state of regulation of digital health in the EU, Germany and US, regulatory pathways for digital health devices, protection and privacy of health data, mobile health validation, risk-based classification of medical devices, regulation of clinical decision support systems, telemedicine, artificial intelligence and emerging technologies, reimbursement for digital health services and liability for digital health products. The experts expressed and explained key points where current regulation is deficient. The review of the legal frameworks revealed deficiencies which provide opportunities and recommendations to further develop and strengthen the regulatory landscape. Conclusions: A key element to a robust regulatory framework is the ability to ensure trust and confidence in using digital health technology. Technology must measure the impact on quality of life and burden of disease and not merely involve the collection of data.

Critical Issues in Mobile Solution-Based Clinical Decision Support Systems

2021 ◽  
pp. 32-45
Author(s):  
Nalika Ulapane ◽  
Nilmini Wickramasinghe
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Support Systems ◽  
Digital Health ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Primary Objective ◽  
Critical Issues

The use of mobile solutions for clinical decision support is still a rather nascent area within digital health. Shedding light on this important application of mobile technology, this chapter presents the initial findings of a scoping review. The review's primary objective is to identify the state of the art of mobile solution based clinical decision support systems and the persisting critical issues. The authors contribute by classifying identified critical issues into two matrices. Firstly, the issues are classified according to a matrix the authors developed, to be indicative of the stage (or timing) at which the issues occur along the timeline of mobile solution development. This classification includes the three classes: issues persisting at the (1) stage of developing mobile solutions, (2) stage of evaluating developed solutions, and (3) stage of adoption of developed solutions. Secondly, the authors present a classification of the same issues according to a standard socio-technical matrix containing the three classes: (1) technological, (2) process, and (3) people issues.

scholarly journals Accounting And Economic Implications Of Healthcare Information Technology

2011 ◽  
Vol 6 (7) ◽  
Author(s):  
Paul J. Carruth ◽  
Ann K. Carruth
Keyword(s):  
Information Technology ◽  
Healthcare Delivery ◽  
Medical Knowledge ◽  
Clinical Decision Support Systems ◽  
Population Level ◽  
Clinical Decision ◽  
Healthcare Information Technology ◽  
Healthcare Information ◽  
Economic Implications

There is a growing consensus that interoperability of health care technology is greatly needed so that data can be effectively and accurately exchanged across provider groups and organizations to provide quality healthcare while reducing the cost of healthcare delivery. Benefits are expected for physician groups, organizations, and patients.  Perhaps most exciting is the opportunity for integrated patient and population level data leading to clinical decision support systems which assist with the management of patients by integrating medical knowledge with patient characteristics and generating computer based reminders, alerts, and guidelines.  While research supports a multitude of benefits, challenges exist that require long-term commitment before the reality of an integrated healthcare information technology will exist. This article explores the benefits, the barriers, and the long term impact of Healthcare Information Technology on future healthcare delivery systems.

scholarly journals Decentralized Digital Health Services Caught Between the Pressure for Innovation and the Burden of Regulations

2021 ◽  
Author(s):  
Lea Meier ◽  
Kevin Tippenhauer ◽  
Murat Sariyar
Keyword(s):  
Decision Support ◽  
Health Services ◽  
Digital Health ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Support Service ◽  
Third Party ◽  
Trade Offs ◽  
External Software ◽  
Multiple Challenges

Multiple challenges await third-party digital health services when trying to enter the health market. Prominent examples of such services are clinical decision support systems provided as external software. Uncertainty about their challenges, technical as well as legal, pose serious hurdles for many innovations to be adopted early on. There are many options and trade-offs to provide digital healthcare solutions as a third-party service. This paper discusses them by referring to a pharmacogenetic decision support service. By providing best-practices, scenario descriptions and templates designed for third-party services with respect to legal and technical issues, obstacles and uncertainties can be reduced, which will have an impact on better diagnoses and treatments in the healthcare system.

Principles of information systems design for creation of thematic services based on integrated use of ground-aerospace data and modeling results

2020 ◽  
Vol 5 ◽  
pp. 163-168
Author(s):  
V.A. Zelentsov ◽  
◽  
A.S. Semenov
Keyword(s):  
Information Technologies ◽  
Service Oriented Architecture ◽  
High Reliability ◽  
Systems Design ◽  
Remote Sensing Data ◽  
User Friendliness ◽  
Systems Implementation ◽  
Service Oriented ◽  
Business Process Execution ◽  
Interdisciplinary Projects

The paper describes an architecture and examples of information technologies and systems implementation for automating interdisciplinary projects accomplishment and creating thematic services that require utilizing Earth remote sensing data. It is proposed using approaches based on a service-oriented architecture, web services technologies, and technologies based on the Business Process Execution Language to organize the interaction of system components. Testing results show that the proposed approaches ensure achieving maximum automation of systems running, high reliability of the results, and user friendliness.

A Highly-Interactive and User-Friendly PHR Application for the Provision of Homecare Services

2011 ◽  
pp. 197-217 ◽  
Author(s):  
Vasso Koufi ◽  
Flora Malamateniou ◽  
George Vassilacopoulos
Keyword(s):  
Healthcare Professionals ◽  
Service Oriented Architecture ◽  
Treatment Plan ◽  
Personal Health Record ◽  
Healthcare Delivery ◽  
Quality Of Healthcare ◽  
Technological Infrastructure ◽  
Service Oriented ◽  
User Friendly

Homecare is an important component of the continuum of care as it provides the potential to improve quality of life and quality of healthcare delivery while containing costs. Personal Health Record (PHR) systems constitute a technological infrastructure that can support greater flexibility for healthcare professionals and patients, thus allowing for more effective homecare services. In particular, PHRs are intended to reach patients outside of care settings, influence their behaviors and satisfy their demand for greater information and access. Moreover, PHRs can facilitate access to comprehensive real-time patient data for healthcare professionals thus enabling them to identify problems quickly (e.g. prior to scheduled appointments) and steer patients to appropriate facilities when needed. To this ends, PHR technology needs to evolve well beyond providing a consolidated patient record, in ways that make it more widely applicable and valuable to health systems. The development of applications and tools on top of PHR systems can allow the PHR to function as a platform for both patients and healthcare professionals to exchange information and interact with the health system (e.g., scheduling appointments electronically). This chapter presents a prototype PHR-based system that aims at supporting chronic disease management. In particular, it assists healthcare professionals in assessing an individual’s condition and in forming the appropriate treatment plan for him/her while it provides individuals with a user-friendly application for step-to-step guidance to their treatment plans. The system has been developed on the grounds of a service-oriented architecture where healthcare process automation is realized by means of dynamic, patient-related workflows.

OP199 From Pilot Studies To System-Wide Innovation: Challenges And Opportunities For Clinical Decision Support Systems (CDSS) Implementation In Australia

2021 ◽  
Vol 37 (S1) ◽  
pp. 5-6
Author(s):  
Mah Laka ◽  
Adriana Milazzo ◽  
Drew Carter ◽  
Tracy Merlin
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Clinical Decision Making ◽  
Support Systems ◽  
Digital Health ◽  
National Level ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Policy Framework

IntroductionThe clinical data is increasing at a considerably higher rate than the capacity of the healthcare system and clinicians to manage this data. Digital tools such as clinical decision support systems (CDSS) provide opportunities for evidence-based patient care by intelligently filtering and presenting the information required for clinical decision making at the point of care. Despite the success of pilot projects, CDSS have had limited implementation in broader health systems. We aimed to identify challenges faced by policymakers for CDSS implementation and to provide policy recommendations.MethodsWe conducted eleven semi-structured interviews with Australian policymakers from state and national committees involved in digital health activities. The data were analyzed using reflexive thematic analysis to identify policy priorities.ResultsOur findings indicate that fragmentation of care processes and structures in the digital health ecosystem is one of the main impediments to delivering coordinated care using CDSS. Five themes for policy action were identified: (i) establishing a shared conceptual framework for user-centered design of CDSS that is aligned with stakeholders’ priorities, (ii) maintaining the right balance between the customization and standardization of systems, (iii) developing mutually agreed semantic interoperability standards at the local, state and national level, allowing generation and exchange of information across the health system without changing its context and meaning, (iv) reorienting organizational structures to build capacity to foster change, and (v) developing collaborative care models to avoid conflicting interests between stakeholders.ConclusionsFindings highlight the importance of developing system-wide guidance to establish a clear vision for CDSS implementation and alignment of organizational processes across all levels of health care. There is a need to build a shared policy framework for modelling the innovative activities such as CDSS implementation across the digital health landscape which minimizes the operational and strategic fragmentation of different organizations.

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