ReactiveFnJ: A Choreographed Model for Fork-Join Workflow in Serverless Computing

Function-as-a-Service (FaaS) is an event-based reactive programming model where functions run in ephemeral stateless containers for short duration. For building complex serverless applications, function composition is crucial to coordinate and synchronize the workflow of an application. Some serverless orchestration systems exist, but they are in their primitive state and do not provide inherent support for non-trivial workflows like, Fork-Join. To address this gap, we propose a fully serverless and scalable design model ReactiveFnJ for Fork-Join workflow. The intent of this work is to illustrate a design which is completely choreographed, reactive, asynchronous, and represents a dynamic composition model for serverless applications. Our design uses two innovative patterns, namely, Relay Composition and Master-Worker Composition to solve execution time-out challenges. As a Proof-of-Concept (PoC), the prototypical implementation of Split-Sort-Merge use case, based on Fork-Join workflow is discussed and evaluated. The ReactiveFnJ handles embarrassingly parallel computations, and its design does not depend on any external orchestration services, messaging services, and queue services. ReactiveFnJ facilitates in designing fully automated pipelines for distributed data processing systems, satisfying the Serverless Trilemma in true essence. A file of any size can be processed using our effective and extensible design without facing execution time-out challenges. The proposed model is generic and can be applied to a wide range of serverless applications that are based on the Fork-Join workflow pattern. It fosters the choreographed serverless composition for complex workflows. The proposed design model is useful for software engineers and developers in industry and commercial organizations, total solution vendors and academic researchers.

Data Stream Harmonization For Heterogeneous Workflows

Transport infrastructure relies heavily on extended multi sensor networks and data streams to support its advanced real time monitoring and decision making. All relevant stakeholders are highly concerned on how travel patterns, infrastructure capacity and other internal / external factors (such as weather) affect, deteriorate or improve performance. Usually new network infrastructure can be remarkably expensive to build thus the focus is constantly in improving existing workflows, reduce overheads and enforce lean processes. We propose suitable graph-based workflow monitoring met­hods for developing efficient performance measures for the rail industry using extensive business process workflow pattern analysis based on Case-based Reasoning (CBR) combined with standard Data Mining methods. The approach focuses on both data preparation, cleaning and workflow integration of real network data. Preliminary results of this work are promising since workflow integration seems efficient against data complexity and domain peculiarities as well as scale on demand whilst demonstrating efficient accuracy. A number of modelling experiments are presented, that show that the approach proposed here can provide a sound basis for the effective and useful analysis of operational sensor data from train Journeys.

Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

Objectives We characterize physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) are explored within the context of organizational complexity for the delivery of care. Methods Two urban clinical sites, including an academic teaching ED, were selected. Fourteen physicians were recruited. Overall, 62 hours of direct clinical observations were conducted characterizing clinical activities (EHR use, team communication, and patient care). Data were analyzed using qualitative open-coding techniques and descriptive statistics. Timeline belts were used to represent temporal events. Results At site 1, physicians, engaged in more team communication, followed by direct patient care. Although physicians spent 61% of their clinical time at workstations, only 25% was spent on the EHR, primarily for clinical documentation and review. Site 2 physicians engaged primarily in direct patient care spending 52% of their time at a workstation, and 31% dedicated to EHRs, focused on chart review. At site 1, physicians showed nonlinear complex workflow patterns with a greater frequency of multitasking and interruptions, resulting in workflow fragmentation. In comparison, at site 2, a less complex environment with a unique patient assignment system, resulting in a more linear workflow pattern. Conclusion The nature of the clinical practice and EHR-mediated workflow reflects the ED work practices. Physicians in more complex organizations may be less efficient because of the fragmented workflow. However, these effects can be mitigated by effort distribution through team communication, which affords inherent safety checks.

Mitigating the impact of COVID-19 on oncology services in low- and middle-income countries: a pragmatic approach

The rapid spread of COVID-19 has caused massive mortality worldwide. Healthcare systems are presently being put in jeopardy as they are stretched to their maximum capacity. Oncology patients are at an increased risk, not only because of their compromised immunity, but also because of the possibility that their cancer will progress from early stage to advanced stage as a result of delays to their treatment. Advanced age and comorbidities further add to the risks associated with COVID-19, especially in patients undergoing radiation or chemotherapy. Since prompt treatment is important for patients with cancer, strategies to curtail the infection rate without treatment interruptions are urgently needed. This article presents and explains the workflow pattern followed in an oncology ward, as well as the strategies and interventions adopted to mitigate the impact of the COVID-19 pandemic on oncology patients.

Variation in Electronic Health Record Workflow Patterns: A Multisite study

Objectives Electronic health records (EHRs) continue to have significant usability challenges in part due to differences in workflow. The objective of this study was to examine workflow pattern variations for one specific task: emergency physicians placing a magnetic resonance imaging (MRI) order. Methods A between-subjects usability study was conducted using two different major EHR vendor products across four different provider sites (n = 55). A clinical scenario concerning for spinal cord compression was read to participants who then completed an ordering task using a training environment representative of their native EHR. The primary outcome measures were accuracy, time on task, and number of clicks. Results We identified four different workflows to complete the same order. One workflow required two steps (enabled at one site), one workflow required four steps (enabled at two sites), and two workflows required six steps to complete the task (available at all sites). Of the 12 physicians who employed the two-step workflow, 8 (67%) had the correct order and correct indication, the average time on task was 29.65 (standard deviation [SD] = 13.77), and the mean number of clicks was 13.5 (SD = 18.87). In contrast, for the 43 physicians who employed other workflows, 7 (21%) had the correct order and correct indication, with the average time on task of 73.1 (SD = 30.12) and mean clicks of 27.64 (SD = 13.25) (p < 0.01 for all three comparisons). Discussion These different approaches were made possible by technical specifications leading to multiple workflow options available to physicians in the EHR environment. EHR design maximizing usability can reduce the work effort and improve the accuracy of physician ordering.

Setting Up Workflow of an Intraoperative MRI Unit: A Single-Centre Experience of First 53 Cases

Background Setting up of a new “nearby” operation room type intraoperative magnetic resonance imaging (iMRI) unit poses a unique set of challenges to the operating team. We describe here an account of our experiences and a step by step protocol designed by us and followed to troubleshoot the issues encountered. The primary objective of the study was to observe our learning curve in the process of setting up of a new iMRI unit. The secondary objectives were to look at the number of residues detected, quality of imaging, and complications during iMRI. Materials and Methods An observational study was conducted over a 3-month period involving cases requiring iMRI. Initially, a simulation was performed using healthy volunteers, which helped in developing a systematic protocol and drafting checklists to ensure a smooth workflow pattern. Data collection included details regarding hindrances encountered, how these were tackled, iMRI details (residual tumor, re-surgery), and complications, if any. Results A total of 53 cases underwent iMRI in the study period. Among these, 51 were tumor cases that revealed residue (detected in 28 [54.9%] cases), and re-surgery for further resection was performed in 21/28 (75%) cases. A very high level of surgeons’ satisfaction regarding image quality of intraoperative scan was recorded (45/53 [84%]). The number of personnel required for shifting and shifting times could be reduced with efficient utilization of the checklist. Conclusion A methodical approach to tackle impediments while setting up a new unit such as iMRI facilitates its smooth functioning and ensures minimal interruptions and evades undue complications.

The myth of standardized workflow in primary care

Objective Primary care efficiency and quality are essential for the nation’s health. The demands on primary care physicians (PCPs) are increasing as healthcare becomes more complex. A more complete understanding of PCP workflow variation is needed to guide future healthcare redesigns. Methods This analysis evaluates workflow variation in terms of the sequence of tasks performed during patient visits. Two patient visits from 10 PCPs from 10 different United States Midwestern primary care clinics were analyzed to determine physician workflow. Tasks and the progressive sequence of those tasks were observed, documented, and coded by task category using a PCP task list. Variations in the sequence and prevalence of tasks at each stage of the primary care visit were assessed considering the physician, the patient, the visit’s progression, and the presence of an electronic health record (EHR) at the clinic. Results PCP workflow during patient visits varies significantly, even for an individual physician, with no single or even common workflow pattern being present. The prevalence of specific tasks shifts significantly as primary care visits progress to their conclusion but, notably, PCPs collect patient information throughout the visit. Discussion PCP workflows were unpredictable during face-to-face patient visits. Workflow emerges as the result of a “dance” between physician and patient as their separate agendas are addressed, a side effect of patient-centered practice. Conclusions Future healthcare redesigns should support a wide variety of task sequences to deliver high-quality primary care. The development of tools such as electronic health records must be based on the realities of primary care visits if they are to successfully support a PCP’s mental and physical work, resulting in effective, safe, and efficient primary care.