Richard Lenz

IT support for healthcare processes - premises, challenges, perspectives

Healthcare processes require the cooperation of different organizational units and medical disciplines. In such an environment optimal process support becomes crucial. Though healthcare processes frequently change, and therefore the separation of the flow logic from the application code seems to be promising, workflow technology has not yet been broadly used in healthcare environments. In this paper we elaborate both the potential and the essential limitations of IT support for healthcare processes. We identify different levels of process support in healthcare, and distinguish between organizational processes and the medical treatment process. To recognize the limitations of IT support we adopt a broad socio-technical perspective based on scientific literature and personal experience. Despite of the limitations we identified, undeniably, IT has a huge potential to improve healthcare quality which has not been explored by current IT solutions. In particular, we indicate how advanced process management technology can improve IT support for healthcare processes.

A Practical Approach to Process Support in Health Information Systems

This article describes the design of a generator tool for rapid application development. The generator tool is an integral part of a healthcare information system, and newly developed applications are embedded into the healthcare information system from the very beginning. The tool-generated applications are based on a document oriented user interaction paradigm. A significant feature is the support of intra- and interdepartmental clinical processes by means of providing document flow between different user groups. For flexible storage of newly developed applications, a generic EAV-type (Entity-Attribute-Value) database schema is used. Important aspects of a consequent implementation, like database representation of structured documents, document flow, versioning, and synchronization are presented. Applications generated by this approach are in routine use in more than 200 hospitals in Germany.

IT support for healthcare processes

Patient treatment processes require the cooperation of different organizational units and medical disciplines. In such an environment an optimal process support becomes crucial. Though healthcare processes frequently change, and therefore the separation of the flow logic from the application code seems to be promising, workflow management technology has not yet been broadly used in healthcare environments. In this paper we discuss why it is difficult to adequately support patient treatment processes by IT systems and which challenges exist in this context. We identify different levels of process support and distinguish between generic process patterns and medical guidelines / pathways. While the former shall help to coordinate the healthcare process among different people and organizational units (e.g., the handling of a medical order), the latter are linked to medical treatment processes. Altogether there is a huge potential regarding the IT support of healthcare processes.

Towards a flexible, process-oriented IT architecture for an integrated healthcare network

Healthcare information systems play an important role in improving healthcare quality. As providing healthcare increasingly changes from isolated treatment episodes towards a continuous medical process involving multiple healthcare professionals and institutions, there is an obvious need for an information system to support processes and span the whole healthcare network. A suitable architecture for such an information system must take into account that it has to work as an integral part of a complex socio-technical system with changing conditions and requirements. We have surveyed the core requirements of healthcare professionals and analysed the literature for known problems and information needs. We consolidated the results to define use cases for an integrated information system as communication patterns, from which general implications on the required properties of a helathcare network information system could be derived. Key issues are flexibility, adaptability, robustness, integration of existing systems and standards, semantic compatibility, security and process orientation. Based on these results an IT architecture is being designed that is capable of addressing the requirements mostly on the basis of well-established standards and concepts.

Research: Communication support for cooperative work

Desktop conferencing and distributed graphical editing applications allow people to perform cooperative work regardless of their geographic location. One such example is the CoDraft application presented here. This collaborative system allows concurrent sketching on a shared drawing board. The current version is implemented on top of point-to-point communication services. It is shown that these services are not well suited for cooperative applications. Therefore, a multiparty communication platform is proposed that manages groups of application instances and multicast messages, handles group voting and transfers files to more than one target site at a time. This platform greatly simplifies the development of cooperative applications. Additionally, the platform allows the lower-level multicast functionality to be more fully exploited, thus improving response time and throughput performance.

Informationsintegration in Gesundheitsversorgungsnetzen

Informationssysteme sind im Gesundheitswesen von hoher Bedeutung, und aktuelle gesundheitspolitische Entwicklungen forcieren ihren Ausbau.

Report of conference track 2: pathways to open architectures

The goal of open architectures is to establish the conditions for building coherent and comprehensive systems out of components and to minimize the effort needed to integrate different components. Yet, it has become apparent that there are different perceptions concerning the notion of a ‘component’, especially in terms of granularity and scope. There are also different views concerning the desirable degree of autonomy of a component. With respect to the requirement that a component should be substitutable, an inclusive definition would consider a component as ‘an element of the health information system (HIS) that can be replaced by another element without strongly affecting the rest of the system, provided that it has the same technical , syntactical and semantic interface and the same dependencies ’. This pragmatic definition recognizes that the interchangeability of components can range from ‘plug-and-play’ to ‘modify-and-reuse’. 2. Building a component-based HIS

Adaptive distributed data management with weak consistent replicated data

The intention of this paper is to suggest a novel concept for distributed data management that allows a flexible adaptation to application needs. The basic idea is to improve data availability and performance of read operations by weak consistent data replication according to the need-to-know principle. Need-to-know means that data only have to be made available where they are needed and only as current and consistent as required by the applications that access these data. This in turn requires to provide means to specify the needs of the applications. ASPECT A(.A_pplication-oriented SPEcification of Consistency Terms) is such a technique that allows to specify weak consistency requirements from an applications point of view. This paper summarizes the motivation and key concepts of ASPECT and details the concept of consistency islands. The consistency island for a certain data item is a set of consistent replicas, which changes its structure over time according to application needs. The consistency island is used to synchronize updates and though it is not bound to a certain copy it behaves like a primary copy, which ensures convergence of replicas. The dynamic and adaptive structure of the consistency island, however enables an increase of performance and higher availability compared to traditional replica-ton approaches.

α− Flow: A Document-Based Approach to Inter-institutional Process Support in Healthcare

Inter-institutional collaboration requires clean task boundaries and the separation of responsibilities. In addition, healthcare processes are intrinsically fluid. Traditional activity-oriented workflow models or content-oriented workflow models do not provide adequate support for the paper-based working practice in healthcare. The α-flow approach adopts electronic documents as the primary means of information ex-change, fusing both paradigms into a combined workflow schema model, wherein workflow schemas are represented as documents which are shared coequally to content documents.

A mediated publish-subscribe system for inter-institutional process support in healthcare

Inadequate availability of patient information is a major cause for medical errors and affects costs in healthcare. Traditional information integration in healthcare does not solve the problem. For chronic diseases and multimorbidity, the significance of patient information availability is yet increasing. Applying a document-oriented paradigm to a mediated publish-subscribe infrastructure allows to foster inter-institutional information exchange in healthcare. The goal of the proposed architecture is to provide information exchange between strict autonomous healthcare institutions, bridging the gap between primary and secondary care, following traditional paper-based working practice. In a distributed healthcare scenario, the patient has to maintain sovereignty over any personal health information. Therefore, the proposed mediated publish-subscribe architecture essentially decouples the roles of information author and information publisher into distinct actors.