Weizi Li

Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

Knowledge-based clinical pathway for medical quality improvement

Clinical pathways have been adopted for various diseases in clinical departments for quality improvement as a result of standardization of medical activities in treatment process. Using knowledge-based decision support on the basis of clinical pathways is a promising strategy to improve medical quality effectively. However, the clinical pathway knowledge has not been fully integrated into treatment process and thus cannot provide comprehensive support to the actual work practice. Therefore this paper proposes a knowledge-based clinical pathway management method which contributes to make use of clinical knowledge to support and optimize medical practice. We have developed a knowledge-based clinical pathway management system to demonstrate how the clinical pathway knowledge comprehensively supports the treatment process. The experiences from the use of this system show that the treatment quality can be effectively improved by the extracted and classified clinical pathway knowledge, seamless integration of patient-specific clinical pathway recommendations with medical tasks and the evaluating pathway deviations for optimization.

Adaptive Requirement-Driven Architecture for Integrated Healthcare Systems

In order to improve the quality of healthcare services, large-scale medical information systems should be integrated with adaptability in response to the changing medical environment. In this paper, we propose a requirement-driven architecture for healthcare information systems that will be able to respond to new requirements. The system operates through the mapping mechanism between these layers and thus can organize functions dynamically adapting to user’s requirement. Furthermore, we introduce the organizational semiotics methods to capture and analyze user’s requirement through ontology chart and norms. Based on these results, the structure of user’s requirement pattern (URP) is established as the driving factor of our system. Finally, we propose an integration framework for data sharing amongst different hospital organizations and also present the HL7 based virtual database to realize the data integration. Our research makes a contribution to the design and implementation of the architecture of healthcare systems which can adapt to the changing medical environment.

A Semiotic Multi-Agent Modeling Approach for Clinical Pathway Management

Clinical pathway (CP) is the standard way to manage medical activities in order to improve the efficiency and minimize the cost of healthcare service. However current application of CPs can hardly adapt to the dynamic and complex clinical processes which involve the coordination of social agents in hospital. This paper focuses on developing a multi-agent modeling method to build up the system that can increase the execution efficiency of clinical pathway. In particular, we present a semiotic approach to analyze the requirement of clinical pathway. Furthermore we describe how the EDA (Epistemic, Deontic, and Axiological) agent and the negotiation model are realized and applied to support the clinical pathway management. Finally, the clinical pathway of breast cancer is presented to demonstrate our methods

Pragmatic Oriented Data Interoperability for Smart Healthcare Information Systems

Smart healthcare is a complex domain for systems integration due to human and technical factors and heterogeneous data sources involved. As a part of smart city, it is such a complex area where clinical functions require smartness of multi-systems collaborations for effective communications among departments, and radiology is one of the areas highly relies on intelligent information integration and communication. Therefore, it faces many challenges regarding integration and its interoperability such as information collision, heterogeneous data sources, policy obstacles, and procedure mismanagement. The purpose of this study is to conduct an analysis of data, semantic, and pragmatic interoperability of systems integration in radiology department, and to develop a pragmatic interoperability framework for guiding the integration. We select an on-going project at a local hospital for undertaking our case study. The project is to achieve data sharing and interoperability among Radiology Information Systems (RIS), Electronic Patient Record (EPR), and Picture Archiving and Communication Systems (PACS). Qualitative data collection and analysis methods are used. The data sources consisted of documentation including publications and internal working papers, one year of non-participant observations and 37 interviews with radiologists, clinicians, directors of IT services, referring clinicians, radiographers, receptionists and secretary. We identified four primary phases of data analysis process for the case study: requirements and barriers identification, integration approach, interoperability measurements, and knowledge foundations. Each phase is discussed and supported by qualitative data. Through the analysis we also develop a pragmatic interoperability framework that summaries the empirical findings and proposes recommendations for guiding the integration in the radiology context.

Normative Modeling for Personalized Clinical Pathway Using Organizational Semiotics Methods

Clinical pathways are widely adopted by many large hospitals around the world in order to provide high-quality patient treatment and reduce the length and cost of hospital stay. However, nowadays most of them are static and non-personalized. Our objective is to capture and represent clinical pathway using organizational semiotics method including Semantic Analysis which determines semantic units in clinical pathway, their relationship and their patterns of behavior, and Norm Analysis which extracts and specifies the norms that establish how and when these medical behaviors will occur. Finally, we propose a method to develop clinical pathway ontology based on the results of Semantic Analysis and Norm analysis. This approach will give a contribution to design personalized clinical pathway by defining a set of possible patterns of behavior and the norms that govern the behavior based on patient¿s condition.

Evaluation Frameworks for Information Systems Integration: From a Semiotic Lens

Information systems integration aims at the interaction, information exchange and interoperability between information systems, devices and units. Research efforts have contributed in evaluation of information systems integration on the development of evaluation frameworks. To improve the usability and measurability of evaluation, a review of existing evaluation frameworks including their evolution and classifications of different interoperability levels is conducted. The theory of organisational semiotics is used for a comparative analysis of the frameworks and future work.

Assessing Pragmatic Interoperability of Information Systems from a Semiotic Perspective

Most of studies on interoperability of systems integration focus on technical and semantic levels, but hardly extend investigations on pragmatic level. Our past work has addressed pragmatic interoperability, which is concerned with the relationship between signs and the potential behaviour and intention of responsible agents. We also define the pragmatic interoperability as a level concerning with the aggregation and optimisation of various business processes for achieving intended purposes of different information systems. This paper, as the extension of our previous research, is to propose an assessment method for measuring pragmatic interoperability of information systems. We firstly propose interoperability analysis framework, which is based on the concept of semiosis. We then develop pragmatic interoperability assessment process from two dimensions including six aspects (informal, formal, technical, substantive, communication, and control). We finally illustrate the assessment process in an example.

e-Leadership through strategic alignment: an empirical study of small- and medium-sized enterprises in the digital age

Small- and medium-sized enterprises (SMEs) play an important role in the European economy. A critical challenge faced by SME leaders, as a consequence of the continuing digital technology revolution, is how to optimally align business strategy with digital technology to fully leverage the potential offered by these technologies in pursuit of longevity and growth. There is a paucity of empirical research examining how e-leadership in SMEs drives successful alignment between business strategy and digital technology fostering longevity and growth. To address this gap, in this paper we develop an empirically derived e-leadership model. Initially we develop a theoretical model of e-leadership drawing on strategic alignment theory. This provides a theoretical foundation on how SMEs can harness digital technology in support of their business strategy enabling sustainable growth. An in-depth empirical study was undertaken interviewing 42 successful European SME leaders to validate, advance and substantiate our theoretically driven model. The outcome of the two stage process – inductive development of a theoretically driven e-leadership model and deductive advancement to develop a complete model through in-depth interviews with successful European SME leaders – is an e-leadership model with specific constructs fostering effective strategic alignment. The resulting diagnostic model enables SME decision makers to exercise effective e-leadership by creating productive alignment between business strategy and digital technology improving longevity and growth prospects.

Assessing Pragmatic Interoperability for Process Alignment in Collaborative Working Environment

This paper is an extension of our previous study on pragmatic interoperability assessment for process alignment. In this study, we conduct four case studies in industrial companies and hospitals in order to gather their viewpoints regarding the concerns when condensing process alignment in a collaborative working environment. Used techniques include interview, observation, and documentation. The collected results firstly are summarised into three layers based on our previous developed pragmatic assessment model, and then are transformed into the elements which constitutes the purposed method, and finally based on the summarised results we purpose a method for assessing pragmatic interoperability for process alignment in collaborative working environment. The method contains two parts: one gives all the elements of pragmatic interoperability that should be concerned when considering process alignment in collaborative working environment, and the other one is a supplementary method for dealing with technical concerns.