How workflow management systems enable the achievement of value driven healthcare delivery

Workflow in clinical trial sites & its association with near miss events for data quality: ethnographic, workflow & systems simulation

BACKGROUND

With the exponential expansion of clinical trials conducted in (Brazil, Russia, India, and China) and VISTA (Vietnam, Indonesia, South Africa, Turkey, and Argentina) countries, corresponding gains in cost and enrolment efficiency quickly outpace the consonant metrics in traditional countries in North America and European Union. However, questions still remain regarding the quality of data being collected in these countries. We used ethnographic, mapping and computer simulation studies to identify/address areas of threat to near miss events for data quality in two cancer trial sites in Brazil.

METHODOLOGY/PRINCIPAL FINDINGS

Two sites in Sao Paolo and Rio Janeiro were evaluated using ethnographic observations of workflow during subject enrolment and data collection. Emerging themes related to threats to near miss events for data quality were derived from observations. They were then transformed into workflows using UML-AD and modeled using System Dynamics. 139 tasks were observed and mapped through the ethnographic study. The UML-AD detected four major activities in the workflow evaluation of potential research subjects prior to signature of informed consent, visit to obtain subject́s informed consent, regular data collection sessions following study protocol and closure of study protocol for a given project. Field observations pointed to three major emerging themes: (a) lack of standardized process for data registration at source document, (b) multiplicity of data repositories and (c) scarcity of decision support systems at the point of research intervention. Simulation with policy model demonstrates a reduction of the rework problem.

CONCLUSIONS/SIGNIFICANCE

Patterns of threats to data quality at the two sites were similar to the threats reported in the literature for American sites. The clinical trial site managers need to reorganize staff workflow by using information technology more efficiently, establish new standard procedures and manage professionals to reduce near miss events and save time/cost. Clinical trial sponsors should improve relevant support systems.

A technology ecosystem perspective on hospital management information systems: lessons from the health literature

Hospital managers have a large range of information needs including quality metrics, financial reports, access information needs, educational, resourcing and decision support needs. Currently these needs involve interactions by managers with numerous disparate systems, both electronic such as SAP, Oracle Financials, PAS' (patient administration systems) like HOMER, and relevant websites; and paper-based systems. Hospital management information systems (HMIS) can be thought of sitting within a Technology Ecosystem (TE). In addition, Hospital Management Information Systems (HMIS) could benefit from a broader and deeper TE model, and the HMIS environment may in fact represents its own TE (the HMTE). This research will examine lessons from the health literature in relation to some of these issues, and propose an extension to the base model of a TE.

The role of medicinal ontologies in querying and exchanging pharmaceutical information

The technology developed for interoperable autonomous systems has significantly changed during the past few years. In particular, XML is rapidly becoming the key standard for data representation and transportation. However, the introduction of XML is not enough but many other XML-based technologies have to be deployed in order to achieve a seamless interoperability between the organisations of the healthcare sector. In this article we have restricted ourselves on electronic prescription systems and on the chances that Semantic Web technologies can provide. In particular, we report our work on medicinal ontologies and how they can be exploited (i) in providing querying facilities on electronic prescriptions and (ii) in achieving semantic interoperability between medicinal information systems. Especially, we introduced our adopted RDF-based messaging and show its gains over XML-based messaging.