L. Hederman

Although clinical practice guidelines (CPGs) have been suggested as a means of encapsulating best practice in evidence-based medical treatment, their usage in clinical environments has been disappointing. Criticisms of guideline representations have been that they are predominantly narrative and are difficult to incorporate into clinical information systems. This paper analyses the use of UML process modelling techniques for guideline representation and proposes the automated generation of executable guidelines using XMI. This hybrid UML-XMI approach provides flexible authoring of guideline decision and control structures whilst integrating appropriate data flow. It also uses an open XMI standard interface to allow the use of authoring tools and process control systems from multiple vendors. The paper first surveys CPG modelling formalisms followed by a brief introduction to process modelling in UMI. Furthermore, the modelling of CPGs in UML is presented leading to a case study of e...

User engagement is often associated with successful information systems implementation, with this being particularly true in developing countries in the Global South. However, the term remains poorly understood with many seemingly conflicting definitions and the term “user engagement” has come to mean a variety of things in the literature. Also, it is unclear at what stage(s) of the design, development, implementation and use phase(s) that user engagement should apply to. This research examines the meaning of user engagement with the objective of bringing some level of clarity to suit the information communication technology for development (ICT4D) context. To this end, we propose an expanded definition of the term user engagement. The research also suggests what stages of the design, development, implementation and use phase of the technology this expanded definition of user engagement most usefully applies to by drawing lessons on user engagement in a variety of mobile health projects from the Global South. Qualitative methods of data analysis were used in collecting data which show that user engagement as applied to a specific phase of each of the projects was essential for the ongoing success of each project.

Despite the significance of user engagement for efficacy of mobile health (mHealth) in the Global South, many such interventions do not include user-engaging attributes. This is because socio-technical aspects are frequently not considered during the design, development, and implementation, stages of such initiatives. In addition, there is little discussion in the literature about the role socio-technical factors play in user-centered design processes for mHealth. This research posits consideration of socio-technical factors is required as techno-centric approaches to mHealth design and user engagement, as well as those relying on existing universal frameworks for user-centered design, have proven to be ineffective with the result that most mHealth projects in the Global South fail to sustain. This research examines projects in Sierra Leone where semi-structured interviews were conducted with mHealth designers and developers in order to explore their attitudes towards user engagemen...

This paper examines how the concepts and designs of workflow management systems and distributed systems management can be integrated and customized to manage open laboratory computing services. The paper outlines the objectives of managing laboratory computing services and identifies techniques and designs which facilitate this management. The paper also outlines the implementation of an open laboratory service management system.

... Posted in: Development Review 2009. Author: Sarah Barry, Lucy Hederman, Malcolm Maclachlan, Eilish McAuliffe, Charles Normand. Organisation Learning And Accountability An Opportunity for an Irish Contribution to Aid Effectiveness.pdf. ...

Background The etiology of ANCA-associated vasculitis (AAV) and triggers of relapse are poorly understood. Vitamin D (vitD) is an important immunomodulator, potentially responsible for the observed latitudinal differences between granulomatous and non-granulomatous AAV phenotypes. A narrow ultraviolet B spectrum induces vitD synthesis (vitD-UVB) via the skin. We hypothesised that prolonged periods of low ambient UVB (and by extension vitD deficiency) are associated with the granulomatous form of the disease and an increased risk of AAV relapse. Methods Patients with AAV recruited to the Irish Rare Kidney Disease (RKD) (n = 439) and UKIVAS (n = 1961) registries were studied. Exposure variables comprised latitude and measures of ambient vitD-UVB, including cumulative weighted UVB dose (CW-D-UVB), a well-validated vitD proxy. An n-of-1 study design was used to examine relapse risk. Multi-level models and logistic regression were used to examine the effect of predictors on AAV relapse r...

Despite the significance of user engagement for efficacy of mobile health (mHealth) in the Global South, many such interventions do not include user-engaging attributes. This is because socio-technical aspects are frequently not considered during the design, development, and implementation, stages of such initiatives. In addition, there is little discussion in the literature about the role socio-technical factors play in user-centered design processes for mHealth. This research posits consideration of socio-technical factors is required as techno-centric approaches to mHealth design and user engagement, as well as those relying on existing universal frameworks for user-centered design, have proven to be ineffective with the result that most mHealth projects in the Global South fail to sustain. This research examines projects in Sierra Leone where semi-structured interviews were conducted with mHealth designers and developers in order to explore their attitudes towards user engagemen...

The use of routinely available electronic sources of healthcare data on the spread of influenza has the potential to enhance current surveillance activities. This study aimed to develop a method for identifying influenza-related records from general practitioner(GP) out-of-hours (OOH) services in Ireland. Data from one such service were interrogated for keywords relating to influenza-like illness (ILI) and a proxy measure of influenza activity in the community setting was developed. Comparison of this syndromic surveillance measure with national data on ILI consultation rates demonstrated a statistically significant temporal correlation.In five out of six influenza seasons investigated,peaks in the GP OOH influenza-related calls appeared at least one week ahead of peaks in the national ILI consultation rates. The method described in this paper has been extended to nine OOH services in Ireland (covering 70% of the Irish population) to provide weekly figures on self-reported illness f...

There is an ongoing challenge as to how best manage and understand ‘big data’ in precision medicine settings. This paper describes the potential for a Linked Data approach, using a Resource Description Framework (RDF) model, to combine multiple datasets with temporal and spatial elements of varying dimensionality. This “AVERT model” provides a framework for converting multiple standalone files of various formats, from both clinical and environmental settings, into a single data source. This data source can thereafter be queried effectively, shared with outside parties, more easily understood by multiple stakeholders using standardized vocabularies, incorporating provenance metadata and supporting temporo-spatial reasoning. The approach has further advantages in terms of data sharing, security and subsequent analysis. We use a case study relating to anti-Glomerular Basement Membrane (GBM) disease, a rare autoimmune condition, to illustrate a technical proof of concept for the AVERT m...

Timely access to general practitioner (GP) care is a recognized strategy to address avoidable hospitalization. Little is known about patients seeking planned (decided ahead) and unplanned (decided on day) GP visits. The Patient Journey Record System (PaJR) provides a biopsychosocial real-time monitoring and support service to chronically ill and older people over 65 who may be at risk of an avoidable hospital admission. This study aims to describe reported profiles associated with planned and unplanned GP visits during the week in the PaJR database of regular outbound phone calls made by Care Guides to multi-morbid older patients. One hundred fifty consecutive patients with one or more chronic condition (including chronic obstructive pulmonary disease, heart/vascular disease, heart failure and/or diabetes), one or more hospital admission in previous year, and consecutively recruited from hospital discharge, out-of-hour care and GP practices comprised the study sample. Using a semistructured script, Care Guides telephoned the patients approximately every 3 week days, and entered call data into the PaJR database in 2011. The PaJR project identified and prompted unplanned visits according to its algorithms. Logistic regression modelling and descriptive statistics identified significant predictors of planned and unplanned visits and patterns of GP visits on weekdays reported in calls. In 5096 telephone calls, unplanned versus planned GP visits were predicted by change in health state, significant symptom concerns, poor self-rated health, bodily pain and concerns about caregiver or intimates. Calls not reporting visits had significantly fewer of these features. Planned visits were associated with general and medication concerns, reduced social participation and feeling down. Planned visits were highest on Monday and trended downwards to Fridays. Unplanned visits were reported at the same rate each weekday and more frequently when the interval between calls was ≥3 days. The PaJR project Care Guides advised patients to make unplanned visits in 6.3% of calls and advised planned GP visits in 2.5% of calls. Unplanned GP visits consistently indicated a significant change to worse health with planned visits presenting less acuity in this study of older multi-morbid patients in general practice, when monitored by regular calls at about every 3 days. The PaJR study actively prompted GP visits according to its algorithms. Assessing and predicting acuity in older multi-morbid patients appears to be a promising strategy to improve access to primary care, and thus to reducing avoidable hospital utilization. Further research is needed to investigate the topic on a wider scale.

In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic healthcare record (EHR) with extensibility, interoperability and decision support functionality. Incorporating the openEHR standard, we designed a set of archetypes in line with the current best practice and clinical guidelines. They guide the information gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone during our work at the HRB Centre for Primary Care Research.

Clinical guidelines can be represented using models, such as GLIF, specifically designed for healthcare guidelines. This paper demonstrates that they can also be modelled using a mainstream business modelling language such as UML. The paper presents a guideline in GLIF and as UML activity diagrams, and then presents a mapping of GLIF primitives to UML. The potential benefits of using a mainstream modelling language are outlined. These include availability of advanced modelling tools, transfer between modelling tools, and automation via business workflow technology.

Timely access to general practitioner (GP) care is a recognized strategy to address avoidable hospitalization. Little is known about patients seeking planned (decided ahead) and unplanned (decided on day) GP visits. The Patient Journey Record System (PaJR) provides a biopsychosocial real-time monitoring and support service to chronically ill and older people over 65 who may be at risk of an avoidable hospital admission. This study aims to describe reported profiles associated with planned and unplanned GP visits during the week in the PaJR database of regular outbound phone calls made by Care Guides to multi-morbid older patients. One hundred fifty consecutive patients with one or more chronic condition (including chronic obstructive pulmonary disease, heart/vascular disease, heart failure and/or diabetes), one or more hospital admission in previous year, and consecutively recruited from hospital discharge, out-of-hour care and GP practices comprised the study sample. Using a semist...

The provision of patient data to clinicians as and when it becomes available is a general objective of information systems in healthcare. It is known that the timely receipt of patient data can have a significant bearing on healthcare outcomes. One of the on-going tasks is to provide this data in the form of an Electronic Healthcare Record according to some agreed standard. The aim in this paper is to provide patient data in electronic form by pushing the information to the end users as soon it becomes available, in advance of any explicit request from the users. This paper describes how an existing record system, the Synapses Federated Healthcare Records Server, has been extended to incorporate active functionality to facilitate pushing the information to end-user applications. The user must specify the information of interest to him, so that the system pushes only information useful to the final user. The approach proposed here relies solely on the use of callbacks through the mid...

Expectations for development aid are changing. New voices are seeking recognition, new approaches and methods are being explored. The grand narrative of development according to the modernist spirit of the second half of the 20th century is firmly on the ...