User-centered requirements engineering in health information systems: a study in the hemophilia field

The use of sophisticated information and communication technologies (ICTs) in the health care domain is a way to improve the quality of services. However, there are also hazards associated with the introduction of ICTs in this domain and a great number of projects have failed due to the lack of systematic consideration of human and other non-technology issues throughout the design or implementation process, particularly in the requirements engineering process. This paper presents the methodological approach followed in the design process of a web-based information system (WbIS) for managing the clinical information in hemophilia care, which integrates the values and practices of user-centered design (UCD) activities into the principles of software engineering, particularly in the phase of requirements engineering (RE). This process followed a paradigm that combines a grounded theory for data collection with an evolutionary design based on constant development and refinement of the generic domain model using three well-known methodological approaches: (a) object-oriented system analysis; (b) task analysis; and, (c) prototyping, in a triangulation work. This approach seems to be a good solution for the requirements engineering process in this particular case of the health care domain, since the inherent weaknesses of individual methods are reduced, and emergent requirements are easier to elicit. Moreover, the requirements triangulation matrix gives the opportunity to look across the results of all used methods and decide what requirements are critical for the system success.     

The impact of interface-induced handling requirements on action generation in technical system control

In analysing action generation in technical system control we differentiate between a purely cognitive stage of pre-actional decision-making and an action-related cognitive-physical stage of action planning and plan execution. This study investigates the impact of interface-induced handling requirements on the action-related processes in the domain of artificial respiration in intensive care. Thirty-two novice and experienced intensive care nurses had to solve three realistic control tasks on two types of respiration unit equipped either with an 'analogue' or with a 'digital' user interface. The quality of the novices' plan execution and—unexpectedly— action planning, too, decreased when working on the 'digital' interface. Interface-induced handling requirements obviously have an important influence on the usability of technical systems not only on a purely cognitive level, but also on the action-related level.     

The impact of interface-induced handling requirements on action generation in technical system control

Abstract

In analysing action generation in technical system control we differentiate between a purely cognitive stage of pre-actional decision-making and an action-related cognitive-physical stage of action planning and plan execution. This study investigates the impact of interface-induced handling requirements on the action-related processes in the domain of artificial respiration in intensive care. Thirty-two novice and experienced intensive care nurses had to solve three realistic control tasks on two types of respiration unit equipped either with an ‘analogue’ or with a ‘digital’ user interface. The quality of the novices’ plan execution and—unexpectedly— action planning, too, decreased when working on the ‘digital’ interface. Interface-induced handling requirements obviously have an important influence on the usability of technical systems not only on a purely cognitive level, but also on the action-related level.     

Eine modulare gesundheitsakte als antwort auf kommunikationsprobleme im gesundheitswesen

Since 2000 the University of Muenster has developed an electronic health record (EHR) called ?akteonline.de“. Several clinics and departments use the EHR in routine. ?akteonline.de“ in its current structure supports patients as well as health care professionals and aims at providing a collaborative health information system which perfectly supports the clinical workflow even across institutional boundaries. In order to fulfill high data security and data protection requirements strictly, complex encryption, authorization and access control components have been developed. The IT-structure of the German health care system is very heterogeneous and peripheral. The thereby generated additional costs in the economic and social area are comprehensible and the patient is unable to claim the central position intended by politics and society. The development effort of ?akteonline.de“ currently focuses on the introduction of an electronic foundation for an ?integrated care“. For that communication possibilities for different clinical systems, like systems for physician or clinical information systems as well as communication possibilities between different departments in a hospital or networking between Institutions and the patient himself, have to be provided. The various needs of the institutions and people involved, have to be considered individually within one concept. Based on gathered experiences and with regard to increasing requirements in the areas of interoperability, integration and international cooperation the system architecture and the basic data model underwent several evolutionary enhancements. The focus of this paper lies on describing the use of new technologies and open standards in order to create and enhance a loosely coupled, modular and flexible EHR, that represents a common information and communication tool for patients and health care professionals.     

A knowledge-based architecture for the management of patient-focused care pathways

There is need for software systems in order to coordinate the activities of healthcare professionals involved in the treatment of a patient, aligning the care delivery around already existing Clinical Practice Guidelines (CPGs). This is being carried out in care organizations by implementing integrated Care Pathways (CPs). Nonetheless, the generation of these care pathways is not trivial, and multiple barriers exist for their development and enactment. In this paper, a knowledge-based architecture is presented that, by means of Knowledge Engineering methods and Artificial Intelligence Planning and Scheduling (AI P&S) techniques, is able to automatically generate these care pathways from a computer-interpretable representation of CPGs, tackling some of these barriers. Firstly, these techniques consider the patient profile, the care organization details as well as the temporal and resource constraints, implicit in a care process, in order to generate a patient-focused care pathway. Moreover, they also allow the enactment of personalized care plans in a web-based format, powered by a workflow runtime engine, thus providing an ubiquitous and interactive execution to healthcare professionals. Finally, the architecture also includes monitoring and replanning techniques in order to check the current health status of patients and adapt care plans when they do not progress as expected. For the experimental evaluation of the architecture, several tests have been carried out in order to simulate a clinical environment where different care plans were automatically executed, monitored and adapted regarding the health conditions of patients as well as the recommendations specified in a real, CPG of the paediatric oncology area. As conclusion, the proposed architecture seems to be an adequate infrastructure for supporting the automated generation as well as the interactive execution and monitoring of patient-focused care pathways.     

SEMPA – Ein Ansatz des Semantischen Prozessmanagements zur Planung von Prozessmodellen

Currently process modeling is mostly done manually. Therefore, the initial design of process models as well as changes to process models which are frequently necessary to react to new market developments or new regulations are time-consuming tasks. In this paper we introduce SEMPA, an approach for the partly automatic planning of process models. Using ontologies to semantically describe actions – as envisioned in Semantic Business Process Management –, a process model for a specified problem setting can be created automatically. In comparison to existing planning algorithms our approach creates process models including control structures and is able to cope with complex and numerical input and output parameters of actions. The prototypical implementation as well as an example taken from the financial services domain illustrate the practical benefit of our approach.     

Effective Hybrid Content-Based Collaborative Filtering Approach for Requirements Engineering

Requirements engineering (RE) is among the most valuable and critical processes in software development. The quality of this process significantly affects the success of a software project. An important step in RE is requirements elicitation, which involves collecting project-related requirements from different sources. Repositories of reusable requirements are typically important sources of an increasing number of reusable software requirements. However, the process of searching such repositories to collect valuable project-related requirements is time-consuming and difficult to perform accurately. Recommender systems have been widely recognized as an effective solution to such problem. Accordingly, this study proposes an effective hybrid content-based collaborative filtering recommendation approach. The proposed approach will support project stakeholders in mitigating the risk of missing requirements during requirements elicitation by identifying related requirements from software requirement repositories. The experimental results on the RALIC dataset demonstrate that the proposed approach considerably outperforms baseline collaborative filtering-based recommendation methods in terms of prediction accuracy and coverage in addition to mitigating the data sparsity and cold-start item problems.     

Model-driven engineering of planning and optimisation algorithms for pervasive computing environments

This paper presents a model-driven approach to developing pervasive computing applications that exploits design-time information to support the engineering of planning and optimisation algorithms that reflect the presence of uncertainty, dynamism and complexity in the application domain. In particular, the task of generating code to implement planning and optimisation algorithms in pervasive computing domains is addressed.We present a layered domain model that provides a set of object-oriented specifications for modelling physical and sensor/actuator infrastructure and state-space information. Our model-driven engineering approach is implemented in two transformation algorithms. The initial transformation parses the domain model and generates a planning model for the application being developed that encodes an application’s states, actions and rewards. The second transformation parses the planning model and selects and seeds a planning or optimisation algorithm for use in the application.We present an empirical evaluation of the impact of our approach on the development effort associated with two pervasive computing applications from the Intelligent Transportation Systems (ITS) domain, and provide a quantitative evaluation of the performance of the algorithms generated by the transformations.     

Automated composition of Web services via planning in asynchronous domains

The service-oriented paradigm promises a novel degree of interoperability between business processes, and is leading to a major shift in way distributed applications are designed and realized. While novel and more powerful services can be obtained, in such setting, by suitably orchestrating existing ones, manually developing such orchestrations is highly demanding, time-consuming and error-prone. Providing automated service composition tools is therefore essential to reduce the time to market of services, and ultimately to successfully enact the service-oriented approach.In this paper, we show that such tools can be realized based on the adoption and extension of powerful AI planning techniques, taking the “planning via model-checking” approach as a stepping stone. In this respect, this paper summarizes and substantially extends a research line that started early in this decade and has continued till now. Specifically, this work provides three key contributions.First, we describe a novel planning framework for the automated composition of Web services, which can handle services specified and implemented using industrial standard languages for business processes modeling and execution, like ws-bpel. Since these languages describe stateful Web services that rely on asynchronous communication primitives, a distinctive aspect of the presented framework is its ability to model and solve planning problems for asynchronous domains.Second, we formally spell out the theory underlying the framework, and provide algorithms to solve service composition in such framework, proving their correctness and completeness. The presented algorithms significantly extend state-of-the-art techniques for planning under uncertainty, by allowing the combination of asynchronous domains according to behavioral requirements.Third, we provide and discuss an implementation of the approach, and report extensive experimental results which demonstrate its ability to scale up to significant cases for which the manual development of ws-bpel composed services is far from trivial and time consuming.     

Management of performance requirements for information systems

The management of performance requirements is a major challenge for information systems as well as other software systems. This is because performance requirements can have a global impact on the target system. In addition, there are interactions and trade-offs among performance requirements, other nonfunctional requirements (NFRs), and the numerous alternatives for the target system. To provide a systematic approach to managing performance requirements, this paper presents a performance requirements framework (PeRF). It integrates and catalogues a variety of kinds of knowledge of information systems and performance. These include: performance concepts, software performance engineering principles for building performance into systems, and information systems development knowledge. In addition, layered structures organize performance knowledge and the development process. All this knowledge is represented using an existing goal-oriented approach, the “NFR framework”, which offers a developer-directed graphical treatment for stating NFRs, analyzing and interrelating them, and determining the impact of decisions upon NFRs. This approach allows customized solutions to be built, taking into account the characteristics of the particular domain. The use of PeRF in managing performance requirements is illustrated in a study of performance requirements and other NFRs for a university student record system. This paper concludes with a summary of other studies of information systems, tool support and directions for future work     

A platform for the development of patient applications in the domain of personalized health

Personalized health (p-health) systems can contribute significantly to the sustainability of healthcare systems, though their feasibility is yet to be proven. One of the problems related to their development is the lack of well-established development tools for this domain. As the p-health paradigm is focused on patient self-management, big challenges arise around the design and implementation of patient systems. This paper presents a reference platform created for the development of these applications, and shows the advantages of its adoption in a complex project dealing with cardio-vascular diseases.     

Towards assessing the networkability of health care providers: a maturity model approach

This paper presents a networkability maturity model as an approach to assess a health care organisation’s capacity with regards to being able to efficiently engage in business relationships. Continuously rising costs and increasingly restrained budgets for health care put pressure on the public health systems. A low division of labour and integration of processes along cross-organisational patient therapy provides large potential for improvements in efficiency and efficacy. It is the aim of the presented model to enable identification of potentials for improvements and respective measures to advance the ability to benefit from specialisation and collaboration along the value chain. The presented model is developed based on a classification of related state-of-the-art in maturity models to assess individual factors of networkability which are integrated to form an overall framework comprising six components and respective factors to be assessed. As networkability maturity addresses the interrelation of strategy, organisational design and information systems design, the paper adheres to requirements for effective design science research applied to the process of construction of a networkability maturity model applicable for health care providers. It therefore concludes with a case-based evaluation according to the design research literature and identification of further research.     

Function and process modeling for integrated product and manufacturing system platforms

Manufacturing companies face increasingly tougher individual customer requirements that force them to revise conceptual solutions for the redesigning of products. This situation limits the reuse of ready-made components and requires physical changes to the manufacturing system. In these settings, platforms must be prepared with greater flexibility to allow development over time. The corresponding platform models need to include conceptual considerations for products and manufacturing systems. The literature advocates functional modeling to capture these considerations but applies it separately to either the product domain or to the manufacturing domain. Further, its relationship to manufacturing processes is not expounded. Thus, functional modeling falls short of its potential to facilitate the integrated development of products and manufacturing systems.This paper puts forth an integrated platform model using functional modeling to capture the conceptual considerations for products and manufacturing systems together with the manufacturing processes. The model is tested for consistency and then illustrated by studying a real case example from the automotive industry modeled according to the approach suggested. The example shows that the model facilitates an understanding of the design of products and their manufacturing systems, including functions shared across domains and across lifecycle phases. Thus, the model is proposed for the conceptual phase of designing, aimed at reusing and redesigning components, machinery, manufacturing processes and design solutions.     

Data rich,information poor: Data,information and decision support in the NHS

The need for data and information to meet health service management objectives has been put into sharp focus as the requirements driven by the 1991 NHS reforms take effect, but this means more than simply gathering appropriate data. There is also a shortage of management analytical skills for training and development. Decision support systems can help to overcome that skills gap by assisting in the interpretation of data and providing support for more proactive management. Examples from the UK health service are discussed, with particular reference to strategic service planning for long term care of elderly people, and consideration given to the potential role that computer-based decision support systems might have in future management information strategies.     

Using UML/MARTE to support performance tuning and stress testing in real-time systems

Real-time embedded systems (RTESs) operating in safety-critical domains have to satisfy strict performance requirements in terms of task deadlines, response time, and CPU usage. Two of the main factors affecting the satisfaction of these requirements are the configuration parameters regulating how the system interacts with hardware devices, and the external events triggering the system tasks. In particular, it is necessary to carefully tune the parameters in order to ensure a satisfactory trade-off between responsiveness and usage of computational resources, and also to stress test the system with worst-case inputs likely to violate the requirements. Performance tuning and stress testing are usually manual, time-consuming, and error-prone processes, because the system parameters and input values range in a large domain, and their impact over performance is hard to predict without executing the system. In this paper, we provide an approach, based on UML/MARTE, to support the generation of system configurations predicted to achieve a satisfactory trade-off between response time and CPU usage, and stress test cases that push the system tasks to violate their deadlines. First, we devise a conceptual model that specifies the abstractions required for analyzing task deadlines, response time, and CPU usage, and provide a mapping between these abstractions and UML/MARTE. Then, we prune the UML/MARTE metamodel to only contain a purpose-specific subset of entities needed to support performance tuning and stress testing. The pruned version is a supertype of UML/MARTE, which ensures that all instances of the pruned metamodel are also instances of UML/MARTE. Finally, we cast the generation of configurations and stress test cases as two constrained optimization problems (COPs) over our conceptual model. The input data for these COPs in automatically generated via a model-to-text (M2T) transformation from models specified in the pruned UML/MARTE metamodel to the Optimization Programming Language. We validate our approach in a safety-critical RTES from the maritime and energy domain, showing that (1) our conceptual model can be applied in an industrial setting with reasonable effort, and (2) the optimization problems effectively identify configurations predicted to minimize response time and CPU usage, and stress test cases that maximize deadline misses. Based on our experience, we highlight challenges and potential issues to be aware of when using UML/MARTE to support performance tuning and stress testing in an industrial context.     

DEVELOPMENT OF AN EXPERT SYSTEM FOR CHRONIC OBSTRUCTIVE LUNG DISEASE

The long-term health care of patients suffering from chronic obstructive lung disease or high-risk persons entails time-consuming medical measures taken on the occasion of frequent return visits. It is tedious for the physician to execute this health-care program in a conventional manner. An expert system could effectively assist him in performing this challenging task. This article describes the technical concept of an expert system for this purpose based on the medical foundations outlined in a companion article (Jahn, 1990). The known expert systems for pulmonary diseases cannot sufficiently support the physician involved in this type of health care, since they are, among other things, limited to a “snapshot” approach to patient assessment. In contrast, the expert system now being developed handles temporal changes, gives advice on scheduling appropriate time intervals for return visits, and compares the actual response to therapy with the expected response.     

Setting quality targets for coming releases with QUPER: an industrial case study

Quality requirements play a critical role in driving architectural design and are an important issue in software development. Therefore, quality requirements need to be considered, specified, and quantified early during system analysis and not later in the development phase in an ad-hoc fashion. This paper presents the quality performance model that estimates quality targets in relation to market expectations as a basis for the architecting of quality requirements. The purpose of the model is to provide concepts for qualitative reasoning of quality levels in the decision-making of setting actual targets of quality requirements for coming releases of the product. The quality performance model is evaluated at one case company, using a market-driven development approach, in the electronic payment-processing domain. The results show that the model is useful for supporting early decision-making in, e.g., release planning of quality requirements.     

Development of holonic manufacturing execution systems

Rapid changes of market demands and pressures of competition require manufacturers to maintain highly flexible manufacturing systems to cope with a complex manufacturing environment. To meet these requirements, this work adopts the concepts of holon and holarchy to design manufacturing systems. Holon and holarchy are derived from the studies of social organizations and living organisms and possess the properties of intelligence, autonomy, cooperation, reconfigurability, and extensibility. Moreover, advanced manufacturing systems also require the properties of security certification and failure recovery. Based on the requirements of these properties, a systematic approach is proposed to develop a holonic manufacturing execution system (HMES) for the semiconductor industry. This systematic approach starts with a system analysis by collecting domain requirements and analyzing domain knowledge. The HMES Holarchy is designed by the procedure of constructing an abstract object model based on domain knowledge, partitioning application domain into functional holons, identifying generic parts among functional holons, developing the Generic Holon, defining holarchy messages and the holarchy framework of HMES, and finally designing functional holons based on the Generic Holon. It is believed that this proposed systematic approach provides a novel and efficient way to design HMES.     

A hybrid genetic approach for solving an integrated multi-objective operating room planning and scheduling problem

In this paper, we propose a multi-objective integer linear programming model aiming at efficiently planning and managing hospital operating room suites. By effectively exploiting a novel hybrid genetic solution approach, the devised optimization model is able to determine, in an integrated way, (i) the operating room time assigned to each surgical specialty, (ii) the operating room time assigned to each surgical team, (iii) the surgery admission planning and (iv) the surgery scheduling. The resulting Pareto frontiers provide a set of “optimal” solutions able to support hospital managers in efficiently orchestrating the involved resources and planning surgeons and surgeries. On this basis, the proposed solution framework could represent a suitable engine for the development of advanced and effective health care management decision support systems.