Studying the impact of interoperable electronic health records on workflow in ambulatory care

Many of the proposed benefits of health information systems, particularly those regarding efficiency, are assumed to be caused by changes in clinical provider and staff workflow. Assessing the extent to which electronic health records (EHRs) are having the expected effects and identifying barriers to anticipated improvements requires a detailed understanding of how such systems affect day-to-day work activities. This study utilized interviews and observations to develop prototypical workflow models of day-to-day activities in ambulatory practices, allowing activity changes due to the implementation of EHRs with varying levels of interoperability to be identified. Primary and specialty care practices from a multi-county region were sampled. Results showed that EHRs did not consistently improve efficiency, but variously reduced, added, or simply changed work tasks. The impact depended on the work process, level of interoperability, and type of provider involved, as well as aspects of the user interface design. Additionally, implementing EHR systems did not eliminate the use of paper from work processes. Implications for successful implementation and design of EHR systems are provided.Relevance to industryEffectively designing and implementing health IT systems in clinical settings requires an understanding of how the IT system will impact, and be integrated with, existing work activities, and how these impacts may depend on the level of interoperability achieved by the IT system.     

允许违反局部时间约束的科学工作流调度策略

提高科学工作流在云环境中的执行效率、降低执行费用受到广泛关注。用户期望的局部QoS约束与工作流的总体执行效率之间往往存在矛盾。针对该现象,在前期的研究基础上提出一种允许违反局部时间约束的科学工作流调度策略。通过对已聚簇的工作流任务集使用任务后向优先合并的方法,可实现任务间空闲时间片的合理利用,进而优化科学工作流的执行时间;另外,为充分利用任务的松弛时间,提高工作流的整体执行效率,允许部分任务的调度违反局部最晚完成时间的约束。实验结果表明,该策略能提前科学工作流的最早完成时间,提高处理机的利用率,并最终降低工作流的执行费用。     

一种时间控制模型在工作流中的研究与应用

现代企业对工作任务完成的时效性非常看重,而很多实际应用的工作流解决方案,包括应用广泛的国内外开源工作流引擎,都存在着任务分配不均和任务容易超时的问题。论文提出在工作流引擎中引入一种时间控制模型,通过模型的任务时间计量平台来衡量任务耗费时间,并以此来合理分配工作任务,避免任务超时。实际应用后发现,任务超时率下降明显,表明模型是行之有效的,也为企业级工作流引擎模型的架构设计和实际应用提供了参考。     

Using tablets in medical consultations: Single loop and double loop learning processes

ObjectiveThis paper investigates the influence of using tablet in waiting rooms and medical examinations on how physicians give information and how patients learn. It further assesses the factors that impact patient satisfaction.MethodsPatients and physicians in a primary care clinic were given a tablet device to search for health information in the waiting room, and when interacting with the physician, while physicians used the tablet device to share information with patients during the medical consultation. 82 patients completed a ‘pre’ survey on using tablets to search for health related information and a ‘post’ survey after their visit. Structural equation modeling was employed to analyze patient's perceptions.ResultsTablet use during consultation has a negative effect on patients' perceptions of physician information giving, but using the tablet in the waiting room has a positive impact on patient learning, perceptions of physicians' information giving and patient satisfaction.ConclusionsThis study indicates the importance of tablet use in ensuring information giving and patient learning. It further highlights the potential for tablets to promote single-loop learning in the medical encounter by better preparing patients for the physician's information giving. Tablets also enable double-loop learning, which leads to greater patient satisfaction.     

基于任务分配和数据集副本的科学工作流数据布局

云环境下科学工作流的数据布局成为当前工作流研究中的一个热点问题,对科学工作流中任务和数据之间多对多关系进行分析,可以发现不同数据布局方案在数据传输上的费用各不相同,在很大程度上影响工作流的运行成本。为降低科学工作流数据集传输费用,提出一种基于任务分配和数据集副本的科学工作流数据布局方法。该方法从任务分配开始,在定量计算任务依赖度的基础上进行任务分配,根据分配结果给出一个基于数据集副本的两阶段数据布局方法,以实现科学工作流运行中传输费用的优化。实例结果表明,与工作流层方法相比,该方法可以有效降低科学工作流的运行成本。     

用SQL实现工作流的并发控制

工作流技术在信息系统的应用中，并发控制机制的设计是经常要面临的问题。给出一种基于将工作流中数据和任务分离的工作流并发控制机制，在保证工作流正确性的前提下，引入“数据约束”和“任务约束”的概念来提高工作流的工作性能和降低工作流设计的复杂性，并用数据库中SQL语言强有力的约束控制加以实现。     

基于授权约束的工作流任务指派算法

在电子政务、电子商务等工作流应用环境中,任务执行者主要是组织机构中的人,访问控制系统的授权约束需求是工作流任务指派要考虑的重要问题,已提出的许多工作流授权模型主要讨论授权的实现过程,而较少涉及授权的约束或依赖关系。工作流任务指派必须与访问控制系统结合,为此提出工作流任务指派中授权约束的相关概念,讨论了满足授权约束的工作流任务指派实现算法及算法的复杂度,同时,给出在实际应用中各系统部署的示意图及授权约束验证系统主要接口的功能;最后,指出了该实现方法的优点及未来研究方向。     

Common motifs in scientific workflows: An empirical analysis

Workflow technology continues to play an important role as a means for specifying and enacting computational experiments in modern science. Reusing and re-purposing workflows allow scientists to do new experiments faster, since the workflows capture useful expertise from others. As workflow libraries grow, scientists face the challenge of finding workflows appropriate for their task, understanding what each workflow does, and reusing relevant portions of a given workflow. We believe that workflows would be easier to understand and reuse if high-level views (abstractions) of their activities were available in workflow libraries. As a first step towards obtaining these abstractions, we report in this paper on the results of a manual analysis performed over a set of real-world scientific workflows from Taverna, Wings, Galaxy and Vistrails. Our analysis has resulted in a set of scientific workflow motifs that outline (i) the kinds of data-intensive activities that are observed in workflows (Data-Operation motifs), and (ii) the different manners in which activities are implemented within workflows (Workflow-Oriented motifs). These motifs are helpful to identify the functionality of the steps in a given workflow, to develop best practices for workflow design, and to develop approaches for automated generation of workflow abstractions.     

Managing heterogeneous multi-system tasks to support enterprise-wide operations

The computing environment in most medium-sized and large enterprises involves old main-frame based (legacy) applications and systems as well as new workstation-based distributed computing systems. The objective of the METEOR project is to support multi-system workflow applications that automate enterprise operations. This paper deals with the modeling and specification of workflows in such applications. Tasks in our heterogeneous environment can be submitted through different types of interfaces on different processing entities. We first present a computational model for workflows that captures the behavior of both transactional and non-transactional tasks of different types. We then develop two languages for specifying a workflow at different levels of abstraction: the Workflow Specification Language (WFSL) is a declarative rule-based language used to express the application-level interactions between multiple tasks, while the Task Specification Language (TSL) focuses on the issues related to individual tasks. These languages are designed to address the important issues of inter-task dependencies, data formatting, data exchange, error handling, and recovery. The paper also presents an architecture for the workflow management system that supports the model and the languages. Recommended by: Omran Bukhres and e. Kühn     

一种人机结合的研讨工作流集成方法

提出了用工作流集成的思路来研究人机结合研讨问题,人机结合研讨是基于研讨工作流,利用系统中的各种资源,通过人机相互作用产生新的信息,采用适配器的方法来实现单项研讨任务工作流集成,适配器采用XML数据表示的形式,可以实现对象内部异构数据转换以及对象间的数据交换,多项研讨任务工作流集成采用研讨工作流、研讨子任务和研讨对象的3层架构实现,通过扩展的业务通信形式语言(XLBC)实现不同的工作流之间的互操作。     

On verification of nested workflows with extra constraints: From theory to practice

Workflows are used to formally describe processes of various types such as business and manufacturing processes. One of the critical tasks of workflow management is automated discovery of possible flaws in the workflow – workflow verification. In this paper, we formalize the problem of workflow verification as the problem of verifying that there exists a feasible process for each task in the workflow. This problem is tractable for nested workflows that are the workflows with a hierarchical structure similar to hierarchical task networks in planning. However, we show that if extra synchronization, precedence, or causal constraints are added to the nested structure, the workflow verification problem becomes NP-complete. We present a workflow verification algorithm for nested workflows with extra constraints that is based on constraint satisfaction techniques and exploits an incremental temporal reasoning algorithm. We then experimentally demonstrate efficiency of the proposed techniques on randomly generated workflows with various structures and sizes. The paper is concluded by notes on exploiting the presented techniques in the application FlowOpt for modeling, optimizing, visualizing, and analyzing production workflows.     

着色时间工作流网任务调度的时间约束分析

为实现工作流管理系统中的任务调度和时间管理,避免流程在多任务运转时产生溢出,提高流程的工作效率。采用不固定时延定义了着色时间Petri网,通过控制任务间的最小时距避免了溢出,并用任务监测器实现了相应的控制策略。以各任务间的时间间隔最小为优化目标,对串行、并行、条件选择和循环四种基本着色时间工作流网进行了时序分析和任务调度,推导出多任务在基本着色时间工作流网调度的数学模型和着色时间工作流网整体运行时间函数的计算公式。最后通过一个审批流程对论述的任务调度方法进行了验证。     

A hybrid evolutionary algorithm for task scheduling and data assignment of data-intensive scientific workflows on clouds

A growing number of data- and compute-intensive experiments have been modeled as scientific workflows in the last decade. Meanwhile, clouds have emerged as a prominent environment to execute this type of workflows. In this scenario, the investigation of workflow scheduling strategies, aiming at reducing its execution times, became a top priority and a very popular research field. However, few work consider the problem of data file assignment when solving the task scheduling problem. Usually, a workflow is represented by a graph where nodes represent tasks and the scheduling problem consists in allocating tasks to machines to be executed at a predefined time aiming at reducing the makespan of the whole workflow. In this article, we show that the scheduling of scientific workflows can be improved when both task scheduling and the data file assignment problems are treated together. Thus, we propose a new workflow representation, where nodes of the workflow graph represent either tasks or data files, and define the Task Scheduling and Data Assignment Problem (TaSDAP), considering this new model. We formulated this problem as an integer programming problem. Moreover, a hybrid evolutionary algorithm for solving it, named HEA-TaSDAP, is also introduced. To evaluate our approach we conducted two types of experiments: theoretical and practical ones. At first, we compared HEA-TaSDAP with the solutions produced by the mathematical formulation and by other works from related literature. Then, we considered real executions in Amazon EC2 cloud using a real scientific workflow use case (SciPhy for phylogenetic analyses). In all experiments, HEA-TaSDAP outperformed the other classical approaches from the related literature, such as Min–Min and HEFT.     

Boundary-Object Trimming: On the Invisibility of Medical Secretaries’ Care of Records in Healthcare Infrastructures

As health care IT gradually develops from being stand-alone systems towards integrated infrastructures, the work of various groups, occupations and units is likely to become more tightly integrated and dependent upon each other. Hitherto, the focus within health care has been upon the two most prominent professions, physicians and nurses, but most likely other non-clinical occupations will become relevant for the design and implementation of health care IT. In this paper, we describe the cooperative work of medical secretaries at two hospital departments, based on a study evaluating a comprehensive electronic health record (EHR) shortly after implementation. The subset of data on medical secretaries includes observation (11 hours), interviews (three individual and one group) and survey data (31 of 250 respondents were medical secretaries). We depict medical secretaries’ core task as to take care of patient records by ensuring that information is complete, up to date, and correctly coded, while they also carry out information gatekeeping and articulation work. The importance of these tasks to the departments’ work arrangements was highlighted by the EHR implementation, which also coupled the work of medical secretaries more tightly to that of other staff, and led to task drift among professions. Medical secretaries have been relatively invisible to health informatics and CSCW, and we propose the term ‘boundary-object trimming’ to foreground and conceptualize one core characteristic of their work: maintenance and optimization of the EHR as a boundary object. Finally, we reflect upon the hitherto relative invisibility of medical secretaries which may be related to issues of gender and power.     

作业流访问控制策略

作业流是一系列任务,它由一个任务集和一个任务关系集组成,其中,任务关系集说明各任务的执行顺序。该文在给出作业流定义的基础上,提出了一种基于作业流Petri网描述的访问控制机制,并介绍了该机制的实现。     

基于行为特征的语义工作流修正算法

工作流修正是工作流重用的重要任务.目前在基于工作流的可重用片段——stream的语义工作流修正中,当工作流stream库中不存在与检索语义工作流中的工作流stream结构相似的stream时,无法修正检索工作流.针对这种情况,提出了一种改进方案——基于stream行为特征修正语义工作流.使用任务紧邻关系集表达stream的行为特征.对于检索语义工作流中的每个与变更请求不一致的stream,使用锚集合数据索引和stream匹配规则对工作流stream库过滤得到候选匹配stream集;之后基于stream的行为相似性和变更请求对候选stream集进行验证,得到与变更请求一致程度最高和足够相似的匹配stream;然后更新变更请求,使用每个检索到的匹配stream替换原stream以逐步修正检索语义工作流中的缺陷;最后得到修正语义工作流.实验结果表明,与现有的基于工作流stream的修正算法相比,本文的算法得到了整体质量更好的修正语义工作流集,其适应性更好.该修正算法能为业务过程管理人员为适应新业务需求的工作流建模提供较好质量的修正语义工作流供参考,对提高工作流重用的效率和质量有较大帮助.     

一种高效的跨平台工作流优化方法

为了应对复杂的数据分析任务,研究人员设计开发出结合多个平台的跨平台数据处理系统。系统跨平台工作流中算子的平台选择对于系统性能至关重要,因为算子在不同平台上的实现会产生性能间的显著差异。目前多使用基于成本的优化方法来实现跨平台工作流的平台选择,但现有的成本模型由于无法挖掘跨平台工作流的潜在信息而导致成本估计不准确。提出一种高效的跨平台工作流优化方法,采用GGFN模型作为成本模型,以算子特征和工作流特征作为模型输入,利用图注意力机制捕捉有向无环图型跨平台工作流的结构信息和算子邻居节点信息,同时结合门控循环单元记忆算子的运行时序信息,从而实现准确的成本估计。在此基础上,根据跨平台工作流的特点设计算子实现平台的枚举算法,利用基于GGFN的成本模型和延迟贪婪剪枝方法进行枚举操作,为每个算子选择合适的实现平台。实验结果表明,该方法可以将跨平台工作流的执行性能提升3倍,运行时间缩短60%以上。     

Static scheduling of multiple workflows with soft deadlines in non-dedicated heterogeneous environments

Typical patterns of using scientific workflows include their periodical executions using a fixed set of computational resources. Using the statistics from multiple runs, one can accurately estimate task execution and communication times to apply static scheduling algorithms. Several workflows with known estimates could be combined into a set to improve the resulting schedule. In this paper, we consider the mapping of multiple workflows to partially available heterogeneous resources. The problem is how to fill free time windows with tasks from different workflows, taking into account users’ requirements of the urgency of the results of calculations. To estimate quality of schedules for several workflows with various soft deadlines, we introduce the unified metric incorporating levels of meeting constraints and fairness of resource distribution.The main goal of the work was to develop a set of algorithms implementing different scheduling strategies for multiple workflows with soft deadlines in a non-dedicated environment, and to perform a comparative analysis of these strategies. We study how time restrictions (given by resource providers and users) influence the quality of schedules, and which scheme of grouping and ordering the tasks is the most effective for the batched scheduling of non-urgent workflows. Experiments with several types of synthetic and domain-specific sets of multiple workflows show that: (i) the use of information about time windows and deadlines leads to the significant increase of the quality of static schedules, (ii) the clustering-based scheduling scheme outperforms task-based and workflow-based schemes. This was confirmed by an evaluation of studied algorithms on a basis of the CLAVIRE workflow management platform.     

基于多段间隔监督度量学习的病人相似度算法

伴随着医疗卫生服务的信息化进程推进,病人相似度成为了医疗电子健康数据的二次利用中的重要问题.在已有医疗专家对病人健康数据的评估信息下,可以将病人相似度问题转化为有监督的距离度量学习问题.通常的做法是对病人的医疗健康数据打标签来作为监督信息.在现有的病人相似度计算工作中,对监督信息的利用是很局限的;多是比较两个不同病人的标签是否完全相等来判断病人相似与否;在实际中,病人的标签往往是多个维度,这种比较忽略了标签本身的相似性.本文将病人的诊断数据作为监督信息,在度量学习中,根据标签的相似程度将目标病人的邻居区分开来,形成多段间隔,更充分地利用监督信息.在基于多标签的KNN分类评估实验中,该算法学习出的相似度度量在Hamming Loss和a-Accuracy两种指标下性能有很大提升.     

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.