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computer system development with standardization

computers and Standards 1983年第4期2卷 173-180页

作者： Chon, Kilnam Rim, Kee Wook Department of Computer Science Korea Advanced Institute of Science and Technology Seoul P.O. Box 150 Chongryang South Korea Korea Institute of Electronic Technology Kyung-buk P.O. Box 31 Gumi South Korea

Opportunity for computer development among developing and small, developed countries has been limited so far. Recent trends in the standardization of both hardware and software components make computer development feasible among these countries, too. The driving force is the microelectronics revolution led by current microprocessors and their large software assets. Now computer development can be highly modularized. This paper attempts to establish a modularized development methodology using standardization. Basic building blocks are described and a case study on a computer National Project in the Republic of Korea is included in this paper. © 1983.

关键词： computer systems development Microcomputers Standards

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Pilot implementation of health information systems: Issues and challenges

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INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS 2010年第9期79卷 637-648页

作者： Bansler, Jorgen P. Havn, Erling Univ Copenhagen Dept Comp Sci DK-2300 Copenhagen Denmark Tech Univ Denmark Dept Engn Management DK-2800 Lyngby Denmark

Objectives: This study aims to explore the issues and challenges involved in designing and organizing pilot implementations of health information systems (HIS). Pilot implementations are a widely used approach for identifying design flaws and implementation issues before full-scale deployment of new HIS. However, it is not uncommon for pilot implementations to fail in the sense that little can be learned from them. Method: We employed an interpretive case study approach in attempting to throw light on the reasons why pilot implementations sometimes fail. We studied the (failed) pilot implementation of an electronic Pregnancy Record (ePR) in Denmark. Our primary data collection methods comprised participant observations, semi-structured interviews and document analyses. Results: Based on a comprehensive evaluation of the implementation process, we identify three major challenges that complicated the pilot project and eventually led to its failure, namely difficulties in (1) defining an appropriate scope for the pilot implementation, (2) coping with unanticipated technical and practical problems, and (3) ensuring commitment from test users and their managers. Conclusion: Pilot implementations are a very useful technique for developing HIS, but also one that is very difficult to do successfully. It is sometimes assumed that pilot implementations are less complicated and risky than regular, full-scale implementations. However, pilot implementations are not just small-scale versions of conventional implementations;they are fundamentally different and they have their own complications and issues to deal with that make them hard to design and manage. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

关键词： Information systems Information systems development computer systems development computer systems evaluation Pilot studies Medical records systems, computerized Organizational case studies

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Physicians' experiences of participation in healthcare IT development in Finland: Willing but not able

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INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS 2012年第2期81卷 98-113页

作者： Martikainen, Susanna Viitanen, Johanna Korpela, Mikko Laaveri, Tinja Univ Eastern Finland Sch Comp FI-70211 Kuopio Finland Aalto Univ Sch Sci & Technol Strateg Usabil Res Grp Espoo Finland Univ Helsinki Cent Hosp Dept Med Helsinki Finland HUS ICT Helsinki Finland

Objective: To learn (1) about the kind of experiences that physicians have with participation in healthcare IT development;(2) whether physicians are interested in participating in IT development activities, and if so, how;and (3) the visions that physicians have regarding future IT systems. Methods: A web-based questionnaire which was answered by about one-third of the working-age physicians in Finland, which is exceptionally broad and sizeable a sample. This research deals with only a small part of the entire questionnaire. The questions used for this study were both quantitative and qualitative. Statistical methods were applied to the former and content analysis to the latter. Results: The responding physicians were highly critical of their IT systems, and their experiences with the current methods of participation, or rather the lack of it, were quite negative. However, a very significant proportion of the respondents were willing to contribute to IT systems development, contrary to a common assumption that clinicians are disinterested. Visioning of future systems was quite cautious, dealing mainly with usability improvements to the current systems. Conclusions: Major improvements are needed both in the usability of the systems currently in use in Finland and in the collaboration between end-users and developers. Improved methods of participation need to be developed and applied, particularly for the procurement, deployment and on-going development of commercial-off-the-shelf applications. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

关键词： End-user participation computer systems development Medical informatics applications Physicians Finland Questionnaires User-computer interface

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Design issues for a big city immunization registry

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AMERICAN JOURNAL OF PREVENTIVE MEDICINE 1997年第2期13卷 26-31页

作者： Fairbrother, G Troob, C Friedman, S Butts, GC All Kids Count 93 Worth Street New York NY 10013 United States

New York is the nation's largest city with a birth cohort of more than 130,000 and nearly 2 million children aged 18 years and under. Its sheer size has important implications for registry design, as do the poverty, cultural diversity, and mobility of the population, as well as large numbers of special groups, such as homeless people and recent immigrants. The size and diversity of the provider population also have consequences for immunization registry planning. The private sector is heavily represented-about 55% of the immunizations are given by physicians in private practice, voluntary hospitals, and private clinics. Public and private providers practice in a variety of settings and span all levels of technologic sophistication. This article addresses the ways in which New York City's technical registry design and implementation plan have responded to local requirements and constraints. Topics covered include decisions about roles and responsibilities of central registry reporting and retrieving information, child identifiers collected and match strategies, and policy decisions about security and confidentiality. It is instructive to examine the process and rationale for New York City's design decisions, as well as the decisions themselves. Some of the decisions may in fact be generalizable to other large systems;some of the rejected alternatives may be appropriate under a different set of constraints. The entire decision process demonstrates how a group of planners took a general concept (an immunization registry) and modified it in the course of bringing it to the threshold of implementation, in the summer of 1996.

关键词： immunization registries private practice computer systems development decision making

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Technology strategies for a state immunization information system

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AMERICAN JOURNAL OF PREVENTIVE MEDICINE 1997年第2期13卷 51-57页

作者： Arzt, NH Salkowitz, SM UNIV PENN LEONARD DAVIS INST HLTH ECONPHILADELPHIAPA 19104

The New Jersey Comprehensive Immunization Program (NJ-CIP) is a collaborative project of The Robert Wood Johnson Medical School and the New Jersey Department of Health and Senior Services. It is an All Kids Count (AKC) project, funded by The Robert Wood Johnson Foundation, to develop a pilot State Immunization Information System (SIIS) in Camden, New Jersey, and plan for the expansion of the system throughout New Jersey. NJ-CIP initially sought technical expertise from university settings to promote a research-based selection of the technical components of the software and network. A technical team was created to focus on future needs, using prototyping for the application and selecting the best emerging technology, instead of relying only on what was commercially available at the start of the project. The technical team has positioned the project to pursue a variety of deployment options, funding sources, and partnerships with major hospital/provider organizations to move from a pilot to the NJ SIIS, and to qualify New Jersey as an Information Network for Public Health Officials (INPHO) state, through the following key technical directions: (1) establishing open systems technical architecture, including use of the Internet as the wide-area network connecting sites;(2) developing a standards-based application software using the National Vaccine Advisory Council minimum data set, and providing interfaces to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)/Aid to Families with Dependent Children (AFDC), the Electronic Birth Record, and Clinical Assessment Statistical Application (CASA), including a Health Level 7 (HL7) interface for data exchange;(3) piloting a variety of reproducible deployment models from the Camden sites, all supporting both on-line use and electronic interfaces to local data systems.

关键词： immunization information systems computer systems development computer communication networks computer software medical record linkage

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Incorporating Guideline Adherence and Practice Implementation Issues into the Design of Decision Support for Beta-Blocker Titration for Heart Failure

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APPLIED CLINICAL INFORMATICS 2018年第2期9卷 478-489页

作者： Smith, Michael W. Brown, Charnetta Virani, Salim S. Weir, Charlene R. Petersen, Laura A. Kelly, Natalie Akeroyd, Julia Garyin, Jennifer H. Univ Americas Puebla Dept Ind & Mech Engn Cholula Pue Mexico Houston VA HSR&D Ctr Innovat Qual Effectiveness & Houston TX USA Baylor Coll Med Dept Med Sect Cardiovasc Res Houston TX 77030 USA Salt Lake City VA Hlth Care Syst HSR&D Informat D Salt Lake City UT USA Univ Utah Dept Biomed Informat Salt Lake City UT USA Baylor Coll Med Dept Med Sect Hlth Serv Res Houston TX 77030 USA Ohio State Univ Div Hlth Informat Management & Syst Columbus OH 43210 USA Indianapolis VA Med Ctr HSR&D Ctr Hlth Informat & Indianapolis IN USA

Background The recognition of and response to undertreatment of heart failure (HF) patients can be complicated. A clinical reminder can facilitate use of guideline-concordant beta-blocker titration for HF patients with depressed ejection fraction. However, the design must consider the cognitive demands on the providers and the context of the work. Objective This study's purpose is to develop requirements for a clinical decision support tool (a clinical reminder) by analyzing the cognitive demands of the task along with the factors in the Cabana framework of physician adherence to guidelines, the health information technology (HIT) sociotechnical framework, and the Promoting Action on Research Implementation in Health Services (PARIHS) framework of health services implementation. It utilizes a tool that extracts information frommedical records (including ejection fraction in free text reports) to identify qualifying patients at risk of undertreatment. Methods We conducted interviews with 17 primary care providers, 5 PharmDs, and 5 Registered Nurses across three Veterans Health Administration outpatient clinics. The interviews were based on cognitive task analysis (CTA) methods and enhanced through the inclusion of the Cabana, HIT sociotechnical, and PARIHS frameworks. The analysis of the interview data led to the development of requirements and a prototype design for a clinical reminder. We conducted a small pilot usability assessment of the clinical reminder using realistic clinical scenarios. Results We identified organizational challenges (such as time pressures and underuse of pharmacists), knowledge issues regarding the guideline, and information needs regarding patient history and treatment status. We based the design of the clinical reminder on how to best address these challenges. The usability assessment indicated the tool could help the decision and titration processes. Conclusion Through the use of CTA methods enhanced with adherence, sociotechnical, and i

关键词： clinical decision support heart failure computer systems development primary health care adrenergic beta-antagonists

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Ten steps to a successful statewide immunization registry

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AMERICAN JOURNAL OF PREVENTIVE MEDICINE 1997年第2期13卷 12-16页

作者： Popovich, ML Hughes, T AIISP Scientific Technologies Corporation Tucson AZ United States

Lessons learned play a valuable role in understanding the dynamics of building immunization registries. These extend beyond technical issues. Arizona has identified 10 steps in the natural evolution of a system that are leading to a successful state immunization registry development project. Identifying the technical solutions for implementing a registry is somewhat straightforward. Providing a cost-constrained, user-efficient, timely, and implementable solution is somewhat harder. Eliminating barriers and convincing providers to participate to create a ''win-win'' environment for all involved is harder still. Maintaining user enthusiasm and energy is the challenge. The Arizona immunization project has identified and is following 10 steps that are key to meeting these challenges and achieving the required success. The steps are as follows: (1) establish a coalition of statewide private and public partners;(2) develop a technical plan;(3) review the plan with the community of providers and associated immunization organizations;(4) secure adequate funding;(5) create an integrated development team that includes technical, immunization-specialist, and user-support members;(6) market, educate, and sell the solution to providers, schools, nurse associations, managed care organizations, and parents on the system;(7) develop and test components of the system in a pilot mode, building and expanding upon success and not being afraid of failure;(8) maintain project visibility;(9) provide ongoing and timely user support and interaction, listening to providers;and (10) change with the times, adapt the program as the need arises. Medical Subject Headings (MeSH): immunization registries;computer systems development.

关键词： immunization registries computer systems development

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Citizen Personas: Exploring Challenges of Citizen-Centric eHealth 26

Citizen Personas: Exploring Challenges of Citizen-Centric eH...

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26th Medical Informatics in Europe (MIE) Conference on Digital Healthcare Empowering Europeans

作者： Petersen, Lone Stub Bertelsen, Pernille Aalborg Univ Danish Ctr Hlth Informat DaCHI Aalborg Denmark

ISBN: (纸本)9781614995128;9781614995111

Within the field of eHealth, there is a shift towards a patient perspective. However, the focus on the patient often fails to acknowledge and achieve a citizen-centric perspective because there is a lack of understanding of the context and complexities of the person and her relations, interests and activities. In this paper we use the persona of 'Citizen Hanne' for two purposes. Firstly, to highlight and provide detail in the understanding of the citizen perspective and thereby facilitate a shift towards a citizen-centric perspective, which is advanced by many in the field of eHealth. Secondly, we want to further nourish a critical goal of highlighting the challenges in doing citizen-centric eHealth and pointing out the barriers for reaching this goal.

关键词： eHealth Public Participation Patient Participation Empowerment Democracy Community-Based Participatory Research computer systems development

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Cooperation and communication challenges in small-scale eHealth development projects

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INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS 2013年第12期82卷 E375-E385页

作者： Petersen, Lone Stub Bertelsen, Pernille Bjornes, Charlotte Aalborg Univ Dept Planning Danish Ctr Hlth Informat Aalborg Denmark Aalborg Univ Hosp Clin Nursing Res Unit Aalborg Denmark

Aim: In eHealth development there is an increasing focus on user participation inspired by the information systems field of practice and research. There are, however, many other challenges in developing information systems that fit healthcare practices. One of these is the challenge of cooperation and communication in development projects that are initiated and managed by clinicians e. g. cooperating with IT professionals in 'bottom up' health informatics projects that have been initiated and are managed by healthcare professional project managers. Method: The analysis and results are drawn from a qualitative case study on a systems development project that was managed by a local, non-technical, healthcare professional and the complex blend and interactions with the IT professionals in the phases of ideas, design, development, implementation, maintenance and distribution. Results: We analyze the challenges of cooperation and communication using perspectives from information systems research and the concepts of 'language-games' and 'shared design spaces', and thereby exploring the boundaries between the different communication, practice and culture of the IT professionals and the healthcare professionals. Conclusion: There is a need to (a) develop a better understanding of the development process from the point of view of the 'user' and (b) tools for making technical knowledge explicit in the development process. Cooperative and communicative methods are needed that support and develop the shared design spaces between IT professionals and the clinical context in order to strengthen small-scale health information systems projects. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

关键词： eHealth computer systems development Software DESIGN Language Cooperation Communication Participation

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User-centred design. For users or by users?

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Ergonomics 1995年第8期38卷 1667-1667页

作者： Eason, K.D. Human Sciences and Advanced Technology (HUSAT) Research Institute University of Technology Loughborough LE11 3TU United Kingdom

When ergonomists contribute to the design of products and services they aim to be user-centred. This paper explores two possible meanings of user-centredness;the ergonomist may use theories and findings about human behaviour to act for the user or may help the user to participate in design. Both approaches are well known in ergonomics and they can point in conflicting directions. This paper examines the rationale for the two approaches and presents the results of a survey, which found that the most successful strategy was to mix the two approaches. It offers a classification to support the identification of the appropriate approach to adopt in different situations. The paper proposes, for example, that ‘design by users’ is the appropriate strategy when significant value judgements have to be taken in a local or bespoke design setting. By contrast a ‘design for users’ approach is appropriate for the design of generic products. An additional approach ‘design for users with users’ is introduced for settings that require knowledge about human characteristics and that need users to make value judgements. © 1995 Taylor and Francis Ltd.

关键词： Change agents computer systems development The practice of ergonomics User-centred design

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