5th International Workshop on Software Engineering in Health Care (SEHC 2013) Craig E. Kuziemsky
John Knight
Telfer School of Management University of Ottawa Ottawa, Canada
[email protected]
Department of Computer Science University of Virginia Charlottesville, USA
[email protected]
Abstract—Our ability to deliver timely, effective and cost efficient healthcare services remains one of the world’s foremost challenges. The challenge has numerous dimensions including the need to develop: (a) a highly functional yet secure electronic health record system that integrates a multitude of incompatible existing systems, (b) in-home patient support systems to reduce demand on professional health-care facilities, and (c) innovative technical devices such as advanced pacemakers that support other healthcare procedures. Responding to this challenge will necessitate increased development and usage of softwareintensive systems in all aspects of healthcare services. However the increased digitization of healthcare has identified extensive requirements related to the development, use, evolution, and integration of health software in areas such as the volume and dependability of software required, and the safety and security of the associated devices. The goal of the fifth workshop on Software Engineering for Health Care was to discuss recent research innovations and to continue developing an interdisciplinary community to develop a research, educational and industrial agenda for supporting software engineering in the health care sector. Index Terms—Software engineering, healthcare, design, evaluation, interoperability, work processes
systems
I. OVERVIEW An Institute of Medicine report published in 2012 concluded that healthcare has become too complex and costly to continue on its present trajectory, and that digital technologies will be a key aspect of healthcare delivery [1]. In order to facilitate the digitization of healthcare in the US, the Office of the National Coordinator (ONC) for Health Information Technology continues to develop protocols for health IT standards, interoperability and meaningful use [2]. Yet despite well described needs for software development and efforts of organizations like ONC to deliver those needs unintended consequences such as workflow and usability issues, poor system interoperability, and privacy and security continue to be ongoing problems [3]. While the digitization of the healthcare system has the potential to vastly improve healthcare delivery it needs to be done using sound engineering principles. Software solutions to address healthcare issues are often developed as a one-off solution to a problem, labeled a bricolage solution [4], (French for tinkering) rather than a
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systematic solution to the problem. Aside from the potential of poorly engineered solutions introducing unintended consequences, one-off solutions may further entrench existing processes and contribute to system inertia rather than being the catalyst for meaningful system transformation. Software engineering will play a crucial role in the healthcare system transformation that is upon us. The current healthcare paradigm is one of connectivity and information exchange. Advances in software engineering will guide and mold the transformation, because our ability to provide connected and integrated service delivery will be driven by our ability to construct the necessary software. Of course, a substantial portfolio of software engineering tools and techniques is already available. While many of these tools and techniques can be applied to healthcare the unique nature of the healthcare sector will provides the opportunity for the discovery of novel solutions from the software engineering community. For example, healthcare requires advances in areas such as ultra-large-scale systems design and development in order to provide integrated solutions while achieving the necessary levels of patient safety, and also providing strong levels of assurance of all aspects of patient privacy. Many services and treatments that are presently manual are being automated, and new treatments are evolving that are heavily dependent on IT and its underlying software. The increased delivery of healthcare services via collaborative teams means that information needs to be sharable across providers and settings while still protecting patient privacy. These changes to care delivery will only increase the importance of software engineering in healthcare. Governments worldwide are putting up large investments in healthcare IT. The US government intends to spend $36.3 billion over the next several years on implementing electronic health record software and systems [5], while in Europe the eHealth market is at EUR 20.9 billion and climbing [6]. The Canada Health Infoway [7] is a not-for-profit agency coordinating the IT activities of regional health-care authorities and has received over $2B for electronic health records, telehealth and public health surveillance solutions. The developing world is also investing in IT to improve the quality and efficiency of health-care, motivated primarily by the need to collect epidemiological data in a timely fashion.
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ICSE 2013, San Francisco, CA, USA Workshop Summaries
At a very high level, there are (at least) five important problems in health care in which the SEHC community can play a guiding role: • Establishing, maintaining and sharing complete and up-to-date electronic health records (EHRs). • Developing evidence based clinical decision-support systems in which all relevant information will be retrieved and appropriately presented to health-care professionals at the point of care. This information should be cross-referenced with related domain knowledge (about drug contraindications, for example) and empirical evidence (about related clinical studies, for example). • Development of comprehensive, large-scale, highperformance, high-availability platforms for remoteaccess healthcare to provide service in non-traditional settings like patient’s homes, clinics or remote settings. • Development of technologies for assisted living including ambient/pervasive systems that monitor the activities and physiological parameters of patients, recognize “interesting” changes in their status and alert health professionals and family members. • Development of systems for large-scale analytics based on EHR data. Knowledge extracted by data-mining and interactive tools is essential for evidence-based care delivery as well as for epidemiology and health-care policy making. II. WORKSHOP GOALS At the 3rd SEHC workshop in 2011 we began development of a report on software engineering in healthcare. The report defined the key issues related to software engineering in healthcare to position the SEHC community to make a meaningful contribution to healthcare transformation. The report was revisited and revised during and after the 2012 workshop in order to become the working framework for the SEHC community. After the 2012 workshop a SEHC Wiki was created to be the working version of the SEHC framework
(https://xserve.cs.uvic.ca/wiki/projects/sehcwiki/SEHC_Comm unity_Wiki.html). The 5th workshop on SEHC used content from the report to guide the workshop discussions to ensure sustainability and progress within the SEHC community between workshops and also to maintain continuity in the workshops from year to year. The workshop discussed recent advances in related research to continue the process of identifying key issues in the field and more importantly solutions to the issues. The theme for the 5th SEHC workshop was “Moving beyond entrenched ways – Software engineering for healthcare transformation in the 21st Century”. REFERENCES [1] Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, http://www.iom.edu/Reports/2012/Best-Care-at-Lower-CostThe-Path-to-Continuously-Learning-Health-Care-inAmerica.aspx [2] The Office of the National Coordinator (ONC) for Health Information Technology http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_ gov__onc/1200 [3] Bloomrosen M, Starren J, Lorenzi NM et al., Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting J Am Med Inform Assoc 2011;18:82-90 [4] Coiera E. Why system inertia makes healthcare reform so difficult. BMJ 2011;342:d3693 [5] G. Eason, B. Noble, and I. N. Sneddon, “On certain integrals of Lipschitz-Hankel type involving products of Bessel functions,” Phil. Trans. Roy. Soc. London, vol. A247, pp. 529–551, April 1955. (references) [6] R. Giampieretti, L. Gatzoulis, I. Iakovidis (2009) Health for a Sustainable Growth. Oslo Teknopol News. [7] Canada Health Infoway, https://www.infoway-inforoute.ca/
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