Modern health care systems are information dense and increasingly relying on computer-based information systems. Regrettably, many of these information systems behave only as an information repository, and the interoperability between different systems remains a challenge even with decades of investment in health information exchange standards. Medical records are complex data models and developing medical data import / export functions a is difficult, prone to error and hard to maintain process. Bidirectional transformations (bx) theories have been developed within the last decade in the fields of software engineering, programming languages and databases as a mechanism for relating different data models and keeping them consistent with each other. Current bx theories and tools have been applied to hand-picked, small-size problems outside of the health care sector. However, we believe that medical record exchange is a promising industrial application case for applying bx theories and may resolve some of the interoperability challenges in this domain. We introduce BXE2E, a proof-of-concept framework which frames the medical record interoperability challenge as a bx problem and provides a real world application of bx theories. During our experiments, BXE2E was able to reliably import / export medical records correctly and with reasonable performance. By applying bx theories to the medical document exchange problem, we are able to demonstrate a method of reducing the difficulty of creating and maintaining such a system as well as reducing the number of errors that may result. The fundamental BXE2E design allows it to be easily integrated to other data systems that could benefit from bx theories. / Graduate / 0984

Les outils du système d‘information sont un support aux activités des acteurs de l‘organisation. Les entreprises remplacent leurs outils par de nouveaux à la recherche de l‘amélioration de la performance, de la qualité, etc. Néanmoins, l‘implémentation d‘un nouvel outil numérique est un processus d‘adaptation mutuelle entre l‘organisation et la technologie, qui comporte des changements sur plusieurs dimensions et à différents niveaux de granularité. L‘objectif de nos travaux est de contribuer à accompagner ces changements dans le but de favoriser l‘innovation organisationnelle. Nous proposons d‘appréhender la diversité des évolutions dans l‘organisation et des adaptations de l‘outil à travers la diversité des transformations « potentielles » et « effectives » des usages. Afin d‘identifier la diversité des transformations « potentielles » des usages, nous proposons de comparer la diversité des usages « effectifs » de l‘outil « à remplacer » et « potentiels » de l‘outil « à introduire ». Une fois identifiées, les transformations « potentielles » peuvent être maitrisées à travers des décisions sur les usages à délaisser, à conserver, à adopter, jusqu‘à l‘émergence de nouveaux usages. C‘est la mise en oeuvre de ces transformations « effectives » qui implique des évolutions dans l‘organisation et/ou des adaptations de l‘outil. Nous définissons un modèle d‘usage pour tenir compte de la diversité des usages. A partir de ce modèle, nous définitions des méthodes d‘exploration graduelle de la diversité des usages et de la diversité des transformations des usages, orientées organisation ou outil. Nous illustrons l‘application des méthodes proposées à travers le cas d‘étude d‘informatisation du dossier de soins dans une structure d‘hospitalisation à domicile. / Information system tools provide support for the activities of actors in an organization. Companies replace their tools by new ones in search of performance or quality improvements, etc. However, the implementation of a new digital tool is a process of mutual adaptation between the organization and the technology, which involves changes on several dimensions and on different levels of granularity. The aim of our work is to contribute to manage these changes in order to encourage organizational innovation. We propose to grasp the diversity of evolutions in the organization and of adaptations in the tool through the diversity of ―potential‖ and ―effective‖ transformations in usages. In order to identify diversity of ―potential‖ usages, we propose to compare the diversity of ―effective‖ usages of the tool ―to replace‖ and of ―potential‖ usages of the tool ―to introduce‖. Once identified, the ―potential‖ transformations can be managed through decision making on usages to abandon, to keep, to adopt, to the emergence of new usages. It‘s the implementation of these ―effective‖ transformations that involves evolutions in the organization and adaptations of the tool. We set a usage model to consider the diversity of usages. From this model, we define methods for gradual exploration of the diversity of usages and of usage transformations, organization- and tool-oriented. We illustrate the application of methods proposed through the case study of computerization of the patient care record in a home care structure.