Designing ICT systems in the developing world is perceived to be a challenge. But is this really a challenge if we use state-of-the-art development methods? Will the fact that most standards and heuristics are made in the western world render them useless as tools of making modern computer software for the underdeveloped world? In this thesis I will analyze the findings of a software development project I did for my employer, National Center for Fetal Medicine (NCFM) at St. Olav’s Hospital in Trondheim, Norway. In this project we used a user centered development process as defined in ISO 9142-210 to make and test the prototype of an ultrasound help system. We tested the system using two different user groups: midwives in KwaZulu-Natal participating in an ultrasound teaching and training program held by NCFM and midwives in Trondheim, Norway, receiving a post-qualification course in ultrasound diagnostics also held by NCFM at the Norwegian University of Science and Technology (NTNU) in Trondheim. I will analyze the test results and then do an evaluation of the methods used – both the user-centered design process and the usability methods to see if the methods have worked in my project.

Unsurprisingly the National Health Service (NHS) has harnessed the prolific growth in Internet access to alleviate the increasing burden incurred due to rising healthcare costs. Healthcare interventions focus on the promotion of good behaviours; prevention of bad behaviours; provision of support for shared decision making; increasing knowledge and improving monitoring. Healthcare researchers typically rely on professional software developers in the creation of Internet interventions. Although varying in nomenclature Internet interventions typically consist of the same underlying components, such as navigation, logic and response capture. The LifeGuide Authoring Tool provides a potential solution to reduce this reliance of researchers on software developers in the creation of interventions. However the logic creation command line interface provided by LifeGuide is identified as a potential barrier for adoption, by nonprogrammers, due to their lack of experience with the strict programming style syntax it requires. Through the adoption of user-centred design techniques; early and continuous user involvement; rapid prototyping and interface design principles, a Graphical User Interface (GUI) was developed, with the potential to lower this barrier for researchers with no previous programming experience. A jigsaw metaphor was adopted in the design of the interface, utilising templates and pre-populated fields, with the aim of reducing errors and lowering the cognitive load experienced by users. A task-based evaluation compared the existing LifeGuide interface, with the new GUI, in the creation of commonly used logic. Higher results were reported over the five main usability measures: effectiveness; engagement; efficiency; ease of learning and error tolerability in favour of the GUI, in the creation of intervention logic. Continuing requests to the author to develop healthcare Internet Interventions supports the research, that there is still a heavy reliance of researchers on software developers. A further application for this approach was identified in the development of a tool to support healthcare researchers in the creation of mobile phone messaging interventions.

Advanced information technologies promise a massive influx of individual-specific medical data. These rich sources offer great potential for an increased understanding of disease mechanisms and for providing evidence-based and personalized clinical decision support. However, the size, complexity, and biases of the data pose new challenges, which make it difficult to transform the data to useful and actionable knowledge using conventional statistical analysis. The so-called “Big Data” era has created an emerging and urgent need for scalable, computer-based data mining methods that can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. The goal of my Ph.D. research is to address some key challenges in current clinical deci-sion support, including (1) the lack of a flexible, evidence-based, and personalized data mining tool, (2) the need for interactive interfaces and visualization to deliver the decision support knowledge in an accurate and effective way, (3) the ability to generate temporal rules based on patient-centric chronological events, and (4) the need for quantitative and progressive clinical predictions to investigate the causality of targeted clinical outcomes. The problem statement of this dissertation is that the size, complexity, and biases of the current clinical data make it very difficult for current informatics technologies to extract individual-specific knowledge for clinical decision support. This dissertation addresses these challenges with four overall specific aims: Evidence-Based and Personalized Decision Support: To develop clinical decision support systems that can generate evidence-based rules based on personalized clinical conditions. The systems should also show flexibility by using data from different clinical settings. Interactive Knowledge Delivery: To develop an interactive graphical user interface that expedites the delivery of discovered decision support knowledge and to propose a new visualiza-tion technique to improve the accuracy and efficiency of knowledge search. Temporal Knowledge Discovery: To improve conventional rule mining techniques for the discovery of relationships among temporal clinical events and to use case-based reasoning to evaluate the quality of discovered rules. Clinical Casual Analysis: To expand temporal rules with casual and time-after-cause analyses to provide progressive clinical prognostications without prediction time constraints. The research of this dissertation was conducted with frequent collaboration with Children’s Healthcare of Atlanta, Emory Hospital, and Georgia Institute of Technology. It resulted in the development and adoption of concrete application deliverables in different medical settings, including: the neuroARM system in pediatric neuropsychology, the PHARM system in predictive health, and the icuARM, icuARM-II, and icuARM-KM systems in intensive care. The case studies for the evaluation of these systems and the discovered knowledge demonstrate the scope of this research and its potential for future evidence-based and personalized clinical decision support.

<p>Healthcare is very information-intensive. Hence, it has become necessary to use the support of computers in order to efficiently improve such an information-intensive organisation.</p><p>This thesis points out deficiencies in the area of information security in home healthcare regarding personal integrity and secrecy. Home healthcare is, in Sweden, performed by the municipalities. The work is based on the recommendations and common advice for processing of personal data compiled by the Data Inspection Board. Two municipalities in the Västra Götaland Region have been investigated. One of the municipalities has a manual system and the other has a computerized system for personal data management.</p><p>The work includes a field study where persons from both municipalities have been observed. It also includes interviews based on the comprehensive questions from the Data Inspection Board and questions arisen from the observations.</p><p>The work shows that a very clear need of training among personnel involved in home healthcare. It also shows the need for elaborate security measures including levels on access profiles. A weak point concerning security is also the heavy use of facsimile transmission for information distribution.</p>

Healthcare is very information-intensive. Hence, it has become necessary to use the support of computers in order to efficiently improve such an information-intensive organisation. This thesis points out deficiencies in the area of information security in home healthcare regarding personal integrity and secrecy. Home healthcare is, in Sweden, performed by the municipalities. The work is based on the recommendations and common advice for processing of personal data compiled by the Data Inspection Board. Two municipalities in the Västra Götaland Region have been investigated. One of the municipalities has a manual system and the other has a computerized system for personal data management. The work includes a field study where persons from both municipalities have been observed. It also includes interviews based on the comprehensive questions from the Data Inspection Board and questions arisen from the observations. The work shows that a very clear need of training among personnel involved in home healthcare. It also shows the need for elaborate security measures including levels on access profiles. A weak point concerning security is also the heavy use of facsimile transmission for information distribution.

We have received a mission from a surgical ward at a hospital in northern Sweden; they want a solution that can be used on portable devices. On these devices the healthcare professionals should be able to document the measured vital signs and the results should automatically be documented in the patient record. In the context of a Participatory Design project we conducted design sessions which focused on the user interface of the solution but also deliberated possible functionalities that were not mentioned in the original mission description. The purpose of this study is to describe the situation surrounding the measurement of vital signs of patients. It is currently done manually on a paper form and then registered in the digital patient record. Our aim was to find a design and formulate the functional requirement of a tablet application together with the staff at a hospital in Sweden.

Real-time sensing brings the proliferation of big data that contains rich information of complex systems. It is well known that real-world systems show high levels of nonlinear and nonstationary behaviors in the presence of extraneous noise. This brings significant challenges for human experts to visually inspect the integrity and performance of complex systems from the collected data. My research goal is to develop innovative methodologies for modeling and optimizing complex systems, and create enabling technologies for real-world applications. Specifically, my research focuses on Mining Dynamic Recurrences in Nonlinear and Nonstationary Systems for Feature Extraction, Process Monitoring and Fault Diagnosis. This research will enable and assist in (i) sensor-driven modeling, monitoring and optimization of complex systems; (ii) integrating product design with system design of nonlinear dynamic processes; and (iii) creating better prediction/diagnostic tools for real-world complex processes. My research accomplishments include the following. (1) Feature Extraction and Analysis: I proposed a novel multiscale recurrence analysis to not only delineate recurrence dynamics in complex systems, but also resolve the computational issues for the large-scale datasets. It was utilized to identify heart failure subjects from the 24-hour heart rate variability (HRV) time series and control the quality of mobile-phone-based electrocardiogram (ECG) signals. (2) Modeling and Prediction: I proposed the design of stochastic sensor network to allow a subset of sensors at varying locations within the network to transmit dynamic information intermittently, and a new approach of sparse particle filtering to model spatiotemporal dynamics of big data in the stochastic sensor network. It may be noted that the proposed algorithm is very general and can be potentially applicable for stochastic sensor networks in a variety of disciplines, e.g., environmental sensor network and battlefield surveillance network. (3) Monitoring and Control: Process monitoring of dynamic transitions in complex systems is more concerned with aperiodic recurrences and heterogeneous types of recurrence variations. However, traditional recurrence analysis treats all recurrence states homogeneously, thereby failing to delineate heterogeneous recurrence patterns. I developed a new approach of heterogeneous recurrence analysis for complex systems informatics, process monitoring and anomaly detection. (4) Simulation and Optimization: Another research focuses on fractal-based simulation to study spatiotemporal dynamics on fractal surfaces of high-dimensional complex systems, and further optimize spatiotemporal patterns. This proposed algorithm is applied to study the reaction-diffusion modeling on fractal surfaces and real-world 3D heart surfaces.

The Swedish   healthcare system today has longer queues than before, low treatment rates   and lack of accessibility, treatment and service. Business Intelligence   System (BIS) purpose is to support organizations and businesses in different   types of decision-making that in turn can make the operations more efficient.   The purpose of this thesis is to develop and test a model that describes the   effects that BIS have on the healthcare system according to previous research   on Swedish healthcare staff and their experiences of these systems. The study   has been carried out through qualitative interviews with respondents who work   with BIS in the Swedish healthcare system. A model developed from previous   research has according to the purpose of this study been developed and tested   against the collected empirical data to see if the effects that the previous   research has identified are in line with what Swedish healthcare staff has identified.   The entire model which consists of BIS basic functionality and BIS effects on   healthcare has been tested against another respondent who did not participate   on any interview but instead performed a thorough analysis of the whole   model. What were tested by this respondent were the model’s flow, structure   and constituents. The result of this study came to the conclusion that the   basic functionality of the model developed and the identified effects are in   accordance with the effects identified by the Swedish healthcare staff they   receive from the BIS within their work. / Sammanfattning: Den svenska sjukvården har idag längre köer än   tidigare, låg behandlingstakt och brister i tillgänglighet, bemötande och   service. Business Intelligence System (BIS) har som syfte att stödja   organisationer och verksamheter vid olika typer av beslutstaganden som i sin   tur kan effektivisera verksamheten. Syftet med detta examensarbete är att   utveckla och testa en modell som beskriver de effekter som BIS har på   sjukvården enligt tidigare forskning mot svensk sjukvårdspersonal och deras   upplevelser utav dessa system. Studien har utförts genom kvalitativa   intervjuer med respondenter som arbetar med BIS inom den svenska sjukvården.   En modell som bygger på tidigare forskning har enligt syftet i denna studie   utvecklats och testats mot den insamlade empirin för att se om de effekter   som den tidigare forskningen har identifierat stämmer överens med vad svensk   sjukvårdspersonal har identifierat. Hela modellen som består av BIS   grundläggande funktionalitet samt BIS effekter på sjukvården har sedan   testats mot ytterligare en respondent som inte deltog i någon intervju utan   endast analyserat modellens helhet. Det som testades av denna respondent var   modellens flöde, struktur och beståndsdelar. Resultatet av denna studie kom   fram till att den framtagna modellens grundläggande funktionalitet samt de   effekter som återfinns i modellen stämmer överens med de effekter som den   svenska sjukvårdspersonalen har identifierat att de får ut av BIS inom sitt   arbete.,

This thesis was one of the deliverables of StandIN. The purpose of StandIN was to propose a common framework including standards for technical interoperability. The goal of this thesis was to structure and analyze information about the knowledge- and adoption level of the standards among providers of healthcare information systems (HIS's). Moreover, it aimed to evaluate different aspect that might affect the adoption. The target group was providers of HIS's used in Swedish county councils and regions. The information was gathered through a survey and semi-structured interviews, and stored in an Excel database. From the database, Pivot tables and charts were created in order to show the knowledge- as well as adoption level of the different standards. The results were thereafter compared to theory about interoperability and standard adoption. It was clear that the knowledge level varied for the different standards. In addition, the adoption level was very low - except from CCOW and HL7 v2. Least adopted were domain-specific standards. The results also indicated a trend for only adopting parts of standards. Moreover, many providers stated that they performed specific integrations rather than followed common standards. This seemed to be due to the choice of standards being too wide, and the actual adoption not being consistent among the different providers. According to the providers, an introduction of a national framework based on uniform and consistent international standards was an awaited solution to the problem. A future extension of this thesis would be to perform a similar study involving the customers. The database could also be used to do clustered analyses of the adoption state in different county councils and regions. Moreover, it could be used to analyze the development of standard adoption over time. / Den här uppsatsen var ett utav delresultaten i StandIN, ett initiativ till att ta fram ett gemensamt ramverk med standarder för teknisk interoperabilitet. Den här uppsatsen syftade till att strukturera och analysera information om kunskaps- och tillämpningsnivån för de tilltänkta standarderna. Målgruppen var leverantörer av vårdinformationssystem som används i Sveriges landsting och regioner. Informationen samlades in genom en enkät samt semi-strukturerade intervjuer, och lagrades sedan i en Excel-databas. Pivot-tabeller och -diagram skapades för att visualisera kunskaps- och tillämpningsnivån, och resultaten jämfördes sedan med teori om interoperabilitet och standardtillämpning. Det var tydligt att kunskapsnivån skilde sig för de olika standarderna. Tillämpningsnivån var generellt sett väldigt låg, bortsett från CCOW och HL7 v2. Minst tillämpade var domänspecifika standarder. Det var också tydligt att centrala leverantörer inte tillämpade samma standarder, vilket troligtvis påverkar de kompletterande systemen. Många leverantörer gjorde snarare specifika integrationer, än följde gemensamma standarder. Anledningen var att valet av standarder var för brett, och att den faktiska tillämpningen av standarder inte var konsekvent mellan olika leverantörer. Enligt leverantörerna skulle ett nationellt ramverk med enhetliga och internationella standarder vara en efterlängtad lösning på problemet. En fortsättning på denna uppsats är att använda databasen till att göra klusteranalyser för tillämpningsnivån av standarder hos system i olika landsting och regioner. Databasen skulle också kunna användas till att analysera utvecklingen av kunskap och tillämpning över tid. / StandIN

With the introduction of RIS and PACS technologies in clinical radiology, the field has become increasingly technology dependent. The quality assurance in radiology have however yet to catch on. With many quality assurance programs mainly focusing on the clinical side of radiology whilst little attention is paid to the technical aspects. This thesis serves to change that, by investigating quality assurance of radiology equipment in the workflow of hospital physicists and biomedical engineers at Södersjukhuset emergency hospital. To improve said workflows, process modelling and multi-actor system analysis was utilized in combination with the on-site inventory system Medusa. In order to model the workflows, the process modelling technique flowchart was used. To add additional information into the flowcharts, multi-actor system analysis was employed. This was done for the workflow of both scheduled and unscheduled maintenance of radiology equipment. Initially resulting in a pair of pre-study models which modelled the after the existing workflows. From said pair of pre-study models, both redundancies and main objectives for improvement were deduced. This in combination with an extensive semistructured literature review, led to a list of requirements. Two pairs of improved models were then created with the list of requirements in mind. All the models were then evaluated, including the pair of pre-study models, in workshops held with hospital physicists, biomedical engineers and respective leadership staff. These workshops contained both an open discussion and a questionnaire, asking the participants to rate the alignment of the models with the different requirements in the list. Based on the results from the workshops, one of the proposed pairs of improved models were then chosen as the final solution of an improved workflow. A workflow in which redundancies were reduced, traceability capabilities added in form of digital storage, and alignment with legislative demands from SSM assured. A step in the digitalization of Södersjukhuset. Utilizing digital technology to improve quality assurance in the workflow of radiology equipment. / I samband med introduktionen av RIS och PACS teknologi i klinisk radiologi, så har fältet blivit mer teknikdrivet. Kvalitetledning av radiologisk utrustning har däremot inte förändrats. Då de flesta kvalitetslednings program har primärt fokus på den kliniska sidan av radiologi och förbiser de tekniska aspekterna. Detta examensarbete försöker bemöta detta, genom att utreda kvalitetsledningen av radiologisk utrustning hos arbetsflödena av sjukhusfysiker och medicintekniska ingenjörer på Södersjukhuset. För att förbättra arbetsflödena, så användes processmodellering och analys av multi-aktörsystem i kombination med det lokala inventariesystemet Medusa. För att skapa en modell av arbetsflödet så användes processmodelleringstekniken flowchart. För att lägga till ytterligare information i flödena så utfördes en multi-aktörsystem analys. Detta utfördes för både förebyggande- och avhjälpande underhåll av radiologisk utrustning. Vilket resulterade i ett par av förstudiemodeller som modellerade det nuvarande arbetsflödet. Baserat på detta par av förstudiemodeller, så kunde både överflödigheter och huvudsakliga förbättringsmål härledas. Detta i kombination med en semistrukturerad litteraturundersökning, ledde till en lista med krav på modellerna. Sedan så skapades två par av modeller som förslag till förbättrat arbetsflöde, baserat på listan med krav. För att utvärdera alla modeller, inklusive förstudiemodellerna, så hölls workshops med sjukhusfysiker, medicintekniska ingenjörer och respektive chefspersonal. Dessa workshops innehöll både en öppen diskussion och ett formulär, som bad deltagarna att utvärdera de olika paren av modeller gentemot de olika kraven som hade formulerats i listan. Baserat på resultaten från dessa workshops, så valdes en av de två förslagna paren av modeller för förbättrat arbetsflöde, som en slutgiltig lösning. Ett arbetsflöde där överflödigheter har motarbetats, spårbarhet förbättrats med hjälp av digital lagring, och sammanstämning med regulatoriska krav från SSM har säkerställts. Ett steg i digitaliseringen av Södersjukhuset, genom att utnyttja digital teknik för att förbättra kvalitetledningen av radiologisk utrustning.