Demand-driven System Research Articles

Towards a continuous evolution and adaptation of information systems in healthcare

Objectives: To address the problem of alignment of health information systems to healthcare processes, which is a major challenge in healthcare organizations; to present a layered approach for system evolution and adaptation based on an application framework and rapid application development; to accomplish a demand-driven system evolution by embedding the software engineering process in business process optimization projects and by closely involving end users to improve their own work practices. Methods: We have used a holistic health information system as a core application framework. System functionality is incrementally improved using an integrated “generator tool” for rapid application development. We have developed an iterative and participatory software engineering process, adapted to the conditions of the generator tool. The documentation techniques provided by the Unified Modeling Language (UML) were modified to achieve a straight forward documentation covering the whole development cycle from the business process model to generator-based computer applications. Results and conclusion: The layered approach for system evolution did provide an environment in which a flexible and participatory software development process could be established. Today, generator-based applications are used in all clinical departments of our 1200-bed University Hospital. We expect that tools for rapid application development will be further improved and will play an increasingly important role to establish responsive IT-infrastructures where the application developer can concentrate on business process alignment instead of coding and debugging.

Tool Management and Job Allocation in Flexible Machining Cells Part 1: Work-Oriented Strategies

In many flexible machining cells, total priority is given to meeting a scheduled list of work orders. The management of the tooling resource required to process these work schedules is also important. This paper presents and investigates strategies for tool management and job allocation in such a demand-driven system, and are termed work oriented. These generic strategies are described, forecasting the required level of tool exchange activity at individual machines according to different sets of issue and return rules. A computational study using industrial data has been conducted to assess the effectiveness of the strategies over a range of different system characteristics and under the influence of two job allocation rules. The model, data and range of parameters are discussed and results are presented and compared. Conclusions are drawn regarding the success of the study, the nature of the data used and the relative performance of the strategies.

The New National Health Service: A Case of Postmodernism?

The National Health Service in Britain has recently undergone a major re organization. It has moved away from being a planned system of health care delivery to a demand driven system organized on the principles of (quasi-) market competition and quality assurance. These changes are intended by gov ernment to 'empower' the consumer (patient) with real choice and to incorpor ate the health professionals within a more effective and efficient system of hospital management. It is in this context that the paper examines the use fulness of 'postmodernity' as an explanation for the emergence of new 'flex ible' organizational forms within the hospital service. The paper will concen trate on the ideological and organizational contradictions between state policy and local practice, especially in relation to issues of managerial vs professional autonomy and control.

The Capitated Multi-Specialty Medical Group:

This article focuses on the capitated multi-specialty clinic's ability to be the most cost-effective method of controlling employer's escalating health care costs. We outline the characteristics of a multi-specialty clinic that allow it to be an efficient provider of quality medical care. Integration of these inherent characteristics into a capitated prepaid setting results in a health care provider second to none in its ability to effectively manage resources. To achieve this desired goal, compensation to the clinic must be in the form of a comprehensive capitation which includes both primary and specialty care. The basis of the article is that, by combining the efficiencies of a multi-specialty clinic into a system that completely shifts the economic incentives from a demand driven system to a system encouraging appropriate use of resources, a medical group is addressing the fundamental problem of runaway medical costs.