Multiple IT Research Articles

75 A Proactive Risk Assessment of Electronic Blood Product Ordering

Transfusion of blood components is a complex multidisciplinary process from provider order, to blood bank processing, to administration. Errors at any of these points can result in great harm to the patient. Given the complexity and high-risk process of blood ordering, one of our 2016 quality and patient safety (QPS) goals was to conduct a proactive risk assessment (PRA) for blood product ordering using failure modes and effects analysis (FMEA) methodology. The scope for this project included electronic routine order of all blood products through the point of pickup for all locations, excluding the operating rooms, where the electronic order system is not used. The steps prior to the order (type and screen [T&S] specimen collection and testing) and the steps following product pickup (transfusion of the product) were outside of the scope of this project. The FMEA tool was used to identify possible failure modes to reduce these risks. Initially, the clinical systems engineers (CSEs) from the QPS department conducted interviews and observations of the process. Subsequently, two interdisciplinary teams (East Campus and West Campus), comprising key stakeholders from each step of the electronic blood ordering process, were formed and led by the CSEs. The PRA consisted of creating a process map, identifying potential failure modes for each sub-step, assigning a risk score to each potential failure mode, and identifying the potential failure effects and causes. Failure modes were scored for three indicators: severity (S), likelihood of occurrence (O), and probability of detection (D). A risk priority number (RPN) was calculated by multiplying S by O by D. For those failure modes with RPN ≥81, mitigation strategies were developed by the interdisciplinary teams. The East Campus identified 54 failure modes (30 with RPN≥81), and the West Campus identified 103 failure modes (34 with RPN≥81). Potential causes of these failures revealed a wide range, including human error (eg, incorrect patient selected), interdisciplinary communication (eg, inaccurate identification of contact information), IT/equipment (eg, multiple IT systems interfaces), and process issues (eg, lack of transfusion history). Risk mitigation strategies include an enhanced order entry set with logic-based alerts and a streamlined pickup process. In addition, a nursing task list is being developed to facilitate pre-transfusion processes. Finally, a transfusion dashboard is being designed to improve the access of ordering providers to relevant information (eg, transfusion history, transfusion reactions, relevant labs, and T&S status). FMEA is useful for proactively addressing risks for a highly complex process, such as blood product ordering, to identify issues and improve the process. The ultimate goal of this FMEA is to improve quality and patient safety, by preventing transfusion delays and erroneous blood product administration.

CityMii - An integration and interoperable middleware to manage a Smart City

Modern cities are supported by multiple heterogeneous IT systems deployed and managed by distinct agents. In general, those systems use old, dependent and non-standardized technologies, which make them legacy and incompatible systems. As smart cities are moving toward a fully centralized management approach, the lack of integration among systems raises several problems. Since they are independent, it is not easy to correlate information from different systems and put it together to work in order to achieve application goals.The collaboration among different systems enables an agent to offer new functionalities (services or just information about the city) that cannot be provided by any of these systems working as individual entities. The goal of this paper is to propose an integration middleware to support the management of Smart Cities in a dynamic, transparent and scalable way. The proposed middleware intends to support interoperability among different systems operating in a city.

A cloud-based, knowledge-enriched framework for increasing machining efficiency based on machine tool monitoring

The ever-increasing complexity in manufacturing systems caused by the fluctuating customer demands has highly affected the contemporary shop-floors. The selection of the appropriate cutting parameters is becoming more and more challenging due to the increasing complexity of products. Until now, the knowledge of the machine operators concerning the modification of the machining parameters and the monitoring information is not sufficiently exploited by the optimization systems. Web and Cloud technologies together with wireless sensor networks are required to capture the shop-floor data and enable the ubiquitous access from multiple IT tools. For addressing these challenges, this research work proposes a Cloud-based, knowledge-enriched framework for machining efficiency based on machine tool monitoring. More precisely, it focuses on the optimization of the machining parameters and moves through an event-driven optimization algorithm, utilizing the existing machining knowledge captured by the monitoring system. Based on the features of a new part, a similarity mechanism retrieves the cutting parameters of successfully executed past parts that have been machined. Afterwards, the optimization module, using event-driven function blocks, adapts these parameters to efficiently optimize the moves and the cutting parameters. The monitoring system uses a wireless sensor network and a human operator input via mobile devices. A case study from the mould-making industry is used for validating the proposed framework.

The rise of IT services clusters in India: A case of growth by replication

The Indian IT services sector has grown from small beginnings at the bottom of value creation to a major player in the global information and communications technology (ICT) industry. It commands a 55% share in the global market for IT services. India's IT sector value proposition in terms of low cost with large supply of high quality talent is compelling. As a result, India has become the premier choice not only for outsourcing IT services by the developed-world's multinational corporations (MNCs) but also for locating their own Global In-house Centers (GICs), which simultaneously compete and partner with local firms. This gave rise to six additional clusters beyond the earliest, largest and robust cluster, Bangalore. The paper provides a review of relevant literature; develops a conceptual framework for evaluation of clusters; and presents data and analysis with respect to relative size, growth, specialization, MNC presence and connectivity to local firms through expatriates and returning Indians, ,innovation; and discusses adequacy of ICT infrastructure for future growth. Although there are clear signs that the Indian IT sector has been moving towards a regime of providing high-end value added services, the sector's value proposition – lower cost combined with a large supply of high quality talent – remains the single most compelling reason for the rise and growth of multiple export clusters. Thus the sector's growth appears to be a case of growth by replication rather than innovation. The paper concludes that the Indian IT sector's value proposition in terms of lower cost combined with large supply of high quality talent remains the single most compelling reason for the rise and growth of multiple IT services export clusters. While the old adage, “people follow jobs” still holds for large part of the labor force, there is little doubt that the sprawling IT services clusters in India - with more to come from Tier II and Tier III cities – indicate, in fact, that “jobs follow talent." Both local firms and the MNCs, through their GICs, are pushing the boundaries of location farther and farther to continue to leverage cost advantage and available pools of talent.

On the Design of Fine Grained Access Control With User Authentication Scheme for Telecare Medicine Information Systems

A telecare medicine information system (TMIS) for health-care delivery service requires information exchange among multiple IT systems, where different types of users with different access privileges are involved. In TMIS, users generally communicate via public channels. Hence, authentication is essential to provide access to the genuine users. However, access rights for the correct information and resources for different services to the genuine users can be provided with the help of efficient user access control mechanism. The existing user authentication protocols designed for TMIS only provide authentication, but for this kind of application, it is required that the authorized users should also have unique access privilege to access specific data. This paper puts forwards a new fine grained access control with user authentication scheme for TMIS. We present the formal security analysis using both the widely accepted real-or-random model and Burrows-Abadi–Needham logic. The proposed scheme supports user anonymity, forward secrecy, and efficient password change without contacting the remote server. In addition, the proposed scheme is comparable with respect to communication and computation costs as compared with other related schemes proposed in TMIS. Moreover, better tradeoff among security and functionality features, and communication and computation costs makes the proposed scheme suitable and practical for telecare medicine environments as compared with other existing related schemes.

Jelszómenedzser szoftver alkalmazása az egészségügyben

When using multiple IT systems, handling of passwords in a secure manner means a potential source of problem. The most frequent issues are choosing the appropriate length and complexity, and then remembering the strong passwords. Password manager software provides a good solution for this problem, while greatly increasing the security of sensitive medical data. This article introduces a password manager software and provides basic information of the application. It also discusses how to select a really secure password manager software and suggests a practical application to efficient, safe and comfortable use for health care. Orv. Hetil., 2016, 157(52), 2066-2073.

Venous thromboembolism capture on electronic systems in obstetrics patients at St Thomas' Hospital.

Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the UK. Therefore, timely VTE risk assessment is essential in all obstetrics patients. The Commissioning for Quality and Innovation (CQUIN) payment framework set a target for trusts to complete a VTE risk assessment within 24 hours of admission for 95% of patients. A combination of factors, including lack of integration between multiple IT systems, means that this CQUIN target is currently not being met for obstetric patients in the Hospital Birth Centre at Guys and St Thomas' NHS Trust.This project aims to increase staff awareness of this issue and educate them regarding the correct procedure for VTE assessment. Trialled methods included reminders at staff handovers, use of magnets on the patient whiteboard, posters and stickers displayed around the unit and a loyalty card scheme as incentive to complete assessments. Initial average completion rate was 20.7%, which increased to 67.5% after the first plan, do, study, act (PDSA) cycle with a slight drop to 65.7% after the second cycle. Completion rates increased to 92.3% on the last day of the third PDSA cycle. Although we did not reach the 95% target, we have raised awareness of the importance of recording VTE assessment on electronic systems, and hope we have created sustainable change.

Clinical safety of England's national programme for IT: A retrospective analysis of all reported safety events 2005 to 2011

ObjectiveTo analyse patient safety events associated with England's national programme for IT (NPfIT). MethodsRetrospective analysis of all safety events managed by a dedicated IT safety team between September 2005 and November 2011 was undertaken. Events were reviewed against an existing classification for problems associated with IT. The proportion of reported events per problem type, consequences, source of report, resolution within 24h, time of day and day of week were examined. Sub-group analyses were undertaken for events involving patient harm and those that occurred on a large scale. ResultsOf the 850 events analysed, 68% (n=574) described potentially hazardous circumstances, 24% (n=205) had an observable impact on care delivery, 4% (n=36) were a near miss, and 3% (n=22) were associated with patient harm, including three deaths (0·35%). Eleven events did not have a noticeable consequence (1%) and two were complaints (<1%). Amongst the events 1606 separate contributing problems were identified. Of these 92% were predominately associated with technical rather than human factors. Problems involving human factors were four times as likely to result in patient harm than technical problems (25% versus 8%; OR 3·98, 95%CI 1·90–8.34). Large-scale events affecting 10 or more individuals or multiple IT systems accounted for 23% (n=191) of the sample and were significantly more likely to result in a near miss (6% versus 4%) or impact the delivery of care (39% versus 20%; p<0·001). ConclusionEvents associated with NPfIT reinforce that the use of IT does create hazardous circumstances and can lead to patient harm or death. Large-scale patient safety events have the potential to affect many patients and clinicians, and this suggests that addressing them should be a priority for all major IT implementations.

Implementation of EMR and effects on health care delivery.

250 Background: Electronic health records have potential to enhance health care safety and quality by enabling effective communication, Clinical Decision Support technology, and generation of structured data for analysis. Despite the fact that EHRs have been shown to improve health care processes, the rapid growth of technology used to support medical care has resulted in the creation of enormous volumes of data used to assess and manage healthcare delivery. Valuable data is often siloed in multiple IT systems or captured in free-text clinical notes and non-searchable documents (unstructured data) making it impossible to quickly develop and act on real-time longitudinal data. Methods: Flatiron (FI) operates a "big data" software platform that aggregates, cleans and structures deep clinical oncology data thus facilitating understanding of operational, clinical and financial analytics related to cancer care. The platform proposes to solve these fundamental data challenges, enabling a range of real-time quality measures. It is best understood as three related components: the first is the technical integration between FI and providers' IT and data systems. That integration serves as the plumbing through which data flows securely from the provider to FI. The second is FI’s structured database, which transforms raw clinical, operational, and billing data into clean, structured, longitudinal, real-time patient data. The third is the FI user interface portal, which is a web-based analytics tool that facilitates access to the continually updated structured database. Results: Over 10 institutions have partnered with FI to deploy the platform. The full integration of an institution can be achieved in 12 to 16 weeks with daily updates to the analytics after the initial phase. Over 15,000 patients are expected to be fully integrated in the next 3-6 months. Initial QOPI and other quality measures have been included and customizable dashboards linking charge databases with clinical outcomes have been created. Dashboards with quality metrics will be presented in the conference. Conclusions: Implementation of EMRs alone does not improve healthcare delivery. Data on colorectal cancer patients will be presented at the meeting.

O Problema de Alocação de Recursos e Seleção de Múltiplos Projetos de TI

As organizações que possuem projetos ocorrendo simultaneamente se deparam com a tarefa de selecioná-los segundo algum critério, bem como, a necessidade de alocação de recursos certos aos projetos certos nos tempos certos. O problema de RCPSP (Resource-Constrained Project Scheduling Problem) é um problema difícil que pertence à classe de problemas NP-Hard. Nele pretende-se criar cronogramas com restrições de recursos. Este problema continua desafiador, mesmo tendo origem na década de 1960, devido essencialmente a sua natureza combinatória. O objetivo deste trabalho é avaliar a utilização de técnicas exatas de otimização, no intuito de obter uma alocação ótima de recursos às atividades de múltiplos projetos de TI que usam metodologias ágeis (Scrum), considerando restrição de recursos (analistas e programadores), visando à construção de cronogramas de múltiplos projetos integrados. Utiliza-se neste trabalho uma nova abordagem no sentido de se encontrar a atribuição ótima de projetos considerando as suas prioridades relativas, e a avaliação poder ser realizada para um horizonte de planejamento ou enquanto estão em andamento. Mostramos que nosso modelo promove uma adequada avaliação de atribuição ótima de recursos de TI num contexto real de gestão de projetos para instâncias com até 9 projetos.DOI:10.5585/gep.v4i2.125

Newly designed plastic stent for endoscopic placement above the sphincter of Oddi in patients with malignant hilar biliary obstruction

Plastic stent (PS) occlusion occurs as a result of bacterial adherence to the stent's inner wall. To retain the bacteriological barrier, placing a PS above the sphincter of Oddi ('inside stent') has been investigated. We designed a new PS (inside stent with thread [IT] stent) with attachable nylon thread for use as an inside stent and for easy retrieval. The present study evaluated the IT stent's technical feasibility and efficacy for malignant hilar biliary obstruction. A total of 26 consecutive patients with unresectable malignant hilar biliary obstruction underwent placement of IT stents from August 2007 to February 2011. IT stents were placed across the strictures without sphincterotomy to achieve bilateral drainage. The overall technical success rate of the IT stent was 100% for one session. Multiple IT stents were inserted in 25 cases(two stents in 15 patients, three stents in 10 patients). No stent-related early complications occurred. The functional success rate was 92% (24/26). The rate of reintervention because of stent malfunction was 50% (13/26). In all 16 patients who underwent stent removal, IT stents were easily retrieved using the nylon thread. According to Kaplan-Meier analysis, the median stent patency period was 136 days. IT stents for endoscopic placement above the sphincter of Oddi can be used safely and effectively for malignant hilar biliary obstruction.

Care Managers’ Challenges in Using Multiple Health IT Applications

While care managers use multiple health IT applications to coordinate patient care across transitions of care, they experience challenges posed by these multiple health IT applications. We used a macroergonomic framework (i.e. the work system model), and conducted interviews and observations of care managers (inpatient, outpatient, transition of care) and a web-based survey to assess these challenges. The challenges were related to the care managers’ work system: technologies and tools (e.g., poor interface design of health IT), organization (e.g., no access to some health IT applications), and tasks (e.g., duplicate documentation). Care managers consider the following as major barriers: transferring patient-related information between multiple applications, finding correct information for medication reconciliation and other patient information (e.g., patient’s psychosocial background), and duplicate documentation and data entry. The next phase of the research focuses on how care managers deal with challenges posed by multiple health IT applications to perform their job of coordinating patient care across transitions of care.

An efficient metaheuristic for integrated scheduling and staffing IT projects based on a generalized minimum cost flow network

AbstractScheduling IT projects and assigning the project work to human resources are an important and common tasks in almost any IT service company. It is particularly complex because human resources usually have multiple skills. Up to now only little work has considered IT‐specific properties of the project structure and human resources. In this article, we present an optimization model that simultaneously schedules the activities of multiple IT projects with serial network structures and assigns the project work to multiskilled internal and external human resources with different efficiencies. The goal is to minimize costs. We introduce a metaheuristic that decomposes the problem into a binary scheduling problem and a continuous staffing problem where the latter is solved efficiently by exploiting its underlying network structure. For comparison, we solve the mixed–binary linear program with a state–of–the–art commercial solver. The impacts of problem parameters on computation time and solution gaps between the metaheuristic and the solver are assessed in an experimental study. Our results show that the metaheuristic provides very favorable results in considerable less time than the solver for midsize problems. For larger problems, it shows a similar performance while the solver fails to return feasible solutions. © 2012 Wiley Periodicals, Inc. Naval Research Logistics 59: 111–127, 2012

Challenges to care coordination posed by the use of multiple health IT applications

Coordinating care for hospitalized patients requires the use of multiple sources of information. Using a macroergonomic framework (i.e. the work system model), we conducted interviews and observations of care managers involved in care coordination across transitions of care. When information is distributed across multiple health IT applications, care managers experience a range of challenges, including organizational barriers, technology design problems, skills and knowledge issues, and task performance demands (i.e. issues related to individual information processing and management and sharing of information). These challenges can be used as a checklist to evaluate the proposed IT infrastructure that will allow the integration of multiple health IT applications and, therefore, support coordination across transitions of care.

A Service Oriented Framework for Efficient Resource Orchestration in Future Optical Networks

The future Internet evolution is driven by applications that require simultaneous real-time access to multiple heterogeneous IT (e.g. computing and storage) resources interconnected by high-speed optical networks. Service oriented architectural frameworks have been considered to improve service delivery in this environment by organising distributed heterogeneous resources owned by multiple providers. In this paper, we discuss a service oriented architectural framework tailored to the needs of future Internet applications. The framework introduces the capability to orchestrate the provisioning of distributed heterogeneous resources owned by multiple providers. Central to the framework is a novel resource orchestration model. This model focuses on the optimized selection of heterogeneous IT and network resources owned by different Infrastructure Providers (InPs). The proposed model aims to achieve a global optimum from both the end-users’ and InPs’ point of view across different administrative domains. An integer linear program (ILP) is formulated to obtain optimal results that maximizes the number of accepted requests while minimising resource usage. It is compared against a co-scheduling ILP model, whose objective is to maximise the number of accepted requests only. We then propose a heuristic solution for scalability. Its performance is compared against (i) our proposed ILP (ii) a co-scheduling heuristic that aim to maximise the number of accepted requests only and (iii) an algorithm that does not take into account cross-domain optimisations. Finally, two online algorithms for operational scenarios is proposed which outperforms three benchmark algorithms.

The Malaysia IT outsourcing industry skill-sets requirements of future IT graduates

IT changes very quickly and influences business, industry and the public in an enormous manner. The issue of IT outsourcing (ITO) impact on IT workforce has been discussed widely in many developed countries so much so that the concerns have been tense in that more IT jobs will be transferred to developing countries which provide IT outsourcing services. In addition, with the growth of IT outsourcing and emerging new outsourcing business models such as utility demand, application service provider, business process outsourcing, offshore outsourcing and many more servicing different industry vertical sectors increase the demand for multiple IT skills and capabilities of IT workforce. In this study, we review relevant literature, newspapers and non-academic articles, websites of companies, governments and nongovernmental organisations and others. An outsourcing Malaysia (OM) CEO roundtable discussion is also held to get inputs from the practitioners on the topic. In addition, we seek in-depth insights from seven senior executive managements in service provider firms on the skill sets requirements of fresh IT graduates to fulfill the market needs of IT outsourcing in Malaysia. The four-member research team found that technical, soft and problem-solving skills are the main concerns raised by the key informants. This is in line with the literature review and also the present higher education policy concerns by the Malaysia government.

Realizing Collaborative Film and Television Workflows

In film and television production and post-production, tasks are often outsourced to specialist providers. The complexity of doing this is one reason that the benefits promised through completely tapeless working has yet to be fully realized. This paper presents the approach of the U.K.-funded Multiple User Post-Production IT Services (MUPPITS) project in tackling this problem. The significant challenges to the media creation industry that led to the formation of the project are examined, and an architecture that will help overcome these challenges is proposed. This architecture makes use of collaborative middleware techniques that were originally created for other industries. Two specific scenarios for this approach are outlined, namely digital dailies and post-production rendering The project's work on developing demonstrators for these scenarios is also described.

A quantitative model for understanding multiple vendor IT outsourcing

This is a post print file as per the journal publisher's requirements. Article deposited according to publisher policy posted on SHERPA/ROMEO, July 14, 2011.

The Diffusion of it in Higher Education: Publishing Productivity of Academic Life Scientists

This study investigates widening access to the Internet and other advancements in IT across institutions of higher education and how these advances have affected the publishing productivity of academic life scientists. What distinguishes this study is that institutional IT access is measured across a wide range of institutions and multiple IT indicators are considered: 1) the adoption of BITNET; 2) the registration of domain names (DNS); 3) the availability of the electronic journal database, JSTOR; and 4) the availability of electronic library resources. Data on life scientists are drawn from the 1983, 1995, 2001, and 2003 Survey of Doctorate Recipients. Universities and colleges are classified into several tiers, depending upon research intensity. Three hypotheses are tested: 1) IT enhances the careers of faculty, independent of tier; 2) IT improves the careers of faculty at lower-tiered relative to higher-tiered institutions; and 3) within tier, the IT revolution increases women's publication rates relative to their male counterparts. The study finds that the diffusion of IT in higher education follows the standard S-curve, with highertiered institutions innovating more quickly. Results regarding the impact of IT on the publishing productivity of life scientists provide some support for the first two hypotheses but no support for the third hypothesis.

An Interview with Jon Piot President and CEO Technisource Management Services Frisco, Texas

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsBradley K. JensenJon is President and CEO of Technisource Management Services, Inc. He was a co-founder of Impact Innovations Group which merged with Technisource in November 2005. He has managed multiple IT departments and led IT turnarounds for clients between $50M and $1B in revenue and focuses on helping clients improve their return on technology investments.Bradley K. Jensen received his Ph.D. in Business Computer Information Systems from the University of North Texas (UNT), with majors in Business Computer Information Systems and Computer Science. He is an Assistant Professor in Information Technology and Decision Sciences and Assistant Director of the Information Systems Research Center at UNT, and is also President of JMC Consulting Services, an executive management consulting firm which provides strategic and tactical IT consulting services. His research interests include privacy and security, networking, human factors, e-commerce, and document management. Dr. Jensen has been an executive and consultant with more than 20 years of sales, marketing, and IT experience with several Fortune 100 companies.