ICSE 2011 Workshops
33rd International Conference on Software Engineering
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Third International Workshop on Software Engineering in Healthcare (SEHC 2011), May 22-23, 2011, Waikiki, Honolulu, HI, USA

SEHC 2011 – Proceedings

Contents - Abstracts - Authors

Third International Workshop on Software Engineering in Healthcare (SEHC 2011)


Title Page

Towards a Use-Inspired Research Agenda for Software Engineering in Healthcare
The computer science research community has now recognized to the importance of fundamental, use-inspired and use-directed research and development, in computer science and engineering, for human health, healthcare, and healthcare economics. To cite one example, the first priority stated in the December 2010 Report of the (US) President's Council of Advisors on Science and Technology (PCAST), to the President of the United States, entitled Designing a Digital Future, is that the US Government “...should invest in a national, long-term, multi-agency research initiative on [networking and information technology] for health that goes well beyond the current national program to adopt electronic health records. The initiative should include sponsorship of multi-disciplinary research on three themes: to make possible comprehensive lifelong multi-source health records for individuals; to enable both professionals and the public to obtain and act on health knowledge from diverse and varied sources as part of an interoperable health IT ecosystem; and to provide appropriate information, tools, and assistive technologies that empower individuals to take charge of their own health and healthcare and to reduce its cost.”
The urgent need for improvements in health, healthcare and healthcare economics has emerged as a strategic priority not only for society, in general, but for computer science and engineering, in particular. Software engineering research has a potentially pivotal role to play, because required advances in health and healthcare require fundamental advances in our ability to produce ultra-complex and critical software underlying future health cyber-infrastructure systems and devices.
In this context, the software engineering research community has yet to organize itself around a clear, ambitious, and promising research agenda for health and healthcare. The engagement of software engineering researchers in healthcare remains light, and increasing the involvement of top researchers might require changes the norms and habits of our own research community.
The SEHC workshop series provides a high-visibility, high-impact venue for researchers in software engineering who are active or interested in this area, to assemble to understand and advance the state of the art. The SEHC 2011 workshop will focus specifically on the need to develop and articulate a research agenda and strategy. The product of the workshop will be a significant draft research agenda document. We encourage those interested in this area to attend and contribute to the formulation of this document. A day of talks will be followed by an agenda-setting keynote and a full day of collaboration to produce a draft Software Engineering Agenda for Use-Inspired Research in Health and Healthcare.
Eleni Stroulia, University of Alberta Kevin Sullivan, University of Virginia
Co-Organizers of SEHC 2011

Position Papers

Evolving Requirements in Patient-Centered Software
Kristina Winbladh, Hadar Ziv, and Debra J. Richardson
(University of Delaware, USA; UC Irvine, USA)
The implications of an aging U.S. population indicate that a large portion of the population will receive limited access to the healthcare they need, unless clinical preventive services are provided. Patient-centered healthcare, in which patients gain more access to and control over their own health, is becoming an important part of clinical preventive services and so is software. Healthcare entails highly complex processes that require substantial communication between different healthcare professionals. A major concern for patient-centered software is that it must adapt to changing needs to support long-term wellbeing, i.e., new knowledge must be considered continuously as part of the software lifecycle. This position paper contends that research efforts should be directed toward software engineering solutions that consider evolution as a part of the software lifecycle and use a variety of feedback channels to direct evolution, and presents a research agenda integrated with an approach that addresses evolving needs through a continuous data-driven requirements engineering (RE) technique.

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A Preliminary Study of Apparent Causes and Outcomes of Reported Failures with Patient Management Software
Jens H. Weber-Jahnke
(University of Victoria, Canada)

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A Personalized Medical Information System
Sebastian Klenk, Jürgen Dippon, Peter Fritz, and Gunther Heidemann
(Stuttgart University, Germany; IDM-Foundation, Germany)
Shared decision making is not just a question of collecting enough information, but mostly of gathering the right information and evaluating it correctly. The ever growing amount of available data and the constantly increasing specialization in medicine makes it almost impossible for a patient to get personalized medical information even though this is crucial for a self determined decision. We therefore propose a system that combines epidemiological data, personal medical data, personal data and publicly available data to form one central source of information. We argue that, with currently available methods and data, a patient adapted information system is attainable.

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Precise Process Definitions for Activities of Daily Living: A Basis for Real-time Monitoring and Hazard Detection
Zongfang Lin, Allen R. Hanson, Leon J. Osterweil, and Alexander Wise
(University of Massachusetts at Amherst, USA)
The dramatically increasing population of disabled people and adults who are 65 years old and over will increase financial burdens for assisted living care in the United States and more generally on a global basis. To mitigate these costs, increasing numbers of disabled and elderly people (our clientele) will live alone at home. This paper suggests that the safety of such disabled and elderly people might be increased by using precise process definitions of Activities of Daily Living (ADLs) as the basis for guiding and monitoring their activities. We propose to model ADLs using Little-JIL, a language that supports ADL definitions that are distinguished from other ADL definitions in the literature by their use of such features as concurrency, exception handling, reaction control, and channel communication, all of which are important for monitoring ADLs at appropriately low levels of detail.
This paper uses making tea, making a sandwich and answering a phone, as example ADLs for process definition. It suggests how a client can be monitored in real-time to detect unsafe ADL performance deviations that may lead to hazards. It also suggests how monitoring histories can be used for automated assessments that can provide care providers/specialists with key information about trends.

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Regular Papers

HCMS: Conceptual Description of a Health Content Management System
Hamman W. Samuel and Osmar R. Zaïane
(University of Alberta, Canada)
Health is a hot topic on the Internet. Health websites are unique from other websites because they require a more acute awareness of ethical issues due to potential life threatening risks from misuse of information. We propose and give a high-level description of a Health Content Management System (HCMS) that addresses these issues and other functional needs found in most health websites. In addition, we suggest unique features that are not available in most existing health websites. Surveys of existing health websites and content management systems demonstrate the need for the proposed system. Moreover, the novelty of the proposed HCMS is appraised and asserted in comparison with similar health framework concepts. Our contributions include survey results of more than 50 health websites, a taxonomy of health websites' characteristics, and a blueprint for typical and novel features for health websites.

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Reducing the Footprint of Certifiable Health Software during Early Stage Development
Jens H. Weber-Jahnke, James B. Williams, and Craig E. Kuziemsky
(University of Victoria, Canada; University of Ottawa, Canada)

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Towards Electronic Health Record Support for Collaborative Processes
Craig E. Kuziemsky, James B. Williams, and Jens H. Weber-Jahnke
(University of Ottawa, Canada; University of Victoria, Canada)
As more healthcare delivery is provided by collaborative care teams, there is a need to design tools such as electronic health records to support teams. Much of the existing EHR work has focused on semantic interoperability. While that work is important, collaborative care delivery is largely process driven, meaning that process interoperability must also be considered. This paper takes a first step towards engineering EHR requirements to support collaborative care delivery by defining a set of collaborative competencies. These competencies emphasize process interoperability through separation of data and processes. The findings from this paper can help inform EHR design to support collaborative care delivery.

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On Effective Testing of Health Care Simulation Software
Christian Murphy, M. S. Raunak, Andrew King, Sanjian Chen, Christopher Imbriano, Gail Kaiser, Insup Lee, Oleg Sokolsky, Lori Clarke, and Leon J. Osterweil
(University of Pennsylvania, USA; Loyola University, USA; Columbia University, USA; University of Massachusetts at Amherst, USA)
Health care professionals rely on software to simulate anatomical and physiological elements of the human body for purposes of training, prototyping, and decision making. Software can also be used to simulate medical processes and protocols to measure cost effectiveness and resource utilization. Whereas much of the software engineering research into simulation software focuses on validation (determining that the simulation accurately models real-world activity), to date there has been little investigation into the testing of simulation software itself, that is, the ability to effectively search for errors in the implementation. This is particularly challenging because often there is no test oracle to indicate whether the results of the simulation are correct. In this paper, we present an approach to systematically testing simulation software in the absence of test oracles, and evaluate the effectiveness of the technique.

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Investigating the Influence of Personal Values on Requirements for Health Care Information Systems
Rumyana Proynova, Barbara Paech, Sven H. Koch, Andreas Wicht, and Thomas Wetter
(University of Heidelberg, Germany)
Stakeholder requirements for health care information systems cannot be defined purely objectively. Instead they are influenced by personal and social factors. In this paper, we present preliminary insights into one such factor, namely personal values. Based on work from psychology, we have developed first instruments to elicit personal values and their relationships to software requirements by interviewing nurses and physicians. We report on these instruments and the results of applying them in two small case studies.

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Leveraging Performance Analytics to Improve Integration of Care
Alain Mouttham, Liam Peyton, and Craig E. Kuziemsky
(University of Ottawa, Canada)
The need for healthcare systems to provide efficient, effective and integrated care has put an emphasis on performance analytics. However while performance analytics can measure outcomes and suggest policy and protocol for achieving efficiency; it does not drive the actual integration of care processes. There is a need for research that develops fine-grained metrics and illustrates how to link them into the underlying clinical care processes in order to drive and support integration of care. An integrated case study of cardiac care processes and performance analytics we have been developing at a community hospital in Ontario is used to illustrate our approach. We analyze how fine-grained metrics can be linked into cardiac care processes to address high level performance objectives, and present a technology assessment to identify how software engineering support for the collection and communication of these fine-grained metrics can be provided.

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Evaluating Access Control of Open Source Electronic Health Record Systems
Eric Helms and Laurie Williams
(North Carolina State University, USA)
Incentives and penalties for healthcare providers as laid out in the American Recovery and Reinvestment Act of 2009 have caused tremendous growth in the development and installation of electronic health record (EHR) systems in the US. For the benefit of protecting patient privacy, regulations and certification criteria related to EHR systems stipulate the use of access control of protected health information. The goal of this research is to guide development teams, regulators, and certification bodies by assessing the state of the practice in EHR access control. In this paper, we present a compilation of 25 criteria relative to access control in EHR systems found in the Health Insurance Portability and Accountability Act (HIPAA) regulation, meaningful use certification criteria, best practices embodied in the National Institute for Standards and Technology (NIST) role-based access control standard, and other best practices found in the literature. We then examine the state of the practice in access control by evaluating four open source EHR systems using these 25 evaluation criteria. Our research indicates that the NIST Meaningful Use criteria provide HIPAA compliance, but none of the regulatory and certification criteria address the implementation standards, and best practices related to access control. Additionally, our results indicate that open source EHR system designers are not implementing robust access control mechanisms for the adequate protection of patient data.

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Developing a Virtual-World Simulation
David Chodos, Eleni Stroulia, and Sharla King
(University of Alberta, Canada)
Simulation-based training has been an integral part of health-sciences education for many years, and is becoming increasingly important with the shift towards competency-based education. Virtual worlds have emerged as an effective way to deliver realistic, collaborative training in complex processes, which is consistent with competency-based training and assessment. We have developed MeRiTS, a virtual world-based platform for creating training simulations, to provide students in a wide range of disciplines with this kind of training. Furthermore, through these student training experiences, we will be able to provide a rigorous, comprehensive evaluation of the effectiveness of conducting scenario-based training in virtual worlds. In this paper, we briefly present the MeRiTS architecture, and the underlying theories, components and models that support the system. We then present a detailed description of our most mature scenario, which trains paramedics in proper rescue and patient handoff procedures. We also provide an in-depth discussion of the development process for this scenario, and conclude with some lessons learned from the experience.

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