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2012 4th International Workshop on Software Engineering in Health Care (SEHC), June 4–5, 2012, Zurich, Switzerland

SEHC 2012 – Proceedings

Contents - Abstracts - Authors

4th International Workshop on Software Engineering in Health Care (SEHC)


Title Page

Healthcare Informatics is one of the fastest growing economic sectors in the world today. With the anticipated future advances and investments in this field, it is expected that Healthcare Informatics will become one of the dominant economic factors in the 21st century. In addition to economic importance, this field has the potential to make substantial contributions to the comfort and longevity of every human being on the face of the earth. Software, and thus Software Engineering, has an important role to play in all of this. Medical devices, electronic medical records, robotic-driven surgery are just some examples where software plays a critical role. In addition, medical processes are known to be error prone and prime targets for process improvement technology. Moreover, there are important questions about software quality, user interfaces, systems interoperability, process automation, regulatory regimes, and many other concerns familiar to software engineering practitioners and researchers. The Software Engineering in Health Care (SEHC) workshop series was established to provide a forum for reporting on research and experience associated with this dynamic and challenging domain. The fourth workshop in this series was held in Zurich, Switzerland on June 4 & 5, 2012 in association with the International Conference on Software Engineering. This year, SEHC received 20 submissions -- 11 short papers and tool papers (4 pages each) and 9 research and case study papers (7 pages each). From these, 3 short/tool papers and 8 research/case studies were accepted.

Medical Workflows and Processes

A Timed Model for Healthcare Workflows Based on CSP
Johannes Faber
(United Nations University, China)
In order to precisely analyze healthcare workflows, we examine how healthcare workflows can be modeled and verified with an elementary and concise timed CSP extension. To avoid considering healthcare workflows in isolation, we investigate the usage of our CSP dialect for formally modeling workflows alongside the instruction model of the openEHR specification set, which is a general, maintainable, and interoperable approach to electronic health records. Hence, we present a CSP model for openEHR instructions, which allows timed reasoning, and also integrates a basic notion of data and undefinedness. We show that this CSP dialect is suited to verify important properties of healthcare workflows, like workflow consistency, checking against timed specifications, and resource scheduling.
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A Case Study in Interoperable Support for Collaborative Community Healthcare
Liam Peyton, Craig E. Kuziemsky, and Dishant Langayan
(University of Ottawa, Canada)
This paper describes a two year case study in the engineering and deployment of a Clinical Information System (CIS) called Palliative Care Information System (PAL-IS) for managing and monitoring team-based community care of palliative patients. The case study followed the methodology, architecture and ontology proposed in previous work to address workflow, behavioral and technology issues for CIS that support collaborative, mobile, and accessible healthcare. Both PAL-IS and the methodology used in its development are evaluated. The results give fresh insight into interoperability issues which complicate CIS design. They also highlight the importance of reporting requirements as a major driver for investment in CIS and a critical factor in CIS design.
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What Is a Care Pathway?
Justin Keen
(University of Leeds, UK)
This paper argues that it is possible to develop useful generic representations of care pathways, drawing on evidence and argument about clinical teams, about the ability of teams to cope with radical uncertainty and about the influence of institutional arrangements on the journeys that patients take through health systems. The arguments are used to identify a mismatch between current practices in the design of large scale digital systems and the need for information about risks and outcomes.
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Architectures for Leveraging Integrated Medical Systems

Cancer Treatment Planning: Formal Methods to the Rescue
Janos Mathe, Janos Sztipanovits, Mia Levy, Ethan K. Jackson, and Wolfram Schulte
(Vanderbilt University, USA; Microsoft Research, USA)
This paper describes the ongoing development of ATTENTION, a new kind of clinical decision support system for synthesizing and managing longitudinal treatment plans, such as cancer treatment plans. ATTENTION combines state-of- the-art formal modeling and constraint solving with clinical information systems to synthesize complex cancer treatment plans that are also executable.
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Requirements Specification for Apps in Medical Application Platforms
Brian Larson, John Hatcliff, Samuel Procter, and Patrice Chalin
(Kansas State University, USA)
Existing regulatory agency guidance documents and process standards for medical devices (i.e., IEC 62304) generally consider medical devices to be stand-alone monolithic systems. The format and content of a system requirements document largely follows that of conventional embedded safety- critical systems. However, a vision is emerging of a new paradigm of medical system based on the notion of a medical application platform (MAP). A MAP is a safety- and security- critical real-time computing platform for (a) integrating heterogeneous devices, medical IT systems, and information displays via a communication infrastructure and (b) hosting application programs (i.e., apps) that provide medical utility via the ability to both acquire information from and update/control integrated devices, IT systems, and displays. To ensure a regulatory pathway for MAPs, it is necessary to adapt traditional development processes and artifacts to the specific characteristics of MAP architectures and constituent components. In this paper, we provide an initial proposal for developing and formatting requirements for MAP apps. For illustration, we consider an app that implements two “smart alarms” for pulse oximetry monitoring in a clinical context.
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Variabilities as First-Class Elements in Product Line Architectures of Homecare Systems
Sergio T. Carvalho, Leonardo Murta, and Orlando Loques
(Universidade Federal Fluminense, Brazil; Universidade Federal de Goiás, Brazil)
A homecare system should adapt to changes regarding the patient needs and to variations in the residential environment. This requires a software architecture designed to support customizations before the deployment (static variability) and changes during the system operation (dynamic variability). We present a comprehensive approach in which both kinds of variabilities are seamless described by means of contracts, which are first-class elements associated with a Product Line architecture. To demonstrate the proposed approach, we present a dynamic contract developed to support a context-aware patient reminder application.
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Engineering Safety Critical Medical Systems

Certification and Regulatory Challenges in Medical Device Software Development
Nadica Hrgarek
(MED-EL Medical Electronics, Austria)
The critical nature of safety in medical device software requires a repeatable and compliant software engineering process. This process should take into account the whole development life cycle, risk management, and software verification and validation activities that would commensurate with the device’s complexity and risk. This paper discusses some of the key challenges medical device manufacturers are facing in the development and certification of medical device software. These challenges include: compliance with the EU and US regulatory requirements for medical device software, making software development and maintenance processes more agile in the medical device regulatory environment, integrating usability engineering process/human factors into software development, regulation of networked medical devices and mobile medical applications (apps). The MED-EL case study highlights some of the challenges described in this paper, and the approaches taken to overcome these challenges.
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Health Information Technology

Introducing Safety Cases for Health IT
George Despotou, Tim Kelly, Sean White, and Mark Ryan
(University of York, UK; National Health Service, UK; Rotheram NHS Foundation Trust, UK)
Introduction of IT in the health domain can potentially benefit the quality of the delivered healthcare, also contributing to increase safety. However health IT systems themselves can have safety implications and can result in accidents. Creating a safety case has been in practice in numerous domains and is starting to be adopted in the health IT domain with the most notable example, that of the UK National Health Service (NHS), Information Standards Board for Health and Social Care (ISB) standards (formerly DSCN 14/2009 & DSCN 18/2009). Safety cases can be thought of as a defensible, comprehensible and clear argument, supported by evidence that a system is acceptably safe in its operational context. This paper presents the main areas of safety case practice and its implication for the health IT development and stakeholders.
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Engineering the Healthcare Collaboration Space
Craig E. Kuziemsky, Jens Weber-Jahnke, and James Williams
(University of Ottawa, Canada; University of Victoria, Canada)
Healthcare delivery is highly collaborative work. Designing information and communication technologies to support collaboration is challenging due to the complex and dynamic nature of the healthcare collaboration space. In this paper we introduce ‘collaboration engineering’ as a method for engineering the collaboration space that integrates Intentional Modeling and Interaction Design Theory. We use existing work to identify a set of intentions that define the healthcare collaboration space. We then use a case study to illustrate how our method would be used for engineering the healthcare collaboration space.
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Creating Healthcare Training Simulations in Virtual Worlds
David Chodos, Lucio Gutierrez, and Eleni Stroulia
(University of Alberta, Canada)
Virtual worlds offer a rich, flexible platform for creating immersive, interactive training simulations. In this paper, we describe two different platforms that rely on the same virtual world (OpenSim) to deliver different types of simulation-based learning experiences for health professionals.
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Devices and Applications

A Multi-touch Approach to Control MRI Scans: A User-Centered Study Report
Tulio de Souza Alcantara, Pierre Bastianelli, Jennifer Ferreira, and Frank Maurer
(University of Calgary, Canada)
This paper reports on a study investigating the usability challenges faced by users of Magnetic Resonance Imaging (MRI) tools. In order to understand these problems, observation, shadowing and interviews were conducted with MRI scan users at two centers. After analyzing the collected data, low-fidelity prototypes were created and evaluated. We addressed the usability issues found by proposing a user-friendly and efficient high-fidelity prototype that replaces keyboard and mouse with two multi-touch screens.
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From a Traditional Behavioral Management Program to an M-Health App: Lessons Learned in Developing M-Health Apps for Existing Health Care Programs
Qing Zhu, Chang Liu, and Kenneth A. Holroyd
(Ohio University, USA)
M-health applications provide a unique new way to deliver healthcare. Developing m-health applications involves new challenges different from those encountered when developing traditional healthcare programs and e-health applications. This paper describes the development of an m-health application for behavioral migraine management, and presents lessons learned during the development process from software engineers’ perspective.
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