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Design and evaluation of the ModelHealth toolchain for continuity of care web services

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Motivation: Systems interoperability is a key challenge in providing continuity of care to all patients. The challenge is addressed with information standards and new approaches to systems integration based on service-oriented architectures. Model-driven development promise utilities that are suitable for software service development in the healthcare domain, but development tools are still immature and their industry uptake is low. The knowledge about how model-driven development tools can become more useful to the healthcare software developers should be strengthened. Approach: This paper presents the ModelHealth toolchain that was created in four design/assess cycles, involving 28 students and 41 professional developers in the period 2007–2010. The toolchain provides design assistance for creating software services based on concepts from the CEN-13940 standard for continuity of care, which facilitates development of interoperable software services. Results: The CEN-13940 standard was successfully incorporated into the ModelHealth Toolchain assisting developers in creating software service design models that adhered to the standard. The developers expressed that improved understanding of the target system, documentation generation, and artifact traceability were essential utilities of the model-driven approach. Conclusion: The paper concludes healthcare domain knowledge can be successfully incorporated in a model-driven development toolchain, providing valuable input to the healthcare software service design process. A set of recommendations on how to incorporate domain specific concepts into model-driven development tools is provided. To our knowledge, no other scientific publications have reported from healthcare specific model-driven tool design and evaluations. Our recommendations extend and nuance existing knowledge on model-driven development tooling in general.

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The research presented herein was made possible by the EU Grant IST-034707—the MPOWER project (The MPOWER Consortium 2007). A special thanks to the University of Tromsø, Professor Gunnar Hartvigsen and the master students at the computer science department. Thanks to DIPS ASA for giving me the opportunity to use of their limited time during their developer conference. Finally, thanks to Dr. Erlend Stav, Dr. Geir Kjetil Hanssen, Marius Mikalsen, Dr. Babak Farschian and the other members of the BAMSE research group at SINTEF ICT in Trondheim, Norway. Discussions, valuable input and reviews are essential elements that aid keeping the focus throughout a long research trail.

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Correspondence to Ståle Walderhaug.


Appendix A: Interview guide (semi-structured)

  • Please tell me about your education with focus on software engineering courses, programming languages and other relevant course

  • What do you think about the exercise?

  • Did you understand the exercise scenario

    1. Was the difficulty ok?

  • What do you thing about the first part of the exercise: the computation independent modelling

    1. Use case modelling

      1. Did you use the actors library

      2. Did you find the actors you were looking for

    2. Feature modelling

    3. Trace link modelling

  • What do you think about the second part: platform specific modelling

    1. Information modelling

      1. Which background information did you use to create the information model

      2. Did you get all the details necessary?

    2. Service modelling

      1. How did you identify services

      2. How did you identify interface operations

      3. Service model template

      4. Which information did you use for message design

      5. Did you use the traceability information

  • What did you think about the final part: platform specific modeling

    1. Generating RTF and HTML documentation

      1. What do you think was the most useful?

    2. Using HTML documentation for traceability

    3. DDL Transformation

    4. WSDL Transformation

  • Using the DDL and WSDL files for database and

    1. General comments?

  • Would you like to learn more about MDD

    1. Take more courses at the university?

  • Any other comments?

Appendix B: Experiment Scenario description

MedList—Shared medication list

A common problem for patients, and especially elderly, is the management of medication. The problems include:

  1. (1)

    Read information about dosage and description about when and how the medication should be taken

  2. (2)

    Manage updated medication: change in dosage and amount

  3. (3)

    Share problems with medication between the patient’s family, visiting nurses and the GP.

  4. (4)

    Report back to GP if medication has been taken or not.

In Ulvilla, a nice village just outside of Verdal in Nord-Trøndelag, the happy couple Odd and Anna lives in a small house on their farm Elnes Nedre. They retired seven years ago, and now their oldest son Harald is running the farm together with his wife Åse.

Odd had a stroke 5 years ago, and has since then been on medication. Just recently he got a new type of medicine from his GP, Dr. Abbas. Odd and Anna went to see Dr. Abbas together, but none of them really understood what he said, and they were afraid to ask—after all he is a respected doctor in Verdal. As a result of this uncertainty, Odd takes the medication too often—“to be on the safe side”.

After one week of “misuse”, Odd feels sick and need to see the doctor. It is soon revealed that he as taken to much medicine. Harald and Åse are really angry, and after some phone calls, a new research project is started: MedList. This project will address the problems 1–4 in the list above.

The project will:

  1. (a)

    Build upon a SOA platform, using web services in the local health network

  2. (b)

    Have an easy to use client installed at the GP, patient and the patient’s relatives

  3. (c)

    Share information about medication between the defined actors.

Appendix C: Professional survey questionnaire

The questionnaire (in Norwegian) is available from the author on request.

Appendix D: Interview analysis

Raw material and analysis results are available on request to the author.

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Walderhaug, S. Design and evaluation of the ModelHealth toolchain for continuity of care web services. Autom Softw Eng 20, 185–235 (2013).

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