Chapter 6 : Software Engineering for Healthcare

• Software plays a vital role in health care by managing the vast amounts of information necessary for clinical decision-making.
• Software collects, organizes, and processes data, making it essential for biomedical informatics.
• Understanding health information systems is crucial for their acquisition, implementation, and use in supporting health care delivery.
• Software engineering in health care aims to create systems that improve care delivery.
• Effective software development requires collaboration between designers, users, and informaticians to ensure systems meet the needs of health care providers and patients.

Software Functions in Health Care

• Software enhances access to care, patient engagement, care management, and research recruitment.
• Key functions include data acquisition and storage, data summarization and display, communication and information exchange, decision support, and support for education, research, and public health initiatives.

Case Study: Generation Healthcare System (GHS)

• John Miller, a 42-year-old with type 2 diabetes, used GHS to schedule appointments, receive lab results, and access educational materials.
• Before John's visit, the clinic’s scheduling system alerts staff to collect diabetes-related information.
• During the visit, Dr. Stark reviewed John’s history and new data, with the EHR flagging a potential drug interaction.
• Dr. Stark ordered a hemoglobin A1c test, and John’s nurse drew blood.
• After the visit, Dr. Stark signs the clinic note and sends a summary to John via the patient portal.
• Elevated HbA1c levels prompted a recommendation for a follow-up at the GHS Diabetes Specialty Clinic.
• John used the portal to message Dr. Stark and schedule the appointment.
• Maria, the diabetes care manager, reviewed John’s records and suggested lifestyle changes.
• Over the next year, John struggled with medication adherence and diet, leading to unstable blood sugar levels.
• The EHR flagged John for urgent evaluation due to a dangerously high blood glucose reading.
• Maria escalated the issue to Dr. Stark, who sent John to the emergency department.
• ED doctors accessed John’s EHR to quickly assess and treat him.
• The GHS EHR is part of a statewide health information exchange (HIE).
• John’s wife, Gina, had proxy access to his patient portal, enabling her to view his records and schedule appointments.
• Gina saw a notification about a diabetes research study, which John decided to join.
• The role of software engineering is twofold: to design functional applications and to connect these functions for a seamless experience for clinicians and patients.

Acquiring and Storing Data

• Health care generates vast amounts of data, from lab results to patient monitoring.
• Health care software stores and processes vast amounts of data.
• Early computer systems automated lab analyses and patient monitoring.
• Modern systems integrate data directly into EHRs.
• Departments like labs, pharmacies, and radiology use specialized systems to store and process data, often connecting to external services for efficiency.

Summarizing and Displaying Data

• Computers summarize data and generate reports, while visualization tools help identify trends.
• Computers excel at processing large volumes of data, creating summaries, and generating reports.
• Visualization tools help clinicians identify trends and abnormalities.
• Fast data retrieval is essential.
• Standards like HL7 FHIR improve interoperability.

Facilitating Communication and Information Exchange

• EHRs and hospital information systems (HIS) enable data sharing, integrating clinical and financial data.
• Effective health care requires communication among providers.
• EHRs and hospital information systems (HIS) enable data sharing across departments and institutions.
• Communication networks allow integration of clinical and financial data.
• Challenges remain in standardizing and maintaining these systems.

Generating Alerts, Reminders, and Decision Support

• Decision-support systems help clinicians interpret data, with monitoring systems alerting providers to significant events.
• Decision-support systems help clinicians interpret data and take action.
• Examples include clinical consultation systems, nursing information systems, and pharmacy systems that flag drug interactions.
• Monitoring systems alert providers to significant events, such as abnormal lab results or changes in patient status.

Supporting Education, Research, and Public Health

• Software supports continuous learning, population health management, and public health initiatives.
• Health care professionals must continuously learn, and software supports this through educational programs and decision-support tools.
• Population health management requires systems to monitor individuals’ health outside clinical visits.
• Public health initiatives also rely on data integration for disease surveillance and environmental monitoring.

Software Development Life Cycle (SDLC)

• SDLC ensures software quality and cost control.
• The SDLC provides a framework for software development, ensuring quality and controlling costs.
• Phases include planning/analysis, design, development, integration and test, implementation, verification and validation, operations and maintenance, and evaluation.
• Planning/Analysis: Define project goals, scope, and requirements.
• Involve users and stakeholders to ensure the software meets their needs.
• Design: Explore solutions, system architecture, data storage, and user interfaces.
• Create mock-ups and testing plans.
• Development: Write and configure software, often customizing commercial off-the-shelf (COTS) software.
• In health care, this often involves customizing commercial off-the-shelf (COTS) software.
• Integration and Test: Combine software components and test the system in a safe environment.
• Implementation: Install software, train users, and update policies.
• Install the software in the live environment, train users, and update policies.
• Verification and Validation: Ensure software meets requirements and operates safely.
• Operations and Maintenance: Monitor the system, install updates, and address user feedback.
• Evaluation: Assess the software’s impact on health care delivery.

Software Development Models

• Waterfall Model: A linear approach for projects with stable requirements.
• A linear approach where each phase is completed before moving to the next, best for projects with stable requirements.
• Agile Models: An iterative approach with frequent communication.
• An iterative approach that involves frequent communication with customers and welcomes changes throughout development.

Software Acquisition and Enhancement

• Most health care organizations purchase COTS software.
• Customization and integration with existing systems are often necessary.
• Key considerations include integration and data analytics.
• Most health care organizations purchase COTS software rather than developing it in-house.
• Customization and integration with existing systems are often necessary.
• Integration: Ensure the software works seamlessly with other systems.
• Data warehouses support complex analysis and reporting.
• Data Analytics: Use data warehouses to support complex analysis and reporting.
• Emerging Trends: Adopt standards like HL7 FHIR and SMART on FHIR for interoperability and third-party application integration.

Emerging Trends

• Standards like HL7 FHIR and SMART on FHIR facilitate interoperability.

Emerging Influences and Issues

• Service-Oriented Architectures (SOA): Allow specific functions to run on independent platforms, enabling interoperability.
• EHR as a Platform: Encourage third-party applications to enhance EHR functionality.
• Health Information Exchange (HIE): Facilitate data sharing between organizations.
• Advanced Analytics: Use large datasets to predict outcomes and improve decision-making.