Older age is associated with an increased accumulation of multiple chronic conditions. The clinic... more Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians.
Introduction: A growing share of the population in OECD countries is of age 65 and over, expected... more Introduction: A growing share of the population in OECD countries is of age 65 and over, expected to reach 22% by 2030 (compared to 15% in 2010). Life expectancy has also significantly increased. People at age of 65 are expected to live for an average of 21 and 17 years for women and men; an almost 40% increase since 1960. The profound success in improving life expectancy has resulted in a new set of challenges.
Background: Digitally enabled healthcare services combine socio-technical resources to deliver th... more Background: Digitally enabled healthcare services combine socio-technical resources to deliver the required outcomes to patients. Unintended operation of these services may result in adverse effects to the patient. Eliminating avoidable harm requires a systematic way of analysing the causal conditions, identifying opportunities for intervention. Operators of such services may be required to justify, and communicate, their safety. For example, the UK Standardisation Committee for Care Information (SCCI) standards 0129 and 0160 require a safety justification for health IT (superseded versions were known as the Information Standards Board (ISB) 0129 & 0160. Initial as well as current standards are maintained by the NHS Digital.
The increasing role of Systems of Systems (SoS) in safety-critical applications establishes the n... more The increasing role of Systems of Systems (SoS) in safety-critical applications establishes the need for methods to ensure their safe behaviour. One approach to ensuring this is by means of safety policy — a set of rules that all the system entities must abide by. This paper proposes simulation as a means to evaluate the effectiveness of such a policy. The requirements for simulation models are identified, and a means for decomposing high-level policy goals into machine-interpretable policy rules is described. It is then shown how the enforcement of policy could be integrated into a simple agent architecture based around a blackboard. Finally, an approach to evaluating the safety of a system based using simulation techniques is outlined.
Based on our recent experience, ‘distinguishing fact from fiction’ in relation to System of Syste... more Based on our recent experience, ‘distinguishing fact from fiction’ in relation to System of Systems (SoS) safety has emerged as a pertinent topic in a number of senses. From an analytical perspective, we recognise that it would be a mistake to treat a SoS as ‘just another complex system’. The defining properties of a SoS mean that traditional analysis methods may fall short if applied without additional support. On the other hand, we also argue that the structured and comprehensive analysis of a SoS need not be so complex as to be impractical. We draw on an internal BAE Systems development project, Integrated Aircrew Training (IAT), as an exemplar. IAT interconnects multiple systems and participants – air and ground assets – into a training SoS. As would be expected we have identified a number of sources of complexity in the analysis of this SoS, chiefly the exponential impact of interactions among increasing numbers of system elements on analysis complexity. However, the training domain provides constraints which may be captured as feature models to structure the analysis. We outline a SoS hazard assessment process and associated safety case approach that are the subject of ongoing research and development and as such, are not yet formally recognised. They acknowledge that the presence of human decision-makers in a SoS means that human factors analysis contributes significantly to SoS safety assessment. We discuss the human element in SoS safety analysis and show how its treatment in the case of IAT has caused us to recognise that augmented-reality training brings with it both novel sources and consequences of human ‘error’. In this particular SoS, the ‘fact versus fiction’ differential also applies to SoS users and the notion of participant ‘immersion’ is a key area of interest.
COTS have increasingly been used by industrial practice as a means of maintaining low development... more COTS have increasingly been used by industrial practice as a means of maintaining low development costs of a product, whilst offering significant capability upgrades. COTS are multipurpose products driven by commonly used functionality. However, being general purpose products raises certain challenges regarding their ability to be certified. Previously used (process-based) standards stipulated a process that the product needed to adhere to. This involved production of a generic set of evidence known as the certification pack (CertPack). Being the product of a generic test process, the available (CertPack) COTS evidence may not be sufficient or suitable to support the developers’ safety claims. The challenges raised by use of COTS in such assurance frameworks can have ramifications on a project both from a managerial and safety assurance perspective. The paper presents an analysis of the challenges from the use of CertPack and their impact on assurance and project management. Moreover a process is presented that assists de-risking the integration of evidence, as early as possible during system development or upgrade.
Older age is associated with an increased accumulation of multiple chronic conditions. The clinic... more Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians.
Introduction: A growing share of the population in OECD countries is of age 65 and over, expected... more Introduction: A growing share of the population in OECD countries is of age 65 and over, expected to reach 22% by 2030 (compared to 15% in 2010). Life expectancy has also significantly increased. People at age of 65 are expected to live for an average of 21 and 17 years for women and men; an almost 40% increase since 1960. The profound success in improving life expectancy has resulted in a new set of challenges.
Background: Digitally enabled healthcare services combine socio-technical resources to deliver th... more Background: Digitally enabled healthcare services combine socio-technical resources to deliver the required outcomes to patients. Unintended operation of these services may result in adverse effects to the patient. Eliminating avoidable harm requires a systematic way of analysing the causal conditions, identifying opportunities for intervention. Operators of such services may be required to justify, and communicate, their safety. For example, the UK Standardisation Committee for Care Information (SCCI) standards 0129 and 0160 require a safety justification for health IT (superseded versions were known as the Information Standards Board (ISB) 0129 & 0160. Initial as well as current standards are maintained by the NHS Digital.
The increasing role of Systems of Systems (SoS) in safety-critical applications establishes the n... more The increasing role of Systems of Systems (SoS) in safety-critical applications establishes the need for methods to ensure their safe behaviour. One approach to ensuring this is by means of safety policy — a set of rules that all the system entities must abide by. This paper proposes simulation as a means to evaluate the effectiveness of such a policy. The requirements for simulation models are identified, and a means for decomposing high-level policy goals into machine-interpretable policy rules is described. It is then shown how the enforcement of policy could be integrated into a simple agent architecture based around a blackboard. Finally, an approach to evaluating the safety of a system based using simulation techniques is outlined.
Based on our recent experience, ‘distinguishing fact from fiction’ in relation to System of Syste... more Based on our recent experience, ‘distinguishing fact from fiction’ in relation to System of Systems (SoS) safety has emerged as a pertinent topic in a number of senses. From an analytical perspective, we recognise that it would be a mistake to treat a SoS as ‘just another complex system’. The defining properties of a SoS mean that traditional analysis methods may fall short if applied without additional support. On the other hand, we also argue that the structured and comprehensive analysis of a SoS need not be so complex as to be impractical. We draw on an internal BAE Systems development project, Integrated Aircrew Training (IAT), as an exemplar. IAT interconnects multiple systems and participants – air and ground assets – into a training SoS. As would be expected we have identified a number of sources of complexity in the analysis of this SoS, chiefly the exponential impact of interactions among increasing numbers of system elements on analysis complexity. However, the training domain provides constraints which may be captured as feature models to structure the analysis. We outline a SoS hazard assessment process and associated safety case approach that are the subject of ongoing research and development and as such, are not yet formally recognised. They acknowledge that the presence of human decision-makers in a SoS means that human factors analysis contributes significantly to SoS safety assessment. We discuss the human element in SoS safety analysis and show how its treatment in the case of IAT has caused us to recognise that augmented-reality training brings with it both novel sources and consequences of human ‘error’. In this particular SoS, the ‘fact versus fiction’ differential also applies to SoS users and the notion of participant ‘immersion’ is a key area of interest.
COTS have increasingly been used by industrial practice as a means of maintaining low development... more COTS have increasingly been used by industrial practice as a means of maintaining low development costs of a product, whilst offering significant capability upgrades. COTS are multipurpose products driven by commonly used functionality. However, being general purpose products raises certain challenges regarding their ability to be certified. Previously used (process-based) standards stipulated a process that the product needed to adhere to. This involved production of a generic set of evidence known as the certification pack (CertPack). Being the product of a generic test process, the available (CertPack) COTS evidence may not be sufficient or suitable to support the developers’ safety claims. The challenges raised by use of COTS in such assurance frameworks can have ramifications on a project both from a managerial and safety assurance perspective. The paper presents an analysis of the challenges from the use of CertPack and their impact on assurance and project management. Moreover a process is presented that assists de-risking the integration of evidence, as early as possible during system development or upgrade.
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Papers by George Despotou