Critical challenges in ERP implementation: A qualitative case study in the Canadian oil and gas industry

NASA Astrophysics Data System (ADS)

Menon, Sreekumar A.

This exploratory qualitative single-case study examines critical challenges encountered during ERP implementation based on individual perspectives in four project roles: senior leaders, project managers, project team members, and business users, all specifically in Canadian oil and gas industry. Data was collected by interviewing participants belonging to these categories, and by analyzing project documentation about ERP implementation. The organization for the case study was a leading multinational oil and gas company having a substantial presence in the energy sector in Canada. The study results were aligned with the six management questions regarding critical challenges in ERP: (a) circumstances to implement ERP, (b) benefits and process improvements achieved, (c) best practices implemented, (d) critical challenges encountered, (e) strategies and mitigating actions used, and (f) recommendations to improve future ERP implementations. The study results highlight six key findings. First, the study provided valid circumstances for implementing ERP systems. Second, the study underscored the importance of benefits and process improvements in ERP implementation. Third, the study highlighted that adoption of best practices is crucial for ERP Implementation. Fourth, the study found that critical challenges are encountered in ERP Implementation and are significant during ERP implementation. Fifth, the study found that strategies and mitigating actions can overcome challenges in ERP implementation. Finally, the study provided ten major recommendations on how to improve future ERP implementations.

Continuing challenges for computer-based neuropsychological tests.

PubMed

Letz, Richard

2003-08-01

A number of issues critical to the development of computer-based neuropsychological testing systems that remain continuing challenges to their widespread use in occupational and environmental health are reviewed. Several computer-based neuropsychological testing systems have been developed over the last 20 years, and they have contributed substantially to the study of neurologic effects of a number of environmental exposures. However, many are no longer supported and do not run on contemporary personal computer operating systems. Issues that are continuing challenges for development of computer-based neuropsychological tests in environmental and occupational health are discussed: (1) some current technological trends that generally make test development more difficult; (2) lack of availability of usable speech recognition of the type required for computer-based testing systems; (3) implementing computer-based procedures and tasks that are improvements over, not just adaptations of, their manually-administered predecessors; (4) implementing tests of a wider range of memory functions than the limited range now available; (5) paying more attention to motivational influences that affect the reliability and validity of computer-based measurements; and (6) increasing the usability of and audience for computer-based systems. Partial solutions to some of these challenges are offered. The challenges posed by current technological trends are substantial and generally beyond the control of testing system developers. Widespread acceptance of the "tablet PC" and implementation of accurate small vocabulary, discrete, speaker-independent speech recognition would enable revolutionary improvements to computer-based testing systems, particularly for testing memory functions not covered in existing systems. Dynamic, adaptive procedures, particularly ones based on item-response theory (IRT) and computerized-adaptive testing (CAT) methods, will be implemented in new tests that will be more efficient, reliable, and valid than existing test procedures. These additional developments, along with implementation of innovative reporting formats, are necessary for more widespread acceptance of the testing systems.

NASA GRC MBSE Implementation Status

NASA Technical Reports Server (NTRS)

Parrott, Edith; Trase, Katie; Green, Randi; Varga, Denise; Powell, Joe

2016-01-01

This presentation gives a brief overview on GRCs Model Based System Engineering (MBSE) implementation status. This overview covers: history, project usage and implementation, challenges and future work.

Adaptation and Implementation of a Science-Based Prevention System in Colombia: Challenges and Achievements

PubMed Central

Pérez-Gómez, Augusto; Mejía-Trujillo, Juliana; Brown, Eric C.; Eisenberg, Nicole

2016-01-01

During the last 2 years, the Colombian government and the Nuevos Rumbos Corporation have been implementing an adapted version of the Communities That Care (CTC) prevention system, called Comunidades Que se Cuidan (CQC) in Spanish, for use in Colombia. This brief report presents the process of implementing CQC and identifies some of the main challenges and achievements of implementing the system in eight communities in Colombia. Preliminary results of a pilot study of CQC implementation in Colombia show that prevention system development, including a focus on measuring community risk and protection, can be established successfully in Latin American communities despite a lack of rigorously tested prevention programs and strategies. Moreover, mobilizing community coalitions toward science-based prevention, with a focus on examining local risk and protective factor data, can spur development and evaluation of prevention efforts in Latin America. PMID:28154437

The Challenge of Implementing an ERP System in a Small and Medium Enterprise--A Teaching Case of ERP Project Management

ERIC Educational Resources Information Center

Xu, Hongjiang; Rondeau, Patrick J.; Mahenthiran, Sakthi

2011-01-01

Enterprise Resource Planning (ERP) system implementation projects are notoriously risky. While large-scale ERP cases continue to be developed, relatively few new ERP cases have been published that further ERP implementation education in small to medium size firms. This case details the implementation of a new ERP system in a medium sized…

Introduction to the Special Issue: Challenges and Solutions to Implementing Effective Reading Intervention in Schools.

PubMed

Foorman, Barbara

2016-12-01

This special issue focuses on challenges and solutions to implementing effective reading intervention in schools in the United States. Researchers often develop interventions that prove effective in efficacy studies but then show no impact when implemented at scale in public school settings. The authors of the intervention studies presented here describe a number of common implementation problems stemming from research in primary grades, middle grades, and high schools. Solutions to these implementation problems include establishing researcher-practitioner partnerships to address the systems-level challenges, suggestions for how to obtain buy-in from teachers, and recommendations for reforming preservice and in-service teacher education. © 2016 Wiley Periodicals, Inc.

From a "perfect storm" to "smooth sailing": policymaker perspectives on implementation and sustainment of an evidence-based practice in two states.

PubMed

Willging, Cathleen E; Green, Amy E; Gunderson, Lara; Chaffin, Mark; Aarons, Gregory A

2015-02-01

Policymakers shape implementation and sustainment of evidence-based practices (EBPs), whether they are developing or responding to legislation and policies or negotiating public sector resource constraints. As part of a large mixed-method study, we conducted qualitative interviews with 24 policymakers involved in delivery of the same EBP in two U.S. states. We analyzed transcripts via open and focused coding techniques to identify the commonality, diversity, and complexity of implementation challenges; approaches to overcoming those challenges; and the importance of system-level contextual factors in ensuring successful implementation. Key findings centered on building support and leadership for EBPs; funding and contractual strategies; partnering with stakeholders; tackling challenges via proactive planning and problem solving; and the political, legal, and systemic pressures affecting EBP longevity. The policymaker perspectives offer guidance on nurturing system and organizational practice environments to achieve positive outcomes and for optimally addressing macro-level influences that bear upon the instantiation of EBPs in public sector child welfare systems. © The Author(s) 2014.

From a “Perfect Storm” to “Smooth Sailing”: Policymaker Perspectives on Implementation and Sustainment of an Evidence-Based Practice in Two States

PubMed Central

Willging, Cathleen E.; Green, Amy E.; Gunderson, Lara; Chaffin, Mark; Aarons, Gregory A.

2015-01-01

Policymakers shape implementation and sustainment of evidence-based practices (EBPs), whether they are developing or responding to legislation and policies or negotiating public sector resource constraints. As part of a large mixed-method study, we conducted qualitative interviews with 24 policymakers involved in delivery of the same EBP in two U.S. states. We analyzed transcripts via open and focused coding techniques to identify the commonality, diversity, and complexity of implementation challenges; approaches to overcoming those challenges; and the importance of system-level contextual factors in ensuring successful implementation. Key findings centered on building support and leadership for EBPs; funding and contractual strategies; partnering with stakeholders; tackling challenges via proactive planning and problem solving; and the political, legal, and systemic pressures affecting EBP longevity. The policymaker perspectives offer guidance on nurturing system and organizational practice environments to achieve positive outcomes and for optimally addressing macro-level influences that bear upon the instantiation of EBPs in public sector child welfare systems. PMID:25125232

Challenges experienced by nurses in the implementation of a healthcare reform plan in Iran.

PubMed

Salarvand, Shahin; Azizimalekabadi, Maryam; Jebeli, Azadeh Akbari; Nazer, Mohamadreza

2017-04-01

The Healthcare Reform Plan is counted as a plan for improving healthcare services in Iran. Undoubtedly pros and cons can be seen either in plan or implementation. This study was conducted to describe nurses' challenges in implementing healthcare reform in Iran. A qualitative method centered upon conventional content analysis was applied. We used purposive sampling and data saturation was obtained by 30 participants. Data were analyzed using MAXQDA software. Challenges experienced by nurses in the implementation of this reform include; unsuitable infrastructure, unfavorable vision, a complicated challenge, the necessity of monitoring, control plan outcomes, the impact on nurses, people's misconceptions and solutions. The Healthcare Reform Plan in Iran is a solution to establish equality in the health system, however, to eliminate these challenges, revision and appropriate foundation of infrastructures is called for.

Shared Electronic Health Record Systems: Key Legal and Security Challenges.

PubMed

Christiansen, Ellen K; Skipenes, Eva; Hausken, Marie F; Skeie, Svein; Østbye, Truls; Iversen, Marjolein M

2017-11-01

Use of shared electronic health records opens a whole range of new possibilities for flexible and fruitful cooperation among health personnel in different health institutions, to the benefit of the patients. There are, however, unsolved legal and security challenges. The overall aim of this article is to highlight legal and security challenges that should be considered before using shared electronic cooperation platforms and health record systems to avoid legal and security "surprises" subsequent to the implementation. Practical lessons learned from the use of a web-based ulcer record system involving patients, community nurses, GPs, and hospital nurses and doctors in specialist health care are used to illustrate challenges we faced. Discussion of possible legal and security challenges is critical for successful implementation of shared electronic collaboration systems. Key challenges include (1) allocation of responsibility, (2) documentation routines, (3) and integrated or federated access control. We discuss and suggest how challenges of legal and security aspects can be handled. This discussion may be useful for both current and future users, as well as policy makers.

Health care in China: improvement, challenges, and reform.

PubMed

Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

2013-02-01

Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues.

ERP Project Management Lessons Learned

ERIC Educational Resources Information Center

Carroll, Timothy D.

2009-01-01

Implementing an enterprise resource planning (ERP) system is a major undertaking for any higher education institution, with many challenges along the way. More than three years ago, Roane State Community College began a journey to implement an ERP system. Roane State recently completed a very successful implementation of the SunGard Banner Student…

The challenge of benchmarking health systems: is ICT innovation capacity more systemic than organizational dependent?

PubMed

Lapão, Luís Velez

2015-01-01

The article by Catan et al. presents a benchmarking exercise comparing Israel and Portugal on the implementation of Information and Communication Technologies in the healthcare sector. Special attention was given to e-Health and m-Health. The authors collected information via a set of interviews with key stakeholders. They compared two different cultures and societies, which have reached slightly different implementation outcomes. Although the comparison is very enlightening, it is also challenging. Benchmarking exercises present a set of challenges, such as the choice of methodologies and the assessment of the impact on organizational strategy. Precise benchmarking methodology is a valid tool for eliciting information about alternatives for improving health systems. However, many beneficial interventions, which benchmark as effective, fail to translate into meaningful healthcare outcomes across contexts. There is a relationship between results and the innovational and competitive environments. Differences in healthcare governance and financing models are well known; but little is known about their impact on Information and Communication Technology implementation. The article by Catan et al. provides interesting clues about this issue. Public systems (such as those of Portugal, UK, Sweden, Spain, etc.) present specific advantages and disadvantages concerning Information and Communication Technology development and implementation. Meanwhile, private systems based fundamentally on insurance packages, (such as Israel, Germany, Netherlands or USA) present a different set of advantages and disadvantages - especially a more open context for innovation. Challenging issues from both the Portuguese and Israeli cases will be addressed. Clearly, more research is needed on both benchmarking methodologies and on ICT implementation strategies.

Challenges experienced by nurses in the implementation of a healthcare reform plan in Iran

PubMed Central

Salarvand, Shahin; Azizimalekabadi, Maryam; Jebeli, Azadeh Akbari; Nazer, Mohamadreza

2017-01-01

Introduction The Healthcare Reform Plan is counted as a plan for improving healthcare services in Iran. Undoubtedly pros and cons can be seen either in plan or implementation. This study was conducted to describe nurses’ challenges in implementing healthcare reform in Iran. Methods A qualitative method centered upon conventional content analysis was applied. We used purposive sampling and data saturation was obtained by 30 participants. Data were analyzed using MAXQDA software. Results Challenges experienced by nurses in the implementation of this reform include; unsuitable infrastructure, unfavorable vision, a complicated challenge, the necessity of monitoring, control plan outcomes, the impact on nurses, people’s misconceptions and solutions. Conclusions The Healthcare Reform Plan in Iran is a solution to establish equality in the health system, however, to eliminate these challenges, revision and appropriate foundation of infrastructures is called for. PMID:28607646

Brief Strategic Family Therapy: Implementing evidence-based models in community settings

PubMed Central

Szapocznik, José; Muir, Joan A.; Duff, Johnathan H.; Schwartz, Seth J.; Brown, C. Hendricks

2014-01-01

Reflecting a nearly 40-year collaborative partnership between clinical researchers and clinicians, the present article reviews the authors’ experience in developing, investigating, and implementing the Brief Strategic Family Therapy (BSFT) model. The first section of the article focuses on the theory, practice, and studies related to this evidence-based family therapy intervention targeting adolescent drug abuse and delinquency. The second section focuses on the implementation model created for the BSFT intervention– a model that parallels many of the recommendations furthered within the implementation science literature. Specific challenges encountered during the BSFT implementation process are reviewed, along with ways of conceptualizing and addressing these challenges from a systemic perspective. The implementation approach that we employ uses the same systemic principles and intervention techniques as those that underlie the BSFT model itself. Recommendations for advancing the field of implementation science, based on our on-the-ground experiences, are proposed. PMID:24274187

Enterprise-wide implementation of digital radiography in oral and maxillofacial imaging: the University of Florida Dentistry System.

PubMed

Nair, Madhu K; Pettigrew, James C; Loomis, Jeffrey S; Bates, Robert E; Kostewicz, Stephen; Robinson, Boyd; Sweitzer, Jean; Dolan, Teresa A

2009-06-01

The implementation of digital radiography in dentistry in a large healthcare enterprise setting is discussed. A distinct need for a dedicated dental picture archiving and communication systems (PACS) exists for seamless integration of different vendor products across the system. Complex issues are contended with as each clinical department migrated to a digital environment with unique needs and workflow patterns. The University of Florida has had a dental PACS installed over 2 years ago. This paper describes the process of conversion from film-based imaging from the planning stages through clinical implementation. Dentistry poses many unique challenges as it strives to achieve better integration with systems primarily designed for imaging; however, the technical requirements for high-resolution image capture in dentistry far exceed those in medicine, as most routine dental diagnostic tasks are challenging. The significance of specification, evaluation, vendor selection, installation, trial runs, training, and phased clinical implementation is emphasized.

Management experiences and trends for water reuse implementation in Northern California.

PubMed

Bischel, Heather N; Simon, Gregory L; Frisby, Tammy M; Luthy, Richard G

2012-01-03

In 2010, California fell nearly 300,000 acre-ft per year (AFY) short of its goal to recycle 1,000,000 AFY of municipal wastewater. Growth of recycled water in the 48 Northern California counties represented only 20% of the statewide increase in reuse between 2001 and 2009. To evaluate these trends and experiences, major drivers and challenges that influenced the implementation of recycled water programs in Northern California are presented based on a survey of 71 program managers conducted in 2010. Regulatory requirements limiting discharge, cited by 65% of respondents as a driver for program implementation, historically played an important role in motivating many water reuse programs in the region. More recently, pressures from limited water supplies and needs for system reliability are prevalent drivers. Almost half of respondents (49%) cited ecological protection or enhancement goals as drivers for implementation. However, water reuse for direct benefit of natural systems and wildlife habitat represents just 6-7% of total recycling in Northern California and few financial incentives exist for such projects. Economic challenges are the greatest barrier to successful project implementation. In particular, high costs of distribution systems (pipelines) are especially challenging, with $1 to 3 million/mile costs experienced. Negative perceptions of water reuse were cited by only 26% of respondents as major hindrances to implementation of surveyed programs.

Activity-Based Management System Implementation in Higher Education Institution: Benefits and Challenges

ERIC Educational Resources Information Center

Ismail, Noor Azizi

2010-01-01

Purpose: The purpose of this paper is to discuss how activity-based costing (ABC) technique can be applied in the context of higher education institutions. It also discusses the obstacles and challenges to the successful implementation of activity-based management (ABM) in the higher education environment. Design/methodology/approach: This paper…

Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals.

PubMed

Edmisten, Catherine; Hall, Charles; Kernizan, Lorna; Korwek, Kimberly; Preston, Aaron; Rhoades, Evan; Shah, Shalin; Spight, Lori; Stradi, Silvia; Wellman, Sonia; Zygadlo, Scott

2017-08-01

Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Human Factors Integration Challenges in the Terminal Radar Approach Control (TRACON) Environment

DOT National Transportation Integrated Search

2003-01-01

This document describes human factors challenges that need to be considered in the implementation of planned enhancements to : the Standard Terminal Automation Replacement System (STARS), Common Automated Radar Terminal System (ARTS), and the : ARTS ...

Human factors integration challenges in the terminal radar approach control (TRACON) environment

DOT National Transportation Integrated Search

2003-01-31

This document describes human factors challenges that need to be considered in the implementation of planned enhancements to the Standard Terminal Automation Replacement System (STARS), Common Automated Radar terminal System (ARTS), and the ARTS Colo...

Moving research tools into practice: the successes and challenges in promoting uptake of classification tools.

PubMed

Cunningham, Barbara Jane; Hidecker, Mary Jo Cooley; Thomas-Stonell, Nancy; Rosenbaum, Peter

2018-05-01

In this paper, we present our experiences - both successes and challenges - in implementing evidence-based classification tools into clinical practice. We also make recommendations for others wanting to promote the uptake and application of new research-based assessment tools. We first describe classification systems and the benefits of using them in both research and practice. We then present a theoretical framework from Implementation Science to report strategies we have used to implement two research-based classification tools into practice. We also illustrate some of the challenges we have encountered by reporting results from an online survey investigating 58 Speech-language Pathologists' knowledge and use of the Communication Function Classification System (CFCS), a new tool to classify children's functional communication skills. We offer recommendations for researchers wanting to promote the uptake of new tools in clinical practice. Specifically, we identify structural, organizational, innovation, practitioner, and patient-related factors that we recommend researchers address in the design of implementation interventions. Roles and responsibilities of both researchers and clinicians in making implementations science a success are presented. Implications for rehabilitation Promoting uptake of new and evidence-based tools into clinical practice is challenging. Implementation science can help researchers to close the knowledge-to-practice gap. Using concrete examples, we discuss our experiences in implementing evidence-based classification tools into practice within a theoretical framework. Recommendations are provided for researchers wanting to implement new tools in clinical practice. Implications for researchers and clinicians are presented.

Regionalization in the SUS: implementation process, challenges and perspectives in the critical view of system managers.

PubMed

Carvalho, Andre Luis Bonifácio de; Jesus, Washington Luiz Abreu de; Senra, Isabel Maria Vilas Boas

2017-04-01

This article examines the regionalization process in the Brazilian Health System, identifying frameworks and challenges of this process from critical dialogue on the subject, contextualized by the experience of the management system and in the light of an established theoretical debate in the last decade. We used the thematic content analysis of legal and documentary surveys of the regionalization process in SUS, collated by elements of the historical and political context in the period. As evidence, it appears that the regionalization process has been incremental decentralization/deconcentration of management and health actions and services. There are important challenges, particularly in relation to ensuring access and system governance structure, which contributes to critical thinking and construction of new perspectives by those who lead their implementation.

The "big bang" implementation: not for the faint of heart.

PubMed

Anderson, Linda K; Stafford, Cynthia J

2002-01-01

Replacing a hospital's obsolete mainframe computer system with a modern integrated clinical and administrative information system presents multiple challenges. When the new system is activated in one weekend, in "big bang" fashion, the challenges are magnified. Careful planning is essential to ensure that all hospital staff are fully prepared for this transition, knowing this conversion will involve system downtime, procedural changes, and the resulting stress that naturally accompanies change. Implementation concerns include staff preparation and training, process changes, continuity of patient care, and technical and administrative support. This article outlines how the University of Missouri Health Care addressed these operational concerns during this dramatic information system conversion.

Computer-Aided Diagnosis Systems for Lung Cancer: Challenges and Methodologies

PubMed Central

El-Baz, Ayman; Beache, Garth M.; Gimel'farb, Georgy; Suzuki, Kenji; Okada, Kazunori; Elnakib, Ahmed; Soliman, Ahmed; Abdollahi, Behnoush

2013-01-01

This paper overviews one of the most important, interesting, and challenging problems in oncology, the problem of lung cancer diagnosis. Developing an effective computer-aided diagnosis (CAD) system for lung cancer is of great clinical importance and can increase the patient's chance of survival. For this reason, CAD systems for lung cancer have been investigated in a huge number of research studies. A typical CAD system for lung cancer diagnosis is composed of four main processing steps: segmentation of the lung fields, detection of nodules inside the lung fields, segmentation of the detected nodules, and diagnosis of the nodules as benign or malignant. This paper overviews the current state-of-the-art techniques that have been developed to implement each of these CAD processing steps. For each technique, various aspects of technical issues, implemented methodologies, training and testing databases, and validation methods, as well as achieved performances, are described. In addition, the paper addresses several challenges that researchers face in each implementation step and outlines the strengths and drawbacks of the existing approaches for lung cancer CAD systems. PMID:23431282

Student Information Systems--Implementation Challenges and the Road Ahead

ERIC Educational Resources Information Center

Mukerjee, Sheila

2012-01-01

This paper presents a practitioner's view on student system implementations in the Australian university sector. A student information system is a core system of any university and integral to its operations and services to students. These systems are constantly on the list of major projects and at any point in time, a university is either…

Implementing a regional oncology information system: approach and lessons learned.

PubMed

Evans, W K; Ashbury, F D; Hogue, G L; Smith, A; Pun, J

2014-10-01

Paper-based medical record systems are known to have major problems of inaccuracy, incomplete data, poor accessibility, and challenges to patient confidentiality. They are also an inefficient mechanism of record-sharing for interdisciplinary patient assessment and management, and represent a major problem for keeping current and monitoring quality control to facilitate improvement. To address those concerns, national, regional, and local health care authorities have increased the pressure on oncology practices to upgrade from paper-based systems to electronic health records. Here, we describe and discuss the challenges to implementing a region-wide oncology information system across four independent health care organizations, and we describe the lessons learned from the initial phases that are now being applied in subsequent activities of this complex project. The need for change must be shared across centres to increase buy-in, adoption, and implementation. It is essential to establish physician leadership, commitment, and engagement in the process. Work processes had to be revised to optimize use of the new system. Culture change must be included in the change management strategy. Furthermore, training and resource requirements must be thoroughly planned, implemented, monitored, and modified as required for effective adoption of new work processes and technology. Interfaces must be established with multiple existing electronic systems across the region to ensure appropriate patient flow. Periodic assessment of the existing project structure is necessary, and adjustments are often required to ensure that the project meets its objectives. The implementation of region-wide oncology information systems across different health practice locations has many challenges. Leadership is essential. A strong, collaborative information-sharing strategy across the region and with the supplier is essential to identify, discuss, and resolve implementation problems. A structure that supports project management and accountability contributes to success.

Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network.

PubMed

Sperber, Nina R; Carpenter, Janet S; Cavallari, Larisa H; J Damschroder, Laura; Cooper-DeHoff, Rhonda M; Denny, Joshua C; Ginsburg, Geoffrey S; Guan, Yue; Horowitz, Carol R; Levy, Kenneth D; Levy, Mia A; Madden, Ebony B; Matheny, Michael E; Pollin, Toni I; Pratt, Victoria M; Rosenman, Marc; Voils, Corrine I; W Weitzel, Kristen; Wilke, Russell A; Ryanne Wu, R; Orlando, Lori A

2017-05-22

To realize potential public health benefits from genetic and genomic innovations, understanding how best to implement the innovations into clinical care is important. The objective of this study was to synthesize data on challenges identified by six diverse projects that are part of a National Human Genome Research Institute (NHGRI)-funded network focused on implementing genomics into practice and strategies to overcome these challenges. We used a multiple-case study approach with each project considered as a case and qualitative methods to elicit and describe themes related to implementation challenges and strategies. We describe challenges and strategies in an implementation framework and typology to enable consistent definitions and cross-case comparisons. Strategies were linked to challenges based on expert review and shared themes. Three challenges were identified by all six projects, and strategies to address these challenges varied across the projects. One common challenge was to increase the relative priority of integrating genomics within the health system electronic health record (EHR). Four projects used data warehousing techniques to accomplish the integration. The second common challenge was to strengthen clinicians' knowledge and beliefs about genomic medicine. To overcome this challenge, all projects developed educational materials and conducted meetings and outreach focused on genomic education for clinicians. The third challenge was engaging patients in the genomic medicine projects. Strategies to overcome this challenge included use of mass media to spread the word, actively involving patients in implementation (e.g., a patient advisory board), and preparing patients to be active participants in their healthcare decisions. This is the first collaborative evaluation focusing on the description of genomic medicine innovations implemented in multiple real-world clinical settings. Findings suggest that strategies to facilitate integration of genomic data within existing EHRs and educate stakeholders about the value of genomic services are considered important for effective implementation. Future work could build on these findings to evaluate which strategies are optimal under what conditions. This information will be useful for guiding translation of discoveries to clinical care, which, in turn, can provide data to inform continual improvement of genomic innovations and their applications.

Drug safety assurance through clinical genotyping: near-term considerations for a system-wide implementation of personalized medicine.

PubMed

Kane, Michael D; Springer, John A; Sprague, Jon E

2008-07-01

The rationale and overall system-wide behavior of a clinical genotyping information system (both DNA analysis and data management) requires a near-term, scalable approach, which is emerging in the focused implementation of pharmacogenomics and drug safety assurance. The challenges to implementing a successful clinical genotyping system are described, as are how the benefits of a focused, near-term system for drug safety assessment and assurance overcome the logistical and operational challenges that perpetually hinder the development of a societal-scale clinical genotyping system. This rationale is based on the premise that a focused application domain for clinical genotyping, specifically drug safety assurance, provides a transition paradigm for both professionals and consumers of healthcare, thereby facilitating the movement of genotyping from bench to bedside and paving the way for the adoption of prognostic and diagnostic applications in clinical genomics.

A Pilot Study of the Challenges and Prospects of Continuous Assessment Implementation in Nigeria

ERIC Educational Resources Information Center

Owolabi, Henry O.; Onuka, Adams O. U.

2010-01-01

This study obtained basic information from teachers and students on the challenges and prospects of implementing continuous assessment (CA) in the Nigerian school system. Secondary Schools in Ilorin, the capital city of Kwara State, located in the central region of Nigeria were sampled for use in the study. It employed survey research design…

Moving from Good Ideas in Educational Systems Change to Sustainable Program Implementation: Coming to Terms with Some of the Realities

ERIC Educational Resources Information Center

Noell, George H.; Gansle, Kristin A.

2009-01-01

Proponents of systemic changes in education commonly encounter ethical, theoretical, and pragmatic challenges in moving from possibility to implementation of their vision of change. Although ethical and theoretical issues are critically important to a successful change initiative, pragmatic issues relevant to assuring program implementation have…

Using iKidTools™ Software Support Systems to Develop and Implement Self-Monitoring Interventions

ERIC Educational Resources Information Center

Patti, Angela L.; Miller, Kevin J.

2011-01-01

Educational teams often are faced with the task of developing and implementing Behavioral Intervention Plans (BIPs) for students who present challenging and/or disruptive behaviors. This article describes the steps used to develop and implement a self-monitoring BIP that incorporated an innovative software system, iKidTools™. An authentic case…

The implementation of mindfulness in healthcare systems: a theoretical analysis.

PubMed

Demarzo, M M P; Cebolla, A; Garcia-Campayo, J

2015-01-01

Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way. Copyright © 2015 Elsevier Inc. All rights reserved.

Implementation of workflow engine technology to deliver basic clinical decision support functionality.

PubMed

Huser, Vojtech; Rasmussen, Luke V; Oberg, Ryan; Starren, Justin B

2011-04-10

Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform.

Co-management of Water, Energy, and Food Systems: Where Are We and What Does it Take for Implementation?

NASA Astrophysics Data System (ADS)

Akhbari, M.

2015-12-01

Water, energy, and food are closely bound in consumption and production patterns. To increase resource efficiency and productivity in a sustainable fashion, co-management of water, energy, and food resources is becoming inevitable. These co-management schemes require implementation of nexus-based approaches, which takes the interconnections of water, energy, and food systems into account and considers that development in one area may have major effects on others. While society, economy and environment are the action areas to implement a nexus approach, finance, governance, infrastructure and technology can create solutions. Existing obstacles in the action areas and challenges associated with creating solutions increase the complexities to develop nexus-based approaches and complicate their implementation. This study, identifies existing social, economic, and environmental obstacles, financial demands and constraints, shortcomings in governance, and infrastructure problems in the United States as the main challenges that need to be overcome. Then, it will be discussed how advanced technology could be employed to facilitate implementation of nexus-based approaches, followed by providing some recommendations to enable institutions to employ new technology, overcome existing obstacles, and address challenges in order to implement nexus-based management approaches.

Operational research as implementation science: definitions, challenges and research priorities.

PubMed

Monks, Thomas

2016-06-06

Operational research (OR) is the discipline of using models, either quantitative or qualitative, to aid decision-making in complex implementation problems. The methods of OR have been used in healthcare since the 1950s in diverse areas such as emergency medicine and the interface between acute and community care; hospital performance; scheduling and management of patient home visits; scheduling of patient appointments; and many other complex implementation problems of an operational or logistical nature. To date, there has been limited debate about the role that operational research should take within implementation science. I detail three such roles for OR all grounded in upfront system thinking: structuring implementation problems, prospective evaluation of improvement interventions, and strategic reconfiguration. Case studies from mental health, emergency medicine, and stroke care are used to illustrate each role. I then describe the challenges for applied OR within implementation science at the organisational, interventional, and disciplinary levels. Two key challenges include the difficulty faced in achieving a position of mutual understanding between implementation scientists and research users and a stark lack of evaluation of OR interventions. To address these challenges, I propose a research agenda to evaluate applied OR through the lens of implementation science, the liberation of OR from the specialist research and consultancy environment, and co-design of models with service users. Operational research is a mature discipline that has developed a significant volume of methodology to improve health services. OR offers implementation scientists the opportunity to do more upfront system thinking before committing resources or taking risks. OR has three roles within implementation science: structuring an implementation problem, prospective evaluation of implementation problems, and a tool for strategic reconfiguration of health services. Challenges facing OR as implementation science include limited evidence and evaluation of impact, limited service user involvement, a lack of managerial awareness, effective communication between research users and OR modellers, and availability of healthcare data. To progress the science, a focus is needed in three key areas: evaluation of OR interventions, embedding the knowledge of OR in health services, and educating OR modellers about the aims and benefits of service user involvement.

Service Providers’ Experiences and Perspectives on Recovery-Oriented Mental Health System Reform

PubMed Central

Piat, Myra; Lal, Shalini

2016-01-01

Objective With the use of a qualitative approach, this study focuses on service providers’ experiences and perspectives on recovery-oriented reform. Methods Nine focus groups were conducted with a sample of 68 service providers recruited from three Canadian sites. Results Three major themes were identified: 1) positive attitudes towards recovery-oriented reform; 2) skepticism towards recovery-oriented reform; and 3) challenges associated with implementing recovery-oriented practice. These challenges pertained to conceptual uncertainty and consistency around the meanings of recovery; application of recovery-oriented practice with certain populations and in certain contexts; bureaucratization of recovery-oriented tools; limited leadership support; and, societal stigma and social exclusion of persons with mental illnesses. Conclusions and Implications for Practice The findings point towards challenges that might arise as system planners move ahead in their efforts toward implementing recovery within the mental health system. In this regard, we offer several recommendations for the planning of organizational and educational practices that support the implementation of recovery-oriented practice. PMID:22491368

Race to the Top - Early Learning Challenge: 2015 Annual Performance Report. Vermont

ERIC Educational Resources Information Center

Race to the Top - Early Learning Challenge, 2016

2016-01-01

This Race to the Top - Early Learning Challenge (RTT-ELC) annual performance report for the year 2015 describes Vermont's accomplishments, lessons learned, challenges, and strategies Vermont will implement to address those challenges. Vermont's remarkable progress in increasing participation in their tiered quality rating and improvement system,…

Maryland Public School Standards for Telecommunications Distribution Systems: Infrastructure Design for Voice, Video, and Data Communications.

ERIC Educational Resources Information Center

Maryland State Dept. of Education, Baltimore. School Facilities Branch.

Telecommunications infrastructure has the dual challenges of maintaining quality while accommodating change, issues that have long been met through a series of implementation standards. This document is designed to ensure that telecommunications systems within the Maryland public school system are also capable of meeting both challenges and…

A Plan for Revolutionary Change in Gas Turbine Engine Control System Architecture

NASA Technical Reports Server (NTRS)

Culley, Dennis E.

2011-01-01

The implementation of Distributed Engine Control technology on the gas turbine engine has been a vexing challenge for the controls community. A successful implementation requires the resolution of multiple technical issues in areas such as network communications, power distribution, and system integration, but especially in the area of high temperature electronics. Impeding the achievement has been the lack of a clearly articulated message about the importance of the distributed control technology to future turbine engine system goals and objectives. To resolve these issues and bring the technology to fruition has, and will continue to require, a broad coalition of resources from government, industry, and academia. This presentation will describe the broad challenges facing the next generation of advanced control systems and the plan which is being put into action to successfully implement the technology on the next generation of gas turbine engine systems.

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study

PubMed Central

Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-01-01

Background The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. Objective We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. Methods We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Conclusions Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. PMID:29669709

A Story of a Journey in Implementing an E-Assessment System at a South African University

ERIC Educational Resources Information Center

Singh, U. G.; Wassermann, J. M.

2016-01-01

Following the challenges faced in the selection and implementation of e-assessment tools for student assessment, I undertook a journey of implementing an e-assessment system within the University of KwaZulu-Natal (UKZN). This article describes the path traversed and highlights the potholes and expressways on this road towards e-assessment…

Implementing technology-based embedded assessment in the home and community life of individuals aging with disabilities: a participatory research and development study.

PubMed

Chen, Ke-Yu; Harniss, Mark; Patel, Shwetak; Johnson, Kurt

2014-03-01

The goal of the study was to investigate the accuracy, feasibility and acceptability of implementing an embedded assessment system in the homes of individuals aging with disabilities. We developed and studied a location tracking system, UbiTrack, which can be used for both indoor and outdoor location sensing. The system was deployed in the homes of five participants with spinal cord injuries, muscular dystrophy, multiple sclerosis and late effects of polio. We collected sensor data throughout the deployment, conducted pre and post interviews and collected weekly diaries to measure ground truth. The system was deployed successfully although there were challenges related to system installation and calibration. System accuracy ranged from 62% to 87% depending upon room configuration and number of wireless access points installed. In general, participants reported that the system was easy to use, did not require significant effort on their part and did not interfere with their daily lives. Embedded assessment has great potential as a mechanism to gather ongoing information about the health of individuals aging with disabilities; however, there are significant challenges to its implementation in real-world settings with people with disabilities that will need to be resolved before it can be practically implemented. Technology-based embedded assessment has the potential to promote health for adults with disabilities and allow for aging in place. It may also reduce the difficulty, cost and intrusiveness of health measurement. Many new commercial and non-commercial products are available to support embedded assessment; however, most products have not been well-tested in real-world environments with individuals aging with disability. Community settings and diverse population of people with disabilities pose significant challenges to the implementation of embedded assessment systems.

Challenges to EHR implementation in electronic- versus paper-based office practices.

PubMed

Zandieh, Stephanie O; Yoon-Flannery, Kahyun; Kuperman, Gilad J; Langsam, Daniel J; Hyman, Daniel; Kaushal, Rainu

2008-06-01

Challenges in implementing electronic health records (EHRs) have received some attention, but less is known about the process of transitioning from legacy EHRs to newer systems. To determine how ambulatory leaders differentiate implementation approaches between practices that are currently paper-based and those with a legacy EHR system (EHR-based). Qualitative study. Eleven practice managers and 12 medical directors all part of an academic ambulatory care network of a large teaching hospital in New York City in January to May of 2006. Qualitative approach comparing and contrasting perceived benefits and challenges in implementing an ambulatory EHR between practice leaders from paper- and EHR-based practices. Content analysis was performed using grounded theory and ATLAS.ti 5.0. We found that paper-based leaders prioritized the following: sufficient workstations and printers, a physician information technology (IT) champion at the practice, workflow education to ensure a successful transition to a paperless medical practice, and a high existing comfort level of practitioners and support staff with IT. In contrast, EHR-based leaders prioritized: improved technical training and ongoing technical support, sufficient protection of patient privacy, and open recognition of physician resistance, especially for those who were loyal to a legacy EHR. Unlike paper-based practices, EHR-based leadership believed that comfort level with IT and adjustments to workflow changes would not be difficult challenges to overcome. Leadership at paper- and EHR-based practices in 1 academic network has different priorities for implementing a new EHR. Ambulatory practices upgrading their legacy EHR have unique challenges.

Foundational Report Series: Advanced Distribution Management Systems for Grid Modernization, DMS Industry Survey

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singh, Ravindra; Uluski, Robert; Reilly, James T.

The objective of this survey is to benchmark current practices for DMS implementation to serve as a guide for future system implementations. The survey sought information on current plans to implement DMS, DMS functions of interest, implementation challenges, functional benefits achieved, and other relevant information. These survey results were combined (where possible) with results of similar surveys conducted in the previous four years to observe trends over time.

Challenges with the implementation of an Integrated Disease Surveillance and Response (IDSR) system: systematic review of the lessons learned.

PubMed

Phalkey, Revati K; Yamamoto, Shelby; Awate, Pradip; Marx, Michael

2015-02-01

Despite a realistic strategy and availability of resources, multiple challenges still overwhelm countries grappling with the challenges of communicable disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy is by far the most pragmatic strategy in resource-poor settings. The objective of this study was to systematically review and document the lessons learned and the challenges identified with the implementation of the IDSR in low- and middle-income countries and to identify the main barriers that contribute to its sub-optimal functioning. A systematic review of literature published in English using Web of Knowledge, PubMed, and databases of the World Health Organization (WHO) and the Centers for Disease Control (CDC) between 1998 and 2012 was undertaken. Additionally, manual reference and grey literature searches were conducted. Citations describing core and support functions or the quality attributes of the IDSR as described by WHO and CDC were included in the review. Thirty-three assessment studies met the inclusion criteria. IDSR strategy has been best adopted and implemented in the WHO-AFRO region. Although significant progress is made in overcoming the challenges identified with vertical disease surveillance strategies, gaps still exist. Mixed challenges with core and support IDSR functions were observed across countries. Main issues identified include non-sustainable financial resources, lack of co-ordination, inadequate training and turnover of peripheral staff, erratic feedback, inadequate supervision from the next level, weak laboratory capacities coupled with unavailability of job aids (case definitions/reporting formats), and poor availability of communication and transport systems particularly at the periphery. Best outcomes in core functions and system attributes were reported when support surveillance functions performed optimally. Apart from technical and technological issues, human resources and the health care system structures that receive the IDSR determine its output. The challenges identified with IDSR implementation are largely 'systemic'. IDSR will best benefit from skill-based training of personnel and strengthening of the support surveillance functions alongside health care infrastructures at the district level. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Implementation Challenges for Multivariable Control: What You Did Not Learn in School

NASA Technical Reports Server (NTRS)

Garg, Sanjay

2008-01-01

Multivariable control allows controller designs that can provide decoupled command tracking and robust performance in the presence of modeling uncertainties. Although the last two decades have seen extensive development of multivariable control theory and example applications to complex systems in software/hardware simulations, there are no production flying systems aircraft or spacecraft, that use multivariable control. This is because of the tremendous challenges associated with implementation of such multivariable control designs. Unfortunately, the curriculum in schools does not provide sufficient time to be able to provide an exposure to the students in such implementation challenges. The objective of this paper is to share the lessons learned by a practitioner of multivariable control in the process of applying some of the modern control theory to the Integrated Flight Propulsion Control (IFPC) design for an advanced Short Take-Off Vertical Landing (STOVL) aircraft simulation.

HIT implementation in critical access hospitals: extent of implementation and business strategies supporting IT use.

PubMed

Bahensky, James A; Ward, Marcia M; Nyarko, Kwame; Li, Pengxiang

2011-08-01

Small rural hospitals face considerable financial and personnel resource shortages which hinder their efforts to implement complex health information technology (HIT) systems. A survey on the use of HIT was completed by 85% of Iowa's 82 Critical Access Hospitals (CAH). Analyses indicate that low IT staffing in CAHs is a barrier to implementing HIT solutions. CAHs with fewer staff tend to employ alternative business strategies. There is a clear relationship between having IT staff at a CAH and the types of technologies used. Many CAHs report having difficulty expanding upon HIT functionalities due to the challenges of finding IT staff with healthcare expertise. Most CAHs are in the transition point of planning for or beginning implementation of complex clinical information systems. Strategies for addressing these challenges will need to evolve as the HIT investments by rural hospitals race to keep pace with the goals for the nation.

Lessons Learned: Implementation of the Milwaukee Urban Systemic Initiative in Years One and Two. Report for the Milwaukee Public Schools.

ERIC Educational Resources Information Center

Doyle, Lynn H.; Huinker, DeAnn

The Urban Systemic Initiatives (USI) program is an effort sponsored by the National Science Foundation (NSF) that targets large urban school systems with the goal of sustainable implementation of high-quality, standards-based teaching for the purpose of attaining system-wide increases in students' learning of challenging mathematics and science.…

Human Factors Guidance for Control Room and Digital Human-System Interface Design and Modification, Guidelines for Planning, Specification, Design, Licensing, Implementation, Training, Operation and Maintenance

DOE Office of Scientific and Technical Information (OSTI.GOV)

R. Fink, D. Hill, J. O'Hara

2004-11-30

Nuclear plant operators face a significant challenge designing and modifying control rooms. This report provides guidance on planning, designing, implementing and operating modernized control rooms and digital human-system interfaces.

Consider Clicking In: Using Audience Response Systems to Spark Discussion

ERIC Educational Resources Information Center

Barbour, Joshua B.

2013-01-01

Audience response systems, also known as clickers, hold much promise for use in the communication classroom. Yet potential benefits notwithstanding, implementing new technology in the classroom also offers challenges for faculty who must master it themselves while managing students' learning. Successful clicker implementation, like the…

Automated Test for NASA CFS

NASA Technical Reports Server (NTRS)

McComas, David C.; Strege, Susanne L.; Carpenter, Paul B. Hartman, Randy

2015-01-01

The core Flight System (cFS) is a flight software (FSW) product line developed by the Flight Software Systems Branch (FSSB) at NASA's Goddard Space Flight Center (GSFC). The cFS uses compile-time configuration parameters to implement variable requirements to enable portability across embedded computing platforms and to implement different end-user functional needs. The verification and validation of these requirements is proving to be a significant challenge. This paper describes the challenges facing the cFS and the results of a pilot effort to apply EXB Solution's testing approach to the cFS applications.

GUIDANCE FOR IMPLEMENTING A POINT-OF-USE (POU) OR POINT-OF-ENTRY (POE) TREATMENT STRATEGY FOR COMPLIANCE WITH SDWA

EPA Science Inventory

The challenges facing small drinking water systems were a major focus of the 1996 Amendments to the Safe Drinking Water Act (SDWA). One way Congress sought to help systems meet these challenges was by explicitly allowing systems to install point-of-use (POU) and point-of-entry (P...

Next Generation Air Transportation System : progress and challenges in planning and implementing the transformation of the National Airspace System : testimony before the Subcommittee on Aviation, Committee on Transportation and Infrastructure, U.S. Senat

DOT National Transportation Integrated Search

2010-04-21

To prepare for future air traffic growth, the Federal Aviation Administration (FAA), including its Joint Planning and Development Office (JPDO) and Air Traffic Organization, is planning and implementing the Next Generation Air Transportation System (...

Challenges in the use of the mental health information system in a resource-limited setting: lessons from Ghana.

PubMed

Kpobi, Lily; Swartz, Leslie; Ofori-Atta, Angela L

2018-02-08

One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a Mental Health Information System (MHIS) has been found most successful since a properly established and operational MHIS is helpful for developing equitable and appropriate mental health care systems. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital of Ghana was old and outdated. In light of this and other factors, a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana was undertaken in 2010. Four years after its implementation, we explored user experiences with the new system, and report here the challenges that were identified with use of the new MHIS. Individual semi-structured interviews were conducted with nine clinical and administrative staff of the Accra Psychiatric Hospital to examine their experiences with the new MHIS. Participants in the study were in three categories: clinical staff, administrator, and records clerk. Participants' knowledge of the system and its use, as well as the challenges they had experienced in its use were explored using an interpretative phenomenological approach. The data suggest that optimal use of the current MHIS had faced significant implementation challenges in a number of areas. Central challenges reported by users included increased workload, poor staff involvement and training, and absence of logistic support to keep the system running. Setting up a new system does not guarantee its success. As important as it is to have a mental health information system, its usefulness is largely dependent on proper implementation and maintenance. Further, the system can facilitate policy transformation only when the place of mental health in district, regional and national health discourse improves.

Model Meets Data: Challenges and Opportunities to Implement Land Management in Earth System Models

NASA Astrophysics Data System (ADS)

Pongratz, J.; Dolman, A. J.; Don, A.; Erb, K. H.; Fuchs, R.; Herold, M.; Jones, C.; Luyssaert, S.; Kuemmerle, T.; Meyfroidt, P.

2016-12-01

Land-based demand for food and fibre is projected to increase in the future. In light of global sustainability challenges only part of this increase will be met by expansion of land use into relatively untouched regions. Additional demand will have to be fulfilled by intensification and other adjustments in management of land that already is under agricultural and forestry use. Such land management today occurs on about half of the ice-free land surface, as compared to only about one quarter that has undergone a change in land cover. As the number of studies revealing substantial biogeophysical and biogeochemical effects of land management is increasing, moving beyond land cover change towards including land management has become a key focus for Earth system modeling. However, a basis for prioritizing land management activities for implementation in models is lacking. We lay this basis for prioritization in a collaborative project across the disciplines of Earth system modeling, land system science, and Earth observation. We first assess the status and plans of implementing land management in Earth system and dynamic global vegetation models. A clear trend towards higher complexity of land use representation is visible. We then assess five criteria for prioritizing the implementation of land management activities: (1) spatial extent, (2) evidence for substantial effects on the Earth system, (3) process understanding, (4) possibility to link the management activity to existing concepts and structures of models, (5) availability of data required as model input. While the first three criteria have been assessed by an earlier study for ten common management activities, we review strategies for implementation in models and the availability of required datasets. We can thus evaluate the management activities for their performance in terms of importance for the Earth system, possibility of technical implementation in models, and data availability. This synthesis reveals some "low-hanging" fruits for model implementation, but also challenges for the assessment of land management effects by modeling. The identified gaps can guide prioritization within the data community from the Earth system and Earth system modeling perspective.

Model meets data: Challenges and opportunities to implement land management in Earth System Models

NASA Astrophysics Data System (ADS)

Pongratz, Julia; Dolman, Han; Don, Axel; Erb, Karl-Heinz; Fuchs, Richard; Herold, Martin; Jones, Chris; Luyssaert, Sebastiaan; Kuemmerle, Tobias; Meyfroidt, Patrick; Naudts, Kim

2017-04-01

Land-based demand for food and fibre is projected to increase in the future. In light of global sustainability challenges only part of this increase will be met by expansion of land use into relatively untouched regions. Additional demand will have to be fulfilled by intensification and other adjustments in management of land that already is under agricultural and forestry use. Such land management today occurs on about half of the ice-free land surface, as compared to only about one quarter that has undergone a change in land cover. As the number of studies revealing substantial biogeophysical and biogeochemical effects of land management is increasing, moving beyond land cover change towards including land management has become a key focus for Earth system modeling. However, a basis for prioritizing land management activities for implementation in models is lacking. We lay this basis for prioritization in a collaborative project across the disciplines of Earth system modeling, land system science, and Earth observation. We first assess the status and plans of implementing land management in Earth system and dynamic global vegetation models. A clear trend towards higher complexity of land use representation is visible. We then assess five criteria for prioritizing the implementation of land management activities: (1) spatial extent, (2) evidence for substantial effects on the Earth system, (3) process understanding, (4) possibility to link the management activity to existing concepts and structures of models, (5) availability of data required as model input. While the first three criteria have been assessed by an earlier study for ten common management activities, we review strategies for implementation in models and the availability of required datasets. We can thus evaluate the management activities for their performance in terms of importance for the Earth system, possibility of technical implementation in models, and data availability. This synthesis reveals some "low-hanging" fruits for model implementation, but also challenges for the assessment of land management effects by modeling. The identified gaps can guide prioritization within the data community from the Earth system and Earth system modeling perspective.

[Sustainability and excellence of the Catalan health system. New paradigms, challenges and responses].

PubMed

Fernández i Alegre, Roser; Argenter i Giralt, Miquel; Rodríguez i Guasch, Xavier

2015-11-01

The aim of a health system and the priority of any government is to anticipate problems before they appear, provide an innovative response to these new needs and healthcare models, improve access of the general public and patients to health care, especially care for the most vulnerable groups, improve healthcare results and implement the structural reforms necessary to maintain a viable and sustainable quality public healthcare system for everyone. In the current environment, health systems are facing new economic, demographic, care, social, technological and political paradigms to which health policy must respond. Faced with these challenges, health systems, especially in the case of Catalonia, are challenged to take decisions on how best to approach the implementation of structural reform designed to facilitate the necessary economic and fiscal sustainability in the service of fresh and innovative health policies and patient-centred care within a system marked by excellence and equity. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Experiences from the implementation of a biosafety system in Slovenia.

PubMed

Milavec, Mojca; Racman, Darja Stanic

2007-09-01

The development and implementation of an effective national biosafety system is important for several key reasons: to ensure safe access to products of modern biotechnology, to build public confidence, to encourage the growth of domestic modern biotechnology, and to comply with international standards and agreements. There is no single best approach in the development and implementation of a national biosafety system and each country is faced with unique challenges. Slovenia is a small country and a new EU Member State. However, it has developed and implemented an efficient national biosafety system. The key elements of this system are administrative procedure, risk assessment, enforcement, and public participation and information.

A Fuzzy Expert System for Fault Management of Water Supply Recovery in the ALSS Project

NASA Technical Reports Server (NTRS)

Tohala, Vapsi J.

1998-01-01

Modeling with a new software is a challenge. CONFIG is a challenge and is design to work with many types of systems in which discrete and continuous processes occur. The CONFIG software was used to model the two subsystem of the Water Recovery system: ICB and TFB. The model worked manually only for water flows with further implementation to be done in the future. Activities in the models are stiff need to be implemented based on testing of the hardware for phase III. More improvements to CONFIG are in progress to make it a more user friendly software.

Distributed Prognostic Health Management with Gaussian Process Regression

NASA Technical Reports Server (NTRS)

Saha, Sankalita; Saha, Bhaskar; Saxena, Abhinav; Goebel, Kai Frank

2010-01-01

Distributed prognostics architecture design is an enabling step for efficient implementation of health management systems. A major challenge encountered in such design is formulation of optimal distributed prognostics algorithms. In this paper. we present a distributed GPR based prognostics algorithm whose target platform is a wireless sensor network. In addition to challenges encountered in a distributed implementation, a wireless network poses constraints on communication patterns, thereby making the problem more challenging. The prognostics application that was used to demonstrate our new algorithms is battery prognostics. In order to present trade-offs within different prognostic approaches, we present comparison with the distributed implementation of a particle filter based prognostics for the same battery data.

Implementation of workflow engine technology to deliver basic clinical decision support functionality

PubMed Central

2011-01-01

Background Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. Results We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. Conclusions We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform. PMID:21477364

Qualitative analysis of vendor discussions on the procurement of Computerised Physician Order Entry and Clinical Decision Support systems in hospitals

PubMed Central

Cresswell, Kathrin M; Lee, Lisa; Slee, Ann; Coleman, Jamie; Bates, David W; Sheikh, Aziz

2015-01-01

Objectives We studied vendor perspectives about potentially transferable lessons for implementing organisations and national strategies surrounding the procurement of Computerised Physician Order Entry (CPOE)/Clinical Decision Support (CDS) systems in English hospitals. Setting Data were collected from digitally audio-recorded discussions from a series of CPOE/CDS vendor round-table discussions held in September 2014 in the UK. Participants Nine participants, representing 6 key vendors operating in the UK, attended. The discussions were transcribed verbatim and thematically analysed. Results Vendors reported a range of challenges surrounding the procurement and contracting processes of CPOE/CDS systems, including hospitals’ inability to adequately assess their own needs and then select a suitable product, rushed procurement and implementation processes that resulted in difficulties in meaningfully engaging with vendors, as well as challenges relating to contracting leading to ambiguities in implementation roles. Consequently, relationships between system vendors and hospitals were often strained, the vendors attributing this to a lack of hospital management's appreciation of the complexities associated with implementation efforts. Future anticipated challenges included issues surrounding the standardisation of data to enable their aggregation across systems for effective secondary uses, and implementation of data exchange with providers outside the hospital. Conclusions Our results indicate that there are significant issues surrounding capacity to procure and optimise CPOE/CDS systems among UK hospitals. There is an urgent need to encourage more synergistic and collaborative working between providers and vendors and for a more centralised support for National Health Service hospitals, which draws on a wider body of experience, including a formalised procurement framework with value-based product specifications. PMID:26503385

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.

PubMed

Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-04-18

The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. ©Naomi Muinga, Steve Magare, Jonathan Monda, Onesmus Kamau, Stuart Houston, Hamish Fraser, John Powell, Mike English, Chris Paton. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.04.2018.

Health information exchange implementation: lessons learned and critical success factors from a case study.

PubMed

Feldman, Sue S; Schooley, Benjamin L; Bhavsar, Grishma P

2014-08-15

Much attention has been given to the proposition that the exchange of health information as an act, and health information exchange (HIE), as an entity, are critical components of a framework for health care change, yet little has been studied to understand the value proposition of implementing HIE with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A sociotechnical systems approach and an interorganizational systems framework were used to examine implementation of a health system electronic medical record (EMR) system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations. The objective of the study was to focus on the implementation of a health system onto a statewide HIE; provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE (organizations with the shared goal of exchanging health information); and to understand the organizational motivations and value propositions apparent during HIE implementation. We used a formative evaluation methodology to investigate the first implementation of a health system onto the statewide HIE. Qualitative methods (direct observation, 36 hours), informal information gathering, semistructured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from sociotechnical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders' perspectives across technical, organizational, and governance dimensions. Several challenges, successes, and lessons learned during the implementation of a health system to the statewide HIE were found. The most significant perceived success was accomplishing the implementation, although many interviewees also underscored the value of a project champion with decision-making power. In terms of lessons learned, social reasons were found to be very significant motivators for early implementation, frequently outweighing economic motivations. It was clear that understanding the guides early in the project would have mitigated some of the challenges that emerged, and early communication with the electronic health record vendor so that they have a solid understanding of the undertaking was critical. An HIE implementations evaluation framework was found to be useful for assessing challenges, motivations, value propositions for participating, and success factors to consider for future implementations. This case study illuminates five critical success factors for implementation of a health system onto a statewide HIE. This study also reveals that organizations have varied motivations and value proposition perceptions for engaging in the exchange of health information, few of which, at the early stages, are economically driven.

Health Information Exchange Implementation: Lessons Learned and Critical Success Factors From a Case Study

PubMed Central

2014-01-01

Background Much attention has been given to the proposition that the exchange of health information as an act, and health information exchange (HIE), as an entity, are critical components of a framework for health care change, yet little has been studied to understand the value proposition of implementing HIE with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A sociotechnical systems approach and an interorganizational systems framework were used to examine implementation of a health system electronic medical record (EMR) system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations. Objective The objective of the study was to focus on the implementation of a health system onto a statewide HIE; provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE (organizations with the shared goal of exchanging health information); and to understand the organizational motivations and value propositions apparent during HIE implementation. Methods We used a formative evaluation methodology to investigate the first implementation of a health system onto the statewide HIE. Qualitative methods (direct observation, 36 hours), informal information gathering, semistructured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from sociotechnical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders’ perspectives across technical, organizational, and governance dimensions. Results Several challenges, successes, and lessons learned during the implementation of a health system to the statewide HIE were found. The most significant perceived success was accomplishing the implementation, although many interviewees also underscored the value of a project champion with decision-making power. In terms of lessons learned, social reasons were found to be very significant motivators for early implementation, frequently outweighing economic motivations. It was clear that understanding the guides early in the project would have mitigated some of the challenges that emerged, and early communication with the electronic health record vendor so that they have a solid understanding of the undertaking was critical. An HIE implementations evaluation framework was found to be useful for assessing challenges, motivations, value propositions for participating, and success factors to consider for future implementations. Conclusions This case study illuminates five critical success factors for implementation of a health system onto a statewide HIE. This study also reveals that organizations have varied motivations and value proposition perceptions for engaging in the exchange of health information, few of which, at the early stages, are economically driven. PMID:25599991

Research design issues for evaluating complex multicomponent interventions in neighborhoods and communities.

PubMed

Komro, Kelli A; Flay, Brian R; Biglan, Anthony; Wagenaar, Alexander C

2016-03-01

Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evaluation that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies. The major challenges we discuss concern (a) multiple contexts of evaluation/research, (b) complexity of packages of interventions, and (c) phases of evaluation/research questions. We suggest multiple alternative research designs that maintain rigor but accommodate these challenges and highlight the need for measurement systems. Longitudinal data collection and a standardized continuous measurement system are fundamental to the evaluation and refinement of complex multicomponent interventions. To be useful to T3-T5 translational research efforts in neighborhoods and communities, such a system would include assessments of the reach, implementation, effects on immediate outcomes, and effects of the comprehensive intervention package on more distal health outcomes.

Machine learning challenges in Mars rover traverse science

NASA Technical Reports Server (NTRS)

Castano, R.; Judd, M.; Anderson, R. C.; Estlin, T.

2003-01-01

The successful implementation of machine learning in autonomous rover traverse science requires addressing challenges that range from the analytical technical realm, to the fuzzy, philosophical domain of entrenched belief systems within scientists and mission managers.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.

PubMed

Shah, Hemant; Allard, Raymond D; Enberg, Robert; Krishnan, Ganesh; Williams, Patricia; Nadkarni, Prakash M

2012-03-09

A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts

PubMed Central

2012-01-01

Background A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. Methods In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). Results The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. Conclusions When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies. PMID:22405400

Critical Success Factors (CSFs) for Implementation of Enterprise Resource Planning (ERP) Systems in Various Industries, Including Institutions of Higher Education (IHEs)

ERIC Educational Resources Information Center

Debrosse-Bruno, Marie Michael

2017-01-01

Enterprise Resource Planning (ERP) systems present a management problem for various industries including institutions of higher education (IHEs) because they are costly to acquire, challenging to implement, and often fail to meet anticipated expectations. ERP systems are highly complex due to the nature of the operations they support. This…

Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities.

PubMed

Hartman, D J; Pantanowitz, L; McHugh, J S; Piccoli, A L; OLeary, M J; Lauro, G R

2017-10-01

Digital pathology is becoming technically possible to implement for routine pathology work. At our institution, we have been using digital pathology for second opinion intraoperative consultations for over 10 years. Herein, we describe our experience in converting to a digital pathology platform for primary pathology diagnosis. We implemented an incremental rollout for digital pathology on subspecialty benches, beginning with cases that contained small amounts of tissue (biopsy specimens). We successfully scanned over 40,000 slides through our digital pathology system. Several lessons (both challenges and opportunities) were learned through this implementation. A successful conversion to digital pathology requires pre-imaging adjustments, integrated software and post-imaging evaluations.

Using System Dynamics as an Evaluation Tool: Experience from a Demonstration Program

ERIC Educational Resources Information Center

Fredericks, Kimberly A.; Deegan, Michael; Carman, Joanne G.

2008-01-01

Evaluators are often faced with many challenges in the design and implementation of a program's evaluation. Because programs are entangled in complex networks of structures and stakeholders, they can be challenging to understand, and they often pose issues of competing and conflicting goals. However, by using a systems mapping approach to…

The Grand Challenges of WCRP and the Climate Observing System of the Future

NASA Astrophysics Data System (ADS)

Brasseur, G. P.

2017-12-01

The successful implementation the Paris agreement on climate change (COP21) calls for a well-designed global monitoring system of essential climate variables, climate processes and Earth system budgets. The Grand Challenges implemented by the World Climate Research Programme (WCRP) provide an opportunity to investigate issues of high societal relevance, directly related to sea level rise, droughts, floods, extreme heat events, food security, and fresh water availability. These challenges would directly benefit from a well-designed suite of systematic climate observations. Quantification of the evolution of the global energy, water and carbon budgets as well as the development and the production of near-term and regional climate predictions require that a comprehensive, focused, multi-platform observing system (satellites, ground-based and in situ observations) be established in an international context. This system must be accompanied by the development of climate services that should translate and disseminate scientific outcomes as actionable information for users and stakeholders.

Integrating Oracle Human Resources with Other Modules

NASA Technical Reports Server (NTRS)

Sparks, Karl; Shope, Shawn

1998-01-01

One of the most challenging aspects of implementing an enterprise-wide business system is achieving integration of the different modules to the satisfaction of diverse customers. The Jet Propulsion Laboratory's (JPL) implementation of the Oracle application suite demonstrates the need to coordinate Oracle Human Resources Management System (HRMS) decision across the Oracle modules.

School Psychologists' Stages of Concern with RTI Implementation

ERIC Educational Resources Information Center

Bogue, Heidi; Marrs, Heath; Little, Suzanne

2017-01-01

Responsiveness to intervention has been an important change in models of service delivery within school systems in the recent past. However, there are a significant number of challenges to implementing the paradigm shift that these changes entail (Reschly 2008). Therefore, implementation of RTI varies among states, districts, and schools and some…

Challenges associated with the implementation of the nursing process: A systematic review.

PubMed

Zamanzadeh, Vahid; Valizadeh, Leila; Tabrizi, Faranak Jabbarzadeh; Behshid, Mojghan; Lotfi, Mojghan

2015-01-01

Nursing process is a scientific approach in the provision of qualified nursing cares. However, in practice, the implementation of this process is faced with numerous challenges. With the knowledge of the challenges associated with the implementation of the nursing process, the nursing processes can be developed appropriately. Due to the lack of comprehensive information on this subject, the current study was carried out to assess the key challenges associated with the implementation of the nursing process. To achieve and review related studies on this field, databases of Iran medix, SID, Magiran, PUBMED, Google scholar, and Proquest were assessed using the main keywords of nursing process and nursing process systematic review. The articles were retrieved in three steps including searching by keywords, review of the proceedings based on inclusion criteria, and final retrieval and assessment of available full texts. Systematic assessment of the articles showed different challenges in implementation of the nursing process. Intangible understanding of the concept of nursing process, different views of the process, lack of knowledge and awareness among nurses related to the execution of process, supports of managing systems, and problems related to recording the nursing process were the main challenges that were extracted from review of literature. On systematically reviewing the literature, intangible understanding of the concept of nursing process has been identified as the main challenge in nursing process. To achieve the best strategy to minimize the challenge, in addition to preparing facilitators for implementation of nursing process, intangible understanding of the concept of nursing process, different views of the process, and forming teams of experts in nursing education are recommended for internalizing the nursing process among nurses.

Challenges associated with the implementation of the nursing process: A systematic review

PubMed Central

Zamanzadeh, Vahid; Valizadeh, Leila; Tabrizi, Faranak Jabbarzadeh; Behshid, Mojghan; Lotfi, Mojghan

2015-01-01

Background: Nursing process is a scientific approach in the provision of qualified nursing cares. However, in practice, the implementation of this process is faced with numerous challenges. With the knowledge of the challenges associated with the implementation of the nursing process, the nursing processes can be developed appropriately. Due to the lack of comprehensive information on this subject, the current study was carried out to assess the key challenges associated with the implementation of the nursing process. Materials and Methods: To achieve and review related studies on this field, databases of Iran medix, SID, Magiran, PUBMED, Google scholar, and Proquest were assessed using the main keywords of nursing process and nursing process systematic review. The articles were retrieved in three steps including searching by keywords, review of the proceedings based on inclusion criteria, and final retrieval and assessment of available full texts. Results: Systematic assessment of the articles showed different challenges in implementation of the nursing process. Intangible understanding of the concept of nursing process, different views of the process, lack of knowledge and awareness among nurses related to the execution of process, supports of managing systems, and problems related to recording the nursing process were the main challenges that were extracted from review of literature. Conclusions: On systematically reviewing the literature, intangible understanding of the concept of nursing process has been identified as the main challenge in nursing process. To achieve the best strategy to minimize the challenge, in addition to preparing facilitators for implementation of nursing process, intangible understanding of the concept of nursing process, different views of the process, and forming teams of experts in nursing education are recommended for internalizing the nursing process among nurses. PMID:26257793

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon.

PubMed

Gelmon, Sherril; Bouranis, Nicole; Sandberg, Billie; Petchel, Shauna

2018-01-01

Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics. Between 2015 and 2016, semistructured interviews and focus groups were completed with 85 key informants. Clinics reported similar challenges implementing the PCPCH model, including shifting patterns of care use, fidelity to the PCPCH model, and refining care processes. The following ten implementation strategies emerged: expanding access through care teams, preventing unnecessary emergency department visits through patient outreach, improved communication and referral tracking with outside providers, prioritization of selected program metrics, implementing patient-centered practices, developing continuous improvement capacity through committees and "champions," incorporating preventive services and chronic disease management, standardization of workflows, customizing electronic health records, and integration of mental health. Clinic leaders benefited from understanding the local context in which they were operating. Despite differences in size, ownership, geography, and population, all clinic leaders were observed to be proponents of strategies commonly associated with a "learning organization": systems thinking, personal mastery, mental models, shared vision, and team. Clinics can draw on their own characteristics, use state resources, and look to established PCMHs to build the evidence base for implementation in primary care. © Copyright 2018 by the American Board of Family Medicine.

From Systems Understanding to Personalized Medicine: Lessons and Recommendations Based on a Multidisciplinary and Translational Analysis of COPD.

PubMed

Roca, Josep; Cano, Isaac; Gomez-Cabrero, David; Tegnér, Jesper

2016-01-01

Systems medicine, using and adapting methods and approaches as developed within systems biology, promises to be essential in ongoing efforts of realizing and implementing personalized medicine in clinical practice and research. Here we review and critically assess these opportunities and challenges using our work on COPD as a case study. We find that there are significant unresolved biomedical challenges in how to unravel complex multifactorial components in disease initiation and progression producing different clinical phenotypes. Yet, while such a systems understanding of COPD is necessary, there are other auxiliary challenges that need to be addressed in concert with a systems analysis of COPD. These include information and communication technology (ICT)-related issues such as data harmonization, systematic handling of knowledge, computational modeling, and importantly their translation and support of clinical practice. For example, clinical decision-support systems need a seamless integration with new models and knowledge as systems analysis of COPD continues to develop. Our experience with clinical implementation of systems medicine targeting COPD highlights the need for a change of management including design of appropriate business models and adoption of ICT providing and supporting organizational interoperability among professional teams across healthcare tiers, working around the patient. In conclusion, in our hands the scope and efforts of systems medicine need to concurrently consider these aspects of clinical implementation, which inherently drives the selection of the most relevant and urgent issues and methods that need further development in a systems analysis of disease.

Mentoring the Next Generation of AACRAO Leaders: Taking Advantage of Routines, Exceptions, and Challenges for Developing Leadership Skills

ERIC Educational Resources Information Center

Cramer, Sharon F.

2012-01-01

As members of enrollment management units look ahead to the next few years, they anticipate many institution-wide challenges: (1) implementation of a new student information system; (2) major upgrade of an existing system; and (3) re-configuring an existing system to reflect changes in academic policies or to accommodate new federal or state…

Commercial Sexual Exploitation of Children and State Child Welfare Systems.

PubMed

Bounds, Dawn; Julion, Wrenetha A; Delaney, Kathleen R

2015-01-01

In several states, commercial sexual exploitation of children (CSEC) is now a reportable child abuse offense. Illinois has taken the lead in tackling the issue and the Illinois experience illuminates valuable lessons. This article delineates the protection, practice, and policy implications that evolve when CSEC falls under a state child welfare system. The specific aims are to (a) discuss CSEC, its victims, risks, harms, and challenges inherent in providing effective care; (b) use Illinois as an exemplar to explicate the consequences and implementation challenges of establishing a state reporting system that frames CSEC as a child welfare issue; (c) recommend strategies for developing effective state reporting models, and (d) demonstrate how nurses are well poised to advocate for victims of human trafficking on both state and national levels. Recommendations for improving the identification of CSEC victims and overcoming challenges to state implementation are offered. © The Author(s) 2015.

Doing implementation research on health governance: a frontline researcher's reflexive account of field-level challenges and their management.

PubMed

Patel, Gupteswar; Garimella, Surekha; Scott, Kerry; Mondal, Shinjini; George, Asha; Sheikh, Kabir

2017-11-15

Implementation Research (IR) in and around health systems comes with unique challenges for researchers including implementation, multi-layer governance, and ethical issues. Partnerships between researchers, implementers, policy makers and community members are central to IR and come with additional challenges. In this paper, we elaborate on the challenges faced by frontline field researchers, drawing from experience with an IR study on Village Health Sanitation and Nutrition Committees (VHSNCs). The IR on VHSNC took place in one state/province in India over an 18-month research period. The IR study had twin components; intervention and in-depth research. The intervention sought to strengthen the VHSNC functioning, and concurrently the research arm sought to understand the contextual factors, pathways and mechanism affecting VHSNC functions. Frontline researchers were employed for data collection and a research assistant was living in the study sites. The frontline research assistant experienced a range of challenges, while collecting data from the study sites, which were documented as field memos and analysed using inductive content analysis approach. Due to the relational nature of IR, the challenges coalesced around two sets of relationships (a) between the community and frontline researchers and (b) between implementers and frontline researchers. In the community, the frontline researcher was viewed as the supervisor of the intervention and was perceived by the community to have power to bring about beneficial changes with public services and facilities. Implementers expected help from the frontline researcher in problem-solving in VHSNCs, and feedback on community mobilization to improve their approaches. A concerted effort was undertaken by the whole research team to clarify and dispel concerns among the community and implementers through careful and constant communication. The strategies employed were both managerial, relational and reflexive in nature. Frontline researchers through their experiences shape the research process and its outcome and they play a central role in the research. It demonstrates that frontline researcher resilience is very crucial when conducting health policy and systems research.

Drivers and challenges for implementing ISO 14001 environmental management systems in an emerging Gulf Arab country.

PubMed

Waxin, Marie-France; Knuteson, Sandra L; Bartholomew, Aaron

2017-11-13

Worldwide, ISO 14001 certification for organizations has become the norm, but the Arab world accounts for an insignificant portion of all the certified organizations. There is a dearth of research on environmental management systems (EMS) in Arab and emerging countries and in public organizations. The objectives of this research are to: (1) examine the key drivers and challenges related to implementation of ISO 14001 certified EMS in the United Arab Emirates, an emerging Arab country and (2) compare and contrast these drivers and challenges between private and public organizations. We adopt an explorative, qualitative methodology, using semi-structured interviews with environmental managers in 11 organizations (6 private and 5 public) from different industrial sectors. Drivers of EMS certification were mostly similar between private and public organizations, with some differences. Compliance with regulations and standards, and increasing environmental performance were the main drivers for ISO 14001 certification in both private and public organizations. Commitment to sustainability was more important for public organizations. Cost reduction, competitors, leadership commitment and customers' demands were shared drivers, but more stressed by private organizations. Local community and employees' pressures were reported by private organizations only. The challenges to ISO 14001 implementation were similar for private and public organizations. They were: a lack of qualified human resources, practical challenges associated with implementation, a lack of regulations, a lack of support from management, and high costs. Our findings have implications for managers, academics, consultants, and policy makers in the UAE and other emerging markets.

Successes and challenges from formation to implementation of eleven broad-extent conservation programs.

PubMed

Beever, Erik A; Mattsson, Brady J; Germino, Matthew J; Burg, Max Post Van Der; Bradford, John B; Brunson, Mark W

2014-04-01

Integration of conservation partnerships across geographic, biological, and administrative boundaries is increasingly relevant because drivers of change, such as climate shifts, transcend these boundaries. We explored successes and challenges of established conservation programs that span multiple watersheds and consider both social and ecological concerns. We asked representatives from a diverse set of 11 broad-extent conservation partnerships in 29 countries 17 questions that pertained to launching and maintaining partnerships for broad-extent conservation, specifying ultimate management objectives, and implementation and learning. Partnerships invested more funds in implementing conservation actions than any other aspect of conservation, and a program's context (geographic extent, United States vs. other countries, developed vs. developing nation) appeared to substantially affect program approach. Despite early successes of these organizations and benefits of broad-extent conservation, specific challenges related to uncertainties in scaling up information and to coordination in the face of diverse partner governance structures, conflicting objectives, and vast uncertainties regarding future system dynamics hindered long-term success, as demonstrated by the focal organizations. Engaging stakeholders, developing conservation measures, and implementing adaptive management were dominant challenges. To inform future research on broad-extent conservation, we considered several challenges when we developed detailed questions, such as what qualities of broad-extent partnerships ensure they complement, integrate, and strengthen, rather than replace, local conservation efforts and which adaptive management processes yield actionable conservation strategies that account explicitly for dynamics and uncertainties regarding multiscale governance, environmental conditions, and knowledge of the system? © 2014 Society for Conservation Biology.

Successes and challenges from formation to implementation of eleven broad-extent conservation programs

USGS Publications Warehouse

Beever, Erik A.; Bradford, John B.; Germino, Matthew J.; Mattsson, Brady J.; Post van der Burg, Max; Brunson, Mark

2014-01-01

Integration of conservation partnerships across geographic, biological, and administrative boundaries is increasingly relevant because drivers of change, such as climate shifts, transcend these boundaries. We explored successes and challenges of established conservation programs that span multiple watersheds and consider both social and ecological concerns. We asked representatives from a diverse set of 11 broadextent conservation partnerships in 29 countries 17 questions that pertained to launching and maintaining partnerships for broad-extent conservation, specifying ultimate management objectives, and implementation and learning. Partnerships invested more funds in implementing conservation actions than any other aspect of conservation, and a program’s context (geographic extent, United States vs. other countries, developed vs. developing nation) appeared to substantially affect program approach. Despite early successes of these organizations and benefits of broad-extent conservation, specific challenges related to uncertainties in scaling up information and to coordination in the face of diverse partner governance structures, conflicting objectives, and vast uncertainties regarding future system dynamics hindered long-term success, as demonstrated by the focal organizations. Engaging stakeholders, developing conservation measures, and implementing adaptive management were dominant challenges. To inform future research on broad-extent conservation, we considered several challenges when we developed detailed questions, such as what qualities of broad-extent partnerships ensure they complement, integrate, and strengthen, rather than replace, local conservation efforts and which adaptive management processes yield actionable conservation strategies that account explicitly for dynamics and uncertainties regarding multiscale governance, environmental conditions, and knowledge of the system?

Process evaluation of a regional public health model to reduce chronic disease through policy and systems changes, Washington State, 2010-2014.

PubMed

Walkinshaw, Lina P; Mason, Caitlin; Allen, Claire L; Vu, Thuy; Nandi, Paj; Santiago, Patti Migliore; Hannon, Peggy A

2015-03-19

Although the regionalization of public health systems has been well documented in the case of emergency preparedness, there is little literature on the application of regional approaches to other aspects of public health. From 2011 through 2014 the Washington State Department of Health implemented a Community Transformation Grant to support community-level policy and systems changes to decrease chronic disease risk factors and increase access to clinical preventive services. The Department of Health implemented the grant through a regional model, grouping 32 of the state's 35 local health jurisdictions into 5 regions. Our process evaluation identifies the challenges and facilitators to Community Transformation Grant planning and implementation. We conducted 34 key informant interviews with people directly involved in the implementation of the Community Transformation Grant. We interviewed state and local partners, including representatives from each region, the Department of Health, external consultants, and regional partners. We collected data from October 2013 through July 2014. Challenges for planning, building, and implementing a regional model for chronic disease prevention included stakeholder buy-in, regional geography, and communication; facilitators included shared regional history and infrastructure, strong leadership, collaborative relationships, shared vision and goals, sufficient funding, and direct technical assistance and training. Lessons learned in Washington State provide a foundation for other states interested in using a regional approach to reduce chronic disease risk. Policy and systems changes require adequate time, funding, and staffing. States and funders should work closely with local leaders to address these challenges and facilitators.

Computerized provider order entry systems - Research imperatives and organizational challenges facing pathology services.

PubMed

Georgiou, Andrew; Westbrook, Johanna; Braithwaite, Jeffrey

2010-07-13

Information and communication technologies (ICT) are contributing to major changes taking place in pathology and within health services more generally. In this article, we draw on our research experience for over 7 years investigating the implementation and diffusion of computerized provider order entry (CPOE) systems to articulate some of the key informatics challenges confronting pathology laboratories. The implementation of these systems, with their improved information management and decision support structures, provides the potential for enhancing the role that pathology services play in patient care pathways. Beyond eliminating legibility problems, CPOE systems can also contribute to the efficiency and safety of healthcare, reducing the duplication of test orders and diminishing the risk of misidentification of patient samples and orders. However, despite the enthusiasm for CPOE systems, their diffusion across healthcare settings remains variable and is often beset by implementation problems. Information systems like CPOE may have the ability to integrate work, departments and organizations, but unfortunately, health professionals, departments and organizations do not always want to be integrated in ways that information systems allow. A persistent theme that emerges from the research evidence is that one size does not fit all, and system success or otherwise is reliant on the conditions and circumstances in which they are located. These conditions and circumstances are part of what is negotiated in the complex, messy and challenging area of ICT implementation. The solution is not likely to be simple and easy, but current evidence suggests that a combination of concerted efforts, better research designs, more sophisticated theories and hypotheses as well as more skilled, multidisciplinary research teams, tackling this area of study will bring substantial benefits, improving the effectiveness of pathology services, and, as a direct corollary, the quality of patient care.

Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services.

PubMed

Aarons, Gregory A; Fettes, Danielle L; Sommerfeld, David H; Palinkas, Lawrence A

2012-02-01

Many public sector service systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This article describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. The authors integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research.

Mixed Methods for Implementation Research: Application to Evidence-Based Practice Implementation and Staff Turnover in Community Based Organizations Providing Child Welfare Services

PubMed Central

Aarons, Gregory A.; Fettes, Danielle L.; Sommerfeld, David H.; Palinkas, Lawrence

2013-01-01

Many public sector services systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well-suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This paper describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. We integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research. PMID:22146861

Integrating Technologies, Methodologies, and Databases into a Comprehensive Terminology Management Environment to Support Interoperability among Clinical Information Systems

ERIC Educational Resources Information Center

Shakib, Shaun Cameron

2013-01-01

Controlled clinical terminologies are essential to realizing the benefits of electronic health record systems. However, implementing consistent and sustainable use of terminology has proven to be both intellectually and practically challenging. First, this project derives a conceptual understanding of the scope and intricacies of the challenge by…

Managing laboratory automation in a changing pharmaceutical industry

PubMed Central

Rutherford, Michael L.

1995-01-01

The health care reform movement in the USA and increased requirements by regulatory agencies continue to have a major impact on the pharmaceutical industry and the laboratory. Laboratory management is expected to improve effciency by providing more analytical results at a lower cost, increasing customer service, reducing cycle time, while ensuring accurate results and more effective use of their staff. To achieve these expectations, many laboratories are using robotics and automated work stations. Establishing automated systems presents many challenges for laboratory management, including project and hardware selection, budget justification, implementation, validation, training, and support. To address these management challenges, the rationale for project selection and implementation, the obstacles encountered, project outcome, and learning points for several automated systems recently implemented in the Quality Control Laboratories at Eli Lilly are presented. PMID:18925014

What Facilitates and Impedes Collaborative Work during Higher Education Software Implementation Projects?

ERIC Educational Resources Information Center

Cramer, Sharon F.; Tetewsky, Sheldon J.; Marczynski, Kelly S.

2010-01-01

Implementations of new or major upgrades of existing student information systems require incorporation of new paradigms and the exchange of familiar routines for new methods. As a result, implementations are almost always time consuming and expensive. Many people in the field of information technology have identified some of the challenges faced…

Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations.

PubMed

Tuot, Delphine S; Leeds, Kiren; Murphy, Elizabeth J; Sarkar, Urmimala; Lyles, Courtney R; Mekonnen, Tekeshe; Chen, Alice H M

2015-12-19

Access to specialty care remains a challenge for primary care providers and patients. Implementation of electronic referral and/or consultation (eCR) systems provides an opportunity for innovations in the delivery of specialty care. We conducted key informant interviews to identify drivers, facilitators, barriers and evaluation metrics of diverse eCR systems to inform widespread implementation of this model of specialty care delivery. Interviews were conducted with leaders of 16 diverse health care delivery organizations between January 2013 and April 2014. A limited snowball sampling approach was used for recruitment. Content analysis was used to examine key informant interview transcripts. Electronic referral systems, which provide referral management and triage by specialists, were developed to enhance tracking and operational efficiency. Electronic consultation systems, which encourage bi-directional communication between primary care and specialist providers facilitating longitudinal virtual co-management, were developed to improve access to specialty expertise. Integrated eCR systems leverage both functionalities to enhance the delivery of coordinated, specialty care at the population level. Elements of successful eCR system implementation included executive and clinician leadership, established funding models for specialist clinician reimbursement, and a commitment to optimizing clinician workflows. eCR systems have great potential to streamline access to and enhance the coordination of specialty care delivery. While different eCR models help solve different organizational challenges, all require institutional investments for successful implementation, such as funding for program management, leadership and clinician incentives.

Implementation status of accrual accounting system in health sector.

PubMed

Mehrolhassani, Mohammad Hossien; Khayatzadeh-Mahani, Akram; Emami, Mozhgan

2014-07-29

Management of financial resources in health systems is one of the major issues of concern for policy makers globally. As a sub-set of financial management, accounting system is of paramount importance. In this paper, which presents part of the results of a wider research project on transition process from a cash accounting system to an accrual accounting system, we look at the impact of components of change on implementation of the new system. Implementing changes is fraught with many obstacles and surveying these challenges will help policy makers to better overcome them. The study applied a quantitative manner in 2012 at Kerman University of Medical Science in Iran. For the evaluation, a teacher made valid questionnaire with Likert scale was used (Cranach's alpha of 0.89) which included 7 change components in accounting system. The study population was 32 subordinate units of Kerman University of Medical Sciences and for data analysis, descriptive and inferential statistics and correlation coefficient in SPSS version 19 were used. Level of effect of all components on the implementation was average downward (5.06±1.86), except for the component "management & leadership (3.46±2.25)" (undesirable from external evaluators' viewpoint) and "technology (6.61±1.92) and work processes (6.35±2.19)" (middle to high from internal evaluators' viewpoint). Results showed that the establishment of accrual accounting system faces infrastructural challenges, especially the components of leadership and management and followers. As such, developing effective measures to overcome implementation obstacles should target these components.

Overcoming the Challenges of Implementing a Multi-Mission Distributed Workflow System

NASA Technical Reports Server (NTRS)

Sayfi, Elias; Cheng, Cecilia; Lee, Hyun; Patel, Rajesh; Takagi, Atsuya; Yu, Dan

2009-01-01

A multi-mission approach to solving the same problems for various projects is enticing. However, the multi-mission approach leads to the need to develop a configurable, adaptable and distributed system to meet unique project requirements. That, in turn, leads to a set of challenges varying from handling synchronization issues to coming up with a smart design that allows the "unknowns" to be decided later. This paper discusses the challenges that the Multi-mission Automated Task Invocation Subsystem (MATIS) team has come up against while designing the distributed workflow system, as well as elaborates on the solutions that were implemented. The first is to design an easily adaptable system that requires no code changes as a result of configuration changes. The number of formal deliveries is often limited because each delivery costs time and money. Changes such as the sequence of programs being called, a change of a parameter value in the program that is being automated should not result in code changes or redelivery.

Paving the road to personalized medicine: recommendations on regulatory, intellectual property and reimbursement challenges

PubMed Central

Knowles, Lori; Luth, Westerly; Bubela, Tania

2017-01-01

Abstract Personalized medicine (PM) aims to harness a wave of ‘omics’ discoveries to facilitate research and discovery of targeted diagnostics and therapies and increase the efficiency of healthcare systems by predicting and treating individual predispositions to diseases or conditions. Despite significant investment, limited progress has been made bringing PM to market. We describe the major perceived regulatory, intellectual property, and reimbursement challenges to the development, translation, adoption, and implementation of PM products into clinical care. We conducted a scoping review to identify (i) primary challenges for the development and implementation of PM identified in the academic literature; (ii) solutions proposed in the academic literature to address these challenges; and (iii) gaps that exist in that literature. We identified regulatory barriers to PM development and recommendations in 344 academic papers. Regulatory uncertainty was a cross-cutting theme that appeared in conjunction with other themes including: reimbursement; clinical trial regulation; regulation of co-development; unclear evidentiary requirements; insufficient incentives for research and development; incompatible information systems; and different regulation of different diagnostics. To fully realize the benefits of PM for healthcare systems and patients, regulatory, intellectual property, and reimbursement challenges need to be addressed in lock step with scientific advances. PMID:29868182

The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation

PubMed Central

Fusheini, Adam

2016-01-01

Background: National/social health insurance schemes have increasingly been seen in many low- and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004. Several peer review studies and other research reports have since assessed the performance of the scheme with positive rating while challenges also noted. This paper contributes to the literature on economic and political implementation challenges based on empirical evidence from the perspectives of the different category of actors and institutions involved in the process. Methods: Qualitative in-depth interviews were held with 33 different category of participants in four selected district mutual health insurance schemes in Southern (two) and Northern (two) Ghana. This was to ascertain their views regarding the main challenges in the implementation process. The participants were selected through purposeful sampling, stakeholder mapping, and snowballing. Data was analysed using thematic grouping procedure. Results: Participants identified political issues of over politicisation and political interference as main challenges. The main economic issues participants identified included low premiums or contributions; broad exemptions, poor gatekeeper enforcement system; and culture of curative and hospital-centric care. Conclusion: The study establishes that political and economic factors have influenced the implementation process and the degree to which the policy has been implemented as intended. Thus, we conclude that there is a synergy between implementation and politics; and achieving UHC under the NHIS requires political stewardship. Political leadership has the responsibility to build trust and confidence in the system by providing the necessary resources and backing with minimal interference in the operations. For sustainability of the scheme, authorities need to review the exemption policy, rate of contributions, especially, from informal sector employees and recruitment criteria of scheme workers, explore additional sources of funding and re-examine training needs of employees to strengthen their competences among others. PMID:27694681

The Politico-Economic Challenges of Ghana's National Health Insurance Scheme Implementation.

PubMed

Fusheini, Adam

2016-04-27

National/social health insurance schemes have increasingly been seen in many low- and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004. Several peer review studies and other research reports have since assessed the performance of the scheme with positive rating while challenges also noted. This paper contributes to the literature on economic and political implementation challenges based on empirical evidence from the perspectives of the different category of actors and institutions involved in the process. Qualitative in-depth interviews were held with 33 different category of participants in four selected district mutual health insurance schemes in Southern (two) and Northern (two) Ghana. This was to ascertain their views regarding the main challenges in the implementation process. The participants were selected through purposeful sampling, stakeholder mapping, and snowballing. Data was analysed using thematic grouping procedure. Participants identified political issues of over politicisation and political interference as main challenges. The main economic issues participants identified included low premiums or contributions; broad exemptions, poor gatekeeper enforcement system; and culture of curative and hospital-centric care. The study establishes that political and economic factors have influenced the implementation process and the degree to which the policy has been implemented as intended. Thus, we conclude that there is a synergy between implementation and politics; and achieving UHC under the NHIS requires political stewardship. Political leadership has the responsibility to build trust and confidence in the system by providing the necessary resources and backing with minimal interference in the operations. For sustainability of the scheme, authorities need to review the exemption policy, rate of contributions, especially, from informal sector employees and recruitment criteria of scheme workers, explore additional sources of funding and re-examine training needs of employees to strengthen their competences among others. © 2016 by Kerman University of Medical Sciences

Synthetic biology: advancing the design of diverse genetic systems

PubMed Central

Wang, Yen-Hsiang; Wei, Kathy Y.; Smolke, Christina D.

2013-01-01

A main objective of synthetic biology is to make the process of designing genetically-encoded biological systems more systematic, predictable, robust, scalable, and efficient. The examples of genetic systems in the field vary widely in terms of operating hosts, compositional approaches, and network complexity, ranging from a simple genetic switch to search-and-destroy systems. While significant advances in synthesis capabilities support the potential for the implementation of pathway- and genome-scale programs, several design challenges currently restrict the scale of systems that can be reasonably designed and implemented. Synthetic biology offers much promise in developing systems to address challenges faced in manufacturing, the environment and sustainability, and health and medicine, but the realization of this potential is currently limited by the diversity of available parts and effective design frameworks. As researchers make progress in bridging this design gap, advances in the field hint at ever more diverse applications for biological systems. PMID:23413816

Making Choices, Taking Chances, Facing Challenges, Managing Change: The Implementation of a Voice/Video/Data Network at the Alliance Library System.

ERIC Educational Resources Information Center

Wilford, Valerie J.; Logan, Lee; Bell, Lori; Cloyes, Kay

The Alliance Library System (ALS) is one of 12 regional library systems in Illinois, providing a full spectrum of support services for 300 member libraries of all types (public, school, academic, and special) located in west central Illinois. This paper describes the process by which ALS implemented a voice/video/data network connecting their four…

Man-systems distributed system for Space Station Freedom

NASA Technical Reports Server (NTRS)

Lewis, J. L.

1990-01-01

Viewgraphs on man-systems distributed system for Space Station Freedom are presented. Topics addressed include: description of man-systems (definition, requirements, scope, subsystems, and topologies); implementation (approach, tools); man-systems interfaces (system to element and system to system); prime/supporting development relationship; selected accomplishments; and technical challenges.

Technical experiences of implementing a wireless tracking and facial biometric verification system for a clinical environment

NASA Astrophysics Data System (ADS)

Liu, Brent; Lee, Jasper; Documet, Jorge; Guo, Bing; King, Nelson; Huang, H. K.

2006-03-01

By implementing a tracking and verification system, clinical facilities can effectively monitor workflow and heighten information security in today's growing demand towards digital imaging informatics. This paper presents the technical design and implementation experiences encountered during the development of a Location Tracking and Verification System (LTVS) for a clinical environment. LTVS integrates facial biometrics with wireless tracking so that administrators can manage and monitor patient and staff through a web-based application. Implementation challenges fall into three main areas: 1) Development and Integration, 2) Calibration and Optimization of Wi-Fi Tracking System, and 3) Clinical Implementation. An initial prototype LTVS has been implemented within USC's Healthcare Consultation Center II Outpatient Facility, which currently has a fully digital imaging department environment with integrated HIS/RIS/PACS/VR (Voice Recognition).

Why the elderly could bankrupt Canada and how demographic imperatives will force the redesign of acute care service delivery.

PubMed

Sinha, Samir K

2011-01-01

Canada's aging population poses a significant challenge for the existing healthcare system. While individuals 65 and older accounted for 13.7% of the population in 2005, they accounted for 60% of all acute care service spending. This paper further illustrates how the heterogeneity of the older population and its impact on patterns of healthcare use demonstrate the failings of our current care systems. Our outdated acute care models frequently disadvantage the system's highest users, who are often characterized by factors such as poly-morbidity, functional impairment and social frailty. Understanding how implementing innovative models that challenge deeply ingrained ways of providing care has proven to be a significant challenge, this paper highlights one hospital's mission to transform current traditional paradigms of care by developing and implementing an elder-friendly hospital integrated service delivery model. This hospital aims to demonstrate wide-ranging benefits of this model that can contribute toward optimizing the outcomes of hospitalization for older adults and the system as a whole. The establishment of a national agency that could support the development of a national aging strategy to promote best practice dissemination and implementation could also ensure that the significant health, social and economic benefits that better care models can realize could be more easily achieved.

Rocky milieu: challenges of effective integration of clinical risk management into hospitals in Iran.

PubMed

Farokhzadian, Jamileh; Nayeri, Nahid Dehghan; Borhani, Fariba

2015-01-01

Healthcare risks and clinical risks have been recognized as a major challenge in healthcare. Clinical risks can never be eliminated and can have serious adverse effects on patient safety. Thus, a clinical risk management (CRM) system has been introduced in the healthcare system to improve quality services. The aim of this study was to explore nurses' experiences related to the challenges of implementing CRM in the organizational context. This qualitative study was based on the conventional content analysis of the Lundman and Graneheim approach, and it consisted of 22 interview sessions with 20 nurses. The purposive sampling method was used to choose the participants from three hospitals affiliated with the Kerman University of Medical Sciences. We used semi-structured interviews and review of relevant documents to collect data. The analysis of the data led to the emergence of "rocky milieu" as the main theme, and it consisted of three categories that, along with their subcategories, explain the challenges of implementing CRM. The three categories and their subcategories were (1) organizational culture and leadership challenges (decision and performance of leadership and cultural resistance to change), (2) limitation of resources (financial, human, and physical and equipment resources), and (3) variations and complexities in working conditions (the emotional, psychological, and social atmosphere and the heaviness of workload). Attempts have been made to establish CRM through clinical governance and accreditation, but organizational challenges have created a rocky milieu for implementing CRM. However, from an organizational context concerning the suitability of healthcare in Iran, there are obvious needs to move toward quality improvement and safe practices through the effective implementation of CRM.

Rocky milieu: Challenges of effective integration of clinical risk management into hospitals in Iran

PubMed Central

Farokhzadian, Jamileh; Nayeri, Nahid Dehghan; Borhani, Fariba

2015-01-01

Healthcare risks and clinical risks have been recognized as a major challenge in healthcare. Clinical risks can never be eliminated and can have serious adverse effects on patient safety. Thus, a clinical risk management (CRM) system has been introduced in the healthcare system to improve quality services. The aim of this study was to explore nurses’ experiences related to the challenges of implementing CRM in the organizational context. This qualitative study was based on the conventional content analysis of the Lundman and Graneheim approach, and it consisted of 22 interview sessions with 20 nurses. The purposive sampling method was used to choose the participants from three hospitals affiliated with the Kerman University of Medical Sciences. We used semi-structured interviews and review of relevant documents to collect data. The analysis of the data led to the emergence of “rocky milieu” as the main theme, and it consisted of three categories that, along with their subcategories, explain the challenges of implementing CRM. The three categories and their subcategories were (1) organizational culture and leadership challenges (decision and performance of leadership and cultural resistance to change), (2) limitation of resources (financial, human, and physical and equipment resources), and (3) variations and complexities in working conditions (the emotional, psychological, and social atmosphere and the heaviness of workload). Attempts have been made to establish CRM through clinical governance and accreditation, but organizational challenges have created a rocky milieu for implementing CRM. However, from an organizational context concerning the suitability of healthcare in Iran, there are obvious needs to move toward quality improvement and safe practices through the effective implementation of CRM. PMID:25968444

Supply Chain Management on IBS Implementation in Klang Valley Construction Industry: Challenges and Issues

NASA Astrophysics Data System (ADS)

Azrizal Fauzi, Mohd; Hasim, Sulaiman; Awang, Anizah; Ridzuan, Ahmad Ruslan Mohd; Nur Yunus, Juzailah

2017-12-01

Industrialized Building System (IBS) is a system where the components of the building are manufactured in a factory and it will be transported to the site to form the structures. The supply chain management (SCM) is a system where the delivery flows of the IBS products from manufacturers to the site. The aim of this research is to identify the major challenges and to analyze the issues on IBS implementation in SCM in Klang Valley from the manufacturers perspective. The methodology used in this paper is based on primary data through questionnaire and interview. Questionnaires were sent to the Manufacturers. It can be concluded that this paper attempts to present more on the challenges and issues that those companies of manufacturers faced during their success journey in finding integration in their supply chain. The main contributions of this paper are integrating all the supply chain integration challenges and issues on IBS. Therefore, these contributions will be helpful for the organization of manufacturers and IBS players that establish the integration in their SCM.

Health system capacity: maternal health policy implementation in the state of Gujarat, India

PubMed Central

Sanneving, Linda; Kulane, Asli; Iyer, Aditi; Ahgren, Bengt

2013-01-01

Introduction The Government of Gujarat has for the past couple of decades continuously initiated several interventions to improve access to care for pregnant and delivering women within the state. Data from the last District Family Heath survey in Gujarat in 2007–2008 show that 56.4% of women had institutional deliveries and 71.5% had at least one antenatal check-up, indicating that challenges remain in increasing use of and access to maternal health care services. Objective To explore the perceptions of high-level stakeholders on the process of implementing maternal health interventions in Gujarat. Method Using the policy triangle framework developed by Walt and Gilson, the process of implementation was approached using in-depth interviews and qualitative content analysis. Result Based on the analysis, three themes were developed: lack of continuity; the complexity of coordination; and lack of confidence and underutilization of the monitoring system. The findings suggest that decisions made and actions advocated and taken are more dependent on individual actors than on sustainable structures. The findings also indicate that the context in which interventions are implemented is challenged in terms of weak coordination and monitoring systems that are not used to evaluate and develop interventions on maternal health. Conclusions The implementation of interventions on maternal health is dependent on the capacity of the health system to implement evidence-based policies. The capacity of the health system in Gujarat to facilitate implementation of maternal health interventions needs to be improved, both in terms of the role of actors and in terms of structures and processes. PMID:23522352

A review of active control approaches in stabilizing combustion systems in aerospace industry

NASA Astrophysics Data System (ADS)

Zhao, Dan; Lu, Zhengli; Zhao, He; Li, X. Y.; Wang, Bing; Liu, Peijin

2018-02-01

Self-sustained combustion instabilities are one of the most plaguing challenges and problems in lean-conditioned propulsion and land-based engine systems, such as rocket motors, gas turbines, industrial furnace and boilers, and turbo-jet thrust augmenters. Either passive or active control in open- or closed-loop configurations can be implemented to mitigate such instabilities. One of the classical disadvantages of passive control is that it is only implementable to a designed combustor over a limited frequency range and can not respond to the changes in operating conditions. Compared with passive control approaches, active control, especially in closed-loop configuration is more adaptive and has inherent capacity to be implemented in practice. The key components in closed-loop active control are 1) sensor, 2) controller (optimization algorithm) and 3) dynamic actuator. The present work is to outline the current status, technical challenges and development progress of the active control approaches (in open- or closed-loop configurations). A brief description of feedback control, adaptive control, model-based control and sliding mode control are provided first by introducing a simplified Rijke-type combustion system. The modelled combustion system provides an invaluable platform to evaluate the performance of these feedback controllers and a transient growth controller. The performance of these controllers are compared and discussed. An outline of theoretical, numerical and experimental investigations are then provided to overview the research and development progress made during the last 4 decades. Finally, potential, challenges and issues involved with the design, application and implementation of active combustion control strategies on a practical engine system are highlighted.

Operational Earthquake Forecasting and Earthquake Early Warning: The Challenges of Introducing Scientific Innovations for Public Safety

NASA Astrophysics Data System (ADS)

Goltz, J. D.

2016-12-01

Although variants of both earthquake early warning and short-term operational earthquake forecasting systems have been implemented or are now being implemented in some regions and nations, they have been slow to gain acceptance within the disciplines that produced them as well as among those for whom they were intended to assist. To accelerate the development and implementation of these technologies will require the cooperation and collaboration of multiple disciplines, some inside and others outside of academia. Seismologists, social scientists, emergency managers, elected officials and key opinion leaders from the media and public must be the participants in this process. Representatives of these groups come from both inside and outside of academia and represent very different organizational cultures, backgrounds and expectations for these systems, sometimes leading to serious disagreements and impediments to further development and implementation. This presentation will focus on examples of the emergence of earthquake early warning and operational earthquake forecasting systems in California, Japan and other regions and document the challenges confronted in the ongoing effort to improve seismic safety.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana.

PubMed

Mupara, Lucia U; Lubbe, Johanna C

2016-01-01

Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana.

A systems approach to purchasing and implementing new technology.

PubMed

Kinney, Kristin

2007-01-01

There are many risks associated with purchasing and implementing new technology. The challenge is to reduce these risks to gain maximum benefit from the new technology purchased. In the high-cost world of healthcare, there is little room for wasting time and money related to technology implementation. If the workflow of the current system is not adequately understood before purchasing and implementing a new technology, that technology may mask underlying problems and/or create new ones. The purpose of this article is to present a framework for analyzing the current process or system, identifying the strengths and the areas in need of improvement. A thorough understanding of the problems with the current system and the barriers to change is necessary to ensure the selection of the "right" technology and promote its implementation.

Local Implementation Effectiveness of a Multi-Tier System of Support in Elementary School Settings

ERIC Educational Resources Information Center

Houlton, Terry P.

2017-01-01

Ensuring all students learn at high levels is demanding. Multi-tier systems of supports (MTSS) has shown promise as a way to promote high levels of learning for all students while catching students who are struggling to learn. However, implementing MTSS models in school districts and schools has seen its challenges. The context of an individual…

Commitment to Quality Education Services through ISO 9000: A Case Study of Romania

ERIC Educational Resources Information Center

Paunescu, Carmen; Fok, Wing

2005-01-01

The paper discusses a model of quality management system for higher education. One of the main objectives of this paper is to highlight the challenges facing the school during implementation of the ISO 9001 standard and the benefits of successfully implementing such a quality system can bring to higher education. Based on the experience of a…

Evaluating Progress: State Education Agencies and the Implementation of New Teacher Evaluation Systems. WP #2015-09

ERIC Educational Resources Information Center

McGuinn, Patrick

2015-01-01

In a 2012 paper for the Center for American Progress, "The State of Evaluation Reform," Patrick McGuinn (Drew University) identified the opportunities and challenges facing education agencies in Race to the Top (RTTT) grant-winning states as they prepared for the implementation of new teacher evaluation systems. The 2012 study undertook…

Sharpen Your Pencils and Roll Up Your Sleeves: A Case Study in Implementing GASB's New Financial Reporting Model.

ERIC Educational Resources Information Center

Green, Tim; Williamson, Margie E.; Endris, William L., jR.

2000-01-01

Describes how the Vernon Parish (Louisiana) School District implemented Governmental Accounting Board Statement No. 34 for fiscal year 1999. Implementing GASB 34 was mentally challenging and demanded a team effort. The system uses columnar displays for major funds and contains burdensome capital-assets accounting standards. (MLH)

Exploring a model-driven architecture (MDA) approach to health care information systems development.

PubMed

Raghupathi, Wullianallur; Umar, Amjad

2008-05-01

To explore the potential of the model-driven architecture (MDA) in health care information systems development. An MDA is conceptualized and developed for a health clinic system to track patient information. A prototype of the MDA is implemented using an advanced MDA tool. The UML provides the underlying modeling support in the form of the class diagram. The PIM to PSM transformation rules are applied to generate the prototype application from the model. The result of the research is a complete MDA methodology to developing health care information systems. Additional insights gained include development of transformation rules and documentation of the challenges in the application of MDA to health care. Design guidelines for future MDA applications are described. The model has the potential for generalizability. The overall approach supports limited interoperability and portability. The research demonstrates the applicability of the MDA approach to health care information systems development. When properly implemented, it has the potential to overcome the challenges of platform (vendor) dependency, lack of open standards, interoperability, portability, scalability, and the high cost of implementation.

ERP implementation in hospitals: a case study.

PubMed

Agarwal, Divya; Garg, Poonam

2012-01-01

In a competitive healthcare sector, hospitals have to focus on their processes in order to deliver high-quality care while at the same time reducing costs. Many hospitals have decided to adopt one or another Enterprise Resource Planning (ERP) system to improve their businesses, but implementing an ERP system can be a demanding endeavour. The systems are so difficult to implement that some are successful; many have failed, causing multimillion dollar losses. The challenge of ERP solutions lie in implementation because they are complex, time consuming and expensive too. This paper describes the various process workflows and phases of ERP implementation at Fortis Hospital Cunningham Road, Bangalore, India. This knowledge will provide valuable insights for the researchers and practitioners to understand the different process workflows and to make informed decisions when implementing ERP in any hospital.

ERP System Implementation: An Oil and Gas Exploration Sector Perspective

NASA Astrophysics Data System (ADS)

Mishra, Alok; Mishra, Deepti

Enterprise Resource Planning (ERP) systems provide integration and optimization of various business processes which leads to improved planning and decision quality, smoother coordination between business units resulting in higher efficiency, and quicker response time to customer demands and inquiries. This paper reports challenges, opportunities and outcome of ERP implementation in Oil & Gas exploration sector. This study will facilitate in understanding transition, constraints and implementation of ERP in this sector and also provide guidelines from lessons learned in this regard.

Reference software implementation for GIFTS ground data processing

NASA Astrophysics Data System (ADS)

Garcia, R. K.; Howell, H. B.; Knuteson, R. O.; Martin, G. D.; Olson, E. R.; Smuga-Otto, M. J.

2006-08-01

Future satellite weather instruments such as high spectral resolution imaging interferometers pose a challenge to the atmospheric science and software development communities due to the immense data volumes they will generate. An open-source, scalable reference software implementation demonstrating the calibration of radiance products from an imaging interferometer, the Geosynchronous Imaging Fourier Transform Spectrometer1 (GIFTS), is presented. This paper covers essential design principles laid out in summary system diagrams, lessons learned during implementation and preliminary test results from the GIFTS Information Processing System (GIPS) prototype.

Role of Educational Strategies for Human Resources in Green Infrastructure Operation and Maintenance

NASA Astrophysics Data System (ADS)

Ebrahimi, G.; Thurm, B.; Öberg, G.

2014-12-01

Rainwater harvesting and water reuse are receiving increasing attention as they hold the potential to effectively improve water conservation efforts. While many technical solutions have been developed, alternative water systems in built environments face significant challenges in the implementation and operational phases. The aim of this study is to examine obstacles to the implementation of alternative water systems in practice and identify criteria of feasible and sustainable solutions that allow bypassing of the identified obstacles. Interviews were conducted with planners, system designers and operators to find out which factors that central actors believe influence successful implementation of such systems. The results were analyzed in light of the literature. The actual performance of the water harvesting and reuse systems in four recently built green buildings in the Province of British Columbia, Canada was analyzed in light of the predicted outcome, according to the criteria identified in the interviews. It was found that the major obstacle to success is that the practical challenges involved in the implementation of alternative systems are underestimated. This, for example, leads to that education strategies for operational staff are not developed, and the staff is left floundering. This study highlights the importance of recognizing the need for strategic and directed educational programs for the human resources who are involved in operating and maintaining rainwater harvesting and water reuse systems.

Implementation Status of Accrual Accounting System in Health Sector

PubMed Central

Mehrolhassani, Mohammad Hossien; Khayatzadeh-Mahani, Akram; Emami, Mozhgan

2015-01-01

Introduction: Management of financial resources in health systems is one of the major issues of concern for policy makers globally. As a sub-set of financial management, accounting system is of paramount importance. In this paper, which presents part of the results of a wider research project on transition process from a cash accounting system to an accrual accounting system, we look at the impact of components of change on implementation of the new system. Implementing changes is fraught with many obstacles and surveying these challenges will help policy makers to better overcome them. Methods: The study applied a quantitative manner in 2012 at Kerman University of Medical Science in Iran. For the evaluation, a teacher made valid questionnaire with Likert scale was used (Cranach’s alpha of 0.89) which included 7 change components in accounting system. The study population was 32 subordinate units of Kerman University of Medical Sciences and for data analysis, descriptive and inferential statistics and correlation coefficient in SPSS version 19 were used. Results: Level of effect of all components on the implementation was average downward (5.06±1.86), except for the component “management & leadership (3.46±2.25)” (undesirable from external evaluators’ viewpoint) and “technology (6.61±1.92) and work processes (6.35±2.19)” (middle to high from internal evaluators’ viewpoint). Conclusions: Results showed that the establishment of accrual accounting system faces infrastructural challenges, especially the components of leadership and management and followers. As such, developing effective measures to overcome implementation obstacles should target these components. PMID:25560337

Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice.

PubMed

Aarons, Gregory A; Fettes, Danielle L; Hurlburt, Michael S; Palinkas, Lawrence A; Gunderson, Lara; Willging, Cathleen E; Chaffin, Mark J

2014-01-01

Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team approach. Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare. Semistructured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment framework. Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration; competing priorities across levels of leadership; power struggles; and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. System-wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes.

Collaboration, Negotiation, and Coalescence for Interagency-Collaborative Teams to Scale-up Evidence-Based Practice

PubMed Central

Aarons, Gregory A.; Fettes, Danielle; Hurlburt, Michael; Palinkas, Lawrence; Gunderson, Lara; Willging, Cathleen; Chaffin, Mark

2014-01-01

Objective Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team (ICT) approach. Methods Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare®. Semi-structured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Results Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration, competing priorities across levels of leadership, power struggles, and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. Conclusions System wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes. PMID:24611580

Characterizing implementation strategies using a systems engineering survey and interview tool: a comparison across 10 prevention programs for drug abuse and HIV sexual risk behavior.

PubMed

Czaja, Sara J; Valente, Thomas W; Nair, Sankaran N; Villamar, Juan A; Brown, C Hendricks

2016-05-17

Although many behavioral interventions have proven to be efficacious, new methodologies are required beyond efficacy trials to understand how to adopt, implement with fidelity, and sustain behavioral interventions in community settings. In this paper, we present a new approach, based on systems engineering concepts and methods, for characterizing implementation strategies that are used to deliver evidence-based behavioral interventions in health and social service settings. We demonstrate the use of this approach with implementation strategies, used or being used for broader dissemination of 10 evidence-based prevention program projects focused on the prevention of drug or HIV sex risk behaviors. The results indicate that there are wide variations in intervention approaches and that there are challenges in program implementation including maintaining program fidelity, serving community needs, and adequate resources. The results also indicate that implementation requires a committed partnership between the program developers, implementation researchers, and community partners. In addition, there is a need for adaptability within programs to meet community needs, resources, and priorities while maintaining program fidelity. Our methodological approach enabled us to highlight challenges associated with the community implementation of health risk prevention interventions. We also demonstrate how comprehensive descriptions of interventions facilitate understanding of the requirements of program implementation and decisions about the feasibility of implementing a program in community settings.

National Airspace System : free flight tools show promise, but implementation challenges remain

DOT National Transportation Integrated Search

2001-08-31

To help meet growing demand for air travel, the Federal Aviation Administration (FAA), in collaboration with the aviation community, is implementing a new approach for air traffic management known as free flight. By using a set of new automated techn...

What Does Innovation Mean for Moral Educators?

ERIC Educational Resources Information Center

Reiman, Alan J.; Dotger, Benjamin H.

2008-01-01

This article examines the links between prosocial moral education, educational innovations and concerns of school system personnel during an innovation's implementation process. The role of social innovations in promoting prosocial moral education is discussed with attention given to the challenges and processes associated with implementing such…

Electronic Health Records in the Cloud: Improving Primary Health Care Delivery in South Africa.

PubMed

Cilliers, Liezel; Wright, Graham

2017-01-01

In South Africa, the recording of health data is done manually in a paper-based file, while attempts to digitize healthcare records have had limited success. In many countries, Electronic Health Records (EHRs) has developed in silos, with little or no integration between different operational systems. Literature has provided evidence that the cloud can be used to 'leapfrog' some of these implementation issues, but the adoption of this technology in the public health care sector has been very limited. This paper aims to identify the major reasons why the cloud has not been used to implement EHRs for the South African public health care system, and to provide recommendations of how to overcome these challenges. From the literature, it is clear that there are technology, environmental and organisational challenges affecting the implementation of EHRs in the cloud. Four recommendations are provided that can be used by the National Department of Health to implement EHRs making use of the cloud.

Integration of Treatment Innovation Planning and Implementation: Strategic Process Models and Organizational Challenges

PubMed Central

Lehman, Wayne E. K.; Simpson, D. Dwayne; Knight, Danica K.; Flynn, Patrick M.

2015-01-01

Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A 2-phase procedural approach is therefore presented based on the integration of TCU models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings. PMID:21443294

What Are the Professional, Political, and Ethical Challenges of Co-Creating Health Care Systems?

PubMed

Singh, Guddi; Owens, John; Cribb, Alan

2017-11-01

Co-creation is seen by many as a means of meeting the multiple challenges facing contemporary health care systems by involving institutions, professionals, patients, and stakeholders in new roles, relationships, and collaborative practices. While co-creation has the potential to positively transform health care systems, it generates a number of political and ethical challenges that should not be overlooked. We suggest that those involved in envisioning and implementing co-creation initiatives pay close attention to significant questions of equity, power, and justice and to the fundamental challenge of securing a common vision of the aims of and agendas for health care systems. While such initiatives present significant opportunities for improvement, they need to be viewed in light of their accompanying professional, political, and ethical challenges. © 2017 American Medical Association. All Rights Reserved.

Implementation of Three Text to Speech Systems for Kurdish Language

NASA Astrophysics Data System (ADS)

Bahrampour, Anvar; Barkhoda, Wafa; Azami, Bahram Zahir

Nowadays, concatenative method is used in most modern TTS systems to produce artificial speech. The most important challenge in this method is choosing appropriate unit for creating database. This unit must warranty smoothness and high quality speech, and also, creating database for it must reasonable and inexpensive. For example, syllable, phoneme, allophone, and, diphone are appropriate units for all-purpose systems. In this paper, we implemented three synthesis systems for Kurdish language based on syllable, allophone, and diphone and compare their quality using subjective testing.

Managing the Challenges of Adopting Electronic Medical Records: An Exploratory Study of the Challenges Faced by African American Health Care Professionals

ERIC Educational Resources Information Center

Riddick, William P.

2013-01-01

The implementation of technology within the health care industry is viewed as a possible solution for lowering costs and improving health care delivery to patients. Electronic medical record system(s) (EMRS) are information technology tools viewed within the health care industry as a possible solution for aiding improvements in health care…

Hospital management autonomy in Chile: the challenges for human resources in health.

PubMed

Méndez, Claudio A; Torres A, M Cristina

2010-04-01

In Latin America, some health sector reforms have included steps to the implementation of autonomous hospitals. In Chile, the health system is implementing a reform that introduces a network of self-managed institutions. These organizations will be high complexity centers that involve greater technical diversity, cost centers and mechanisms to evaluate users' satisfaction. For human resources in health, the implementation of these centers creates challenges in the planning of service provision and a change from the traditional management style of the teams to one based on networks. These challenges include the estimation of gaps in medical specialists and in other professions in the health sector. In order to be successful with self-management, Chile needs to establish universal and local policies that address training and the organization of health service provisioning in these institutions.

The development of effects-based air quality management regimes

NASA Astrophysics Data System (ADS)

Longhurst, J. W. S.; Irwin, J. G.; Chatterton, T. J.; Hayes, E. T.; Leksmono, N. S.; Symons, J. K.

This paper considers the evolution of attempts to control and manage air pollution, principally but not exclusively focussing upon the challenge of managing air pollution in urban environments. The development and implementation of a range of air pollution control measures are considered. Initially the measures implemented primarily addressed point sources, a small number of fuel types and a limited number of pollutants. The adequacy of such a source-control approach is assessed within the context of a changing and challenging air pollution climate. An assessment of air quality management in the United Kingdom over a 50-year timeframe exemplifies the range of issues and challenges in contemporary air quality management. The need for new approaches is explored and the development and implementation of an effects-based, risk management system for air quality regulation is evaluated.

Focus Upon Implementing the GGOS Decadal Vision for Geohazards Monitoring

NASA Astrophysics Data System (ADS)

LaBrecque, John; Stangl, Gunter

2017-04-01

The Global Geodetic Observing System of the IAG identified present and future roles for Geodesy in the development and well being of the global society. The GGOS is focused upon the development of infrastructure, information, analysis, and educational systems to advance the International Global Reference Frame, the International Celestial Reference System, the International Height Reference System, atmospheric dynamics, sea level change and geohazards monitoring. The geohazards initiative is guided by an eleven nation working group initially focused upon the development and integration of regional multi-GNSS networks and analysis systems for earthquake and tsunami early warning. The opportunities and challenges being addressed by the Geohazards working group include regional network design, algorithm development and implementation, communications, funding, and international agreements on data access. This presentation will discuss in further detail these opportunities and challenges for the GGOS focus upon earthquake and tsunami early warning.

Impact Challenges in Community Science-with-Practice: Lessons from PROSPER on Transformative Practitioner-Scientist Partnerships and Prevention Infrastructure Development

PubMed Central

Greenberg, Mark

2011-01-01

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships—networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy. PMID:21222151

Impact challenges in community science-with-practice: lessons from PROSPER on transformative practitioner-scientist partnerships and prevention infrastructure development.

PubMed

Spoth, Richard; Greenberg, Mark

2011-09-01

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships-networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy.

Implementing post-trial access plans for HIV prevention research.

PubMed

Paul, Amy; Merritt, Maria W; Sugarman, Jeremy

2018-05-01

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access (PTA) to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Government Certification and Accreditation: Make a Choice

ERIC Educational Resources Information Center

Miles, Tracy L.

2009-01-01

One of the most significant challenges faced by government officials today is securing information systems to make them more resilient to attack from increasingly complex challenges from cyber-criminals, state-sponsored groups, and other threats. Over the years, the federal government has developed and implemented Certification and Accreditation…

Family medicine in Iran: facing the health system challenges.

PubMed

Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

2014-11-30

In response to the current fragmented context of health systems, it is essential to support the revitalization of primary health care in order to provide a stronger sense of direction and integrity. Around the world, family medicine recognized as a core discipline for strengthening primary health care setting. This study aimed to understand the perspectives of policy makers and decision makers of Iran's health system about the implementation of family medicine in Iran urban areas. This study is a qualitative study with framework analysis. Purposive semi-structured interviews were conducted with Policy and decision makers in the five main organizations of Iran health care system. The codes were extracted using inductive and deductive methods. According to 27 semi-structured interviews were conducted with Policy and decision makers, three main themes and 8 subthemes extracted, including: The development of referral system, better access to health care and the management of chronic diseases. Family medicine is a viable means for a series of crucial reforms in the face of the current challenges of health system. Implementation of family medicine can strengthen the PHC model in Iran urban areas. Attempting to create a general consensus among various stakeholders is essential for effective implementation of the project.

Challenges to Implementing Communicable Disease Surveillance in New York City Evacuation Shelters After Hurricane Sandy, November 2012

PubMed Central

Ridpath, Alison D.; Bregman, Brooke; Jones, Lucretia; Reddy, Vasudha; Waechter, HaeNa

2015-01-01

Hurricane Sandy hit New York City (NYC) on October 29, 2012. Before and after the storm, 73 temporary evacuation shelters were established. The total census of these shelters peaked at approximately 6,800 individuals. Concern about the spread of communicable diseases in shelters prompted the NYC Department of Health and Mental Hygiene (DOHMH) to rapidly develop a surveillance system to report communicable diseases and emergency department transports from shelters. We describe the implementation of this system. Establishing effective surveillance in temporary shelters was challenging and required in-person visits by DOHMH staff to ensure reporting. After system establishment, surveillance data were used to identify some potential disease clusters. For the future, we recommend pre-event planning for disease surveillance. PMID:25552754

Dryden Flight Research Center Critical Chain Project Management Implementation

NASA Technical Reports Server (NTRS)

Hines, Dennis O.

2012-01-01

In Fiscal Year 2011 Dryden Flight Research Center (DFRC) implemented a new project management system called Critical Chain Project Management (CCPM). Recent NASA audits have found that the Dryden workforce is strained under increasing project demand and that multi-tasking has been carried to a whole new level at Dryden. It is very common to have an individual work on 10 different projects during a single pay period. Employee surveys taken at Dryden have identified work/life balance as the number one issue concerning employees. Further feedback from the employees indicated that project planning is the area needing the most improvement. In addition, employees have been encouraged to become more innovative, improve job skills, and seek ways to improve overall job efficiency. In order to deal with these challenges, DFRC management decided to adopt the CCPM system that is specifically designed to operate in a resource constrained multi-project environment. This paper will discuss in detail the rationale behind the selection of CCPM and the goals that will be achieved through this implementation. The paper will show how DFRC is tailoring the CCPM system to the flight research environment as well as laying out the implementation strategy. Results of the ongoing implementation will be discussed as well as change management challenges and organizational cultural changes. Finally this paper will present some recommendations on how this system could be used by selected NASA projects or centers.

Research-Supported Intervention and Discretion among Frontline Workers Implementing Home Visitation Services

ERIC Educational Resources Information Center

Willging, Cathleen E.; Trott, Elise M.; Fettes, Danielle; Gunderson, Lara; Green, Amy E.; Hurlburt, Michael S.; Aarons, Gregory A.

2017-01-01

Objective: We examine how frontline workers and supervisors delivering a research-supported intervention (RSI) to reduce child neglect negotiated system-related challenges, the pragmatics of RSI implementation, and their professional identities and relationships with clients. Methods: We conducted semi-structured interviews, small group…

Optimising molecular diagnostic capacity for effective control of tuberculosis in high-burden settings.

PubMed

Sabiiti, W; Mtafya, B; Kuchaka, D; Azam, K; Viegas, S; Mdolo, A; Farmer, E C W; Khonga, M; Evangelopoulos, D; Honeyborne, I; Rachow, A; Heinrich, N; Ntinginya, N E; Bhatt, N; Davies, G R; Jani, I V; McHugh, T D; Kibiki, G; Hoelscher, M; Gillespie, S H

2016-08-01

The World Health Organization's 2035 vision is to reduce tuberculosis (TB) associated mortality by 95%. While low-burden, well-equipped industrialised economies can expect to see this goal achieved, it is challenging in the low- and middle-income countries that bear the highest burden of TB. Inadequate diagnosis leads to inappropriate treatment and poor clinical outcomes. The roll-out of the Xpert(®) MTB/RIF assay has demonstrated that molecular diagnostics can produce rapid diagnosis and treatment initiation. Strong molecular services are still limited to regional or national centres. The delay in implementation is due partly to resources, and partly to the suggestion that such techniques are too challenging for widespread implementation. We have successfully implemented a molecular tool for rapid monitoring of patient treatment response to anti-tuberculosis treatment in three high TB burden countries in Africa. We discuss here the challenges facing TB diagnosis and treatment monitoring, and draw from our experience in establishing molecular treatment monitoring platforms to provide practical insights into successful optimisation of molecular diagnostic capacity in resource-constrained, high TB burden settings. We recommend a holistic health system-wide approach for molecular diagnostic capacity development, addressing human resource training, institutional capacity development, streamlined procurement systems, and engagement with the public, policy makers and implementers of TB control programmes.

Newborn screening progress in developing countries--overcoming internal barriers.

PubMed

Padilla, Carmencita D; Krotoski, Danuta; Therrell, Bradford L

2010-04-01

Newborn screening is an important public health measure aimed at early identification and management of affected newborns thereby lowering infant morbidity and mortality. It is a comprehensive system of education, screening, follow-up, diagnosis, treatment/management, and evaluation that must be institutionalized and sustained within public health systems often challenged by economic, political, and cultural considerations. As a result, developing countries face unique challenges in implementing and expanding newborn screening that can be grouped into the following categories: (1) planning, (2) leadership, (3) medical support, (4) technical support, (5) logistical support, (6) education, (7) protocol and policy development, (8) administration, (9) evaluation, and (10) sustainability. We review some of the experiences in overcoming implementation challenges in developing newborn screening programs, and discuss recent efforts to encourage increased newborn screening through support networking and information exchange activities in 2 regions-the Asia Pacific and the Middle East/North Africa. Copyright 2010 Elsevier Inc. All rights reserved.

Development and implementation of an integrated chronic disease model in South Africa: lessons in the management of change through improving the quality of clinical practice

PubMed Central

Asmall, Shaidah

2015-01-01

Background South Africa is facing a complex burden of disease arising from a combination of chronic infectious illness and non-communicable diseases. As the burden of chronic diseases (communicable and non-communicable) increases, providing affordable and effective care to the increasing numbers of chronic patients will be an immense challenge. Methods The framework recommended by the Medical Research Council of the United Kingdom for the development and evaluation of complex health interventions was used to conceptualise the intervention. The breakthrough series was utilised for the implementation process. These two frameworks were embedded within the clinical practice improvement model that served as the overarching framework for the development and implementation of the model. Results The Chronic Care Model was ideally suited to improve the facility component and patient experience; however, the deficiencies in other aspects of the health system building blocks necessitated a hybrid model. An integrated chronic disease management model using a health systems approach was initiated across 42 primary health care facilities. The interventions were implemented in a phased approach using learning sessions and action periods to introduce the planned and targeted changes. Conclusion The implementation of the integrated chronic disease management model is feasible at primary care in South Africa provided that systemic challenges and change management are addressed during the implementation process. PMID:26528101

Development and implementation of an integrated chronic disease model in South Africa: lessons in the management of change through improving the quality of clinical practice.

PubMed

Mahomed, Ozayr Haroon; Asmall, Shaidah

2015-01-01

South Africa is facing a complex burden of disease arising from a combination of chronic infectious illness and non-communicable diseases. As the burden of chronic diseases (communicable and non-communicable) increases, providing affordable and effective care to the increasing numbers of chronic patients will be an immense challenge. The framework recommended by the Medical Research Council of the United Kingdom for the development and evaluation of complex health interventions was used to conceptualise the intervention. The breakthrough series was utilised for the implementation process. These two frameworks were embedded within the clinical practice improvement model that served as the overarching framework for the development and implementation of the model. The Chronic Care Model was ideally suited to improve the facility component and patient experience; however, the deficiencies in other aspects of the health system building blocks necessitated a hybrid model. An integrated chronic disease management model using a health systems approach was initiated across 42 primary health care facilities. The interventions were implemented in a phased approach using learning sessions and action periods to introduce the planned and targeted changes. The implementation of the integrated chronic disease management model is feasible at primary care in South Africa provided that systemic challenges and change management are addressed during the implementation process.

Care provider order entry (CPOE): a perspective on factors leading to success or to failure.

PubMed

Ozdas, A; Miller, R A

2007-01-01

Authors provide a perspective on factors leading to successful care provider order entry (CPOE) implementations. Viewpoint of authors supported by background literature review. Authors review both benefits and challenges related to CPOE implementation using three guiding principles: (1) a clinical approach to clinical systems, which claims that CPOE implementation is analogous to a "good" clinician delivering care to a patient; (2) a commitment to quality, which advocates that no compromises should be made in implementing system functionality and clinical system content - the highest objective for CPOE implementation is to provide better quality of care and increased safety for patients; (3) a commitment to fairness, as evidenced by respect for individuals and support of local autonomy, which advocates for minimizing disruptions to clinician-users' workflows, and adequate local control over CPOE system design and evolution, including clinical content management. Past experiences with CPOE implementation can inform future installation attempts. Sociocultural factors dominate in determining the success of implementation, and should govern technical factors.

Boundary‐spanning actors in complex adaptive governance systems: The case of multisectoral nutrition

PubMed Central

Gervais, Suzanne; Hafeez‐ur‐Rehman, Hajra; Sanou, Dia; Tumwine, Jackson

2017-01-01

Abstract A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary‐spanning actors working in 4 Sub‐Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end‐line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary‐spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low‐ and middle‐income countries. PMID:29024002

Intergenerational Learning and Knowledge Transfer--Challenges and Opportunities

ERIC Educational Resources Information Center

Rupcic, Nataša

2018-01-01

Purpose: The purpose of this paper is to highlight challenges and opportunities that surround the process of intergenerational learning and knowledge transfer. Several options in this regard have been discussed from the managerial and employee perspective. Design/methodology/approach: The systems approach has been implemented to identify options…

Agency responses to a system-driven implementation of multiple evidence-based practices in children's mental health services.

PubMed

Regan, Jennifer; Lau, Anna S; Barnett, Miya; Stadnick, Nicole; Hamilton, Alison; Pesanti, Keri; Bando, Lillian; Brookman-Frazee, Lauren

2017-09-19

Large mental health systems are increasingly using fiscal policies to encourage the implementation of multiple evidence-based practices (EBPs). Although many implementation strategies have been identified, little is known about the types and impacts of strategies that are used by organizations within implementation as usual. This study examined organizational-level responses to a fiscally-driven, rapid, and large scale EBP implementation in children's mental health within the Los Angeles County Department of Mental Health. Qualitative methods using the principles of grounded theory were used to characterize the responses of 83 community-based agencies to the implementation effort using documentation from site visits conducted 2 years post reform. Findings indicated that agencies perceived the rapid system-driven implementation to have both positive and negative organizational impacts. Identified challenges were primarily related to system implementation requirements rather than to characteristics of specific EBPs. Agencies employed a variety of implementation strategies in response to the system-driven implementation, with agency size associated with implementation strategies used. Moderate- and large-sized agencies were more likely than small agencies to have employed systematic strategies at multiple levels (i.e., organization, therapist, client) to support implementation. These findings are among the first to characterize organizational variability in response to system-driven implementation and suggest ways that implementation interventions might be tailored by organizational characteristics.

NASA Extreme Environment Mission Operation (NEEMO) 12: Collaborative Accelerated Medical Technology Development

DTIC Science & Technology

2007-12-01

tremendous opportunity to support telesurgical care using mobile systems, where communication assets are challenging . BODY RESEARCH PLAN This... challenged with constraints of remoteness, limited resources, and limited technical expertise. This telesurgery research, funded by TATRC and reported...utilized iChat (V.2.1.3) for the Apple Macintosh. Technology Summary The challenges of implementing the technology were numerous. Beyond the fact that

[Regulatory Program for Medical Devices in Cuba: experiences and current challenges].

PubMed

Pereira, Dulce María Martínez; Rodríguez, Yadira Álvarez; Valdés, Yamila Cedeño; Ribas, Silvia Delgado

2016-05-01

Regulatory control of medical devices in Cuba is conducted through a system based on the Regulatory Program for Medical Devices as a way to ensure the safety, efficacy, and effectiveness of these technologies, which are in use by the National Health System. This program was launched in 1992, when the Regulations for State Evaluation and Registration of Medical Devices were approved. Its successive stages and the merging of regulatory activities for drugs and medical equipment have meant progress toward stronger, more transparent strategies and greater control of industry and the National Health System. Throughout its course the Cuban program has met with challenges and difficulties that it has addressed by drawing on its own experiences. During the new period, the greatest challenges revolve around ensuring that regulatory systems incorporate scientific evaluation, risk levels, maximum rigor through the use of technical standards, and the implementation of international recommendations, together with the application of the ISO 13485 certification scheme, enhanced market monitoring, and classification of medical devices in accordance with their relevance to the country's national health policies. From the regional standpoint, the greatest challenge lies in working toward regulatory convergence. The Collaborating Centre for the Regulation of Health Technologies will support the proposed regulatory strategy and established regional priorities, in particular in connection with the implementation of actions involving medical devices.

Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study.

PubMed

Wright, Adam; Sittig, Dean F; Ash, Joan S; Erickson, Jessica L; Hickman, Trang T; Paterno, Marilyn; Gebhardt, Eric; McMullen, Carmit; Tsurikova, Ruslana; Dixon, Brian E; Fraser, Greg; Simonaitis, Linas; Sonnenberg, Frank A; Middleton, Blackford

2015-11-01

To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

User Perceptions of the Implementation of an Electronic Medication Management System in a Paediatric Setting.

PubMed

Hardie, Rae-Anne; Baysari, Melissa T; Lake, Rebecca; Richardson, Lauren; McCullagh, Cheryl; Westbrook, Johanna I

2017-01-01

The roll-out of a hospital-wide electronic medication management system (eMMS) is a challenging task, requiring planning, coordination, communication and change management. This research aimed to explore the views of doctors and nurses about the strategy used to implement an eMM system in a paediatric hospital. Semi-structured interviews were performed during the first week of the implementation on each ward, and were then followed up three and six weeks post implementation. In total, 90 users (60 nurses and 30 doctors) were asked about their impressions of the implementation, as well as their perceptions of training and IT support. Qualitative thematic analysis was performed by three researchers. Most users perceived the implementation of the eMM to be positive overall. Although perceptions of the implementation process remained largely consistent across the six weeks, users identified several areas where improvements were needed, especially early in implementation, including resources, planning, roll-out strategy and training. These findings are useful for future implementations of eMM systems in paediatric hospitals.

Challenges and potential solutions for big data implementations in developing countries.

PubMed

Luna, D; Mayan, J C; García, M J; Almerares, A A; Househ, M

2014-08-15

The volume of data, the velocity with which they are generated, and their variety and lack of structure hinder their use. This creates the need to change the way information is captured, stored, processed, and analyzed, leading to the paradigm shift called Big Data. To describe the challenges and possible solutions for developing countries when implementing Big Data projects in the health sector. A non-systematic review of the literature was performed in PubMed and Google Scholar. The following keywords were used: "big data", "developing countries", "data mining", "health information systems", and "computing methodologies". A thematic review of selected articles was performed. There are challenges when implementing any Big Data program including exponential growth of data, special infrastructure needs, need for a trained workforce, need to agree on interoperability standards, privacy and security issues, and the need to include people, processes, and policies to ensure their adoption. Developing countries have particular characteristics that hinder further development of these projects. The advent of Big Data promises great opportunities for the healthcare field. In this article, we attempt to describe the challenges developing countries would face and enumerate the options to be used to achieve successful implementations of Big Data programs.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana

PubMed Central

Mupara, Lucia U.; Lubbe, Johanna C.

2016-01-01

Background Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. Design A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. Results The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. Conclusions The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana. PMID:26899774

Building Systems for Successful Implementation of Function-Based Support in Schools

ERIC Educational Resources Information Center

Anderson, Cynthia M.; Horner, Robert H.; Rodriguez, Billie Jo; Stiller, Brianna

2013-01-01

Supporting the full range of students with behavioral challenges requires that schools build the capacity to implement evidence-based behavioral interventions. Fortunately, a substantive body of research documents behavioral interventions are available to both decrease problem behavior and enhance prosocial skills. To date, however, this…

The Philippine Department of Education: Challenges of Policy Implementation amidst Corruption

ERIC Educational Resources Information Center

Reyes, Vicente Chua

2010-01-01

This inquiry interrogates the experiences of local implementation actors of the Philippine Department of Education as they navigate through reform efforts within systemic corruption. Departing from dominant analytical paradigms centred on patron-client frameworks, the article introduces the typology of complex linkages where local actors play…

Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

PubMed Central

Whitaker, Daniel J.; Ryan, Kerry A.; Wild, Robert C.; Self-Brown, Shannon; Lutzker, John R.; Shanley, Jenelle R.; Edwards, Anna M.; McFry, Erin A.; Moseley, Colby N.; Hodges, Amanda E.

2013-01-01

There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyses were conducted to describe the trainee sample, describe initial training and implementation indicators, and to examine correlates of initial training performance and implementation indicators. The quality of SafeCare uptake during training and implementation was high with trainees performing very well on training quizzes and role-plays, and demonstrating high fidelity when implementing SafeCare in the field (performing over 90% of expected behaviors). However, the quantity of implementation was generally low, with relatively few providers (only about 25%) implementing the model following workshop training. There were no significant predictors of training or implementation performance, once corrections for multiple comparisons were applied. The Discussion focuses on challenges to large-scale system-wide implementation of EBP. PMID:22146860

Planning for the Global Earth Observation System of Systems (GEOSS)

USGS Publications Warehouse

Christian, E.

2005-01-01

The Group on Earth Observations was established to promote comprehensive, coordinated, and sustained Earth observations. Its mandate is to implement the Global Earth Observation System of Systems (GEOSS) in accord with the GEOSS 10-Year Implementation Plan and Reference Document. During the months over which the GEOSS Implementation Plan was developed, many issues surfaced and were addressed. This article discusses several of the more interesting or challenging of those issues-e.g. fitting in with existing organizations and securing stable funding - some of which have yet to be resolved fully as of this writing. Despite the relatively short period over which the Implementation Plan had to be developed, there is a good chance that the work undertaken will be influential for decades to come. ?? 2005 Elsevier Ltd. All rights reserved.

Testing "What If?" Scenarios: A Process Known as System Dynamics Allows Leaders to Try out an Initiative before Actually Implementing It

ERIC Educational Resources Information Center

Brauer, Ralph A.

2004-01-01

One challenge of system leadership always has been that even with the best data and research in place, with all the programmatic and political dimensions under control and with years of experience handling similar decisions, you never really know whether a policy initiative will work until you implement it. That is why anyone who has been a school…

Guidelines for Implementing Advanced Distribution Management Systems-Requirements for DMS Integration with DERMS and Microgrids

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Jianhui; Chen, Chen; Lu, Xiaonan

2015-08-01

This guideline focuses on the integration of DMS with DERMS and microgrids connected to the distribution grid by defining generic and fundamental design and implementation principles and strategies. It starts by addressing the current status, objectives, and core functionalities of each system, and then discusses the new challenges and the common principles of DMS design and implementation for integration with DERMS and microgrids to realize enhanced grid operation reliability and quality power delivery to consumers while also achieving the maximum energy economics from the DER and microgrid connections.

Understanding mSOS: A qualitative study examining the implementation of a text-messaging outbreak alert system in rural Kenya

PubMed Central

Toda, Mitsuru; O-Tipo, Shikanga; Mwau, Matilu; Morita, Kouichi

2017-01-01

Outbreaks of epidemic diseases pose serious public health risks. To overcome the hurdles of sub-optimal disease surveillance reporting from the health facilities to relevant authorities, the Ministry of Health in Kenya piloted mSOS (mobile SMS-based disease outbreak alert system) in 2013–2014. In this paper, we report the results of the qualitative study, which examined factors that influence the performances of mSOS implementation. In-depth interviews were conducted with 11 disease surveillance coordinators and 32 in-charges of rural health facilities that took part in the mSOS intervention. Drawing from the framework analysis, dominant themes that emerged from the interviews are presented. All participants voiced their excitement in using mSOS. The results showed that the technology was well accepted, easy to use, and both health workers and managers unanimously recommended the scale-up of the system despite challenges encountered in the implementation processes. The most challenging components were the context in which mSOS was implemented, including the lack of strong existing structure for continuous support supervision, feedback and response action related to disease surveillance. The study revealed broader health systems issues that should be addressed prior to and during the intervention scale-up. PMID:28628629

Health innovation for patient safety improvement.

PubMed

Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

2013-01-01

Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

Governing the implementation of Emergency Obstetric Care: experiences of Rural District Health Managers, Tanzania

PubMed Central

2014-01-01

Background Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. Methods The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Results Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development. Conclusion The study revealed that implementing EmOC is a process accompanied by challenges that require an approach with multiple partners to address them and that, for effective partnership, the roles and responsibilities of each partner should be well stipulated in a clear working framework within the district health system. Partnerships strengthen health system governance and therefore ensure effective implementation of health policies at a local level. PMID:25086597

Governing the implementation of emergency obstetric care: experiences of rural district health managers, Tanzania.

PubMed

Mkoka, Dickson Ally; Kiwara, Angwara; Goicolea, Isabel; Hurtig, Anna-Karin

2014-08-03

Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development. The study revealed that implementing EmOC is a process accompanied by challenges that require an approach with multiple partners to address them and that, for effective partnership, the roles and responsibilities of each partner should be well stipulated in a clear working framework within the district health system. Partnerships strengthen health system governance and therefore ensure effective implementation of health policies at a local level.

Active Time Domain Reflectometry for Tamper Indication in Unattended Safeguards Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sheen, David M.; Smith, Leon E.; Tedeschi, Jonathan R.

2015-07-14

The International Atomic Energy Agency (IAEA) continues to expand its use of unattended measurement systems. An increasing number of systems and an expanding family of instruments create challenges in terms of deployment efficiency and the implementation of data authentication measures. In collaboration with the IAEA, tamper-indicating measures to address data-transmission authentication challenges with unattended safeguards systems are under investigation. Pacific Northwest National Laboratory is studying the viability of active time-domain reflectometry (TDR) along two parallel but interconnected paths: (1) swept-frequency TDR as the highly flexible, laboratory gold standard to which field-deployable options can be compared, and (2) a low-cost commerciallymore » available spread-spectrum TDR technology as one option for field implementation. This paper describes the TDR methods under investigation and the associated benchtop test-bed, tampering scenarios of interest,, and viability measurement results to date (e.g., comparison of relative sensitivity to tamper scenarios).« less

Challenges and opportunities for meningococcal vaccination in the developing world.

PubMed

Shaker, Rouba; Fayad, Danielle; Dbaibo, Ghassan

2018-05-04

Meningococcal disease continues to be a life threatening infection with high morbidity and mortality even in appropriately treated patients. Meningococcal vaccination plays a major role in the control of the disease; however, implementing vaccination remains problematic in the developing world. The objective of this review is to identify the challenges facing the use of meningococcal vaccines in the developing world in order to discuss the opportunities and available solutions to improve immunization in these countries. Inadequate epidemiologic information necessary to implement vaccination and financial challenges predominate. Multiple measures are needed to achieve the successful implementation of meningococcal conjugate vaccination programs that protect against circulating serogroups in developing countries including enhanced surveillance systems, financial support and aid through grants, product development partnerships that are the end result of effective collaboration and communication between different interdependent stakeholders to develop affordable vaccines, and demonstration of the cost-effectiveness of new meningococcal vaccines.

The national response for preventing healthcare-associated infections: research and adoption of prevention practices.

PubMed

Kahn, Katherine L; Mendel, Peter; Leuschner, Kristin J; Hiatt, Liisa; Gall, Elizabeth M; Siegel, Sari; Weinberg, Daniel A

2014-02-01

Healthcare-associated infections (HAIs) have long been the subject of research and prevention practice. When findings show potential to significantly impact outcomes, clinicians, policymakers, safety experts, and stakeholders seek to bridge the gap between research and practice by identifying mechanisms and assigning responsibility for translating research to practice. This paper describes progress and challenges in HAI research and prevention practices, as explained through an examination of Health and Human Services (HHS) Action Plan's goals, inputs, and implementation in each area. We used the Context-Input-Process-Product evaluation model, together with an HAI prevention system framework, to assess the transformative processes associated with HAI research and adoption of prevention practices. Since the introduction of the Action Plan, HHS has made substantial progress in prioritizing research projects, translating findings from those projects into practice, and designing and implementing research projects in multisite practice settings. Research has emphasized the basic science and epidemiology of HAIs, the identification of gaps in research, and implementation science. The basic, epidemiological, and implementation science communities have joined forces to better define mechanisms and responsibilities for translating HAI research into practice. Challenges include the ongoing need for better evidence about intervention effectiveness, the growing implementation burden on healthcare providers and organizations, and challenges implementing certain practices. Although these HAI research and prevention practice activities are complex spanning multiple system functions and properties, HHS is making progress so that the right methods for addressing complex HAI problems at the interface of patient safety and clinical practice can emerge.

Strengthening the Security of ESA Ground Data Systems

NASA Astrophysics Data System (ADS)

Flentge, Felix; Eggleston, James; Garcia Mateos, Marc

2013-08-01

A common approach to address information security has been implemented in ESA's Mission Operations (MOI) Infrastructure during the last years. This paper reports on the specific challenges to the Data Systems domain within the MOI and how security can be properly managed with an Information Security Management System (ISMS) according to ISO 27001. Results of an initial security risk assessment are reported and the different types of security controls that are being implemented in order to reduce the risks are briefly described.

Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study.

PubMed

Kumar, Sameer; Aldrich, Krista

2010-12-01

An EMR system implementation would significantly reduce clinician workload and medical errors while saving the US healthcare system major expense. Yet, compared to other developed nations, the US lags behind. This article examines EMR system efforts, benefits, and barriers, as well as steps needed to move the US closer to a nationwide EMR system. The analysis includes a blueprint for implementation of EMR, industry comparisons to highlight the differences between successful and non-successful EMR ventures, references to costs and benefit information, and identification of root causes. 'Poka-yokes' (avoid (yokeru) mistakes (poka)) will be inserted to provide insight into how to systematically overcome challenges. Implementation will require upfront costs including patient privacy that must be addressed early in the development process. Government structure, incentives and mandates are required for nationwide EMR system in the US.

Communication Challenges in Requirements Definition: A Classroom Simulation

ERIC Educational Resources Information Center

Ramiller, Neil C.; Wagner, Erica L.

2011-01-01

Systems analysis and design is a standard course offering within information systems programs and often an important lecture topic in Information Systems core courses. Given the persistent difficulty that organizations experience in implementing systems that meet their requirements, it is important to help students in these courses get a tangible…

Experience of Implementing ISO 15189 Accreditation at a University Laboratory

PubMed Central

2015-01-01

The present article summarizes the authors’ experience with the implementation of a quality management system based on ISO 17025 and ISO 15189 standards at university laboratories. The accreditation of the analytical procedures at the Universidad Mariano Gálvez represented a challenge due to the unique nature of an educational institution and the difference in nature to the standards implemented. Sample handling and care of the patient were combined to achieve an integrated management system. We explain the development of the management system, the obstacles and benefits of the system and concluding that it is possible to design a management system based on ISO 15189 for the university lab that allowed delivering results assuring technical competence to patient care and welfare. PMID:27683499

Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

PubMed

Hoffman, James M; Baker, Donald K; Howard, Scott C; Laver, Joseph H; Shenep, Jerry L

2011-02-01

Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.

ETHICS OF SMART HOUSE WELFARE TECHNOLOGY FOR OLDER ADULTS: A SYSTEMATIC LITERATURE REVIEW.

PubMed

Sánchez, Veralia Gabriela; Taylor, Ingrid; Bing-Jonsson, Pia Cecilie

2017-01-01

The University College of Southeast Norway has an on-going project to develop a smart house welfare system to allow older adults and people with disabilities to remain in their homes for as long as they wish in safe, dignified, living conditions. This article reviews reported ethical challenges to implementing smart houses for older adults. A systematic literature review identified twenty-four articles in English, French, Spanish, and Norwegian, which were analyzed and synthesized using Hofmann's question list to investigate the reported ethical challenges. Smart houses offer a promising way to improve access to home care for older adults and people with disabilities. However, important ethical challenges arise when implementing smart houses, including cost-effectiveness, privacy, autonomy, informed consent, dignity, safety, and trust. The identified ethical challenges are important to consider when developing smart house systems. Due to the limitations of smart house technology, designers and users should be mindful that smart houses can achieve a safer and more dignified life-style but cannot solve all the challenges related to ageing, disabilities, and disease. At some point, smart houses can no longer help persons as they develop needs that smart houses cannot meet.

Systemic Change for RTI: Key Shifts for Practice

ERIC Educational Resources Information Center

Kozleski, Elizabeth B.; Huber, Jennifer J.

2010-01-01

RTI has the potential to meet the challenges of increasing diversity in student populations and the need for increasingly complex systems of instructional design. Three fundamental shifts in understanding systems and systems change must ground RTI policy and implementation work. First, RTI must be seen as an activity system nested within a larger…

Schools as social complex adaptive systems: a new way to understand the challenges of introducing the health promoting schools concept.

PubMed

Keshavarz, Nastaran; Nutbeam, Don; Rowling, Louise; Khavarpour, Freidoon

2010-05-01

Achieving system-wide implementation of health promotion programs in schools and sustaining both the program and its health related benefits have proved challenging. This paper reports on a qualitative study examining the implementation of health promoting schools programs in primary schools in Sydney, Australia. It draw upon insights from systems science to examine the relevance and usefulness of the concept of "complex adaptive systems" as a framework to better understand ways in which health promoting school interventions could be introduced and sustained. The primary data for the study were collected by semi-structured interviews with 26 school principals and teachers. Additional information was extracted from publicly available school management plans and annual reports. We examined the data from these sources to determine whether schools exhibit characteristics of complex adaptive systems. The results confirmed that schools do exhibit most, but not all of the characteristics of social complex adaptive systems, and exhibit significant differences with artificial and natural systems. Understanding schools as social complex adaptive systems may help to explain some of the challenges of introducing and sustaining change in schools. These insights may, in turn, lead us to adopt more sophisticated approaches to the diffusion of new programs in school systems that account for the diverse, complex and context specific nature of individual school systems. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Opportunities and challenges for implementing cost accounting systems in the Kenyan health system

PubMed Central

Kihuba, Elesban; Gheorghe, Adrian; Bozzani, Fiammetta; English, Mike; Griffiths, Ulla K.

2016-01-01

Background Low- and middle-income countries need to sustain efficiency and equity in health financing on their way to universal health care coverage. However, systems meant to generate quality economic information are often deficient in such settings. We assessed the feasibility of streamlining cost accounting systems within the Kenyan health sector to illustrate the pragmatic challenges and opportunities. Design We reviewed policy documents, and conducted field observations and semi-structured interviews with key informants in the health sector. We used an adapted Human, Organization and Technology fit (HOT-fit) framework to analyze the components and standards of a cost accounting system. Results Among the opportunities for a viable cost accounting system, we identified a supportive broad policy environment, political will, presence of a national data reporting architecture, good implementation experience with electronic medical records systems, and the availability of patient clinical and resource use data. However, several practical issues need to be considered in the design of the system, including the lack of a framework to guide the costing process, the lack of long-term investment, the lack of appropriate incentives for ground-level staff, and a risk of overburdening the current health management information system. Conclusion To facilitate the implementation of cost accounting into the health sector, the design of any proposed system needs to remain simple and attuned to the local context. PMID:27357072

Opportunities and challenges for implementing cost accounting systems in the Kenyan health system.

PubMed

Kihuba, Elesban; Gheorghe, Adrian; Bozzani, Fiammetta; English, Mike; Griffiths, Ulla K

2016-01-01

Low- and middle-income countries need to sustain efficiency and equity in health financing on their way to universal health care coverage. However, systems meant to generate quality economic information are often deficient in such settings. We assessed the feasibility of streamlining cost accounting systems within the Kenyan health sector to illustrate the pragmatic challenges and opportunities. We reviewed policy documents, and conducted field observations and semi-structured interviews with key informants in the health sector. We used an adapted Human, Organization and Technology fit (HOT-fit) framework to analyze the components and standards of a cost accounting system. Among the opportunities for a viable cost accounting system, we identified a supportive broad policy environment, political will, presence of a national data reporting architecture, good implementation experience with electronic medical records systems, and the availability of patient clinical and resource use data. However, several practical issues need to be considered in the design of the system, including the lack of a framework to guide the costing process, the lack of long-term investment, the lack of appropriate incentives for ground-level staff, and a risk of overburdening the current health management information system. To facilitate the implementation of cost accounting into the health sector, the design of any proposed system needs to remain simple and attuned to the local context.

Interventions for Children with Autism Spectrum Disorders in Inclusive School Settings

ERIC Educational Resources Information Center

Koegel, Lynn; Matos-Freden, Rosy; Lang, Russell; Koegel, Robert

2012-01-01

Students with ASD present unique challenges to school systems. Despite these challenges, federal laws require that schools implement research-based practices in the least restrictive environment (LRE). The LRE is often deemed to be the general education classroom and the primary intervention agent is often the classroom teacher. Ensuring students…

Challenges of standardized continuous quality improvement programs in community pharmacies: the case of SafetyNET-Rx.

PubMed

Boyle, Todd A; MacKinnon, Neil J; Mahaffey, Thomas; Duggan, Kellie; Dow, Natalie

2012-01-01

Research on continuous quality improvement (CQI) in community pharmacies lags in comparison to service, manufacturing, and various health care sectors. As a result, very little is known about the challenges community pharmacies face when implementing CQI programs in general, let alone the challenges of implementing a standardized and technologically sophisticated one. This research identifies the initial challenges of implementing a standardized CQI program in community pharmacies and how such challenges were addressed by pharmacy staff. Through qualitative interviews, a multisite study of the SafetyNET-Rx CQI program involving community pharmacies in Nova Scotia, Canada, was performed to identify such challenges. Interviews were conducted with the CQI facilitator (ie, staff pharmacist or technician) in 55 community pharmacies that adopted the SafetyNET-Rx program. Of these 55 pharmacies, 25 were part of large national corporate chains, 22 were part of banner chains, and 8 were independent pharmacies. A total of 10 different corporate chains and banners were represented among the 55 pharmacies. Thematic content analysis using well-established coding procedures was used to explore the interview data and elicit the key challenges faced. Six major challenges were identified, specifically finding time to report, having all pharmacy staff involved in quality-related event (QRE) reporting, reporting apprehensiveness, changing staff relationships, meeting to discuss QREs, and accepting the online technology. Challenges were addressed in a number of ways including developing a manual-online hybrid reporting system, managers paying staff to meet after hours, and pharmacy managers showing visible commitment to QRE reporting and learning. This research identifies key challenges to implementing CQI programs in community pharmacies and also provides a starting point for future research relating to how the challenges of QRE reporting and learning in community pharmacies change over time. Copyright © 2012 Elsevier Inc. All rights reserved.

Setting Learning Analytics in Context: Overcoming the Barriers to Large-Scale Adoption

ERIC Educational Resources Information Center

Ferguson, Rebecca; Macfadyen, Leah P.; Clow, Doug; Tynan, Belinda; Alexander, Shirley; Dawson, Shane

2014-01-01

A core goal for most learning analytic projects is to move from small-scale research towards broader institutional implementation, but this introduces a new set of challenges because institutions are stable systems, resistant to change. To avoid failure and maximize success, implementation of learning analytics at scale requires explicit and…

The Implementation of Progress Files in Higher Education: Reflection as National Policy

ERIC Educational Resources Information Center

Clegg, Sue; Bradley, Sally

2006-01-01

Progress files, involving personal development planning (PDP), are becoming a feature of many higher education systems internationally. In the UK they will become mandatory for all undergraduate students from 2005. This presents a major implementation challenge, because while reflection has been a cornerstone of practice in some areas of higher…

Integration of treatment innovation planning and implementation: strategic process models and organizational challenges.

PubMed

Lehman, Wayne E K; Simpson, D Dwayne; Knight, Danica K; Flynn, Patrick M

2011-06-01

Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A two-phase procedural approach is therefore presented based on the integration of Texas Christian University (TCU) models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

The Indiana Public Health Emergency Surveillance System: Ongoing Progress, Early Findings, and Future Directions

PubMed Central

Grannis, Shaun; Wade, Michael; Gibson, Joseph; Overhage, J. Marc

2006-01-01

Beginning in 2004, the Indiana State Department of Health (ISDH) partnered with the Regenstrief Institute on a 4-year project to implement a statewide biosurveillance system incorporating more than 110 hospitals. This paper describes our evolving experience with the system including ongoing implementation challenges, how the system has helped to uncover events of public health significance, and future directions. The system currently receives emergency department visit data from 50 hospitals totaling nearly 5,000 visits per day, and is projected to have 65 hospitals connected by August 2006. PMID:17238352

Reduction in specimen labeling errors after implementation of a positive patient identification system in phlebotomy.

PubMed

Morrison, Aileen P; Tanasijevic, Milenko J; Goonan, Ellen M; Lobo, Margaret M; Bates, Michael M; Lipsitz, Stuart R; Bates, David W; Melanson, Stacy E F

2010-06-01

Ensuring accurate patient identification is central to preventing medical errors, but it can be challenging. We implemented a bar code-based positive patient identification system for use in inpatient phlebotomy. A before-after design was used to evaluate the impact of the identification system on the frequency of mislabeled and unlabeled samples reported in our laboratory. Labeling errors fell from 5.45 in 10,000 before implementation to 3.2 in 10,000 afterward (P = .0013). An estimated 108 mislabeling events were prevented by the identification system in 1 year. Furthermore, a workflow step requiring manual preprinting of labels, which was accompanied by potential labeling errors in about one quarter of blood "draws," was removed as a result of the new system. After implementation, a higher percentage of patients reported having their wristband checked before phlebotomy. Bar code technology significantly reduced the rate of specimen identification errors.

A review of the National pharmacovigilance system in Malta - implementing and operating a pharmacovigilance management system.

PubMed

Tanti, Amy; Micallef, Benjamin; Serracino-Inglott, Anthony; Borg, John-Joseph

2017-01-01

Regulatory authorities have a legal mandate to implement and maintain a Pharmacovigilance System designed to monitor the safety of authorised medicinal products and detect any change to their risk-benefit balance. Areas covered: This review maps the implementation of pharmacovigilance activities in Malta since accession in the EU in mid 2004 and discusses the challenges the Maltese Regulator encountered while setting up adequate and effective systems to fulfil its legal mandate. Areas reviewed are those around ADR reporting, promotion and safety communications including rapid alerts and recalls, direct healthcare professional communications, risk minimisation measures and safety circulars and quality systems. Expert opinion: Within a ten year period, 3 EU directives on pharmacovigilance were implemented by our agency. Despite limitations to resources, based on a prioritised implementation, the legislation provisions are now fully operational with a good level of sustainability. Lessons learnt from this process are discussed in this review. The coming years will involve strengthening and consolidation of existing processes.

[Challenges to implementation of the ECG reading center in ELSA-Brasil].

PubMed

Ribeiro, Antonio Luiz; Pereira, Samuel Vianney da Cunha; Bergmann, Kaiser; Ladeira, Roberto Marini; Oliveira, Rackel Aguiar Mendes; Lotufo, Paulo A; Mill, José Geraldo; Barreto, Sandhi Maria

2013-06-01

Electrocardiography is an established low-cost method of cardiovascular assessment, utilized for decades large epidemiological studies. Nonetheless, its use in large epidemiological studies presents challenges, especially when seeking to develop a reading center. This article describes the process, difficulties and challenges of implementing an electrocardiogram reading center in Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Among the issues discussed, we have emphasized: the criteria for selection of the electrocardiography machine and the central for storage and management of the machines; the required personnel; the procedures for acquisition and transmission of electrocardiographs to the Reading Center; coding systems, with emphasis on the Minnesota code; ethical and practical issues regarding the delivery of reports to study participants; and aspects related to quality control.

Mothering and midwifery: sometimes a challenge.

PubMed

Fenwick, J

1998-12-01

This paper attempts to present two levels of argument. Firstly it argues that the use of story, in its entirety, is a valid, relevant and useful tool for informing personal and professional knowing. The second level of debate is elicited by the story itself and the discourse surrounding the challenges of implementing continuity of midwifery care models within the mainstream maternity care system. The author hopes that the telling of the story provides a window through which others can share her experience. It is argued that 'identification' with the challenges involved in implementing innovative models of care is an important and vital step in the process, if these models are to begin, survive and achieve their aim of providing women-centred health care.

Enhancing Dissemination, Implementation, and Improvement Science in CTSAs through Regional Partnerships.

PubMed

Inkelas, Moira; Brown, Arleen F; Vassar, Stefanie D; Sankaré, Ibrahima C; Martinez, Arturo B; Kubicek, Katrina; Kuo, Tony; Mahajan, Anish; Gould, Michael; Mittman, Brian S

2015-12-01

Challenges in healthcare policy and practice have stimulated interest in dissemination and implementation science. The Institute of Medicine Committee on the Clinical Translational Science Award (CTSA) program recommended expanding the CTSA program's investment and activity in this domain. Guidance is needed to facilitate successful growth of DII science infrastructure, activity and impacts. Several CTSAs in Southern California collaborated to identify and respond to local challenges and opportunities to expand dissemination, implementation and improvement research by strengthening capacity and relationships between DII researchers and community, health system, and population health partners. Planning and outreach by the Southern California CTSAs increased awareness and interest in DII research and generated recommendations for growth. Recommendations include: increasing strong partnerships with healthcare and population health systems to guide policy research agendas and collaborative DII science; promoting multi-sector partnerships that involve researchers and delivery systems throughout DII processes; bringing together multiple disciplines; and addressing national and international barriers as well as opportunities in DII science. CTSAs through regional collaboration can increase their contributions to improved community health via skill-building, partnership development and enhanced outreach to local healthcare and public health agencies and delivery systems. © 2015 Wiley Periodicals, Inc.

Microbial Efflux Systems and Inhibitors: Approaches to Drug Discovery and the Challenge of Clinical Implementation

PubMed Central

Kourtesi, Christina; Ball, Anthony R; Huang, Ying-Ying; Jachak, Sanjay M; Vera, D Mariano A; Khondkar, Proma; Gibbons, Simon; Hamblin, Michael R; Tegos, George P

2013-01-01

Conventional antimicrobials are increasingly ineffective due to the emergence of multidrug-resistance among pathogenic microorganisms. The need to overcome these deficiencies has triggered exploration for novel and unconventional approaches to controlling microbial infections. Multidrug efflux systems (MES) have been a profound obstacle in the successful deployment of antimicrobials. The discovery of small molecule efflux system blockers has been an active and rapidly expanding research discipline. A major theme in this platform involves efflux pump inhibitors (EPIs) from natural sources. The discovery methodologies and the available number of natural EPI-chemotypes are increasing. Advances in our understanding of microbial physiology have shed light on a series of pathways and phenotypes where the role of efflux systems is pivotal. Complementing existing antimicrobial discovery platforms such as photodynamic therapy (PDT) with efflux inhibition is a subject under investigation. This core information is a stepping stone in the challenge of highlighting an effective drug development path for EPIs since the puzzle of clinical implementation remains unsolved. This review summarizes advances in the path of EPI discovery, discusses potential avenues of EPI implementation and development, and underlines the need for highly informative and comprehensive translational approaches. PMID:23569468

Enhancing Dissemination, Implementation, and Improvement Science in CTSAs through Regional Partnerships

PubMed Central

Brown, Arleen F.; Vassar, Stefanie D.; Sankaré, Ibrahima C.; Martinez, Arturo B.; Kubicek, Katrina; Kuo, Tony; Mahajan, Anish; Gould, Michael; Mittman, Brian S.

2015-01-01

Abstract Background and Importance Challenges in healthcare policy and practice have stimulated interest in dissemination and implementation science. The Institute of Medicine Committee on the Clinical Translational Science Award (CTSA) program recommended expanding the CTSA program's investment and activity in this domain. Guidance is needed to facilitate successful growth of DII science infrastructure, activity and impacts. Objectives Several CTSAs in Southern California collaborated to identify and respond to local challenges and opportunities to expand dissemination, implementation and improvement research by strengthening capacity and relationships between DII researchers and community, health system, and population health partners. Main outcomes Planning and outreach by the Southern California CTSAs increased awareness and interest in DII research and generated recommendations for growth. Recommendations include: increasing strong partnerships with healthcare and population health systems to guide policy research agendas and collaborative DII science; promoting multi‐sector partnerships that involve researchers and delivery systems throughout DII processes; bringing together multiple disciplines; and addressing national and international barriers as well as opportunities in DII science. Implications CTSAs through regional collaboration can increase their contributions to improved community health via skill‐building, partnership development and enhanced outreach to local healthcare and public health agencies and delivery systems. PMID:26602191

A P&T Committee's Transition to a Complete Electronic Meeting System-A Multisite Institution Experience.

PubMed

Al-Jedai, Ahmed H; Algain, Roaa A; Alghamidi, Said A; Al-Jazairi, Abdulrazaq S; Amin, Rashid; Bin Hussain, Ibrahim Z

2017-10-01

In the last few decades, changes to formulary management processes have taken place in institutions with closed formulary systems. However, many P&T committees continued to operate using traditional paper-based systems. Paper-based systems have many limitations, including confidentiality, efficiency, open voting, and paper wastage. This becomes more challenging when dealing with a multisite P&T committee that handles formulary matters across the whole health care system. In this paper, we discuss the implementation of the first paperless, completely electronic, Web-based formulary management system across a large health care system in the Middle East. We describe the transitioning of a multisite P&T committee in a large tertiary care institution from a paper-based to an all-electronic system. The challenges and limitations of running a multisite P&T committee utilizing a paper system are discussed. The design and development of a Web-based committee floor management application that can be used from notebooks, tablets, and hand-held devices is described. Implementation of a flexible, interactive, easy-to-use, and efficient electronic formulary management system is explained in detail. The development of an electronic P&T committee meeting system that encompasses electronic document sharing, voting, and communication could help multisite health care systems unify their formularies across multiple sites. Our experience might not be generalizable to all institutions because this depends heavily on system features, existing processes and workflow, and implementation across different sites.

Development and Classroom Implementation of an Environmental Data Creation and Sharing Tool

ERIC Educational Resources Information Center

Brogan, Daniel S.; McDonald, Walter M.; Lohani, Vinod K.; Dymond, Randel L.; Bradner, Aaron J.

2016-01-01

Education is essential for solving the complex water-related challenges facing society. The Learning Enhanced Watershed Assessment System (LEWAS) and the Online Watershed Learning System (OWLS) provide data creation and data sharing infrastructures, respectively, that combine to form an environmental learning tool. This system collects, integrates…

Boundary-spanning actors in complex adaptive governance systems: The case of multisectoral nutrition.

PubMed

Pelletier, David; Gervais, Suzanne; Hafeez-Ur-Rehman, Hajra; Sanou, Dia; Tumwine, Jackson

2018-01-01

A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary-spanning actors working in 4 Sub-Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end-line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary-spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low- and middle-income countries. © 2017 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

Perspectives and Challenges of HMIS Officials in the Implementation of Health Management Information System (HMIS) with Reference to Maternal Health Services in Assam.

PubMed

Samal, Janmejaya; Dehury, Ranjit Kumar

2016-06-01

Health Management Information System (HMIS) is one of the important components of National Rural Health Mission (NRHM). The web portal of HMIS was launched by the Ministry of Health and Family Welfare (MOHFW), Govt. of India (GOI) in 21(st) Oct. 2008 to enable capturing of public health data from both public and private institutions in rural and urban areas across the country. The aim of the study was to assess the quality perspectives and challenges among HMIS officials in implementing HMIS at their respective levels, i.e. district and block level. We conducted a pilot qualitative study in two districts of Assam. HMIS officials working at district and block level were interviewed in-depth with the help of a semi-structured interview schedule which lasted from May to July 2014. Both HMIS and MCTS (Mother and Child Tracking System) formats were considered useful, by the HMIS officials, for data collection, planning at various levels, tracking maternal and neonatal deaths, institutional deliveries. HMIS officials reported that MCTS is useful for monitoring individual health status especially the status of the mother and child and HMIS being helpful as a health facility monitoring tool. The study used a small sample size, hence similar type of studies are required with large sample size to understand the perspectives and challenges of HMIS officials in the implementation of HMIS.

The Strengths and Challenges of Implementing EBP in Healthcare Systems.

PubMed

Warren, Joan I; McLaughlin, Maureen; Bardsley, Joan; Eich, Joanne; Esche, Carol Ann; Kropkowski, Lola; Risch, Stephen

2016-02-01

Multihospital healthcare system leaders and individual nurses are challenged to integrate standardized evidence-based practices that support continuous performance improvement in their systems. This study was undertaken to evaluate the strength of and the opportunities for implementing evidence-based nursing practice across a diverse 9-hospital system located in the mid-Atlantic region. A cross-sectional survey of 6,800 registered nurses (RNs), with a 24% response rate, was conducted to learn about their attitudes, beliefs, and perceptions toward organizational readiness and implementation of EBP. Although respondents' beliefs about EBP were positive, they reported their ability to implement EBP as extremely low. More than one third (36%) of the respondents worked at two of the system's Magnet designated hospitals. Magnet RNs reported more resources and held more positive beliefs about their hospital's organizational readiness for EBP. Nurses who possess advanced nursing degrees, certification, and who serve in leadership roles were favorable toward EBP. Younger RNs with fewer years in practice were more likely to have positive beliefs toward EBP and embedding it into the organizational culture. Findings mirror previous research where nurses internationally favor EBP yet struggle with similar barriers for implementation. Strategies to link this evidence to action can be taken at local and global levels. Locally, transformational nurse leaders within each hospital can share the vision for implementing EBP and embrace Magnet principles. At the system level, transformational nurse leaders can collectively allocate resources to create a system-wide online EBP education plan with EBP competencies and tool kit to increase RN exposure to EBP and standardize practice. Globally, promoting free and accessible EBP massive open online courses (MOOC) and sharing best practices online and at international forums such as Magnet conferences will help to lead, educate, and mentor nurses with strategies to systematically increase EBP uptake. © 2016 Sigma Theta Tau International.

Sanitation practices and perceptions in Kakuma refugee camp, Kenya: Comparing the status quo with a novel service-based approach

PubMed Central

Nyoka, Raymond; Foote, Andrew D.; Woods, Emily; Lokey, Hana; O’Reilly, Ciara E.; Magumba, Fred; Okello, Patrick; Mintz, Eric D.; Marano, Nina

2017-01-01

Globally, an estimated 2.5 billion people lack access to improved sanitation. Unimproved sanitation increases the risk of morbidity and mortality, especially in protracted refugee situations where sanitation is based on pit latrine use. Once the pit is full, waste remains in the pit, necessitating the construction of a new latrine, straining available land and funding resources. A viable, sustainable solution is needed. This study used qualitative and quantitative methods to design, implement, and pilot a novel sanitation system in Kakuma refugee camp, Kenya. An initial round of 12 pre-implementation focus group discussions (FGDs) were conducted with Dinka and Somali residents to understand sanitation practices, perceptions, and needs. FGDs and a supplementary pre-implementation survey informed the development of an innovative sanitation management system that incorporated the provision of urine and liquid-diverting toilets, which separate urine and fecal waste, and a service-based sanitation system that included weekly waste collection. The new system was implemented on a pilot scale for 6 weeks. During the implementation, bi-weekly surveys were administered in each study household to monitor user perceptions and challenges. At the end of the pilot, the sanitation system was assessed using a second round of four post-implementation FGDs. Those who piloted the new sanitation system reported high levels of user satisfaction. Reported benefits included odor reduction, insect/pest reduction, the sitting design, the appropriateness for special populations, and waste collection. However, urine and liquid diversion presented a challenge for users who perform anal washing and for women who had experienced female genital mutilation. Refugee populations are often culturally and ethnically diverse. Using residents’ input to inform the development of sanitation solutions can increase user acceptability and provide opportunities to improve sanitation system designs based on specific needs. PMID:28704504

Implementing what works: a case study of integrated primary health care revitalisation in Timor-Leste

PubMed Central

2014-01-01

Background Revitalising primary health care (PHC) and the need to reach MDG targets requires developing countries to adapt current evidence about effective health systems to their local context. Timor-Leste in one of the world’s newest developing nations, with high maternal and child mortality rates, malaria, TB and malnutrition. Mountainous terrain and lack of transport pose serious challenges for accessing health services and implementing preventive health strategies. Methods We conducted a non-systematic review of the literature and identified six components of an effective PHC system. These were mapped onto three countries’ PHC systems and present a case study from Timor-Leste’s Servisu Integrado du Saude Comunidade (SISCa) focussing on MDGs. Some of the challenges of implementing these into practice are shown through locally collected health system data. Results An effective PHC system comprises 1) Strong leadership and government in human rights for health; 2) Prioritisation of cost-effective interventions; 3) Establishing an interactive and integrated culture of community engagement; 4) Providing an integrated continuum of care at the community level; 5) Supporting skilled and equipped health workers at all levels of the health system; 6) Creating a systems cycle of feedback using data to inform health care. The implementation case study from Timor-Leste (population 1 million) shows that in its third year, limited country-wide data had been collected and the SISCa program provided over half a million health interactions at the village level. However, only half of SISCa clinics were functional across the country. Attendances included not only pregnant women and children, but also adults and older community members. Development partners have played a key role in supporting this implementation process. Conclusion The SISCa program is a PHC model implementing current best practice to reach remote communities in a new developing country. Despite limited resources, village level healthcare and engagement can be achieved but takes a long-term commitment and partnership. PMID:24559229

Chronic disease management: implementation and coordination of healthcare systems for depressed elderly persons.

PubMed

Severinsson, Elisabeth; Holm, Anne Lise

2014-12-01

The aim of this study was to evaluate the implementation of the research-based Chronic Care Model (CCM), discuss methods and summarise research recommendations for improving the care of depressed elderly persons. Interviews were conducted and state-of-the-art reviews employed. Three important areas emerged: (1) barriers to and facilitating factors in the implementation of the CCM; (2) the challenges involved in re-designing the delivery system and interdisciplinary team collaboration; and (3) empirical evidence pertaining to self-management support and how older persons manage to live with depressive ill-health. In conclusion, implementation research requires evidence-based knowledge, staff involvement and familiarity with the context in which development occurs.

Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS): a cluster randomized trial targeting system-wide improvement in substance use services.

PubMed

Knight, Danica K; Belenko, Steven; Wiley, Tisha; Robertson, Angela A; Arrigona, Nancy; Dennis, Michael; Bartkowski, John P; McReynolds, Larkin S; Becan, Jennifer E; Knudsen, Hannah K; Wasserman, Gail A; Rose, Eve; DiClemente, Ralph; Leukefeld, Carl

2016-04-29

The purpose of this paper is to describe the Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, a cooperative implementation science initiative involving the National Institute on Drug Abuse, six research centers, a coordinating center, and Juvenile Justice Partners representing seven US states. While the pooling of resources across centers enables a robust implementation study design involving 36 juvenile justice agencies and their behavioral health partner agencies, co-producing a study protocol that has potential to advance implementation science, meets the needs of all constituencies (funding agency, researchers, partners, study sites), and can be implemented with fidelity across the cooperative can be challenging. This paper describes (a) the study background and rationale, including the juvenile justice context and best practices for substance use disorders, (b) the selection and use of an implementation science framework to guide study design and inform selection of implementation components, and (c) the specific study design elements, including research questions, implementation interventions, measurement, and analytic plan. The JJ-TRIALS primary study uses a head-to-head cluster randomized trial with a phased rollout to evaluate the differential effectiveness of two conditions (Core and Enhanced) in 36 sites located in seven states. A Core strategy for promoting change is compared to an Enhanced strategy that incorporates all core strategies plus active facilitation. Target outcomes include improvements in evidence-based screening, assessment, and linkage to substance use treatment. Contributions to implementation science are discussed as well as challenges associated with designing and deploying a complex, collaborative project. NCT02672150 .

Looking Forward: The Promise of Widespread Implementation of Parent Training Programs

PubMed Central

Forgatch, Marion S.; Patterson, Gerald R.; Gewirtz, Abigail H.

2013-01-01

Over the past quarter century a body of parent training programs has been developed and validated as effective in reducing child behavior problems, but few of these have made their way into routine practice. This article describes the long and winding road of implementation as applied to children's mental health. Adopting Rogers' (1995) diffusion framework and Fixsen and colleagues' implementation framework (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005), we review more than a decade of research on the implementation of Parent Management Training – Oregon Model (PMTO®). Data from US and international PMTO implementations are used to illustrate the payoffs and the challenges of making empirically supported interventions routine practice in the community. Technological advances that break down barriers to communication across distances, the availability of efficacious programs suitable for implementation, and the urgent need for high quality mental health care provide strong rationales for prioritizing attention to implementation. Over the next quarter of a century, the challenge is to reduce the prevalence of children's psychopathology by creating science-based delivery systems to reach families in need, everywhere. PMID:24443650

A P&T Committee’s Transition to a Complete Electronic Meeting System—A Multisite Institution Experience

PubMed Central

Al-Jedai, Ahmed H.; Algain, Roaa A.; Alghamidi, Said A.; Al-Jazairi, Abdulrazaq S.; Amin, Rashid; Bin Hussain, Ibrahim Z.

2017-01-01

Purpose In the last few decades, changes to formulary management processes have taken place in institutions with closed formulary systems. However, many P&T committees continued to operate using traditional paper-based systems. Paper-based systems have many limitations, including confidentiality, efficiency, open voting, and paper wastage. This becomes more challenging when dealing with a multisite P&T committee that handles formulary matters across the whole health care system. In this paper, we discuss the implementation of the first paperless, completely electronic, Web-based formulary management system across a large health care system in the Middle East. Summary We describe the transitioning of a multisite P&T committee in a large tertiary care institution from a paper-based to an all-electronic system. The challenges and limitations of running a multisite P&T committee utilizing a paper system are discussed. The design and development of a Web-based committee floor management application that can be used from notebooks, tablets, and hand-held devices is described. Implementation of a flexible, interactive, easy-to-use, and efficient electronic formulary management system is explained in detail. Conclusion The development of an electronic P&T committee meeting system that encompasses electronic document sharing, voting, and communication could help multisite health care systems unify their formularies across multiple sites. Our experience might not be generalizable to all institutions because this depends heavily on system features, existing processes and workflow, and implementation across different sites. PMID:29018301

Triple Aim in Canada: developing capacity to lead to better health, care and cost

PubMed Central

Farmanova, Elina; Kirvan, Christine; Verma, Jennifer; Mukerji, Geetha; Akunov, Nurdin; Phillips, Kaye; Samis, Stephen

2016-01-01

Abstract Quality problem Many modern health systems strive for ‘Triple Aim’ (TA)—better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not. Initial assessment Limited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems. Choice of solution To support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community. Implementation Structured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale. Evaluation A summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI. Lessons learned Delivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector. PMID:28423164

Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada

PubMed Central

Vedel, Isabelle; Monette, Michele; Beland, François; Monette, Johanne; Bergman, Howard

2011-01-01

Introduction Québec’s rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system’s focus on acute care and fragmented delivery. Description of policy practice Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases. Conclusion and discussion Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in its management of chronic diseases: implementing the reorganization of primary care, successfully integrating primary and secondary care at the clinical level, and developing effective governance and change management. Efforts should focus on strengthening primary care by implementing nurse practitioners, developing a shared information system, and achieving better collaboration between primary and secondary care. PMID:21677842

Editorial: Challenges and solutions in GW calculations for complex systems

NASA Astrophysics Data System (ADS)

Giustino, F.; Umari, P.; Rubio, A.

2012-09-01

We report key advances in the area of GW calculations, review the available software implementations and define standardization criteria to render the comparison between GW calculations from different codes meaningful, and identify future major challenges in the area of quasiparticle calculations. This Topical Issue should be a reference point for further developments in the field.

Implementing Statewide Longitudinal Student Data Systems: Lessons from the States. Working Paper #22

ERIC Educational Resources Information Center

Anagnostopoulos, Dorothea; Bali, Valentina A.

2011-01-01

Providing accurate and useful information on student achievement is a rising challenge for state educational agencies. With the passage of the No Child Left Behind Act (NCLB) in 2001, such challenges have become more pressing. A centerpiece of the educational accountability movement, NCLB has prompted states to improve their reporting on student…

Carolina Care at University of North Carolina Health Care: Implementing a Theory-Driven Care Delivery Model Across a Healthcare System.

PubMed

Tonges, Mary; Ray, Joel D; Herman, Suzanne; McCann, Meghan

2018-04-01

Patient satisfaction is a key component of healthcare organizations' performance. Providing a consistent, positive patient experience across a system can be challenging. This article describes an organization's approach to achieving this goal by implementing a successful model developed at the flagship academic healthcare center across an 8-hospital system. The Carolina Care at University of North Carolina Health Care initiative has resulted in substantive qualitative and quantitative benefits including higher patient experience scores for both overall rating and nurse communication.

Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites

PubMed Central

Novick, Gina; Womack, Julie A.; Lewis, Jessica; Stasko, Emily C.; Rising, Sharon S.; Sadler, Lois S.; Cunningham, Shayna C.; Tobin, Jonathan N.; Ickovics, Jeannette R.

2016-01-01

Group prenatal care improves perinatal outcomes, but implementing this complex model places substantial demands on settings designed for individual care. To describe perceived barriers and facilitators to implementing and sustaining Centering Pregnancy Plus (CP+) group prenatal care, 24 in-depth interviews were conducted with 22 clinicians, staff, administrators, and study personnel in six of the 14 sites of a randomized trial of the model. All sites served low-income, minority women. Sites for the present evaluation were selected for variation in location, study arm, and initial implementation response. Implementing CP+ was challenging in all sites, requiring substantial adaptations of clinical systems. All sites had barriers to meeting the model’s demands, but how sites responded to these barriers affected whether implementation thrived or struggled. Thriving sites had organizational cultures that supported innovation, champions who advocated for CP+, and staff who viewed logistical demands as manageable hurdles. Struggling sites had bureaucratic organizational structures and lacked buy-in and financial resources, and staff were overwhelmed by the model’s challenges. Findings suggested that implementing and sustaining health care innovation requires new practices and different ways of thinking, and health systems may not fully recognize the magnitude of change required. Consequently, evidence-based practices are modified or discontinued, and outcomes may differ from those in the original controlled studies. Before implementing new models of care, clinical settings should anticipate model demands and assess capacity for adapting to the disruptions of innovation. PMID:26340483

Technical challenges related to implementation of a formula one real time data acquisition and analysis system in a paediatric intensive care unit.

PubMed

Matam, B Rajeswari; Duncan, Heather

2018-06-01

Most existing, expert monitoring systems do not provide the real time continuous analysis of the monitored physiological data that is necessary to detect transient or combined vital sign indicators nor do they provide long term storage of the data for retrospective analyses. In this paper we examine the feasibility of implementing a long term data storage system which has the ability to incorporate real-time data analytics, the system design, report the main technical issues encountered, the solutions implemented and the statistics of the data recorded. McLaren Electronic Systems expertise used to continually monitor and analyse the data from F1 racing cars in real time was utilised to implement a similar real-time data recording platform system adapted with real time analytics to suit the requirements of the intensive care environment. We encountered many technical (hardware and software) implementation challenges. However there were many advantages of the system once it was operational. They include: (1) The ability to store the data for long periods of time enabling access to historical physiological data. (2) The ability to alter the time axis to contract or expand periods of interest. (3) The ability to store and review ECG morphology retrospectively. (4) Detailed post event (cardiac/respiratory arrest or other clinically significant deteriorations in patients) data can be reviewed clinically as opposed to trend data providing valuable clinical insight. Informed mortality and morbidity reviews can be conducted. (5) Storage of waveform data capture to use for algorithm development for adaptive early warning systems. Recording data from bed-side monitors in intensive care/wards is feasible. It is possible to set up real time data recording and long term storage systems. These systems in future can be improved with additional patient specific metrics which predict the status of a patient thus paving the way for real time predictive monitoring.

Seriously Implementing Health Capacity Strengthening Programs in Africa: Comment on "Implementation of a Health Management Mentoring Program: Year-1 Evaluation of Its Impact on Health System Strengthening in Zambézia Province, Mozambique".

PubMed

Lapão, Luís Velez

2015-07-14

Faced with the challenges of healthcare reform, skills and new capabilities are needed to support the reform and it is of crucial importance in Africa where shortages affects the health system resilience. Edwards et al provides a good example of the challenge of implementing a mentoring program in one province in a sub-Saharan country. From this example, various aspects of strengthening the capacity of managers in healthcare are examined based on our experience in action-training in Africa, as mentoring shares many characteristics with action-training. What practical lessons can be drawn to promote the strengthening so that managers can better intervene in complex contexts? Deeper involvement of health authorities and more rigorous approaches are seriously desirable for the proper development of health capacity strengthening programs in Africa. © 2015 by Kerman University of Medical Sciences.

MAVEN Information Security Governance, Risk Management, and Compliance (GRC): Lessons Learned

NASA Technical Reports Server (NTRS)

Takamura, Eduardo; Gomez-Rosa, Carlos A.; Mangum, Kevin; Wasiak, Fran

2014-01-01

As the first interplanetary mission managed by the NASA Goddard Space Flight Center, the Mars Atmosphere and Volatile EvolutioN (MAVEN) had three IT security goals for its ground system: COMPLIANCE, (IT) RISK REDUCTION, and COST REDUCTION. In a multiorganizational environment in which government, industry and academia work together in support of the ground system and mission operations, information security governance, risk management, and compliance (GRC) becomes a challenge as each component of the ground system has and follows its own set of IT security requirements. These requirements are not necessarily the same or even similar to each other's, making the auditing of the ground system security a challenging feat. A combination of standards-based information security management based on the National Institute of Standards and Technology (NIST) Risk Management Framework (RMF), due diligence by the Mission's leadership, and effective collaboration among all elements of the ground system enabled MAVEN to successfully meet NASA's requirements for IT security, and therefore meet Federal Information Security Management Act (FISMA) mandate on the Agency. Throughout the implementation of GRC on MAVEN during the early stages of the mission development, the Project faced many challenges some of which have been identified in this paper. The purpose of this paper is to document these challenges, and provide a brief analysis of the lessons MAVEN learned. The historical information documented herein, derived from an internal pre-launch lessons learned analysis, can be used by current and future missions and organizations implementing and auditing GRC.

Implementing Response to Intervention: Challenges of Diversity and System Change in a High Stakes Environment

ERIC Educational Resources Information Center

Cavendish, Wendy; Harry, Beth; Menda, Anne Maria; Espinosa, Anabel; Mahotiere, Margarette

2016-01-01

Background: The Response to Intervention (RTI) approach involves the use of a dynamic model built around the systematic documentation of students' response to research-based instructional interventions. Although there has been widespread implementation of RTI models for early intervention and in some cases, as a means to identify students with…

Implementation of the Millennium Development Goals in Nigeria through Non-Formal Education Curriculum

ERIC Educational Resources Information Center

Akpama, Simon Ibor; Asor, Love Joseph; Erim, Costly M.; Adekola, G.

2012-01-01

Nigeria is a signatory to the Millennium Development Goals (MDGs) declaration but till now she has not made any significant milestones in actualizing these human development goals. In spite of the coordinated efforts towards mobilizing those in the formal education system to partially address its implementation challenges, serious gaps still exit…

Leading Standards-Based Education Reform: Improving Implementation of Standards to Increase Student Achievement

ERIC Educational Resources Information Center

Vogel, Linda R.

2010-01-01

Standards-based education (SBE) has been the dominant educational reform movement since the early 1980s, reinforced by federal and state accountability systems. This book examines the efforts of educational leaders in implementing SBE to improve student achievement in a variety of demographic contexts but with common challenges. Four stages of SBE…

Strategies Nurse Managers Used to Offset Challenges during Electronic Medical Records Implementation: A Case Study

ERIC Educational Resources Information Center

Easterling, Latasha

2015-01-01

The purpose of this qualitative, descriptive case study was to discover successful approaches used, by nurse managers, to reduce barriers during the implementation of electronic medical record system in one hospital. Fourteen nurse managers were interviewed from an academic health science center in Mississippi. A pilot study was conducted to…

[Primary health care: challenges for implementation in Latin America].

PubMed

Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo

2013-01-01

A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries. Copyright © 2012 Elsevier España, S.L. All rights reserved.

The challenge of a data storage hierarchy

NASA Technical Reports Server (NTRS)

Ruderman, Michael

1992-01-01

A discussion of Mesa Archival Systems' data archiving system is presented. This data archiving system is strictly a software system that is implemented on a mainframe and manages the data into permanent file storage. Emphasis is placed on the fact that any kind of client system on the network can be connected through the Unix interface of the data archiving system.

Restructuring Principal Preparation in Illinois: Perspectives on Implementation Successes, Challenges, and Future Outlook. IERC 2015-3

ERIC Educational Resources Information Center

Klostermann, Brenda K.; Pareja, Amber Stitziel; Hart, Holly; White, Bradford R.; Huynh, Michelle Hanh

2015-01-01

The goals of the current mixed methods study--the Illinois Principal Preparation Implementation Review Project (I-PREP)--are to describe how the new policy is being implemented, learning which aspects of the implementation have been challenging and why they present challenges, and how programs are addressing challenges and realizing improvements…

Advantages and Challenges of 10-Gbps Transmission on High-Density Interconnect Boards

NASA Astrophysics Data System (ADS)

Yee, Chang Fei; Jambek, Asral Bahari; Al-Hadi, Azremi Abdullah

2016-06-01

This paper provides a brief introduction to high-density interconnect (HDI) technology and its implementation on printed circuit boards (PCBs). The advantages and challenges of implementing 10-Gbps signal transmission on high-density interconnect boards are discussed in detail. The advantages (e.g., smaller via dimension and via stub removal) and challenges (e.g., crosstalk due to smaller interpair separation) of HDI are studied by analyzing the S-parameter, time-domain reflectometry (TDR), and transmission-line eye diagrams obtained by three-dimensional electromagnetic modeling (3DEM) and two-dimensional electromagnetic modeling (2DEM) using Mentor Graphics HyperLynx and Keysight Advanced Design System (ADS) electronic computer-aided design (ECAD) software. HDI outperforms conventional PCB technology in terms of signal integrity, but proper routing topology should be applied to overcome the challenge posed by crosstalk due to the tight spacing between traces.

Fault Management Architectures and the Challenges of Providing Software Assurance

NASA Technical Reports Server (NTRS)

Savarino, Shirley; Fitz, Rhonda; Fesq, Lorraine; Whitman, Gerek

2015-01-01

The satellite systems Fault Management (FM) is focused on safety, the preservation of assets, and maintaining the desired functionality of the system. How FM is implemented varies among missions. Common to most is system complexity due to a need to establish a multi-dimensional structure across hardware, software and operations. This structure is necessary to identify and respond to system faults, mitigate technical risks and ensure operational continuity. These architecture, implementation and software assurance efforts increase with mission complexity. Because FM is a systems engineering discipline with a distributed implementation, providing efficient and effective verification and validation (VV) is challenging. A breakout session at the 2012 NASA Independent Verification Validation (IVV) Annual Workshop titled VV of Fault Management: Challenges and Successes exposed these issues in terms of VV for a representative set of architectures. NASA's IVV is funded by NASA's Software Assurance Research Program (SARP) in partnership with NASA's Jet Propulsion Laboratory (JPL) to extend the work performed at the Workshop session. NASA IVV will extract FM architectures across the IVV portfolio and evaluate the data set for robustness, assess visibility for validation and test, and define software assurance methods that could be applied to the various architectures and designs. This work focuses efforts on FM architectures from critical and complex projects within NASA. The identification of particular FM architectures, visibility, and associated VVIVV techniques provides a data set that can enable higher assurance that a satellite system will adequately detect and respond to adverse conditions. Ultimately, results from this activity will be incorporated into the NASA Fault Management Handbook providing dissemination across NASA, other agencies and the satellite community. This paper discusses the approach taken to perform the evaluations and preliminary findings from the research including identification of FM architectures, visibility observations, and methods utilized for VVIVV.

Mars Reconnaissance Orbiter Mission: Systems Engineering Challenges on the Mars Reconnaissance Orbiter Mission

NASA Technical Reports Server (NTRS)

Havens, Glen G.

2007-01-01

MRO project is a system of systems requiring system engineering team to architect, design, integrate, test, and operate these systems at each level of the project. The challenge of system engineering mission objectives into a single mission architecture that can be integrated tested, launched, and operated. Systems engineering must translate high-level requirements into integrated mission design. Systems engineering challenges were overcome utilizing a combination by creative designs built into MRO's flight and ground systems: a) Design of sophisticated spacecraft targeting and data management capabilities b) Establishment of a strong operations team organization; c) Implementation of robust operational processes; and d) Development of strategic ground tools. The MRO system has met the challenge of its driving requirements: a) MRO began its two-year primary science phase on November 7, 2006, and by July 2007, met it minimum requirement to collect 15 Tbits of data after only eight months of operations. Currently we have collected 22 Tbits. b) Based on current performance, mission data return could return 70 Tbits of data by the end of the primary science phase in 2008.

A literature review for large-scale health information system project planning, implementation and evaluation.

PubMed

Sligo, Judith; Gauld, Robin; Roberts, Vaughan; Villa, Luis

2017-01-01

Information technology is perceived as a potential panacea for healthcare organisations to manage pressure to improve services in the face of increased demand. However, the implementation and evaluation of health information systems (HIS) is plagued with problems and implementation shortcomings and failures are rife. HIS implementation is complex and relies on organisational, structural, technological, and human factors to be successful. It also requires reflective, nuanced, multidimensional evaluation to provide ongoing feedback to ensure success. This article provides a comprehensive review of the literature about evaluating and implementing HIS, detailing the challenges and recommendations for both evaluators and healthcare organisations. The factors that inhibit or promote successful HIS implementation are identified and effective evaluation strategies are described with the goal of informing teams evaluating complex HIS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations

PubMed Central

Chan, Lenny L. S.; Fouts, Michelle M.; Murphy, Elizabeth J.

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations. PMID:28197420

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations.

PubMed

Ratanawongsa, Neda; Chan, Lenny L S; Fouts, Michelle M; Murphy, Elizabeth J

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations.

Are We There Yet? Human Factors Knowledge and Health Information Technology - the Challenges of Implementation and Impact.

PubMed

Turner, P; Kushniruk, A; Nohr, C

2017-08-01

Objective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research published in 2015 and 2016. Electronic health records (EHRs) and patient-centred HIT emerged as significant foci of recent HF research. The authors selected prominent papers highlighting ongoing HF and usability challenges in these areas. This selective rather than systematic review of recent HF research highlights these key challenges and reflects on their implications on the future impact of HF research on HIT. Results: Research provides evidence of continued poor design, implementation, and usability of HIT, as well as technology-induced errors and unintended consequences. The paper highlights support for: (i) strengthening the evidence base on the benefits of HF approaches; (ii) improving knowledge translation in the implementation of HF approaches during HIT design, implementation, and evaluation; (iii) increasing transparency, governance, and enforcement of HF best practices at all stages of the HIT system development life cycle. Discussion and Conclusion: HF and usability approaches are yet to become embedded as integral components of HIT development, implementation, and impact assessment. As HIT becomes ever-more pervasive including with patients as end-users, there is a need to expand our conceptualisation of the problems to be addressed and the suite of tactics and strategies to be used to calibrate our pro-active involvement in its improvement. Georg Thieme Verlag KG Stuttgart.

Introduction: the realities of antiretroviral therapy rollout: overcoming challenges to successful programmatic implementation.

PubMed

Ojikutu, Bisola

2007-12-01

In 2006, 2 million human immunodeficiency virus (HIV)-infected people living in low- to middle-income countries were receiving antiretroviral therapy (ART). Although this is an improvement over previous years, significant operational challenges have inhibited progress toward universal access to HIV care and treatment. Despite these challenges, the intense efforts focused on addressing the HIV epidemic present an opportunity for overall health systems improvement in developing nations. In October 2006, Harvard University's Centers for AIDS Research, the Nelson Mandela School of Medicine, the Department of Health of KwaZulu-Natal, and the Medical Research Council of South Africa held a conference entitled "The Realities of Antiretroviral Therapy Rollout: Challenges to Successful Programmatic Implementation" in Durban, South Africa. The goal of the meeting was to bring together international and local leadership, including policy makers, health care workers, and funders, to propose an agenda that would address the challenges to more expeditious provision of HIV care and treatment in resource-limited settings.

Models meet data: Challenges and opportunities in implementing land management in Earth system models.

PubMed

Pongratz, Julia; Dolman, Han; Don, Axel; Erb, Karl-Heinz; Fuchs, Richard; Herold, Martin; Jones, Chris; Kuemmerle, Tobias; Luyssaert, Sebastiaan; Meyfroidt, Patrick; Naudts, Kim

2018-04-01

As the applications of Earth system models (ESMs) move from general climate projections toward questions of mitigation and adaptation, the inclusion of land management practices in these models becomes crucial. We carried out a survey among modeling groups to show an evolution from models able only to deal with land-cover change to more sophisticated approaches that allow also for the partial integration of land management changes. For the longer term a comprehensive land management representation can be anticipated for all major models. To guide the prioritization of implementation, we evaluate ten land management practices-forestry harvest, tree species selection, grazing and mowing harvest, crop harvest, crop species selection, irrigation, wetland drainage, fertilization, tillage, and fire-for (1) their importance on the Earth system, (2) the possibility of implementing them in state-of-the-art ESMs, and (3) availability of required input data. Matching these criteria, we identify "low-hanging fruits" for the inclusion in ESMs, such as basic implementations of crop and forestry harvest and fertilization. We also identify research requirements for specific communities to address the remaining land management practices. Data availability severely hampers modeling the most extensive land management practice, grazing and mowing harvest, and is a limiting factor for a comprehensive implementation of most other practices. Inadequate process understanding hampers even a basic assessment of crop species selection and tillage effects. The need for multiple advanced model structures will be the challenge for a comprehensive implementation of most practices but considerable synergy can be gained using the same structures for different practices. A continuous and closer collaboration of the modeling, Earth observation, and land system science communities is thus required to achieve the inclusion of land management in ESMs. © 2017 John Wiley & Sons Ltd.

Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives.

PubMed

Liles, Elizabeth G; Schneider, Jennifer L; Feldstein, Adrianne C; Mosen, David M; Perrin, Nancy; Rosales, Ana Gabriela; Smith, David H

2015-03-29

Few studies describe system-level challenges or facilitators to implementing population-based colorectal cancer (CRC) screening outreach programs. Our qualitative study explored viewpoints of multilevel stakeholders before, during, and after implementation of a centralized outreach program. Program implementation was part of a broader quality-improvement initiative. During 2008-2010, we conducted semi-structured, open-ended individual interviews and focus groups at Kaiser Permanente Northwest (KPNW), a not-for-profit group model health maintenance organization using the practical robust implementation and sustainability model to explore external and internal barriers to CRC screening. We interviewed 55 stakeholders: 8 health plan leaders, 20 primary care providers, 4 program managers, and 23 endoscopy specialists (15 gastroenterologists, 8 general surgeons), and analyzed interview transcripts to identify common as well as divergent opinions expressed by stakeholders. The majority of stakeholders at various levels consistently reported that an automated telephone-reminder system to contact patients and coordinate mailing fecal tests alleviated organizational constraints on staff's time and resources. Changing to a single-sample fecal immunochemical test (FIT) lessened patient and provider concerns about feasibility and accuracy of fecal testing. The centralized telephonic outreach program did, however, result in some screening duplication and overuse. Higher rates of FIT completion and a higher proportion of positive results with FIT required more colonoscopies. Addressing barriers at multiple levels of a health system by changing the delivery system design to add a centralized outreach program, switching to a more accurate and easier-to-use fecal test, and providing educational and electronic support had both benefits and problematic consequences. Other health care organizations can use our results to understand the complexities of implementing centralized screening programs.

Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention.

PubMed

Kahan, Deborah; Leszcz, Molyn; O'Campo, Patricia; Hwang, Stephen W; Wasylenki, Donald A; Kurdyak, Paul; Wise Harris, Deborah; Gozdzik, Agnes; Stergiopoulos, Vicky

2016-04-27

Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experience with the intervention and factors that helped or hindered successful early implementation. Qualitative data were analyzed using thematic analysis. Stakeholders valued the intervention and its potential to support continuity of care for this population. Service delivery system factors, including organizational capacity and a history of collaborative relationships across the healthcare continuum, and support system factors, such as training and supervision, emerged as key facilitators of program implementation. Operational challenges included early low program referral rates, management of a multi-organizational initiative, variable adherence to the model among participating organizations, and scant access to specialty psychiatric resources. Factors contributing to these challenges included lack of dedicated staff in the ED and limited local system capacity to support this population, and insufficient training and technical assistance available to participating organizations. A multi-organizational brief intervention is an acceptable model to support integration of hospital, primary and community care for frequent ED users. The study highlights the importance of early implementation evaluation to identify potential solutions to implementation barriers that may be applicable to many jurisdictions.

A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery.

PubMed

Tuepker, Anaïs; Elnitsky, Christine; Newell, Summer; Zaugg, Tara; Henry, James A

2018-01-01

Tinnitus is a common condition, especially prevalent among military Veterans. Progressive Tinnitus Management (PTM) is an interdisciplinary, structured, stepped-care approach to providing clinical services, including teaching coping skills, to people bothered by tinnitus. PTM has been shown to be effective at reducing functional distress, but implementation of the intervention outside of a research setting has not been studied, even though dissemination is underway within the Veterans Health Administration (VHA) system in the United States. This study was designed to address a gap in knowledge of PTM clinical implementation to date, with a focus on factors facilitating or hindering implementation in VHA audiology and mental health clinic contexts, and whether implementing sites had developed intervention adaptations. Qualitative interviews were conducted with 21 audiology and mental health clinicians and service chiefs across a regional service network. Interviews were transcribed and coded using a hybrid inductive-deductive analytic approach guided by existing implementation research frameworks and then iteratively developed for emergent themes. PTM prioritization was rare overall, with providers across disciplines challenged by lack of capacity for implementation, but with differences by discipline in challenges to prioritization. Where PTM was prioritized and delivered, this was facilitated by perception of unique value, provider's own experience of tinnitus, observation/experience with PTM delivery, intervention fit with provider's skills, and an environment with supportive leadership and adaptive reserve. PTM was frequently adapted to local contexts to address delivery challenges and diversify patient options. Adaptations included shifting from group to individual formats, reducing or combining sessions, and employing novel therapeutic approaches. Existing adaptations highlight the need to better understand mechanisms underlying PTM's effectiveness, and research on the impact of adaptations on patient outcomes is an important next step. Prioritization of PTM is a key barrier to the scale up and spread of this evidence-based intervention. Developing clinician champions may facilitate dissemination, especially if accompanied by signals of systemic prioritization. Novel approaches exposing clinicians and administrators to PTM may identify and develop clinical champions. Acknowledging the potential for PTM adaptations may make delivery more feasible in the context of existing system constraints and priorities.

Software design and implementation concepts for an interoperable medical communication framework.

PubMed

Besting, Andreas; Bürger, Sebastian; Kasparick, Martin; Strathen, Benjamin; Portheine, Frank

2018-02-23

The new IEEE 11073 service-oriented device connectivity (SDC) standard proposals for networked point-of-care and surgical devices constitutes the basis for improved interoperability due to its independence of vendors. To accelerate the distribution of the standard a reference implementation is indispensable. However, the implementation of such a framework has to overcome several non-trivial challenges. First, the high level of complexity of the underlying standard must be reflected in the software design. An efficient implementation has to consider the limited resources of the underlying hardware. Moreover, the frameworks purpose of realizing a distributed system demands a high degree of reliability of the framework itself and its internal mechanisms. Additionally, a framework must provide an easy-to-use and fail-safe application programming interface (API). In this work, we address these challenges by discussing suitable software engineering principles and practical coding guidelines. A descriptive model is developed that identifies key strategies. General feasibility is shown by outlining environments in which our implementation has been utilized.

Development of the supply chain oriented quality assurance system for aerospace manufacturing SMEs and its implementation perspectives

NASA Astrophysics Data System (ADS)

Hussein, Abdullahi; Cheng, Kai

2016-10-01

Aerospace manufacturing SMEs are continuously facing the challenge on managing their supply chain and complying with the aerospace manufacturing quality standard requirement due to their lack of resources and the nature of business. In this paper, the ERP system based approach is presented to quality control and assurance work in light of seamless integration of in-process production data and information internally and therefore managing suppliers more effectively and efficiently. The Aerospace Manufacturing Quality Assurance Standard (BS/EN9100) is one of the most recognised and essential protocols for developing the industry-operated-and-driven quality assurance systems. The research investigates using the ERP based system as an enabler to implement BS/EN9100 quality management system at manufacturing SMEs and the associated implementation and application perspectives. An application case study on a manufacturing SME is presented by using the SAP based implementation, which helps further evaluate and validate the approach and application system development.

Second Year Site Visits to Milwaukee Urban Systemic Initiative Schools. Report for the Milwaukee Public Schools.

ERIC Educational Resources Information Center

Huinker, DeAnn; Coan, Cheryl

The Urban Systemic Initiatives (USI) program is an effort sponsored by the National Science Foundation (NSF) that targets large urban school systems with the goal of sustainable implementation of high-quality, standards-based teaching for the purpose of attaining system-wide increases in students' learning of challenging mathematics and science.…

Coordinated Transformation among Community Colleges Lacking a State System

ERIC Educational Resources Information Center

Russell, James Thad

2016-01-01

Community colleges face many challenges in the face of demands for increased student success. Institutions continually seek scalable interventions and initiatives focused on improving student achievement. Effectively implementing sustainable change that moves the needle of student success remains elusive. Facilitating systemic, scalable change…

Operator performance-enhancing technologies to improve safety. A US DOT safety initiative for meeting the human-centered systems challenge.

DOT National Transportation Integrated Search

1999-11-01

The program implements DOT Human Factors Coordinating Committee (HFCC) recommendations for a coordinated Departmental Human Factors Research Program to advance the human-centered systems approach for enhancing transportation safety. Human error is a ...

Time-Domain Reflectometry for Tamper Indication in Unattended Monitoring Systems for Safeguards

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tedeschi, Jonathan R.; Smith, Leon E.; Moore, David E.

2014-12-01

The International Atomic Energy Agency (IAEA) continues to expand its use of unattended, remotely monitored measurement systems. An increasing number of systems and an expanding family of instruments create challenges in terms of deployment efficiency and the implementation of data authentication measures. Pacific Northwest National Laboratory (PNNL) leads a collaboration that is exploring various tamper-indicating (TI) measures that could help to address some of the long-standing detector and data-transmission authentication challenges with IAEA’s unattended systems. PNNL is investigating the viability of active time-domain reflectometry (TDR) along two parallel but interconnected paths: (1) swept-frequency TDR as the highly flexible, laboratory goldmore » standard to which field-deployable options can be compared, and (2) a low-cost commercially available spread-spectrum TDR technology as one option for field implementation. This report describes PNNL’s progress and preliminary findings from the first year of the study, and describes the path forward.« less

A System-Level Approach to Overweight and Obesity in the Veterans Health Administration.

PubMed

Raffa, Susan D; Maciejewski, Matthew L; Zimmerman, Lindsey E; Damschroder, Laura J; Estabrooks, Paul A; Ackermann, Ronald T; Tsai, Adam G; Histon, Trina; Goldstein, Michael G

2017-04-01

Healthcare systems are challenged by steady increases in the number of patients who are overweight and obese. Large-scale, evidence-based behavioral approaches for addressing overweight and obesity have been successfully implemented in systems such as the Veterans Health Administration (VHA). These population-based interventions target reduction in risk for obesity-associated conditions through lifestyle change and weight loss, and are associated with modest weight loss. Despite the fact that VHA has increased the overall reach of these behavioral interventions, the number of high-risk overweight and obese patients continues to rise. Recommendations for weight loss medications and bariatric surgery are included in clinical practice guidelines for the management of overweight and obesity, but these interventions are underutilized. During a recent state of the art conference on weight management held by VHA, subject matter experts identified challenges and gaps, as well as potential solutions and overarching policy recommendations, for implementing an integrated system-wide approach for improving population-based weight management.

Risk intelligence: making profit from uncertainty in data processing system.

PubMed

Zheng, Si; Liao, Xiangke; Liu, Xiaodong

2014-01-01

In extreme scale data processing systems, fault tolerance is an essential and indispensable part. Proactive fault tolerance scheme (such as the speculative execution in MapReduce framework) is introduced to dramatically improve the response time of job executions when the failure becomes a norm rather than an exception. Efficient proactive fault tolerance schemes require precise knowledge on the task executions, which has been an open challenge for decades. To well address the issue, in this paper we design and implement RiskI, a profile-based prediction algorithm in conjunction with a riskaware task assignment algorithm, to accelerate task executions, taking the uncertainty nature of tasks into account. Our design demonstrates that the nature uncertainty brings not only great challenges, but also new opportunities. With a careful design, we can benefit from such uncertainties. We implement the idea in Hadoop 0.21.0 systems and the experimental results show that, compared with the traditional LATE algorithm, the response time can be improved by 46% with the same system throughput.

Wind Energy Deployment in Isolated Islanded Power Systems: Challenges & Realities (Poster)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baring-Gould, I.

Rising costs of fuels, energy surety, and the carbon impacts of diesel fuel are driving remote and islanded communities dependent on diesel power generation to look for alternatives. Over the past few years, interest in using wind energy to reduce diesel fuel consumption has increased dramatically, potentially providing economic, environmental, social, and security benefits to the energy supply of isolated and islanded communities. However, the task of implementing such systems has remained elusive and subject to many cases of lower-than-expected performance. This poster describes the current status of integrating higher contribution wind technology into islanded power systems, the progress ofmore » recent initiatives implemented by the U.S. Department of Energy and Interior, and some of the lingering technical and commercial challenges. Operating experience from a number of power systems is described. The worldwide market for wind development in islanded communities (some of these supplying large domestic loads) provides a strong market niche for the wind industry, even in the midst of a slow global recovery.« less

Ethical and Diversity Challenges in Ecologically Sensitive Systems-Oriented Interventions

PubMed Central

Jason, Leonard A.

2016-01-01

This article discusses ethical and diversity challenges involved in implementing ecologically sensitive, systems-oriented research. These issues are considered with reference to a series of community-based interventions dealing with stigma and chronic illness, recovery from substance-use disorders, and prevention of tobacco use. Each of these ecological interventions incorporates a systems approach, which allows an understanding of how individuals affect and are influenced by their social environments. In addition, issues of diversity with respect to underrepresented and marginalized groups are considered, including overcoming obstacles to gaining access to resources and promoting increased opportunities and empowerment. Throughout, the central importance of developing relationships with key gatekeepers and stakeholders, as well as timely and effective communications with various coalition members, is highlighted. By bringing into the research and policy process diverse citizen/participant suggestions and input regarding the need for, or design and implementation of ecologically and systems-based interventions, researchers can build collaborative relationships that fuel trust and partnerships, leading to more ethically responsible research. PMID:26618968

Feasibility of rapid ethical assessment for the Ethiopian health research ethics review system.

PubMed

Addissie, Adamu; Davey, Gail; Newport, Melanie; Farsides, Bobbie; Feleke, Yeweyenhareg

2015-01-01

One of the challenges in the process of ethical medical research in developing countries, including Ethiopia, is translating universal principles of medical ethics into appropriate informed consent documents and their implementation. Rapid Ethical Assessment (REA) has been suggested as a feasible approach to meet this application gap. In the past few years REA has been employed in few research project in Ethiopia and have been found to be a useful and practical approach. Feasibility assessment of REA for the Ethiopian research setting was conducted between 2012-2013 in order to inform the subsequent introduction of REA into research ethics review and governance system in the country. REA was found to be an appropriate, relevant and feasible venture. We argue that REA can be integrated as part of the ethics review and governance system in Ethiopia. REA tools and techniques are considered relevant and acceptable to the Ethiopian research community, with few practical challenges anticipated in their implementation. REA are considered feasible for integration in the Ethiopian ethics review system.

Risk Intelligence: Making Profit from Uncertainty in Data Processing System

PubMed Central

Liao, Xiangke; Liu, Xiaodong

2014-01-01

In extreme scale data processing systems, fault tolerance is an essential and indispensable part. Proactive fault tolerance scheme (such as the speculative execution in MapReduce framework) is introduced to dramatically improve the response time of job executions when the failure becomes a norm rather than an exception. Efficient proactive fault tolerance schemes require precise knowledge on the task executions, which has been an open challenge for decades. To well address the issue, in this paper we design and implement RiskI, a profile-based prediction algorithm in conjunction with a riskaware task assignment algorithm, to accelerate task executions, taking the uncertainty nature of tasks into account. Our design demonstrates that the nature uncertainty brings not only great challenges, but also new opportunities. With a careful design, we can benefit from such uncertainties. We implement the idea in Hadoop 0.21.0 systems and the experimental results show that, compared with the traditional LATE algorithm, the response time can be improved by 46% with the same system throughput. PMID:24883392

Challenges in Visual Analysis of Ensembles

DOE PAGES

Crossno, Patricia

2018-04-12

Modeling physical phenomena through computational simulation increasingly relies on generating a collection of related runs, known as an ensemble. In this paper, we explore the challenges we face in developing analysis and visualization systems for large and complex ensemble data sets, which we seek to understand without having to view the results of every simulation run. Implementing approaches and ideas developed in response to this goal, we demonstrate the analysis of a 15K run material fracturing study using Slycat, our ensemble analysis system.

High Performance Processors for Space Environments: A Subproject of the NASA Exploration Missions Systems Directorate "Radiation Hardened Electronics for Space Environments" Technology Development Program

NASA Technical Reports Server (NTRS)

Johnson, M.; Label, K.; McCabe, J.; Powell, W.; Bolotin, G.; Kolawa, E.; Ng, T.; Hyde, D.

2007-01-01

Implementation of challenging Exploration Systems Missions Directorate objectives and strategies can be constrained by onboard computing capabilities and power efficiencies. The Radiation Hardened Electronics for Space Environments (RHESE) High Performance Processors for Space Environments project will address this challenge by significantly advancing the sustained throughput and processing efficiency of high-per$ormance radiation-hardened processors, targeting delivery of products by the end of FY12.

Grand challenges in mass storage: A system integrator's perspective

NASA Technical Reports Server (NTRS)

Mintz, Dan; Lee, Richard

1993-01-01

The grand challenges are the following: to develop more innovation in approach; to expand the I/O barrier; to achieve increased volumetric efficiency and incremental cost improvements; to reinforce the 'weakest link' software; to implement improved architectures; and to minimize the impact of self-destructing technologies. Mass storage is defined as any type of storage system exceeding 100 GBytes in total size, under the control of a centralized file management scheme. The topics covered are presented in viewgraph form.

Challenges in Visual Analysis of Ensembles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Crossno, Patricia

Modeling physical phenomena through computational simulation increasingly relies on generating a collection of related runs, known as an ensemble. In this paper, we explore the challenges we face in developing analysis and visualization systems for large and complex ensemble data sets, which we seek to understand without having to view the results of every simulation run. Implementing approaches and ideas developed in response to this goal, we demonstrate the analysis of a 15K run material fracturing study using Slycat, our ensemble analysis system.

Restructuring Principal Preparation in Illinois: Perspectives on Implementation Successes, Challenges, and Future Outlook. Executive Summary. IERC 2015-3

ERIC Educational Resources Information Center

Klostermann, Brenda K.; Pareja, Amber Stitziel; Hart, Holly; White, Bradford R.; Huynh, Michelle Hanh

2015-01-01

The goals of the current mixed methods study--the Illinois Principal Preparation Implementation Review Project (I-PREP)--are to describe how the new policy is being implemented, learning which aspects of the implementation have been challenging and why they present challenges, and how programs are addressing challenges and realizing improvements…

Integrating Wraparound into a Schoolwide System of Positive Behavior Supports

ERIC Educational Resources Information Center

Eber, Lucille; Hyde, Kelly; Suter, Jesse C.

2011-01-01

We describe the structure for implementation of the wraparound process within a multi-tiered system of school wide positive behavior support (SWPBS) to address the needs of the 1-5% of students with complex emotional/behavioral challenges. The installation of prerequisite system features that, based on a 3 year demonstration process, we consider…

Defining a Comprehensive Aligned Instructional System: To Ensure Powerful Teaching and Learning for Every Student in Every Classroom

ERIC Educational Resources Information Center

Waters, Louise Bay; O'Meara, Kiley Walsh

2007-01-01

The Stupski Foundation has focused on the implementation of a comprehensive aligned instructional system as a critical lever for district reform. In the challenging environment of urban education, reforms focusing on only one system component (i.e., assessment, curriculum materials, professional development, resource utilization, regulatory…

Developing and Implementing the Qatar Student Assessment System. Research Brief

ERIC Educational Resources Information Center

Gonzalez, Gabriella; Le, Vi-Nhuan; Broer, Markus; Mariano, Louis T.; Froemel, J. Enrique; Goldman, Charles A.; DaVanzo, Julie

2009-01-01

This research brief summarizes the development of a standards-based student assessment system in Qatar, lessons for policymakers in Qatar and elsewhere, and challenges in aligning the assessment with future changes in the curriculum standards. Analysis of Qatar's standards-based student assessment system, the first in the region, offers several…

Implementing a High-Assurance Smart-Card OS

NASA Astrophysics Data System (ADS)

Karger, Paul A.; Toll, David C.; Palmer, Elaine R.; McIntosh, Suzanne K.; Weber, Samuel; Edwards, Jonathan W.

Building a high-assurance, secure operating system for memory constrained systems, such as smart cards, introduces many challenges. The increasing power of smart cards has made their use feasible in applications such as electronic passports, military and public sector identification cards, and cell-phone based financial and entertainment applications. Such applications require a secure environment, which can only be provided with sufficient hardware and a secure operating system. We argue that smart cards pose additional security challenges when compared to traditional computer platforms. We discuss our design for a secure smart card operating system, named Caernarvon, and show that it addresses these challenges, which include secure application download, protection of cryptographic functions from malicious applications, resolution of covert channels, and assurance of both security and data integrity in the face of arbitrary power losses.

Exploring the barriers to implementing National Health Insurance in South Africa: The people's perspective.

PubMed

Passchier, R V

2017-09-22

This article explores the challenges of implementing the proposed National Health Insurance for South Africa (SA), based on the six building blocks of the World Health Organization Health System Framework. In the context of the current SA health system, leadership, finance, workforce, technologies, information and service delivery are explored from the perspective of the people at ground level. Through considerations such as these, the universal health coverage goals of health equity, efficiency, responsiveness and financial risk protection, might be realised.

Wireless pilot monitoring system for extreme race conditions.

PubMed

Pino, Esteban J; Arias, Diego E; Aqueveque, Pablo; Melin, Pedro; Curtis, Dorothy W

2012-01-01

This paper presents the design and implementation of an assistive device to monitor car drivers under extreme conditions. In particular, this system is designed in preparation for the 2012 Atacama Solar Challenge to be held in the Chilean desert. Actual preliminary results show the feasibility of such a project including physiological and ambient sensors, real-time processing algorithms, wireless data transmission and a remote monitoring station. Implementation details and field results are shown along with a discussion of the main problems found in real-life telemetry monitoring.

Implementation of a Research Information Management System in a Pediatric Hospital.

PubMed

Kissling, Alison D; Ballinger, Kimberly D

2018-01-01

Faculty publications have been collected in universities, health, and medical institutions for many years, and Cincinnati Children's is no exception. Since 1949, a yearly list of faculty publications was manually compiled using multiple data sources and disseminated by the Edward L. Pratt Research Library. Products to centralize faculty publication collection and analysis with bibliometric tools are growing in popularity. This article will review the collaborative decision to choose a Research Information Management System and the implementation process including successes, challenges, and future opportunities.

Implementing non-invasive prenatal testing for aneuploidy in a national healthcare system: global challenges and national solutions.

PubMed

van Schendel, Rachèl V; van El, Carla G; Pajkrt, Eva; Henneman, Lidewij; Cornel, Martina C

2017-09-19

Since the introduction of non-invasive prenatal testing (NIPT) in 2011, mainly by commercial companies, a growing demand for NIPT from the public and healthcare professionals has been putting pressure on the healthcare systems of various countries. This study identifies the challenges of establishing a responsible implementation of NIPT for aneuploidy in prenatal healthcare, by looking at the Netherlands. A mixed methods approach involving 13 stakeholder interviews, document analysis and (participatory) observations of the Dutch NIPT Consortium meetings were used. The Diffusion of Innovation Theory and a Network of Actors model were used to interpret the findings. Implementation of NIPT was facilitated by several factors. The set-up of a national NIPT Consortium enabled discussion and collaboration between stakeholders. Moreover, it led to the plan to offer NIPT through a nationwide research setting (TRIDENT studies), which created a learning phase for careful implementation. The Dutch legal context was perceived as a delaying factor, but eventually gave room for the parties involved to organise themselves and their practices. This study shows that implementing advanced technologies with profound effects on prenatal care benefit from a learning phase that allows time to carefully evaluate the technical performance and women's experiences and to enable public debate. Such a coordinated learning phase, involving all stakeholders, will stimulate the process of responsible and sustainable implementation.

Reflections of Malaysian parents of children with developmental disabilities on their experiences with AAC.

PubMed

Joginder Singh, Susheel; Hussein, Nur Hazirah; Mustaffa Kamal, Rahayu; Hassan, Fatimah Hani

2017-06-01

Parents play an important role in the successful implementation of AAC. Previous research has indicated that parents in different countries have varying perceptions about the use of AAC and face different challenges in its implementation. To date, there is limited information about the use of AAC by children in Malaysia or parents' views about its use. The aim of this study was to explore Malaysian parents' perception of AAC and their experience when supporting their children who use AAC. For this study, 12 parents of children with autism spectrum disorder and cerebral palsy were involved in semi-structured individual interviews. Qualitative content analysis was used to analyze interview data. Following analysis, three themes were identified: (a) impact of the use of AAC, (b) challenges faced, and (c) hopes and expectations. Participants reported that the use of AAC had a positive impact on their children, but that they faced challenges related to the child, the settings, and the system itself, as well as a lack of time and support. Findings from this study provide an insight for Malaysian speech therapists about the challenges faced by parents when supporting their children who use AAC, and how important it is to overcome these challenges to ensure successful implementation of AAC.

Universal coverage challenges require health system approaches; the case of India.

PubMed

Duran, Antonio; Kutzin, Joseph; Menabde, Nata

2014-02-01

This paper uses the case of India to demonstrate that Universal Health Coverage (UHC) is about not only health financing; personal and population services production issues, stewardship of the health system and generation of the necessary resources and inputs need to accompany the health financing proposals. In order to help policy makers address UHC in India and sort out implementation issues, the framework developed by the World Health Organization (WHO) in the World Health Report 2000 and its subsequent extensions are advocated. The framework includes final goals, generic intermediate objectives and four inter-dependent functions which interact as a system; it can be useful by diagnosing current shortcomings and facilitating the filling up of gaps between functions and goals. Different positions are being defended in India re the preconditions for UHC to succeed. This paper argues that more (public) money will be important, but not enough; it needs to be supplemented with broad interventions at various health system levels. The paper analyzes some of the most important issues in relation to the functions of service production, generation of inputs and the necessary stewardship. It also pays attention to reform implementation, as different from its design, and suggests critical aspects emanating from a review of recent health system reforms. Precisely because of the lack of comparative reference for India, emphasis is made on the need to accompany implementation with analysis, so that the "solutions" ("what to do?", "how to do it?") are found through policy analysis and research embedded into flexible implementation. Strengthening "evidence-to-policy" links and the intelligence dimension of stewardship/leadership as well as accountability during implementation are considered paramount. Countries facing similar challenges to those faced by India can also benefit from the above approaches. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Building a Global Earth Observation System of Systems (GEOSS) and Its Interoperability Challenges

NASA Astrophysics Data System (ADS)

Ryan, B. J.

2015-12-01

Launched in 2005 by industrialized nations, the Group on Earth Observations (GEO) began building the Global Earth Observation System of Systems (GEOSS). Consisting of both a policy framework, and an information infrastructure, GEOSS, was intended to link and/or integrate the multitude of Earth observation systems, primarily operated by its Member Countries and Participating Organizations, so that users could more readily benefit from global information assets for a number of society's key environmental issues. It was recognized that having ready access to observations from multiple systems was a prerequisite for both environmental decision-making, as well as economic development. From the very start, it was also recognized that the shear complexity of the Earth's system cannot be captured by any single observation system, and that a federated, interoperable approach was necessary. While this international effort has met with much success, primarily in advancing broad, open data policies and practices, challenges remain. In 2014 (Geneva, Switzerland) and 2015 (Mexico City, Mexico), Ministers from GEO's Member Countries, including the European Commission, came together to assess progress made during the first decade (2005 to 2015), and approve implementation strategies and mechanisms for the second decade (2016 to 2025), respectively. The approved implementation strategies and mechanisms are intended to advance GEOSS development thereby facilitating the increased uptake of Earth observations for informed decision-making. Clearly there are interoperability challenges that are technological in nature, and several will be discussed in this presentation. There are, however, interoperability challenges that can be better characterized as economic, governmental and/or political in nature, and these will be discussed as well. With the emergence of the Sustainable Development Goals (SDGs), the World Conference on Disaster Risk Reduction (WCDRR), and the United Nations Framework Convention on Climate Change (UNFCCC) having occurred this year, it will be essential that the interoperability challenges described herein, regardless of their nature, be expeditiously addressed so that Earth observations can indeed inform societal decision-making.

Implementation of Hepatitis Information Management System in Iran.

PubMed

Reza, Safdari; Jebraeil, Farzi; Akbar, Nasiri Ali; Marjan, Ghazisaeedi; Reza, Taghavi Mohammad; Mehdi, Afshari; Mahlagha, Sargolzaee; Farhad, Taji

2015-11-17

Nowadays, hepatitis is of the most important health priorities around the world, where information plays a very significant role in specialized diseases prevention planning, and policy- and decision-making processes. Thus, this study addressed challenges of hepatitis information management and investigated the outcomes of establishing a hepatitis information management system to overcome such challenges. To this end, this research intended to study the implementation of an Electronic hepatitis information management system. This is an applied-developmental study with following specifications and procedures: preparation of study proposal and design, justification of the design's stakeholders, approval of the design by the Postgraduate Education Council of Faculty, determination of pilot hepatitis control center, software development, deciding on control, prevention, and treatment centers, and finally development of a network-based system for collecting and managing hepatitis information. Results indicated that the inconsistency and lack of integrity of data, as well as the lack of communication between related units prevented timely information register of viral hepatic patients and services that are provided to them. This inhibited the possibility of considering a follow-up process. However, the implementation of this system and involvement of relevant units greatly solved these problems. Results show that the implementation of an electronic system for the management of hepatitis control, prevention, and treatment is a regional and national requirement; since, this system with its empowered infrastructure is capable in providing desired services to all laboratories, counseling and health centers, specialized clinics, and physicians connected to the hepatitis network. This enables them to follow up and monitor patients' conditions. That mentioned system paves the way for the analysis of gathered information, managers' and specialists' access in different regions to the data for making appropriate and accurate decisions.

Implementation of Hepatitis Information Management System in Iran

PubMed Central

Reza, Safdari; Jebraeil, Farzi; Akbar, Nasiri Ali; Marjan, Ghazisaeedi; Reza, Taghavi Mohammad; Mehdi, Afshari; Mahlagha, Sargolzaee; Farhad, Taji

2016-01-01

Introduction: Nowadays, hepatitis is of the most important health priorities around the world, where information plays a very significant role in specialized diseases prevention planning, and policy- and decision-making processes. Thus, this study addressed challenges of hepatitis information management and investigated the outcomes of establishing a hepatitis information management system to overcome such challenges. To this end, this research intended to study the implementation of an Electronic hepatitis information management system. Methodology: This is an applied-developmental study with following specifications and procedures: preparation of study proposal and design, justification of the design’s stakeholders, approval of the design by the Postgraduate Education Council of Faculty, determination of pilot hepatitis control center, software development, deciding on control, prevention, and treatment centers, and finally development of a network-based system for collecting and managing hepatitis information. Findings: Results indicated that the inconsistency and lack of integrity of data, as well as the lack of communication between related units prevented timely information register of viral hepatic patients and services that are provided to them. This inhibited the possibility of considering a follow-up process. However, the implementation of this system and involvement of relevant units greatly solved these problems. Conclusion: Results show that the implementation of an electronic system for the management of hepatitis control, prevention, and treatment is a regional and national requirement; since, this system with its empowered infrastructure is capable in providing desired services to all laboratories, counseling and health centers, specialized clinics, and physicians connected to the hepatitis network. This enables them to follow up and monitor patients’ conditions. That mentioned system paves the way for the analysis of gathered information, managers’ and specialists’ access in different regions to the data for making appropriate and accurate decisions. PMID:26755478

Critical success factors in implementing an e-rostering system in a healthcare organisation.

PubMed

Soomro, Zahoor A; Ahmed, Javed; Muhammad, Raza; Hayes, Dawn; Shah, Mahmood H

2017-01-01

Effective and efficient staff scheduling has always been a challenging issue, especially in health service organisations. Both the extremes of staff shortage and overage have an adverse impact on the performance of healthcare organisations. In this case, an electronic and systematic staff scheduling (e-rostering) system is the often seen as the best solution. Unless an organisation has an effective implementation of such a system, possible cost savings, efficiency, and benefits could be minimal. This study is aimed to research key success factors for the successful effective implementation of an electronic rostering system, especially at healthcare organisations. A case study research method was used to evaluate critical success factors for effectively implementing an e-rostering system. The data were collected through interviews and observations. The findings indicate that technical support, an effective policy, leadership, clear goals and objectives, gradual change, evidence of the advantages of the new system, senior management support, and effective communication are the critical success factors in implementing an e-rostering system in healthcare organisations. Prior to this study, no such factors were grounded in the current context, so this research would help in bridging the gap towards effective implementation of an e-rostering system in the healthcare sector. This research also suggests future studies in different cultures and contexts.

A big data approach for climate change indicators processing in the CLIP-C project

NASA Astrophysics Data System (ADS)

D'Anca, Alessandro; Conte, Laura; Palazzo, Cosimo; Fiore, Sandro; Aloisio, Giovanni

2016-04-01

Defining and implementing processing chains with multiple (e.g. tens or hundreds of) data analytics operators can be a real challenge in many practical scientific use cases such as climate change indicators. This is usually done via scripts (e.g. bash) on the client side and requires climate scientists to take care of, implement and replicate workflow-like control logic aspects (which may be error-prone too) in their scripts, along with the expected application-level part. Moreover, the big amount of data and the strong I/O demand pose additional challenges related to the performance. In this regard, production-level tools for climate data analysis are mostly sequential and there is a lack of big data analytics solutions implementing fine-grain data parallelism or adopting stronger parallel I/O strategies, data locality, workflow optimization, etc. High-level solutions leveraging on workflow-enabled big data analytics frameworks for eScience could help scientists in defining and implementing the workflows related to their experiments by exploiting a more declarative, efficient and powerful approach. This talk will start introducing the main needs and challenges regarding big data analytics workflow management for eScience and will then provide some insights about the implementation of some real use cases related to some climate change indicators on large datasets produced in the context of the CLIP-C project - a EU FP7 project aiming at providing access to climate information of direct relevance to a wide variety of users, from scientists to policy makers and private sector decision makers. All the proposed use cases have been implemented exploiting the Ophidia big data analytics framework. The software stack includes an internal workflow management system, which coordinates, orchestrates, and optimises the execution of multiple scientific data analytics and visualization tasks. Real-time workflow monitoring execution is also supported through a graphical user interface. In order to address the challenges of the use cases, the implemented data analytics workflows include parallel data analysis, metadata management, virtual file system tasks, maps generation, rolling of datasets, and import/export of datasets in NetCDF format. The use cases have been implemented on a HPC cluster of 8-nodes (16-cores/node) of the Athena Cluster available at the CMCC Supercomputing Centre. Benchmark results will be also presented during the talk.

The Implementation Challenge and the Learning Health System for SCI Initiative.

PubMed

Stucki, Gerold; Bickenbach, Jerome

2017-02-01

The paper introduces the special issue by linking the International Spinal Cord Injury (InSCI) Community Survey study to the Learning Health System for SCI Initiative (LHS-SCI). The LHS-SCI was designed to respond to the implementation challenge of bringing about policy reform in light of the targeted policy recommendations of World Health Organization's International Perspectives on SCI report as well as the call for action of WHO's Global Disability Action Plan. The paper reviews the components of LHS-SCI relevant to internationally comparable information, a theory of change to guide for action, and the tools for evidence-informed policy. The interplay between persons, their health needs, and the societal response to those needs provides the foundation for the organization of the LHS-SCI Initiative. Moreover, as the other articles in this special issue describe in detail, the rationale, conceptualization, and study design of the InSCI study are also informed by the rationale, and mission, of the LHS for SCI Initiative. The LHS-SCI, and the implementation challenge that motivates it, is responsible for the design of the InSCI study and the overall mission of LHS-SCI to continuously improve the lived experience of people living with SCI around the world through an international evidence- and rights-informed research and policy reform effort.

Global-to-local policy transfer in the introduction of new molecular tuberculosis diagnostics in South Africa.

PubMed

Colvin, C J; Leon, N; Wills, C; van Niekerk, M; Bissell, K; Naidoo, P

2015-11-01

Lack of innovation in diagnostics has contributed to tuberculosis (TB) remaining a global health challenge. It is critical to understand how new diagnostic technologies are translated into policies and how these are implemented. To examine policy transfer for two rapid molecular diagnostic tests, GenoType(®) MDRTBplus and Xpert(®) MTB/RIF, to understand policy development, uptake and implementation in South Africa. A policy transfer analysis framework integrating the key dimensions of policy transfer into one coherent model was used. Two phases of key informant interviews were undertaken with a wide range of stakeholders. Both tests were developed through innovative partnerships and responded to urgent public health needs. GenoType was introduced through a process that was more inclusive than that for Xpert. National policy and planning processes were opaque for both tests. Their implementation, maintenance and expansion suffered from poor communication and coordination, insufficient attention to resource implications, technical challenges and a lack of broader health systems thinking. Our analysis identified the risks and benefits of partnerships for technological innovation, the complex intersections between global and national actors and the impact of health systems on policy transfer, and the risks of rescue- and technology-focused thinking in addressing public health challenges.

Reframing the Dissemination Challenge: A Marketing and Distribution Perspective

PubMed Central

Bernhardt, Jay M.

2009-01-01

A fundamental obstacle to successful dissemination and implementation of evidence-based public health programs is the near-total absence of systems and infrastructure for marketing and distribution. We describe the functions of a marketing and distribution system, and we explain how it would help move effective public health programs from research to practice. Then we critically evaluate the 4 dominant strategies now used to promote dissemination and implementation, and we explain how each would be enhanced by marketing and distribution systems. Finally, we make 6 recommendations for building the needed system infrastructure and discuss the responsibility within the public health community for implementation of these recommendations. Without serious investment in such infrastructure, application of proven solutions in public health practice will continue to occur slowly and rarely. PMID:19833993

iSERVO: Implementing the International Solid Earth Research Virtual Observatory by Integrating Computational Grid and Geographical Information Web Services

NASA Astrophysics Data System (ADS)

Aktas, Mehmet; Aydin, Galip; Donnellan, Andrea; Fox, Geoffrey; Granat, Robert; Grant, Lisa; Lyzenga, Greg; McLeod, Dennis; Pallickara, Shrideep; Parker, Jay; Pierce, Marlon; Rundle, John; Sayar, Ahmet; Tullis, Terry

2006-12-01

We describe the goals and initial implementation of the International Solid Earth Virtual Observatory (iSERVO). This system is built using a Web Services approach to Grid computing infrastructure and is accessed via a component-based Web portal user interface. We describe our implementations of services used by this system, including Geographical Information System (GIS)-based data grid services for accessing remote data repositories and job management services for controlling multiple execution steps. iSERVO is an example of a larger trend to build globally scalable scientific computing infrastructures using the Service Oriented Architecture approach. Adoption of this approach raises a number of research challenges in millisecond-latency message systems suitable for internet-enabled scientific applications. We review our research in these areas.

Reframing the dissemination challenge: a marketing and distribution perspective.

PubMed

Kreuter, Matthew W; Bernhardt, Jay M

2009-12-01

A fundamental obstacle to successful dissemination and implementation of evidence-based public health programs is the near-total absence of systems and infrastructure for marketing and distribution. We describe the functions of a marketing and distribution system, and we explain how it would help move effective public health programs from research to practice. Then we critically evaluate the 4 dominant strategies now used to promote dissemination and implementation, and we explain how each would be enhanced by marketing and distribution systems. Finally, we make 6 recommendations for building the needed system infrastructure and discuss the responsibility within the public health community for implementation of these recommendations. Without serious investment in such infrastructure, application of proven solutions in public health practice will continue to occur slowly and rarely.

ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM

PubMed Central

Haser, Grace C.; Tuttle, R. Michael; Su, Henry K.; Alon, Eran E.; Bergman, Donald; Bernet, Victor; Brett, Elise; Cobin, Rhoda; Dewey, Eliza H.; Doherty, Gerard; Dos Reis, Laura L.; Harris, Jeffrey; Klopper, Joshua; Lee, Stephanie L.; Levine, Robert A.; Lepore, Stephen J.; Likhterov, Ilya; Lupo, Mark A.; Machac, Josef; Mechanick, Jeffrey I.; Mehra, Saral; Milas, Mira; Orloff, Lisa A.; Randolph, Gregory; Revenson, Tracey A.; Roberts, Katherine J.; Ross, Douglas S.; Rowe, Meghan E.; Smallridge, Robert C.; Terris, David; Tufano, Ralph P.; Urken, Mark L.

2017-01-01

Objective The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy. Methods We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed. Results Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance. Conclusion With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient’s clinical status. PMID:26799628

Copability, coping, and learning as focal concepts in the evaluation of computerised diabetes disease management.

PubMed

Boisen, Egil; Bygholm, Ann; Cavan, David; Hejlesen, Ole K

2003-07-01

Within diabetes care, the majority of health decisions are in the hands of the patient. Therefore, the concepts of disease management and self-care represent inescapable challenges for both patient and healthcare professionals, entailing a considerable amount of learning. Thus, a computerised diabetes disease management systems (CDDM) is to be seen not merely as tools for the medical treatment, but also as pedagogical tools to enhance patient competence. The unfortunate lack of success for most knowledge-based systems might be related to the problem of finding an adequate way of evaluating the systems from their development through the implementation phase to the daily clinical practice. The following presents the initial methodological considerations for evaluating the usefulness of a CDDM system called DiasNet, which is being implemented as a learning tool for patients. The evaluation of usefulness of a CDDM, we claim, entails clinical assessment taking into account the challenges and pitfalls in diabetes disease management. Drawing on activity theory, we suggest the concept of copability as a supplement to 'usability' and 'utility' when determining 'usefulness'. We maintain that it is necessary to ask how well the user copes with the new situation using the system. As ways to measure copability of DiasNet the concepts of coping and learning are discussed, as well as ways this methodology might inform systems development, implementation, and daily clinical practice.

Ultra low power CMOS technology

NASA Technical Reports Server (NTRS)

Burr, J.; Peterson, A.

1991-01-01

This paper discusses the motivation, opportunities, and problems associated with implementing digital logic at very low voltages, including the challenge of making use of the available real estate in 3D multichip modules, energy requirements of very large neural networks, energy optimization metrics and their impact on system design, modeling problems, circuit design constraints, possible fabrication process modifications to improve performance, and barriers to practical implementation.

The Development of a System of Study Credits in Ukraine: The Case of Policy Layering in the Bologna Process

ERIC Educational Resources Information Center

Kushnir, Iryna

2017-01-01

The Bologna Process is an intergovernmental initiative aimed to make higher education degrees compatible in Europe. Previous research into the implementation of the Bologna objectives (or action lines) views the influence of the context as a challenge. This article suggests a different approach for analysing the implementation of the Bologna…

The Staff Perceptions of Behavior and Discipline Survey: A Tool to Help Achieve Systemic Change through Schoolwide Positive Behavior Support

ERIC Educational Resources Information Center

Feuerborn, Laura L.; Tyre, Ashli D.; King, Joe P.

2015-01-01

The practices of schoolwide positive behavior support (SWPBS) are dependent on staff implementation in classroom and common areas throughout the school. Thus, gaining the support and commitment of school staff is a critical step toward reaching full implementation of SWPBS. However, achieving buildingwide support can be challenging; many schools…

Evaluative Case Study of the Effectiveness of Professional Development Elements When Implementing a Learning Management System in Elementary Education

ERIC Educational Resources Information Center

Beams, Tara E.

2017-01-01

As school districts across the country attempt to comply with federal and state mandates to effectively integrate technology into today's teaching and learning, they must face the challenge of also developing professional development plans which will adequately and successfully prepare teachers for implementing these new resources and these new…

Meta-Assessment in a Project-Based Systems Engineering Course

ERIC Educational Resources Information Center

Wengrowicz, Niva; Dori, Yehudit Judy; Dori, Dov

2017-01-01

Project-based learning (PBL) facilitates significant learning, but it poses a major assessment challenge for assessing individual content knowledge. We developed and implemented an assessment approach and tool for a mandatory undergraduate systems engineering PBL-based course. We call this type of assessment "student-oriented"…

'It makes me want to run away to Saudi Arabia': management and implementation challenges for public financing reforms from a maternity ward perspective.

PubMed

Penn-Kekana, Loveday; Blaauw, Duane; Schneider, Helen

2004-10-01

Poor practice by health care workers has been identified as contributing to high levels of maternal mortality in South Africa. The country is undergoing substantial structural and financial reforms, yet the impact of these on health care workers performance and practice has not been studied. This study, which consisted of an ethnography of two labour wards (one rural and one urban), aimed to look at the factors that shaped everyday practice of midwives working in district hospitals in South Africa during the implementation of a public sector reform to improve financial management. The study found that the Public Financing Management Act, that aimed to improve the efficiency and accountability of public finance management, had the unintended consequence of causing the quality of maternal health services to deteriorate in the hospital wards studied. The article supports the need for increased dialogue between those working in the sexual and reproductive health and health systems policy arenas, and the importance of giving a voice to front-line health workers who implement systems changes. However, it cautions that there are no simple answers to how health systems should be organized in order to better provide sexual and reproductive health services, and suggests instead that more attention in the debate needs to be paid to the challenges of policy implementation and the socio-political context and process issues which affect the success or failure of the implementation. Copyright 2004 Oxford University Press

The Challenges of Implementing Next Generation Sequencing Across a Large Healthcare System, and the Molecular Epidemiology and Antibiotic Susceptibilities of Carbapenemase-Producing Bacteria in the Healthcare System of the U.S. Department of Defense

PubMed Central

Lesho, Emil; Clifford, Robert; Onmus-Leone, Fatma; Appalla, Lakshmi; Snesrud, Erik; Kwak, Yoon; Ong, Ana; Maybank, Rosslyn; Waterman, Paige; Rohrbeck, Patricia; Julius, Michael; Roth, Amanda; Martinez, Joshua; Nielsen, Lindsey; Steele, Eric; McGann, Patrick; Hinkle, Mary

2016-01-01

Objective We sought to: 1) provide an overview of the genomic epidemiology of an extensive collection of carbapenemase-producing bacteria (CPB) collected in the U.S. Department of Defense health system; 2) increase awareness of the public availability of the sequences, isolates, and customized antimicrobial resistance database of that system; and 3) illustrate challenges and offer mitigations for implementing next generation sequencing (NGS) across large health systems. Design Prospective surveillance and system-wide implementation of NGS. Setting 288-hospital healthcare network. Methods All phenotypically carbapenem resistant bacteria underwent CarbaNP® testing and PCR, followed by NGS. Commercial (Newbler and Geneious), on-line (ResFinder), and open-source software (Btrim, FLASh, Bowtie2, an Samtools) were used for assembly, SNP detection and clustering. Laboratory capacity, throughput, and response time were assessed. Results From 2009 through 2015, 27,000 multidrug-resistant Gram-negative isolates were submitted. 225 contained carbapenemase-encoding genes (most commonly blaKPC, blaNDM, and blaOXA23). These were found in 15 species from 146 inpatients in 19 facilities. Genetically related CPB were found in more than one hospital. Other clusters or outbreaks were not clonal and involved genetically related plasmids, while some involved several unrelated plasmids. Relatedness depended on the clustering algorithm used. Transmission patterns of plasmids and other mobile genetic elements could not be determined without ultra-long read, single-molecule real-time sequencing. 80% of carbapenem-resistant phenotypes retained susceptibility to aminoglycosides, and 70% retained susceptibility to fluoroquinolones. However, among the CPB-confirmed genotypes, fewer than 25% retained susceptibility to aminoglycosides or fluoroquinolones. Conclusion Although NGS is increasingly acclaimed to revolutionize clinical practice, resource-constrained environments, large or geographically dispersed healthcare networks, and military or government-funded public health laboratories are likely to encounter constraints and challenges as they implement NGS across their health systems. These include lack of standardized definitions and quality control metrics, limitations of short-read sequencing, insufficient bandwidth, and the current limited availability of very expensive and scarcely available sequencing platforms. Possible solutions and mitigations are also proposed. PMID:27196272

The Challenges of Implementing Next Generation Sequencing Across a Large Healthcare System, and the Molecular Epidemiology and Antibiotic Susceptibilities of Carbapenemase-Producing Bacteria in the Healthcare System of the U.S. Department of Defense.

PubMed

Lesho, Emil; Clifford, Robert; Onmus-Leone, Fatma; Appalla, Lakshmi; Snesrud, Erik; Kwak, Yoon; Ong, Ana; Maybank, Rosslyn; Waterman, Paige; Rohrbeck, Patricia; Julius, Michael; Roth, Amanda; Martinez, Joshua; Nielsen, Lindsey; Steele, Eric; McGann, Patrick; Hinkle, Mary

2016-01-01

We sought to: 1) provide an overview of the genomic epidemiology of an extensive collection of carbapenemase-producing bacteria (CPB) collected in the U.S. Department of Defense health system; 2) increase awareness of the public availability of the sequences, isolates, and customized antimicrobial resistance database of that system; and 3) illustrate challenges and offer mitigations for implementing next generation sequencing (NGS) across large health systems. Prospective surveillance and system-wide implementation of NGS. 288-hospital healthcare network. All phenotypically carbapenem resistant bacteria underwent CarbaNP® testing and PCR, followed by NGS. Commercial (Newbler and Geneious), on-line (ResFinder), and open-source software (Btrim, FLASh, Bowtie2, an Samtools) were used for assembly, SNP detection and clustering. Laboratory capacity, throughput, and response time were assessed. From 2009 through 2015, 27,000 multidrug-resistant Gram-negative isolates were submitted. 225 contained carbapenemase-encoding genes (most commonly blaKPC, blaNDM, and blaOXA23). These were found in 15 species from 146 inpatients in 19 facilities. Genetically related CPB were found in more than one hospital. Other clusters or outbreaks were not clonal and involved genetically related plasmids, while some involved several unrelated plasmids. Relatedness depended on the clustering algorithm used. Transmission patterns of plasmids and other mobile genetic elements could not be determined without ultra-long read, single-molecule real-time sequencing. 80% of carbapenem-resistant phenotypes retained susceptibility to aminoglycosides, and 70% retained susceptibility to fluoroquinolones. However, among the CPB-confirmed genotypes, fewer than 25% retained susceptibility to aminoglycosides or fluoroquinolones. Although NGS is increasingly acclaimed to revolutionize clinical practice, resource-constrained environments, large or geographically dispersed healthcare networks, and military or government-funded public health laboratories are likely to encounter constraints and challenges as they implement NGS across their health systems. These include lack of standardized definitions and quality control metrics, limitations of short-read sequencing, insufficient bandwidth, and the current limited availability of very expensive and scarcely available sequencing platforms. Possible solutions and mitigations are also proposed.

Update - Concept of Operations for Integrated Model-Centric Engineering at JPL

NASA Technical Reports Server (NTRS)

Bayer, Todd J.; Bennett, Matthew; Delp, Christopher L.; Dvorak, Daniel; Jenkins, Steven J.; Mandutianu, Sanda

2011-01-01

The increasingly ambitious requirements levied on JPL's space science missions, and the development pace of such missions, challenge our current engineering practices. All the engineering disciplines face this growth in complexity to some degree, but the challenges are greatest in systems engineering where numerous competing interests must be reconciled and where complex system level interactions must be identified and managed. Undesired system-level interactions are increasingly a major risk factor that cannot be reliably exposed by testing, and natural-language single-viewpoint specifications areinadequate to capture and expose system level interactions and characteristics. Systems engineering practices must improve to meet these challenges, and the most promising approach today is the movement toward a more integrated and model-centric approach to mission conception, design, implementation and operations. This approach elevates engineering models to a principal role in systems engineering, gradually replacing traditional document centric engineering practices.

The Metro Firm System: meeting the challenges of a changing health care environment.

PubMed

Dawson, N V

Changes in the health care system and especially in reimbursement systems are creating new challenges for all hospitals. These challenges are particularly critical for academic medical centers. The traditional (inpatient) teaching base is threatened by changes in the case mix of patients entering hospitals and by the associated decreasing lengths of stay. The effects of the new financial pressures are intensified in academic centers which have been shown to be less efficient and more costly than community hospitals. This paper describes the formation and evolution of the Metro Firm System, an organizational structure which is adapting to the changing demands placed on an academic medical center. Inherent in its structure is the ability to evaluate easily and rigorously changes that have been suggested in the system prior to implementing them. Operational details essential for understanding functions of and interrelationships within the system are included.

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria.

PubMed

Sam-Agudu, Nadia A; Aliyu, Muktar H; Adeyemi, Olusegun A; Oronsaye, Frank; Oyeledun, Bolanle; Ogidi, Amaka G; Ezeanolue, Echezona E

2018-04-17

Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.

Fault Management Architectures and the Challenges of Providing Software Assurance

NASA Technical Reports Server (NTRS)

Savarino, Shirley; Fitz, Rhonda; Fesq, Lorraine; Whitman, Gerek

2015-01-01

Fault Management (FM) is focused on safety, the preservation of assets, and maintaining the desired functionality of the system. How FM is implemented varies among missions. Common to most missions is system complexity due to a need to establish a multi-dimensional structure across hardware, software and spacecraft operations. FM is necessary to identify and respond to system faults, mitigate technical risks and ensure operational continuity. Generally, FM architecture, implementation, and software assurance efforts increase with mission complexity. Because FM is a systems engineering discipline with a distributed implementation, providing efficient and effective verification and validation (V&V) is challenging. A breakout session at the 2012 NASA Independent Verification & Validation (IV&V) Annual Workshop titled "V&V of Fault Management: Challenges and Successes" exposed this issue in terms of V&V for a representative set of architectures. NASA's Software Assurance Research Program (SARP) has provided funds to NASA IV&V to extend the work performed at the Workshop session in partnership with NASA's Jet Propulsion Laboratory (JPL). NASA IV&V will extract FM architectures across the IV&V portfolio and evaluate the data set, assess visibility for validation and test, and define software assurance methods that could be applied to the various architectures and designs. This SARP initiative focuses efforts on FM architectures from critical and complex projects within NASA. The identification of particular FM architectures and associated V&V/IV&V techniques provides a data set that can enable improved assurance that a system will adequately detect and respond to adverse conditions. Ultimately, results from this activity will be incorporated into the NASA Fault Management Handbook providing dissemination across NASA, other agencies and the space community. This paper discusses the approach taken to perform the evaluations and preliminary findings from the research.

Designing and evaluating an electronic patient falls reporting system: perspectives for the implementation of health information technology in long-term residential care facilities.

PubMed

Mei, Yi You; Marquard, Jenna; Jacelon, Cynthia; DeFeo, Audrey L

2013-11-01

Patient falls are the leading cause of unintentional injury and death among older adults. In 2000, falls resulted in over 10,300 elderly deaths, costing the United States approximately $179 million in incidence and medical costs. Furthermore, non-fatal injuries caused by falls cost the United States $19 billion annually. Health information technology (IT) applications, specifically electronic falls reporting systems, can aid quality improvement efforts to prevent patient falls. Yet, long-term residential care facilities (LTRCFs) often do not have the financial resources to implement health IT, and workers in these settings are often not ready to adopt such systems. Additionally, most health IT evaluations are conducted in large acute-care settings, so LTRCF administrators currently lack evidence to support the value of health IT. In this paper, we detail the development of a novel, easy-to-use system to facilitate electronic patient falls reporting within a LTRCF using off-the-shelf technology that can be inexpensively implemented in a wide variety of settings. We report the results of four complimentary system evaluation measures that take into consideration varied organizational stakeholders' perspectives: (1) System-level benefits and costs, (2) system usability, via scenario-based use cases, (3) a holistic assessment of users' physical, cognitive, and marcoergonomic (work system) challenges in using the system, and (4) user technology acceptance. We report the viability of collecting and analyzing data specific to each evaluation measure and detail the relative merits of each measure in judging whether the system is acceptable to each stakeholder. The electronic falls reporting system was successfully implemented, with 100% reporting at 3-months post-implementation. The system-level benefits and costs approach showed that the electronic system required no initial investment costs aside from personnel costs and significant benefits accrued from user time savings. The usability analysis revealed several fixable design flaws and demonstrated the importance of scenario-based user training. The technology acceptance model showed that users perceived the reporting system to be useful and easy to use, even more so after implementation. Finally, the holistic human factors evaluation identified challenges encountered when nurses used the system as a part of their daily work, guiding further system redesign. The four-pronged evaluation framework accounted for varied stakeholder perspectives and goals and is a highly scalable framework that can be easily applied to health IT implementations in other LTRCFs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Neonatal endocrine emergencies: a primer for the emergency physician.

PubMed

Park, Elizabeth; Pearson, Nadia M; Pillow, M Tyson; Toledo, Alexander

2014-05-01

The resuscitation principles of securing the airway and stabilizing hemodynamics remain the same in any neonatal emergency. However, stabilizing endocrine disorders may prove especially challenging. Several organ systems are affected simultaneously and the clinical presentation can be subtle. Although not all-inclusive, the implementation of newborn screening tests has significantly reduced morbidity and mortality in neonates. Implementing routine screening tests worldwide and improving the accuracy of present tests remains the challenge for healthcare providers. With further study of these disorders and best treatment practices we can provide neonates presenting to the emergency department with the best possible outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Grand Challenges in Clinical Decision Support v10

PubMed Central

Sittig, Dean F.; Wright, Adam; Osheroff, Jerome A.; Middleton, Blackford; Teich, Jonathan M.; Ash, Joan S.; Campbell, Emily; Bates, David W.

2008-01-01

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: Improve the human-computer interface; Disseminate best practices in CDS design, development, and implementation; Summarize patient-level information; Prioritize and filter recommendations to the user; Create an architecture for sharing executable CDS modules and services; Combine recommendations for patients with co-morbidities; Prioritize CDS content development and implementation; Create internet-accessible clinical decision support repositories; Use freetext information to drive clinical decision support; Mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare. PMID:18029232

Using formative evaluation in an implementation project to increase vaccination rates in high-risk veterans: QUERI Series

PubMed Central

Wallace, Carolyn M; Legro, Marcia W

2008-01-01

Background Implementation of research into practice in health care systems is a challenging and often unsuccessful endeavor. The United States Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) research teams include formative evaluations (FE) in their action-oriented VA implementation projects to identify critical information about the processes of implementation that can guide adjustments to project activities, in order to better meet project goals. This article describes the development and use of FE in an action-oriented implementation research project. Methods This two-year action-oriented implementation research project was conducted at 23 VA Spinal Cord Injury (SCI) Centers, and targeted patients, staff and the system of care, such as administration and information technology. Data for FE were collected by electronic and paper surveys, semi-structured and open-ended interviews, notes during conference calls, and exchange of e-mail messages. Specific questions were developed for each intervention (designed to improve vaccination rates for influenza in veterans with spinal cord injury and disorder); informants were selected for their knowledge of interventions and their use in SCI Centers. Results Data from FE were compiled separately for each intervention to describe barriers to progress and guide adjustments to implementation activities. These data addressed the processes of implementing the interventions, problem-solving activities and the status of interventions at SCI Centers. Conclusion Formative evaluations provided the project team with a broad view of the processes of implementing multi-targeted interventions as well as the evolving status of the related best practice. Using FE was useful, although the challenges of conducting FE for non-field researchers should be addressed. Work is needed to develop methods for conducting FE across multiple sites, as well as acknowledging variations in local contexts that affect implementation of interventions. PMID:18430201

Implementing PAT with Standards

NASA Astrophysics Data System (ADS)

Chandramohan, Laakshmana Sabari; Doolla, Suryanarayana; Khaparde, S. A.

2016-02-01

Perform Achieve Trade (PAT) is a market-based incentive mechanism to promote energy efficiency. The purpose of this work is to address the challenges inherent to inconsistent representation of business processes, and interoperability issues in PAT like cap-and-trade mechanisms especially when scaled. Studies by various agencies have highlighted that as the mechanism evolves including more industrial sectors and industries in its ambit, implementation will become more challenging. This paper analyses the major needs of PAT (namely tracking, monitoring, auditing & verifying energy-saving reports, and providing technical support & guidance to stakeholders); and how the aforesaid reasons affect them. Though current technologies can handle these challenges to an extent, standardization activities for implementation have been scanty for PAT and this work attempts to evolve them. The inconsistent modification of business processes, rules, and procedures across stakeholders, and interoperability among heterogeneous systems are addressed. This paper proposes the adoption of specifically two standards into PAT, namely Business Process Model and Notation for maintaining consistency in business process modelling, and Common Information Model (IEC 61970, 61968, 62325 combined) for information exchange. Detailed architecture and organization of these adoptions are reported. The work can be used by PAT implementing agencies, stakeholders, and standardization bodies.

Scaling up HIV viral load - lessons from the large-scale implementation of HIV early infant diagnosis and CD4 testing.

PubMed

Peter, Trevor; Zeh, Clement; Katz, Zachary; Elbireer, Ali; Alemayehu, Bereket; Vojnov, Lara; Costa, Alex; Doi, Naoko; Jani, Ilesh

2017-11-01

The scale-up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point-of-care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low-resource countries. The purpose of this commentary is to review the challenges and solutions from the large-scale implementation of other diagnostic tests, namely nucleic-acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale-up of VL. Experience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale-up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow-up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business. The lessons and innovations from large-scale EID and CD4 programs described here can be adapted to inform more effective scale-up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost-effective test access. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Challenges in Ocean Data Assimilation for the US West Coast

NASA Astrophysics Data System (ADS)

Li, Z.; Chao, Y.; Farrara, J.; Wang, X.

2006-12-01

A three-dimensional variational data assimilation (3DVAR) system has been developed for the Regional Ocean Modeling System (ROMS), and it is called ROMS-DAS. This system provides a capability of predicting meso- to small-scale variations with temporal scales from hours to days in the coastal oceans. To cope with the particular difficulties that result from complex coastlines and bottom topography, unbalanced flows and sparse observations, ROMS-DAS utilizes several novel strategies. These strategies include the implementation of three-dimensional anisotropic and inhomogeneous error correlations, application of particular weak dynamic constraints, and implementation of efficient and reliable algorithms for minimizing the cost function. The ROMS-DAS system was applied in field experiments for Monterey Bay during both 2003 (Autonomous Ocean Sampling Network - AOSN) and 2006 (MB06). These two experiments included intensive data collection from a variety of observational platforms, including satellites, airplanes, High Frequency radars, Acoustic Doppler Current Profilers, ships, drifters, buoys, autonomous underwater vehicles (AUV), and particularly a fleet of undersea gliders. Using these data sets, various data assimilation experiments were performed to address several major data assimilation challenges that arise from multi-scales structures, inhomogeneous properties, dynamical imbalance of the flow, and tides. Basing on these experiments, a set of strategies were formulated to deal with those challenges.

Biomedical Informatics for Computer-Aided Decision Support Systems: A Survey

PubMed Central

Belle, Ashwin; Kon, Mark A.; Najarian, Kayvan

2013-01-01

The volumes of current patient data as well as their complexity make clinical decision making more challenging than ever for physicians and other care givers. This situation calls for the use of biomedical informatics methods to process data and form recommendations and/or predictions to assist such decision makers. The design, implementation, and use of biomedical informatics systems in the form of computer-aided decision support have become essential and widely used over the last two decades. This paper provides a brief review of such systems, their application protocols and methodologies, and the future challenges and directions they suggest. PMID:23431259

The Road to ICD-10-CM/PCS Implementation: Forecasting the Transition for Providers, Payers, and Other Healthcare Organizations

PubMed Central

Sanders, Tekla B; Bowens, Felicia M; Pierce, William; Stasher-Booker, Bridgette; Thompson, Erica Q; Jones, Warren A

2012-01-01

This article will examine the benefits and challenges of the US healthcare system's upcoming conversion to use of the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) and will review the cost implications of the transition. Benefits including improved quality of care, potential cost savings from increased accuracy of payments and reduction of unpaid claims, and improved tracking of healthcare data related to public health and bioterrorism events are discussed. Challenges are noted in the areas of planning and implementation, the financial cost of the transition, a shortage of qualified coders, the need for further training and education of the healthcare workforce, and the loss of productivity during the transition. Although the transition will require substantial implementation and conversion costs, potential benefits can be achieved in the areas of data integrity, fraud detection, enhanced cost analysis capabilities, and improved monitoring of patients’ health outcomes that will yield greater cost savings over time. The discussion concludes with recommendations to healthcare organizations of ways in which technological advances and workforce training and development opportunities can ease the transition to the new coding system. PMID:22548024

75 FR 57006 - Addressing Policy and Logistical Challenges to Smart Grid Implementation

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-17

... electric vehicles, photovoltaic cells, wind turbines, or inflexible nuclear plants? What approaches make... generation and electric vehicles into the electric system; detect and address equipment problems and outages...

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems

PubMed Central

2012-01-01

Background A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments’ healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Methods Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England’s National Health Service’s Care Records Service (NHS CRS). Results/discussion We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. Summary New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries. PMID:22545646

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems.

PubMed

Takian, Amirhossein; Petrakaki, Dimitra; Cornford, Tony; Sheikh, Aziz; Barber, Nicholas

2012-04-30

A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments' healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England's National Health Service's Care Records Service (NHS CRS). We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries.

Earth Observing System (EOS) Aqua and Aura Space Weather Effects on Operational Collision Avoidance

NASA Technical Reports Server (NTRS)

Guit, Bill

2017-01-01

This presentation will describe recent EOS Aqua and Aura operational collision avoidance experience during periods of solar and geomagnetic storm activity. It will highlight challenges faced by the operations team during short-notice, high-risk predicted close approaches. The presentation will highlight the evolution of the operational collision avoidance process for the EOS Aqua and Aura missions. The presentation will highlight operational challenges that have occurred, process improvements that have been implemented and identify potential future challenges.

Research gaps and technology needs in development of PHM for passive AdvSMR components

NASA Astrophysics Data System (ADS)

Meyer, Ryan M.; Ramuhalli, Pradeep; Coble, Jamie B.; Hirt, Evelyn H.; Mitchell, Mark R.; Wootan, David W.; Berglin, Eric J.; Bond, Leonard J.; Henagar, Chuck H., Jr.

2014-02-01

Advanced small modular reactors (AdvSMRs), which are based on modularization of advanced reactor concepts, may provide a longer-term alternative to traditional light-water reactors and near-term small modular reactors (SMRs), which are based on integral pressurized water reactor (iPWR) concepts. SMRs are challenged economically because of losses in economy of scale; thus, there is increased motivation to reduce the controllable operations and maintenance costs through automation technologies including prognostics health management (PHM) systems. In this regard, PHM systems have the potential to play a vital role in supporting the deployment of AdvSMRs and face several unique challenges with respect to implementation for passive AdvSMR components. This paper presents a summary of a research gaps and technical needs assessment performed for implementation of PHM for passive AdvSMR components.

Perspectives and Challenges of HMIS Officials in the Implementation of Health Management Information System (HMIS) with Reference to Maternal Health Services in Assam

PubMed Central

Dehury, Ranjit Kumar

2016-01-01

Introduction Health Management Information System (HMIS) is one of the important components of National Rural Health Mission (NRHM). The web portal of HMIS was launched by the Ministry of Health and Family Welfare (MOHFW), Govt. of India (GOI) in 21st Oct. 2008 to enable capturing of public health data from both public and private institutions in rural and urban areas across the country. Aim The aim of the study was to assess the quality perspectives and challenges among HMIS officials in implementing HMIS at their respective levels, i.e. district and block level. Materials and Methods We conducted a pilot qualitative study in two districts of Assam. HMIS officials working at district and block level were interviewed in-depth with the help of a semi-structured interview schedule which lasted from May to July 2014. Results Both HMIS and MCTS (Mother and Child Tracking System) formats were considered useful, by the HMIS officials, for data collection, planning at various levels, tracking maternal and neonatal deaths, institutional deliveries. HMIS officials reported that MCTS is useful for monitoring individual health status especially the status of the mother and child and HMIS being helpful as a health facility monitoring tool. Conclusion The study used a small sample size, hence similar type of studies are required with large sample size to understand the perspectives and challenges of HMIS officials in the implementation of HMIS. PMID:27504314

Implementation and Performance of a GPS/INS Tightly Coupled Assisted PLL Architecture Using MEMS Inertial Sensors

PubMed Central

Tawk, Youssef; Tomé, Phillip; Botteron, Cyril; Stebler, Yannick; Farine, Pierre-André

2014-01-01

The use of global navigation satellite system receivers for navigation still presents many challenges in urban canyon and indoor environments, where satellite availability is typically reduced and received signals are attenuated. To improve the navigation performance in such environments, several enhancement methods can be implemented. For instance, external aid provided through coupling with other sensors has proven to contribute substantially to enhancing navigation performance and robustness. Within this context, coupling a very simple GPS receiver with an Inertial Navigation System (INS) based on low-cost micro-electro-mechanical systems (MEMS) inertial sensors is considered in this paper. In particular, we propose a GPS/INS Tightly Coupled Assisted PLL (TCAPLL) architecture, and present most of the associated challenges that need to be addressed when dealing with very-low-performance MEMS inertial sensors. In addition, we propose a data monitoring system in charge of checking the quality of the measurement flow in the architecture. The implementation of the TCAPLL is discussed in detail, and its performance under different scenarios is assessed. Finally, the architecture is evaluated through a test campaign using a vehicle that is driven in urban environments, with the purpose of highlighting the pros and cons of combining MEMS inertial sensors with GPS over GPS alone. PMID:24569773

The Emergence and Challenging Growth of the Bio-Ethanol Innovation System in Taiwan (1949-2015).

PubMed

Chung, Chao-Chen; Yang, Siang-Cing

2016-02-19

This study explores the bio-ethanol innovation system in Taiwan from the perspective of a technology innovation system (TIS). Taiwan is a newly industrialized country and is not currently a main producer of bio-ethanol. This study analyzes the evolution of bio-ethanol innovation system in Taiwan and places a particular emphasis on challenges that present policies face in the context of potential long-term bio-ethanol development. Through an evaluation of the consistency of the present research, technology, development and innovation (RTDI) policies as well as the influence of these policies on the functional dynamics of bio-ethanol innovation system, mechanisms prohibiting the system from flourishing are determined. It is suggested that the production of bio-ethanol in Taiwan would be achieved if the government: (1) fixes long-term targets for both domestic bio-ethanol development and emission reduction; and (2) comprehensively designs a set of interrelated RTDI policies in accordance with the functional pattern of the bio-ethanol innovation system and consistently implements these policies. If such measures were implemented, it is considered that the bio-ethanol innovation system in Taiwan would flourish.

The Emergence and Challenging Growth of the Bio-Ethanol Innovation System in Taiwan (1949–2015)

PubMed Central

Chung, Chao-Chen; Yang, Siang-Cing

2016-01-01

This study explores the bio-ethanol innovation system in Taiwan from the perspective of a technology innovation system (TIS). Taiwan is a newly industrialized country and is not currently a main producer of bio-ethanol. This study analyzes the evolution of bio-ethanol innovation system in Taiwan and places a particular emphasis on challenges that present policies face in the context of potential long-term bio-ethanol development. Through an evaluation of the consistency of the present research, technology, development and innovation (RTDI) policies as well as the influence of these policies on the functional dynamics of bio-ethanol innovation system, mechanisms prohibiting the system from flourishing are determined. It is suggested that the production of bio-ethanol in Taiwan would be achieved if the government: (1) fixes long-term targets for both domestic bio-ethanol development and emission reduction; and (2) comprehensively designs a set of interrelated RTDI policies in accordance with the functional pattern of the bio-ethanol innovation system and consistently implements these policies. If such measures were implemented, it is considered that the bio-ethanol innovation system in Taiwan would flourish. PMID:26907306

A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration.

PubMed

Rosen, C S; Matthieu, M M; Wiltsey Stirman, S; Cook, J M; Landes, S; Bernardy, N C; Chard, K M; Crowley, J; Eftekhari, A; Finley, E P; Hamblen, J L; Harik, J M; Kehle-Forbes, S M; Meis, L A; Osei-Bonsu, P E; Rodriguez, A L; Ruggiero, K J; Ruzek, J I; Smith, B N; Trent, L; Watts, B V

2016-11-01

Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4-23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322-1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.

Implementation of quality management for clinical bacteriology in low-resource settings.

PubMed

Barbé, B; Yansouni, C P; Affolabi, D; Jacobs, J

2017-07-01

The declining trend of malaria and the recent prioritization of containment of antimicrobial resistance have created a momentum to implement clinical bacteriology in low-resource settings. Successful implementation relies on guidance by a quality management system (QMS). Over the past decade international initiatives were launched towards implementation of QMS in HIV/AIDS, tuberculosis and malaria. To describe the progress towards accreditation of medical laboratories and to identify the challenges and best practices for implementation of QMS in clinical bacteriology in low-resource settings. Published literature, online reports and websites related to the implementation of laboratory QMS, accreditation of medical laboratories and initiatives for containment of antimicrobial resistance. Apart from the limitations of infrastructure, equipment, consumables and staff, QMS are challenged with the complexity of clinical bacteriology and the healthcare context in low-resource settings (small-scale laboratories, attitudes and perception of staff, absence of laboratory information systems). Likewise, most international initiatives addressing laboratory health strengthening have focused on public health and outbreak management rather than on hospital based patient care. Best practices to implement quality-assured clinical bacteriology in low-resource settings include alignment with national regulations and public health reference laboratories, participating in external quality assurance programmes, support from the hospital's management, starting with attainable projects, conducting error review and daily bench-side supervision, looking for locally adapted solutions, stimulating ownership and extending existing training programmes to clinical bacteriology. The implementation of QMS in clinical bacteriology in hospital settings will ultimately boost a culture of quality to all sectors of healthcare in low-resource settings. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Development and Implementation of Sepsis Alert Systems.

PubMed

Harrison, Andrew M; Gajic, Ognjen; Pickering, Brian W; Herasevich, Vitaly

2016-06-01

Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload, and alert fatigue, due to suboptimal alert performance. Outside the ICU, barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit. Copyright © 2016 Elsevier Inc. All rights reserved.

Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland.

PubMed

Snowden, Austyn; Kolb, Hildegard

2017-05-01

To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. Naturalistic prospective repeated-measures mixed-methods approach. Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations. It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically. © 2016 John Wiley & Sons Ltd.

A complex adaptive systems perspective of health information technology implementation.

PubMed

Keshavjee, Karim; Kuziemsky, Craig; Vassanji, Karim; Ghany, Ahmad

2013-01-01

Implementing health information technology (HIT) is a challenge because of the complexity and multiple interactions that define HIT implementation. Much of the research on HIT implementation is descriptive in nature and has focused on distinct processes such as order entry or decision support. These studies fail to take into account the underlying complexity of the processes, people and settings that are typical of HIT implementations. Complex adaptive systems (CAS) is a promising field that could elucidate the complexity and non-linear interacting issues that are typical in HIT implementation. Initially we sought new models that would enable us to better understand the complex nature of HIT implementation, to proactively identify problem issues that could be a precursor to unintended consequences and to develop new models and new approaches to successful HIT implementations. Our investigation demonstrates that CAS does not provide prediction, but forces us to rethink our HIT implementation paradigms and question what we think we know. CAS provides new ways to conceptualize HIT implementation and suggests new approaches to increasing HIT implementation successes.

First Year Site Visits to Milwaukee Urban Systemic Initiative Schools. A Report on the Milwaukee Public Schools Milwaukee Urban Systemic Initiative.

ERIC Educational Resources Information Center

Huinker, DeAnn; Pearson, Gretchen; Posnanski, Tracy; Coan, Cheryl; Porter, Corrie

The Urban Systemic Initiatives (USI) program is an effort sponsored by the National Science Foundation (NSF) that targets large urban school systems with the goal of sustainable implementation of high-quality, standards-based teaching for the purpose of attaining system-wide increases in students' learning of challenging mathematics and science.…

Survey Results for First Wave Schools of the Milwaukee Urban Systemic Initiative. Report on Milwaukee Public Schools Milwaukee Urban Systemic Initiative.

ERIC Educational Resources Information Center

Huinker, DeAnn; Coan, Cheryl; Mueller, Leah

The Urban Systemic Initiatives (USI) program is an effort sponsored by the National Science Foundation (NSF) that targets large urban school systems with the goal of sustainable implementation of high-quality, standards-based teaching for the purpose of attaining system-wide increases in students' learning of challenging mathematics and science.…

Quality Assurance in Turkish Higher Education

ERIC Educational Resources Information Center

Bugday Ince, Sehriban; Gounko, Tatiana

2014-01-01

The implementation of quality assurance (QA) is one of the most challenging reform areas for Turkey due to the unique organization of its higher education system. This paper explores the development of QA systems in Turkish universities. Using a qualitative case study approach, the authors examine how Turkey accomplishes the goal of implementing…

Opportunities to Align California's PreK-3 Education System

ERIC Educational Resources Information Center

Policy Analysis for California Education, PACE, 2016

2016-01-01

"PreK-3 Alignment in California's Education System: Obstacles and Opportunities" by Rachel Valentino and Deborah J. Stipek reviews the opportunities and challenges that must be addressed to better align PreK-3 education in California. The report describes policies and practices that districts have implemented to strengthen alignment, and…

Barriers to the success of an electronic pharmacovigilance reporting system in Kenya: an evaluation three years post implementation.

PubMed

Agoro, Oscar O; Kibira, Sarah W; Freeman, Jenny V; Fraser, Hamish S F

2018-06-01

Electronic pharmacovigilance reporting systems are being implemented in many developing countries in an effort to improve reporting rates. This study sought to establish the factors that acted as barriers to the success of an electronic pharmacovigilance reporting system in Kenya 3 years after its implementation. Factors that could act as barriers to using electronic reporting systems were identified in a review of literature and then used to develop a survey questionnaire that was administered to pharmacists working in government hospitals in 6 counties in Kenya. The survey was completed by 103 out of the 115 targeted pharmacists (89.5%) and included free-text comments. The key factors identified as barriers were: unavailable, unreliable, or expensive Internet access; challenges associated with a hybrid system of paper and electronic reporting tools; and system usability issues. Coordination challenges at the national pharmacovigilance center and changes in the structure of health management in the country also had an impact on the success of the electronic reporting system. Different personal, organizational, infrastructural, and reporting system factors affect the success of electronic reporting systems in different ways, depending on the context. Context-specific formative evaluations are useful in establishing the performance of electronic reporting systems to identify problems and ensure that they achieve the desired objectives. While several factors hindered the optimal use of the electronic pharmacovigilance reporting system in Kenya, all were considered modifiable. Effort should be directed toward tackling the identified issues in order to facilitate use and improve pharmacovigilance reporting rates.

Experiences and Challenges of Middle and High School Teachers Who Implement Differentiated Instruction

ERIC Educational Resources Information Center

Harman, Pamela

2014-01-01

Within a suburban school system, an achievement gap exists since not all students are meeting state and national educational benchmarks. Despite the efforts of the school system, the achievement gap is endemic and persistent. To address the achievement gap, the school system instituted a Differentiated Instruction (DI) initiative. However, it was…

GlobePort Faces Global Business Challenges--Assessing the Organizational Side of Information Systems Projects

ERIC Educational Resources Information Center

Ghosh, Biswadip

2011-01-01

Published studies have reported that Information System (IS) projects succeed or fail based on how effectively the organizational issues were understood and addressed in the specification, development and implementation stages of the project. This is particularly true in the design and delivery of Inter-Organizational Systems (IOS) that can affect…

Empirical Analysis of Optical Attenuator Performance in Quantum Key Distribution Systems Using a Particle Model

DTIC Science & Technology

2012-03-01

EMPIRICAL ANALYSIS OF OPTICAL ATTENUATOR PERFORMANCE IN QUANTUM KEY DISTRIBUTION SYSTEMS USING A...DISTRIBUTION IS UNLIMITED AFIT/GCS/ENG/12-01 EMPIRICAL ANALYSIS OF OPTICAL ATTENUATOR PERFORMANCE IN QUANTUM KEY DISTRIBUTION SYSTEMS USING ...challenging as the complexity of actual implementation specifics are considered. Two components common to most quantum key distribution

A methodology for Manufacturing Execution Systems (MES) implementation

NASA Astrophysics Data System (ADS)

Govindaraju, Rajesri; Putra, Krisna

2016-02-01

Manufacturing execution system is information systems (IS) application that bridges the gap between IS at the top level, namely enterprise resource planning (ERP), and IS at the lower levels, namely the automation systems. MES provides a media for optimizing the manufacturing process as a whole in a real time basis. By the use of MES in combination with the implementation of ERP and other automation systems, a manufacturing company is expected to have high competitiveness. In implementing MES, functional integration -making all the components of the manufacturing system able to work well together, is the most difficult challenge. For this, there has been an industry standard that specifies the sub-systems of a manufacturing execution systems and defines the boundaries between ERP systems, MES, and other automation systems. The standard is known as ISA-95. Although the advantages from the use of MES have been stated in some studies, not much research being done on how to implement MES effectively. The purpose of this study is to develop a methodology describing how MES implementation project should be managed, utilising the support of ISA- 95 reference model in the system development process. A proposed methodology was developed based on a general IS development methodology. The developed methodology were then revisited based on the understanding about the specific charateristics of MES implementation project found in an Indonesian steel manufacturing company implementation case. The case study highlighted the importance of applying an effective requirement elicitation method during innitial system assessment process, managing system interfaces and labor division in the design process, and performing a pilot deployment before putting the whole system into operation.

Canes Implementation: Analysis of Budgetary, Business, and Policy Challenges

DTIC Science & Technology

2014-12-01

Concept of Operations COTS Commercial Off the Shelf DAG Defense Acquisitions Guidebook DAS Defense Acquisitions System DOD Department of Defense...and Integration NSS National Security Strategy OA Open Architecture OCO Overseas Contingency Operations OEF Operation Enduring Freedom OIF...and software and civilian-type open architecture ( OA ) presents a series of challenges. The purpose of this report is to provide the Navy with a

APhA 2011 REMS white paper: Summary of the REMS stakeholder meeting on improving program design and implementation.

PubMed

American Pharmacists Association; Bough, Marcie

2011-01-01

To develop an improved risk evaluation and mitigation strategies (REMS) system for maximizing effective and safe patient medication use while minimizing burden on the health care delivery system. 34 stakeholders gathered October 6-7, 2010, in Arlington, VA, for the REMS Stakeholder Meeting, convened by the American Pharmacists Association (APhA). Participants included national health care provider associations, including representatives for physicians, physician assistants, nurses, nurse practitioners, and pharmacists, as well as representatives for patient advocates, drug distributors, community pharmacists (chain and independent), drug manufacturer associations (brand, generic, and biologic organizations), and health information technology, standards, and safety organizations. Staff from the Food and Drug Administration (FDA) Center for Drug Evaluation and Research participated as observers. The meeting built on themes from the APhA's 2009 REMS white paper. The current REMS environment presents many challenges for health care providers due to the growing number of REMS programs and the lack of standardization or similarities among various REMS programs. A standardized REMS process that focuses on maximizing patient safety and minimizing impacts on patient access and provider implementation could offset these challenges. A new process that includes effective provider interventions and standardized tools and systems for implementing REMS programs may improve patient care and overcome some of the communication issues providers and patients currently face. Metrics could be put in place to evaluate the effectiveness of REMS elements. By incorporating REMS program components into existing technologies and data infrastructures, achieving REMS implementation that is workflow neutral and minimizes administrative burden may be possible. An appropriate compensation model could ensure providers have adequate resources for patient care and REMS implementation. Overall, stakeholders should continue to work collaboratively with FDA and manufacturers to improve REMS program design and implementation issues. A workable REMS system will require effective patient interventions, standardized elements that limit barriers to implementation for both patients and providers, standardized yet flexible implementation strategies, use of existing technologies in practice settings, increased opportunities for provider input early in REMS design processes, improved communication strategies and awareness of program requirements, and viable provider compensation models needed to offset costs to implement and comply with REMS program requirements.

Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts

PubMed Central

Powell, Byron J.; Beidas, Rinad S.; Rubin, Ronnie M.; Stewart, Rebecca E.; Wolk, Courtney Benjamin; Matlin, Samantha L.; Weaver, Shawna; Hurford, Matthew O.; Evans, Arthur C.; Hadley, Trevor R.; Mandell, David S.

2016-01-01

Raghavan et al. (2008) proposed that effective implementation of evidence-based practices requires implementation strategies deployed at multiple levels of the “policy ecology,” including the organizational, regulatory or purchaser agency, political, and social levels. However, much of implementation research and practice targets providers without accounting for contextual factors that may influence provider behavior. This paper examines Philadelphia’s efforts to work toward an evidence-based and recovery-oriented behavioral health system, and uses the policy ecology framework to illustrate how multifaceted, multilevel implementation strategies can facilitate the widespread implementation of evidence-based practices. Ongoing challenges and implications for research and practice are discussed. PMID:27032411

Methods and implementation of a central biosample and data management in a three-centre clinical study.

PubMed

Angelow, Aniela; Schmidt, Matthias; Weitmann, Kerstin; Schwedler, Susanne; Vogt, Hannes; Havemann, Christoph; Hoffmann, Wolfgang

2008-07-01

In our report we describe concept, strategies and implementation of a central biosample and data management (CSDM) system in the three-centre clinical study of the Transregional Collaborative Research Centre "Inflammatory Cardiomyopathy - Molecular Pathogenesis and Therapy" SFB/TR 19, Germany. Following the requirements of high system resource availability, data security, privacy protection and quality assurance, a web-based CSDM was developed based on Java 2 Enterprise Edition using an Oracle database. An efficient and reliable sample documentation system using bar code labelling, a partitioning storage algorithm and an online documentation software was implemented. An online electronic case report form is used to acquire patient-related data. Strict rules for access to the online applications and secure connections are used to account for privacy protection and data security. Challenges for the implementation of the CSDM resided at project, technical and organisational level as well as at staff level.

Water Injection on Commercial Aircraft to Reduce Airport Nitrogen Oxides

NASA Technical Reports Server (NTRS)

Daggett, David L.; Hendricks, Robert C.; Fucke, Lars; Eames, David J. H.

2010-01-01

The potential nitrogen oxide (NO(x) reductions, cost savings, and performance enhancements identified in these initial studies of waterinjection technology strongly suggest that it be further pursued. The potential for engine maintenance cost savings from this system should make it very attractive to airline operators and assure its implementation. Further system tradeoff studies and engine tests are needed to answer the optimal system design question. Namely, would a low-risk combustor injection system with 70- to 90-percent NO(x) reduction be preferable, or would a low-pressure compressor (LPC) misting system with only 50-percent NO(x) reduction but larger turbine inlet temperature reductions be preferable? The low-pressure compressor injection design and operability issues identified in the report need to be addressed because they might prevent implementation of the LPC type of water-misting system. If water-injection technology challenges are overcome, any of the systems studied would offer dramatic engine NO(x) reductions at the airport. Coupling this technology with future emissions-reduction technologies, such as fuel-cell auxiliary power units will allow the aviation sector to address the serious challenges of environmental stewardship, and NO(x) emissions will no longer be an issue at airports.

EPA LABORATORIES IMPLEMENT EMS PROGRAM

EPA Science Inventory

This paper highlights the breadth and magnitude of carrying out an effective Environmental Management System (EMS) program at the U.S. EPA's research and development laboratories. Federal research laboratories have unique operating challenges compared to more centralized industr...

Highway work zone intrusion alert systems implementation guide.

DOT National Transportation Integrated Search

2017-07-01

Adopting new technology and innovation is vital for governmental entities to effectively conduct business for its citizens. One major challenge of capturing and realizing the multitude of benefits produced by innovative safety technologies is proper ...

Development and implementation of a quality assurance infrastructure in a multisite home visitation program in Ohio and Kentucky.

PubMed

Ammerman, Robert T; Putnam, Frank W; Kopke, Jonathan E; Gannon, Thomas A; Short, Jodie A; Van Ginkel, Judith B; Clark, Margaret J; Carrozza, Mark A; Spector, Alan R

2007-01-01

As home visitation programs go to scale, numerous challenges are faced in implementation and quality assurance. This article describes the origins and implementation of Every Child Succeeds, a multisite home visitation program in southwestern Ohio and Northern Kentucky. In order to optimize quality assurance and generate new learning for the field, a Web-based system (eECS) was designed to systematically collect and use data. Continuous quality assurance procedures derived from business and industry have been established. Findings from data collection have documented outcomes, and have identified clinical needs that potentially undermine the impact of home visitation. An augmented module approach has been used to address these needs, and a program to treat maternal depression is described as an example of this approach. Challenges encountered are also discussed.

Virtual Observation System for Earth System Model: An Application to ACME Land Model Simulations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Dali; Yuan, Fengming; Hernandez, Benjamin

Investigating and evaluating physical-chemical-biological processes within an Earth system model (EMS) can be very challenging due to the complexity of both model design and software implementation. A virtual observation system (VOS) is presented to enable interactive observation of these processes during system simulation. Based on advance computing technologies, such as compiler-based software analysis, automatic code instrumentation, and high-performance data transport, the VOS provides run-time observation capability, in-situ data analytics for Earth system model simulation, model behavior adjustment opportunities through simulation steering. A VOS for a terrestrial land model simulation within the Accelerated Climate Modeling for Energy model is also presentedmore » to demonstrate the implementation details and system innovations.« less

Virtual Observation System for Earth System Model: An Application to ACME Land Model Simulations

DOE PAGES

Wang, Dali; Yuan, Fengming; Hernandez, Benjamin; ...

2017-01-01

Investigating and evaluating physical-chemical-biological processes within an Earth system model (EMS) can be very challenging due to the complexity of both model design and software implementation. A virtual observation system (VOS) is presented to enable interactive observation of these processes during system simulation. Based on advance computing technologies, such as compiler-based software analysis, automatic code instrumentation, and high-performance data transport, the VOS provides run-time observation capability, in-situ data analytics for Earth system model simulation, model behavior adjustment opportunities through simulation steering. A VOS for a terrestrial land model simulation within the Accelerated Climate Modeling for Energy model is also presentedmore » to demonstrate the implementation details and system innovations.« less

Tackling the Transition to UC: To Implement Unified Communications on Campus, It Often Pays to Take a Phased Approach

ERIC Educational Resources Information Center

Ramaswami, Rama

2011-01-01

In this article, the author talks about the challenges faced by two schools that lie, coincidentally, just 110 miles apart in the vast spaces of North Dakota. Both schools, members of the North Dakota University System, decided to forge ahead with a unified communications (UC) implementation. And while their final solutions differ, how the two…

Policy and Research in a Post-Conflict Context: Issues and Challenges in the Implementation of the Rwandan Teacher Development and Management Policy

ERIC Educational Resources Information Center

Rutaisire, John; Gahima, Charles

2009-01-01

Purpose: The purpose of this paper is to assess the relationship between policy development and research evidence with specific reference to the Rwandan Teacher Development and Management Policy introduced in 2005. It aims to highlight the complexity of implementing large-scale system wide change in the specific context of a small African nation…

The cost-effectiveness of quality improvement projects: a conceptual framework, checklist and online tool for considering the costs and consequences of implementation-based quality improvement.

PubMed

Thompson, Carl; Pulleyblank, Ryan; Parrott, Steve; Essex, Holly

2016-02-01

In resource constrained systems, decision makers should be concerned with the efficiency of implementing improvement techniques and technologies. Accordingly, they should consider both the costs and effectiveness of implementation as well as the cost-effectiveness of the innovation to be implemented. An approach to doing this effectively is encapsulated in the 'policy cost-effectiveness' approach. This paper outlines some of the theoretical and practical challenges to assessing policy cost-effectiveness (the cost-effectiveness of implementation projects). A checklist and associated (freely available) online application are also presented to help services develop more cost-effective implementation strategies. © 2015 John Wiley & Sons, Ltd.

Implementation of HIV and Tuberculosis Diagnostics: The Importance of Context

PubMed Central

Dominique, Joyelle K.; Ortiz-Osorno, Alberto A.; Fitzgibbon, Joseph; Gnanashanmugam, Devasena; Gilpin, Christopher; Tucker, Timothy; Peel, Sheila; Peter, Trevor; Kim, Peter; Smith, Steven

2015-01-01

Background. Novel diagnostics have been widely applied across human immunodeficiency virus (HIV) and tuberculosis prevention and treatment programs. To achieve the greatest impact, HIV and tuberculosis diagnostic programs must carefully plan and implement within the context of a specific healthcare system and the laboratory capacity. Methods. A workshop was convened in Cape Town in September 2014. Participants included experts from laboratory and clinical practices, officials from ministries of health, and representatives from industry. Results. The article summarizes best practices, challenges, and lessons learned from implementation experiences across sub-Saharan Africa for (1) building laboratory programs within the context of a healthcare system; (2) utilizing experience of clinicians and healthcare partners in planning and implementing the right diagnostic; and (3) evaluating the effects of new diagnostics on the healthcare system and on patient health outcomes. Conclusions. The successful implementation of HIV and tuberculosis diagnostics in resource-limited settings relies on careful consideration of each specific context. PMID:26409272

Challenges and strategies in applying performance measurement to federal public health programs.

PubMed

DeGroff, Amy; Schooley, Michael; Chapel, Thomas; Poister, Theodore H

2010-11-01

Performance measurement is widely accepted in public health as an important management tool supporting program improvement and accountability. However, several challenges impede developing and implementing performance measurement systems at the federal level, including the complexity of public health problems that reflect multiple determinants and involve outcomes that may take years to achieve, the decentralized and networked nature of public health program implementation, and the lack of reliable and consistent data sources and other issues related to measurement. All three of these challenges hinder the ability to attribute program results to specific public health program efforts. The purpose of this paper is to explore these issues in detail and offer potential solutions that support the development of robust and practical performance measures to meet the needs for program improvement and accountability. Adapting performance measurement to public health programs is both an evolving science and art. Through the strategies presented here, appropriate systems can be developed and monitored to support the production of meaningful data that will inform effective decision making at multiple levels. Published by Elsevier Ltd.

Integrated river basin management, ICT and DSS: Challenges and needs

NASA Astrophysics Data System (ADS)

Gourbesville, Philippe

River basin management is a complex task. Therefore, instruments that help to assess the present situation and assist in the development and evaluation of solutions may be important. Since several decades and after the implementation of the first compulsory legal environments and institutional organizations for IWRM and IRBM, the need for an efficient support in the different decision-making processes has emerged. After several experiences, the demonstration of the interest of ICT and DSS systems is obvious in the water resources management domain. However and until now, most of the efforts have been focused on the theoretical aspects with very few integrations into operational approaches. The implementation of the new European water framework directive (2000) represents today one key example from which some lessons can be learned in the way of definition and use of ICT and DSS systems for IWRM and IRBM. The paper presents the concepts available through ICT and DSS. The example of the WFD is used to underline the challenges and the difficulties for the elaboration of new tools - DSSs - which could be able to answer of the challenges of IWRM and IRBM.

Implementation of an ergonomics program for the welding department inside a car assembly company.

PubMed

Francisco, Caceres; Edwin, Troya

2012-01-01

The premise for this project is to implement an ergonomics program for the welding department of a car assembly company, considering that this area represents the highest occupational risk in relation to musculoskeletal injuries. The project also allows the demonstration of the different implementation processes of an ergonomics program; it also permits the determination of individual risks faced by workers of the welding department, and finally gives a chance of improving common injuries using the sentinel system. The main challenge is to reduce musculoskeletal injuries and absenteeism among welders through actions implemented by the ergonomics program.

Security model for picture archiving and communication systems.

PubMed

Harding, D B; Gac, R J; Reynolds, C T; Romlein, J; Chacko, A K

2000-05-01

The modern information revolution has facilitated a metamorphosis of health care delivery wrought with the challenges of securing patient sensitive data. To accommodate this reality, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). While final guidance has not fully been resolved at this time, it is up to the health care community to develop and implement comprehensive security strategies founded on procedural, hardware and software solutions in preparation for future controls. The Virtual Radiology Environment (VRE) Project, a landmark US Army picture archiving and communications system (PACS) implemented across 10 geographically dispersed medical facilities, has addressed that challenge by planning for the secure transmission of medical images and reports over their local (LAN) and wide area network (WAN) infrastructure. Their model, which is transferable to general PACS implementations, encompasses a strategy of application risk and dataflow identification, data auditing, security policy definition, and procedural controls. When combined with hardware and software solutions that are both non-performance limiting and scalable, the comprehensive approach will not only sufficiently address the current security requirements, but also accommodate the natural evolution of the enterprise security model.

Measurement in Service Businesses: Challenges and Future Directions

NASA Astrophysics Data System (ADS)

Tyagi, Rajesh Kumar

This chapter presents challenges faced by service businesses while implementing a measurement system. A review of existing frameworks is presented and a new framework, the Service Scorecard, is introduced. The Service Scorecard is an adaptation of the Six Sigma Business Scorecard for the service sector. The framework has also been influenced by existing frameworks such as the Malcom Baldrige award criteria, the Balanced Scorecard, the European Quality award and the Service Profit Chain model. The seven elements of the Service Scorecard are Growth, Leadership, Acceleration, Collaboration, Innovation, Execution, and Retention. The examples of measurement systems are presented with concrete real-world case examples. Final thoughts and the challenges faced are also presented.

The Habitat Demonstration Unit Project: A Modular Instrumentation System for a Deep Space Habitat

NASA Technical Reports Server (NTRS)

Rojdev, Kristina; Kennedy, Kriss J.; Yim, Hester; Williamsn, Robert M.; Hafermalz, Scott; Wagner, Raymond S.

2011-01-01

NASA is focused on developing human exploration capabilities in low Earth orbit (LEO), expanding to near Earth asteroids (NEA), and finally to Mars. Habitation is a crucial aspect of human exploration, and a current focus of NASA activities. The Habitation Demonstration Unit (HDU) is a project focused on developing an autonomous habitation system that enables human exploration of space by providing engineers and scientists with a test bed to develop, integrate, test, and evaluate habitation systems. A critical feature of the HDU is the instrumentation system, which monitors key subsystems within the habitat. The following paper will discuss the HDU instrumentation system performance and lessons learned during the 2010 Desert Research and Technology Studies (D-RaTS). In addition, this paper will discuss the evolution of the instrumentation system to support the 2011 Deep Space Habitat configuration, the challenges, and the lessons learned of implementing this configuration. In 2010, the HDU was implemented as a pressurized excursion module (PEM) and was tested at NASA s D-RaTS in Arizona [1]. For this initial configuration, the instrumentation system design used features that were successful in previous habitat instrumentation projects, while also considering challenges, and implementing lessons learned [2]. The main feature of the PEM instrumentation system was the use of a standards-based wireless sensor node (WSN), implementing an IEEE 802.15.4 protocol. Many of the instruments were connected to several WSNs, which wirelessly transmitted data to the command and data handling system via a mesh network. The PEM instrumentation system monitored the HDU during field tests at D-RaTS, and the WSN data was later analyzed to understand the performance of this system. In addition, several lessons learned were gained from the field test experience, which fed into the instrumentation design of the next generation of the HDU.

Incorporating information from the U.S. Department of Energy low-dose program into regulatory decision-making: three policy integration challenges.

PubMed

Locke, Paul A

2009-11-01

The U.S. Department of Energy (U.S. DOE) sponsors a research program aimed at gaining a better understanding of how low-dose radiation affects cellular functioning and progression toward disease. There have been calls to incorporate into regulatory decision-making the scientific information that this program has produced. After a discussion of the evolution of radiation protection law and the weight-of-evidence approach that agencies employ, this paper offers some preliminary thoughts about how to approach this complex and important policy question. Three implementation challenges are identified and discussed. The first implementation challenge involves explaining low-dose effects in a systems biology model. The second challenge arises when issues of population susceptibility are juxtaposed against molecular and mechanistic studies, such as those that make up much of the U.S. DOE low-dose program. The third challenge concerns integrating the results of radiation epidemiology, especially epidemiologic studies among cohorts that are exposed to low dose and low-dose rate radiation, with the results of U.S. DOE low-dose studies.

The Journey Begins: First Year Activities of the MUSI Mathematics/Science Resource Teachers. A Report on the Milwaukee Urban Systemic Initiative.

ERIC Educational Resources Information Center

Huinker, DeAnn; Pearson, Gretchen

The Urban Systemic Initiatives (USI) program is an effort sponsored by the National Science Foundation (NSF) that targets large urban school systems with the goal of sustainable implementation of high-quality, standards-based teaching for the purpose of attaining system-wide increases in students' learning of challenging mathematics and science.…

A real-time biomimetic acoustic localizing system using time-shared architecture

NASA Astrophysics Data System (ADS)

Nourzad Karl, Marianne; Karl, Christian; Hubbard, Allyn

2008-04-01

In this paper a real-time sound source localizing system is proposed, which is based on previously developed mammalian auditory models. Traditionally, following the models, which use interaural time delay (ITD) estimates, the amount of parallel computations needed by a system to achieve real-time sound source localization is a limiting factor and a design challenge for hardware implementations. Therefore a new approach using a time-shared architecture implementation is introduced. The proposed architecture is a purely sample-base-driven digital system, and it follows closely the continuous-time approach described in the models. Rather than having dedicated hardware on a per frequency channel basis, a specialized core channel, shared for all frequency bands is used. Having an optimized execution time, which is much less than the system's sample rate, the proposed time-shared solution allows the same number of virtual channels to be processed as the dedicated channels in the traditional approach. Hence, the time-shared approach achieves a highly economical and flexible implementation using minimal silicon area. These aspects are particularly important in efficient hardware implementation of a real time biomimetic sound source localization system.

Evidence-Based Program Service Deserts: A Geographic Information Systems (GIS) Approach to Identifying Service Gaps for State-Level Implementation Planning.

PubMed

Walker, Sarah Cusworth; Hurvitz, Philip M; Leith, Jessica; Rodriguez, Felix I; Endler, Gregory C

2016-11-01

The long term effects of untreated mental health need for individuals, families and society has prompted a number of federal policy statements encouraging the use of evidence-based programs (EBP) in children's healthcare. However, among other challenges of evidence-based practice implementation, states often do not know where to make investments based on population need. In this paper we present the use of a Geographic Information System approach to undertake a mental health needs assessment for Washington State. Our study found that this technology can be beneficially applied to conducting needs assessment for EBP implementation, and we provide recommendations for future applications.

CMOL/CMOS hardware architectures and performance/price for Bayesian memory - The building block of intelligent systems

NASA Astrophysics Data System (ADS)

Zaveri, Mazad Shaheriar

The semiconductor/computer industry has been following Moore's law for several decades and has reaped the benefits in speed and density of the resultant scaling. Transistor density has reached almost one billion per chip, and transistor delays are in picoseconds. However, scaling has slowed down, and the semiconductor industry is now facing several challenges. Hybrid CMOS/nano technologies, such as CMOL, are considered as an interim solution to some of the challenges. Another potential architectural solution includes specialized architectures for applications/models in the intelligent computing domain, one aspect of which includes abstract computational models inspired from the neuro/cognitive sciences. Consequently in this dissertation, we focus on the hardware implementations of Bayesian Memory (BM), which is a (Bayesian) Biologically Inspired Computational Model (BICM). This model is a simplified version of George and Hawkins' model of the visual cortex, which includes an inference framework based on Judea Pearl's belief propagation. We then present a "hardware design space exploration" methodology for implementing and analyzing the (digital and mixed-signal) hardware for the BM. This particular methodology involves: analyzing the computational/operational cost and the related micro-architecture, exploring candidate hardware components, proposing various custom hardware architectures using both traditional CMOS and hybrid nanotechnology - CMOL, and investigating the baseline performance/price of these architectures. The results suggest that CMOL is a promising candidate for implementing a BM. Such implementations can utilize the very high density storage/computation benefits of these new nano-scale technologies much more efficiently; for example, the throughput per 858 mm2 (TPM) obtained for CMOL based architectures is 32 to 40 times better than the TPM for a CMOS based multiprocessor/multi-FPGA system, and almost 2000 times better than the TPM for a PC implementation. We later use this methodology to investigate the hardware implementations of cortex-scale spiking neural system, which is an approximate neural equivalent of BICM based cortex-scale system. The results of this investigation also suggest that CMOL is a promising candidate to implement such large-scale neuromorphic systems. In general, the assessment of such hypothetical baseline hardware architectures provides the prospects for building large-scale (mammalian cortex-scale) implementations of neuromorphic/Bayesian/intelligent systems using state-of-the-art and beyond state-of-the-art silicon structures.

Leaders' experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review.

PubMed

Baxter, Pamela E; Hewko, Sarah J; Pfaff, Kathryn A; Cleghorn, Laura; Cunningham, Barbara J; Elston, Dawn; Cummings, Greta G

2015-08-01

Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

Opportunities to Meet Challenges in Rural Prevention Research

PubMed Central

Spoth, Richard

2008-01-01

Various rural prevention research challenges have been articulated through a series of sessions convened since the mid 1990s by the National Institutes of Health, particularly the National Institute on Drug Abuse. Salient in this articulation was the need for effective collaboration among rural practitioners and scientists, with special consideration of accommodating the diversity of rural areas and surmounting barriers to implementation of evidence-based interventions. This paper summarizes the range of challenges in rural prevention research and describes an evolving community-university partnership model addressing them. The model entails involvement of public school staff and other rural community stakeholders, linked with scientists by Land Grant University-based Extension system staff. Examples of findings from over 16 years of partnership-based intervention research projects include those on engagement of rural residents, quality implementation of evidence-based interventions, and long-term community-level outcomes, as well as factors in effectiveness of the partnerships. Findings suggest a future focus on building capacity for practitioner-scientist collaboration and developing a network for more widespread implementation of the partnership model in a manner informed by lessons learned from partnership-based research to date. PMID:18237324

Progress and challenges: implementation and use of health information technology among critical-access hospitals.

PubMed

Gabriel, Meghan Hufstader; Jones, Emily B; Samy, Leila; King, Jennifer

2014-07-01

Despite major national investments to support the adoption of health information technology (IT), concerns persist that barriers are inhibiting that adoption and the use of advanced health IT capabilities in rural areas in particular. Using a survey of Medicare-certified critical-access hospitals, we examined electronic health record (EHR) adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption. In 2013, 89 percent of critical-access hospitals had implemented a full or partial EHR. Adoption of key EHR capabilities varied. Critical-access hospitals that had certain types of technical assistance and resources available to support health IT were more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals in the survey. It is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate independently, to assist them in adopting health IT and becoming able to electronically link to the broader health care system. Project HOPE—The People-to-People Health Foundation, Inc.

Foreword: Follow-on Biologics: Implementation Challenges and Opportunities.

PubMed

Paradise, Jordan

2011-01-01

This Book of the Seton Hall Law Review presents the contributions to Follow-On Biologics: Implementation Challenges and Opportunities, a one-day roundtable event hosted by Seton Hall University School of Law in the fall of 2010. The roundtable fostered an international dialogue regarding the future of follow-on biologics in the United States resulting from the Patient Protection and Affordable Care Act of March 2010. THE BIOLOGIC PRICE COMPETITION AND INNOVATION ACT OF 2010. The March 23, 2010, enactment of the Patient Protection and Affordable Care Act (PPACA) and the companion Health Care and Education Affordability Reconciliation Act of 2010 ushered in landmark reform of the American health care system. Along with sweeping overhauls of the health care system generally, PPACA also provides a new regulatory challenge for the Food and Drug Administration (FDA). A subtitle within PPACA, the Biologics Price Competition and Innovation Act (BPCIA), bestows upon FDA broad authority to implement an abbreviated approval route to market for biological products (also known as biologics) that are "biosimilar" to an existing marketed product. The brief introduction will provide a basic comparison of biologics and conventional pharmaceutical drugs that will prove central to the FDA's development of this follow-on biologic pathway as well as specifically examine the content and scope of the BPCIA provisions and identify future challenges for the FDA. It will conclude by highlighting details of presentations during the roundtable held at the Seton Hall University School of Law and introduce the two resulting articles contained with this Book of the Seton Hall Law Review.

The challenges of the family physician policy in Iran: a systematic review and meta-synthesis of qualitative researches.

PubMed

Behzadifar, Masoud; Behzadifar, Meysam; Heidarvand, Sanaz; Gorji, Hasan Abolghasem; Aryankhesal, Aidin; Taheri Moghadam, Sharare; Mohammadibakhsh, Roghayeh; Bragazzi, Nicola Luigi

2018-05-07

A good level of health requires the establishment of primary health care. Family physician policy (FPP) is probably one of such initiatives, which enables societies attaining the universal health coverage. The present study is the first systematic review and meta-synthesis that seeks to provide a more comprehensive understanding of the challenges for FPP in Iran. Several international scholarly databases (namely, ISI/Web of Sciences, PubMed/MEDLINE via Ovid, Embase, PsycINFO, Scopus and CINAHL via EBSCO), as well as three Iranian databases [MagIran, Irandoc and Scientific Information Database (SID) databases], were mined from January 2006 to December 2017. The Noblit & Hare approach was used to analyse the selected studies. Based on the study inclusion criteria, seven studies were retained. Initially, 133 codes were identified. In the second step, two of the authors examined the codes and merged themes based on their similarities and shared meaning. New codes were created through discussion. In the next and final step, eight themes emerged, namely, (i) financing; (ii) motivational factors; (iii) education; (iv) referral system; (v) performance evaluation; (vi) problems with health policy; (vii) health information system; and (viii) culture-building for proper policy implementation. Although more than 10 years have passed since the implementation of FPP in Iran, and despite its positive effects on health, there are still challenges in implementing this policy, which makes it difficult to achieve its objectives. Health decision- and policy-makers in Iran should address these challenges and use all available capacities to face them.

Northern Shenandoah public mobility project evaluation

DOT National Transportation Integrated Search

2003-06-01

Developing new intelligent transportation systems to meet unusual challenges in rural areas where ITS implementation is limited is difficult in part because there are few similar examples to use as guides. In such situations, it is critical to conduc...

Technology in School Foodservice Operations.

ERIC Educational Resources Information Center

Callahan, Tom; Sharma, Vijay K.

2002-01-01

Describes the current state of technology to manage school food-service operations, including, for example, the use of automation to identify and feed needy students and the use of the Internet. Describes challenges of implementing an automated system. (PKP)

Attaining minimally disruptive medicine: context, challenges and a roadmap for implementation.

PubMed

Shippee, N D; Allen, S V; Leppin, A L; May, C R; Montori, V M

2015-01-01

In this second of two papers on minimally disruptive medicine, we use the language of patient workload and patient capacity from the Cumulative Complexity Model to accomplish three tasks. First, we outline the current context in healthcare, comprised of contrasting problems: some people lack access to care and others receive too much care in an overmedicalised system, both of which reflect imbalances between patients' workloads and their capacity. Second, we identify and address five tensions and challenges between minimally disruptive medicine, the existing context, and other approaches to accessible and patient-centred care such as evidence-based medicine and greater patient engagement. Third, we outline a roadmap of three strategies toward implementing minimally disruptive medicine in practice, including large-scale paradigm shifts, mid-level add-ons to existing reform efforts, and a modular strategy using an existing 'toolkit' that is more limited in scope, but can fit into existing healthcare systems.

Overcoming barriers to high performance seismic design using lessons learned from the green building industry

NASA Astrophysics Data System (ADS)

Glezil, Dorothy

NEHRP's Provisions today currently governing conventional seismic resistant design. These provisions, though they ensure the life-safety of building occupants, extensive damage and economic losses may still occur in the structures. This minimum performance can be enhanced using the Performance-Based Earthquake Engineering methodology and passive control systems like base isolation and energy dissipation systems. Even though these technologies and the PBEE methodology are effective reducing economic losses and fatalities during earthquakes, getting them implemented into seismic resistant design has been challenging. One of the many barriers to their implementation has been their upfront costs. The green building community has faced some of the same challenges that the high performance seismic design community currently faces. The goal of this thesis is to draw on the success of the green building industry to provide recommendations that may be used overcome the barriers that high performance seismic design (HPSD) is currently facing.

Core competencies in the science and practice of knowledge translation: description of a Canadian strategic training initiative.

PubMed

Straus, Sharon E; Brouwers, Melissa; Johnson, David; Lavis, John N; Légaré, France; Majumdar, Sumit R; McKibbon, K Ann; Sales, Anne E; Stacey, Dawn; Klein, Gail; Grimshaw, Jeremy

2011-12-09

Globally, healthcare systems are attempting to optimize quality of care. This challenge has resulted in the development of implementation science or knowledge translation (KT) and the resulting need to build capacity in both the science and practice of KT. We are attempting to meet these challenges through the creation of a national training initiative in KT. We have identified core competencies in this field and have developed a series of educational courses and materials for three training streams. We report the outline for this approach and the progress to date. We have prepared a strategy to develop, implement, and evaluate a national training initiative to build capacity in the science and practice of KT. Ultimately through this initiative, we hope to meet the capacity demand for KT researchers and practitioners in Canada that will lead to improved care and a strengthened healthcare system.

Core competencies in the science and practice of knowledge translation: description of a Canadian strategic training initiative

PubMed Central

2011-01-01

Background Globally, healthcare systems are attempting to optimize quality of care. This challenge has resulted in the development of implementation science or knowledge translation (KT) and the resulting need to build capacity in both the science and practice of KT. Findings We are attempting to meet these challenges through the creation of a national training initiative in KT. We have identified core competencies in this field and have developed a series of educational courses and materials for three training streams. We report the outline for this approach and the progress to date. Conclusions We have prepared a strategy to develop, implement, and evaluate a national training initiative to build capacity in the science and practice of KT. Ultimately through this initiative, we hope to meet the capacity demand for KT researchers and practitioners in Canada that will lead to improved care and a strengthened healthcare system. PMID:22152223

The Challenges of Field Testing the Traffic Management Advisor (TMA) in an Operational Air Traffic Control Facility

NASA Technical Reports Server (NTRS)

Hoang, Ty; Swenson, Harry N.

1997-01-01

The Traffic Management Advisor (TMA), the sequence and schedule tool of the Center/TRACON Automation System (CTAS), was evaluated at the Fort Worth Center (ZFW) in the summer of 1996. This paper describes the challenges encountered during the various phases of the TMA field evaluation, which included system (hardware and software) installation, personnel training, and data collection. Operational procedures were developed and applied to the evaluation process that would ensure air safety. The five weeks of field evaluation imposed minimal impact on the hosting facility and provided valuable engineering and human factors data. The collection of data was very much an opportunistic affair, due to dynamic traffic conditions. One measure of the success of the TMA evaluation is that, rather than remove TMA after the evaluation until it could be fully implemented, the prototype TMA is in continual use at ZFW as the fully operational version is readied for implementation.

Integrating Environmental Management in Chemical Engineering Education by Introducing an Environmental Management System in the Student's Laboratory

ERIC Educational Resources Information Center

Montanes, Maria T.; Palomares, Antonio E.

2008-01-01

In this work we show how specific challenges related to sustainable development can be integrated into chemical engineering education by introducing an environmental management system in the laboratory where the students perform their experimental lessons. It is shown how the system has been developed and implemented in the laboratory, what role…

Catalyst for Change: A Case Report of a Campus-wide Student Information System Software Implementation Project

ERIC Educational Resources Information Center

Stivers, Jan; Garrity, N. B.

2004-01-01

When a mid-sized public college made a politically unpopular decision to purchase new student information system software, a team of fourteen people from across campus was assembled and charged with facilitating the transition from the home-grown system. This case report describes the challenges they faced as they worked to understand their…

The Growth of Neurosurgery in East Africa: Challenges.

PubMed

Santos, Maria M; Qureshi, Mubashir M; Budohoski, Karol P; Mangat, Halinder S; Ngerageza, Japhet G; Schöller, Karsten; Shabani, Hamisi K; Zubkov, Micaella R; Härtl, Roger

2018-05-01

As the second of 3 articles in this series, the aim of this article is to provide readers with an understanding of the development of neurosurgery in East Africa (foundations), the challenges that arise in providing neurosurgical care in developing countries (challenges), and an overview of traditional and novel approaches to overcoming these challenges and improving health care in the region (innovations). Recognizing the challenges that need to be addressed is the first step to implementing efficient and qualified surgery delivery systems in low- and middle-income countries. We reviewed the major challenges facing health care in East Africa and grouped them into 5 categories: 1) burden of surgical disease and workforce crisis; 2) global health view of surgery as "the neglected stepchild"; 3) need for recognizing the surgical system as an interdependent network and importance of organizational and equipment deficits; 4) lack of education in the community, failure of primary care systems, and net result of overwhelming tertiary care systems; 5) personal and professional burnout as well as brain drain of promising human resources from low- and middle-income countries in East Africa and similar regions across the world. Each major challenge was detailed and analyzed by authors who have worked or are currently working in the region, providing a personal perspective. Copyright © 2018. Published by Elsevier Inc.

Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

PubMed

Mills, Pamela Ruth; Weidmann, Anita Elaine; Stewart, Derek

2017-12-01

Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information.

A common evaluation framework for the African Health Initiative.

PubMed

Bryce, Jennifer; Requejo, Jennifer Harris; Moulton, Lawrence H; Ram, Malathi; Black, Robert E

2013-01-01

The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results.

Evidence-Based Practice in the United States: Challenges, Progress, and Future Directions

PubMed Central

Correa-de-Araujo, Rosaly

2016-01-01

Scientific literature demonstrates that advances in evidence-based nursing have improved systems of care and women’s health outcomes. Experts agree that nurses worldwide can play a key role in building such evidence and working with interdisciplinary health care teams and systems to accelerate its implementation. PMID:26473771

State Guide to Developing Successful Early Childhood Data Systems

ERIC Educational Resources Information Center

ICF International (NJ1), 2012

2012-01-01

Early education leaders--inside and outside of government--are looking for new ways to improve quality, accountability, and efficiency across many different programs serving young children and their families, and they see investment in data systems as a pivotal part of that effort. However, it can be challenging to develop and implement effective…

Implementation of spatial smart waste management system in malaysia

NASA Astrophysics Data System (ADS)

Omar, M. F.; Termizi, A. A. A.; Zainal, D.; Wahap, N. A.; Ismail, N. M.; Ahmad, N.

2016-06-01

One of the challenges to innovate and create an IoT -enabled solution is in monitoring and management of the environment. Waste collection utilizing the Internet of Things (IoT) with the technology of smart wireless sensors will able to gather fill-level data from waste containers hence providing a waste monitoring solution that brings up savings in waste collection costs. One of the challenges to the local authority is how to monitor the works of contractor effective and efficiently in waste management. This paper will propose to the local authority the implementation of smart waste management in Malaysia to improve the city management and to provide better services to the public towards smart city applications.

Terrorism: a public health threat with a trauma system response.

PubMed

Jacobs, Lenworth M; Burns, Karyl J; Gross, Ronald I

2003-12-01

The threat of mass casualties and widespread infectious disease caused by terrorism is now a challenge for our government and public health system. Funds have been granted to the states by the Centers for Disease Control and Prevention and the Health Resources and Services Administration to establish bioterrorism preparedness and response capabilities. Hartford Hospital has been designated as a Center of Excellence for Bioterrorism Preparedness by the Commissioner of the Connecticut Department of Public Health. The Center of Excellence has implemented strategies to prepare for a possible bioterrorist attack. A unique model that combines epidemiology and traumatology is being used to guide the preparedness activities. Although the focus of the grant from the Connecticut Department of Public Health is bioterrorism, the application of the model can apply to preparation for all terrorist events. Implementation of strategies indicates that bioterrorism preparedness is well underway. Similar initiatives should be achievable by other trauma systems throughout the country. A Center of Excellence for Bioterrorism Preparedness in Connecticut is successfully modifying a trauma system to meet the challenge of a new public health threat, terrorism.

Managing the Challenges of Leadership in ERP Implementations: An Exploratory Study of the Leadership Challenges Encountered by Project Managers Involved in ERP Implementation Projects

ERIC Educational Resources Information Center

Wanjagi, James K.

2013-01-01

Increasingly, organizations are conducting more Enterprise Resource Planning (ERP) projects in order to promote organizational efficiencies. Meanwhile, minimal research has been conducted on the leadership challenges faced by project managers during the ERP project implementations and how these challenges are managed. The existing project…

Implementation challenges of free maternity services policy in Kenya: the health workers' perspective.

PubMed

Wamalwa, Emmanuel Wekesa

2015-01-01

Kenya implemented the policy of free maternity services to reduce maternal mortality and morbidity. For successful implementation of this policy, there is need to monitor the implementation progress, identify the challenges and mitigate them and determine better strategies for implementation based on emerging implementation issues. This study was carried out to determine the challenges facing policy implementation and strategies for better implementation. This was a cross-sectional descriptive study carried at the Rift Valley Provincial General Hospital (RVPGH) and Bondeni maternity. All the staff who work at Bondeni Maternity (including nursing officer in-charge) were included in the study. All the staff who work at the Maternity Unit of the RVPGH were included in the study, as well as the Medical Superintendent of the facility. A total of 110 respondents were sampled. A questionnaire and interview guide were used to collect data. Data was analyzed using SPSS software. A response rate of 91% (n=100) was achieved. Major implementation challenges include inadequate supplies (86%), inadequate funding (38%), staff shortage (92%), lack of motivation among health workers (62%), overwhelming workload (89%) and abuse of services by clients (32%). Strategies for better implementation include employment of more staff, motivation of health workers, improvement in policy financing, training of health workers and provision of adequate supplies. Implementation of free maternity services policy in Kenya is facing challenges but there exists strategies, which, if implemented, will help address these challenges.

We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England

PubMed Central

2012-01-01

Background In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders’ experiences and the local consequences of the implementation of an EHR system into a mental health hospital. Methods Longitudinal, real-time, case study-based evaluation of the implementation and adoption of an EHR software (RiO) into an English mental health hospital known here as Beta. We conducted 48 in-depth interviews with a wide range of internal and external stakeholders, undertook 26 hours of on-site observations, and obtained 65 sets of relevant documents from various types relating to Beta. Analysis was both inductive and deductive, the latter being informed by the ‘sociotechnical changing’ theoretical framework. Results Many interviewees perceived the implementation of the EHR system as challenging and cumbersome. During the early stages of the implementation, some clinicians felt that using the software was time-consuming leading to the conclusion that the EHR was not fit for purpose. Most interviewees considered the chain of deployment of the EHR–which was imposed by NPfIT–as bureaucratic and obstructive, which restricted customization and as a result limited adoption and use. The low IT literacy among users at Beta was a further barrier to the implementation of the EHR. This along with inadequate training in using the EHR software led to resistance to the significant cultural and work environment changes initiated by EHR. Despite the many challenges, Beta achieved some early positive results. These included: the ability to check progress notes and monitor staff activities; improving quality of care as a result of real-time, more accurate and shared patient records across the hospital; and potentially improving the safety of care through increasing the legibility of the clinical record. Conclusions Notwithstanding what was seen as a turbulent, painful and troublesome implementation of the EHR system, Beta achieved some early clinical and managerial benefits from implementing EHRs. The ‘sociotechnical changing’ framework helped us go beyond the dichotomy of success versus failure, when conducting the evaluation and interpreting findings. Given the scope for continued development, there are good reasons, we argue, to scale up the intake of EHR systems by mental health care settings. Software customization and appropriate support are essential to work EHR out in such organizations. PMID:23272770

Strategies for integrating mental health into schools via a multitiered system of support.

PubMed

Stephan, Sharon Hoover; Sugai, George; Lever, Nancy; Connors, Elizabeth

2015-04-01

To fully realize the potential of mental health supports in academic settings, it is essential to consider how to effectively integrate the mental health and education systems and their respective resources, staffing, and structures. Historically, school mental health services have not effectively spanned a full continuum of care from mental health promotion to treatment, and several implementation and service challenges have evolved. After an overview of these challenges, best practices and strategies for school and community partners are reviewed to systematically integrate mental health interventions within a school's multitiered system of student support. Copyright © 2015 Elsevier Inc. All rights reserved.

Mind the gap: implementation challenges break the link between HIV/AIDS research and practice.

PubMed

MacCarthy, Sarah; Reisner, Sari; Hoffmann, Michael; Perez-Brumer, Amaya; Silva-Santisteban, Alfonso; Nunn, Amy; Bastos, Leonardo; Vasconcellos, Mauricio Teixeira Leite de; Kerr, Ligia; Bastos, Francisco Inácio; Dourado, Inês

2016-11-03

Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic.

Mind the gap: implementation challenges break the link between HIV/AIDS research and practice

PubMed Central

MacCarthy, Sarah; Reisner, Sari; Hoffmann, Michael; Perez-Brumer, Amaya; Silva-Santisteban, Alfonso; Nunn, Amy; Bastos, Leonardo; de Vasconcellos, Mauricio Teixeira Leite; Kerr, Ligia; Bastos, Francisco Inácio; Dourado, Inês

2018-01-01

Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic. PMID:27828609

Biometric Attendance and Big Data Analysis for Optimizing Work Processes.

PubMed

Verma, Neetu; Xavier, Teenu; Agrawal, Deepak

2016-01-01

Although biometric attendance management is available, large healthcare organizations have difficulty in big data analysis for optimization of work processes. The aim of this project was to assess the implementation of a biometric attendance system and its utility following big data analysis. In this prospective study the implementation of biometric system was evaluated over 3 month period at our institution. Software integration with other existing systems for data analysis was also evaluated. Implementation of the biometric system could be successfully done over a two month period with enrollment of 10,000 employees into the system. However generating reports and taking action this large number of staff was a challenge. For this purpose software was made for capturing the duty roster of each employee and integrating it with the biometric system and adding an SMS gateway. This helped in automating the process of sending SMSs to each employee who had not signed in. Standalone biometric systems have limited functionality in large organizations unless it is meshed with employee duty roster.

Development and implementation of sepsis alert systems

PubMed Central

Harrison, Andrew M.; Gajic, Ognjen; Pickering, Brian W.; Herasevich, Vitaly

2016-01-01

Synopsis/Summary Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Important barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload & alert fatigue, due to suboptimal alert performance. Outside the ICU, additional barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Currently available evidence does not support routine use of sepsis alert systems in clinical practice. However, continuous improvement in both the afferent (data availability and accuracy of detection algorithms) and efferent (evidence-based decision support and smoother integration into clinical workflow) limbs of sepsis alert systems will help translate theoretical advantages into measurable patient benefit. PMID:27229639

Integrating malaria surveillance with climate data for outbreak detection and forecasting: the EPIDEMIA system.

PubMed

Merkord, Christopher L; Liu, Yi; Mihretie, Abere; Gebrehiwot, Teklehaymanot; Awoke, Worku; Bayabil, Estifanos; Henebry, Geoffrey M; Kassa, Gebeyaw T; Lake, Mastewal; Wimberly, Michael C

2017-02-23

Early indication of an emerging malaria epidemic can provide an opportunity for proactive interventions. Challenges to the identification of nascent malaria epidemics include obtaining recent epidemiological surveillance data, spatially and temporally harmonizing this information with timely data on environmental precursors, applying models for early detection and early warning, and communicating results to public health officials. Automated web-based informatics systems can provide a solution to these problems, but their implementation in real-world settings has been limited. The Epidemic Prognosis Incorporating Disease and Environmental Monitoring for Integrated Assessment (EPIDEMIA) computer system was designed and implemented to integrate disease surveillance with environmental monitoring in support of operational malaria forecasting in the Amhara region of Ethiopia. A co-design workshop was held with computer scientists, epidemiological modelers, and public health partners to develop an initial list of system requirements. Subsequent updates to the system were based on feedback obtained from system evaluation workshops and assessments conducted by a steering committee of users in the public health sector. The system integrated epidemiological data uploaded weekly by the Amhara Regional Health Bureau with remotely-sensed environmental data freely available from online archives. Environmental data were acquired and processed automatically by the EASTWeb software program. Additional software was developed to implement a public health interface for data upload and download, harmonize the epidemiological and environmental data into a unified database, automatically update time series forecasting models, and generate formatted reports. Reporting features included district-level control charts and maps summarizing epidemiological indicators of emerging malaria outbreaks, environmental risk factors, and forecasts of future malaria risk. Successful implementation and use of EPIDEMIA is an important step forward in the use of epidemiological and environmental informatics systems for malaria surveillance. Developing software to automate the workflow steps while remaining robust to continual changes in the input data streams was a key technical challenge. Continual stakeholder involvement throughout design, implementation, and operation has created a strong enabling environment that will facilitate the ongoing development, application, and testing of the system.

Individualized Clinical Coaching in the TLE TeachLivE Lab: Enhancing Fidelity of Implementation of System of Least Prompts among Novice Teachers of Students with Autism

ERIC Educational Resources Information Center

Vince Garland, Krista M.; Holden, Kara; Garland, Dennis Patrick

2016-01-01

One of the challenges facing educators who teach students with autism spectrum disorders is implementing evidence-based practices (EBPs) with fidelity. One EBP used to help such learners in acquiring targeted behavioral or academic skills is prompting. In this study, the authors examine the efficacy of individualized clinical coaching (ICC) of…

Educating towards Inclusive Education: Assessing a Teacher-Training Program for Working with Pupils with Special Educational Needs and Disabilities (SEND) Enrolled in General Education Schools

ERIC Educational Resources Information Center

Shani, Michal; Hebel, Orly

2016-01-01

Implementing inclusive education is one of the major challenges facing the educational system. One of the main difficulties in implementing inclusive education is that general education teachers receive insufficient training to work in complex teaching contexts and to respond to the unique needs of all the pupils in their classroom. The objective…

Opening the Black Box: The Experiences and Lessons From the Public Hospitals Autonomy Policy in Iran.

PubMed

Doshmangir, Leila; Rashidian, Arash; Jafari, Mehdi; Takian, Amirhossein; Ravaghi, Hamid

2015-07-01

Policy formulation and adoption often happen in a black box. Implementation challenges affect and modify the nature of a policy. We analyzed hospitals' autonomy policy in Iran that was intended to reduce hospitals' financial burden on government and improve their efficiency. We followed a retrospective case-study methodology, involving inductive and deductive analyses of parliamentary proceedings, policy documents, gray literature, published papers and interview transcripts. We analyzed data to develop a policy map that included important dates and events leading to the policy process milestones. We identified four time-periods with distinctive features: 'moving toward the policy' (1989 - 1994), disorganized implementation' (1995 - 1997), 'continuing challenges and indecisiveness in hospitals financing' (1998 - 2003), and 'other structural and financial policies in public hospitals' (2004 to date). We found that stakeholders required different and conflicting objectives, which certainly resulted in an unsatisfactory implementation process. The policy led to long-lasting and often negative changes in the hospital sector and the entire Iranian health system. Hospital autonomy appeared to be an ill-advised policy to remedy the inefficiency problems in low socioeconomic areas of the country. The assumption that hospital autonomy reforms would necessarily result in a better health system, may be a false assumption as their success relies on many contextual, structural and policy implementation factors.

Implementation Challenges for Ceramic Matrix Composites in High Temperature Applications

NASA Technical Reports Server (NTRS)

Singh, Mrityunjay

2004-01-01

Ceramic matrix composites are leading candidate materials for a number of applications in aeronautics, space, energy, electronics, nuclear, and transportation industries. In the aeronautics and space exploration systems, these materials are being considered for applications in hot sections of jet engines such as the combustor liner, nozzle components, nose cones, leading edges of reentry vehicles and space propulsion components. Applications in the energy and environmental industries include radiant heater tubes, heat exchangers, heat recuperators, gas and diesel particulate filters (DPFs), and components for land based turbines for power generation. These materials are also being considered for use in the first wall and blanket components of fusion reactors. There are a number of critical issues and challenges related to successful implementation of composite materials. Fabrication of net and complex shape components with high density and tailorable matrix properties is quite expensive, and even then various desirable properties are not achievable. In this presentation, microstructure and thermomechanical properties of composites fabricated by two techniques (chemical vapor infiltration and melt infiltration), will be presented. In addition, critical need for robust joining and assembly technologies in successful implementation of these systems will be discussed. Other implementation issues will be discussed along with advantages and benefits of using these materials for various components in high temperature applications.

Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception.

PubMed

DeSisto, Carla L; Estrich, Cameron; Kroelinger, Charlan D; Goodman, David A; Pliska, Ellen; Mackie, Christine N; Waddell, Lisa F; Rankin, Kristin M

2017-11-21

Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with the Centers for Disease Control and Prevention and other partner agencies, the Association of State and Territorial Health Officials recently convened a multi-state Learning Community to support cross-state collaboration and provide technical assistance for improving state capacity to increase access to long-acting reversible contraception (LARC) in the immediate postpartum period, an evidence-based practice with the potential for reducing unintended pregnancy and improving maternal and child health outcomes. During 2015-2016, the Learning Community included multi-disciplinary, multi-agency teams of state health officials, payers, clinicians, and health department staff from 13 states. This qualitative study was conducted to better understand the successes, challenges, and strategies that the 13 US states in the Learning Community used for increasing access to immediate postpartum LARC. We conducted telephone interviews with each team in the Learning Community. Interviews were semi-structured and organized by the eight domains of the Learning Community. We coded transcribed interviews for facilitators, barriers, and implementation strategies, using a recent compilation of expert-defined implementation strategies as a foundation for coding the latter. Data analysis showed three ways that the activities of the Learning Community helped in policy implementation work: structure and accountability, validity, and preparing for potential challenges and opportunities. Further, the qualitative data demonstrated that the Learning Community integrated six other implementation strategies from the literature: organize clinician implementation team meetings, conduct educational meetings, facilitation, promote network weaving, provide ongoing consultation, and distribute educational materials. Convening a multi-state learning collaborative is a promising approach for facilitating the implementation of new reimbursement policies for evidence-based practices complicated by systems challenges. By integrating several implementation strategies, the Learning Community serves as a meta-strategy for supporting implementation.

Schools as Sites for Recruiting Participants and Implementing Research.

PubMed

Bartlett, Robin; Wright, Tiffany; Olarinde, Tia; Holmes, Tara; Beamon, Emily R; Wallace, Debra

2017-01-01

Schools can be a valuable resource for recruitment of participants for research involving children, adolescents, and parents. Awareness of the benefits and challenges of working with schools can assist researchers in developing effective school partnerships. This article discusses the advantages of conducting research within the school system as well as the challenges that may also arise. Such challenges include developing key contacts, building relationships, logistical arrangements, and facilitating trust in the research topic and team. Suggestions for strategies to forge successful collaborative relationships with schools are provided.

Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum.

PubMed

Jawhari, Badeia; Keenan, Louanne; Zakus, David; Ludwick, Dave; Isaac, Abraam; Saleh, Abdullah; Hayward, Robert

2016-10-01

Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi. Participants were interviewed using open-ended, semi-structured questions. Content analysis was used when exploring transcribed data. Three major themes - systems, software, and social considerations - emerged from content analysis, with sustainability concerns prevailing. Although participants reported many systems (e.g., power, network, Internet, hardware, interoperability) and software (e.g., data integrity, confidentiality, function) challenges, social factors (e.g., identity management, training, use incentives) appeared the most important impediments to sustainability. These findings are consistent with what others have reported, especially the importance of practical barriers to EMR deployments in resource-constrained settings. Other findings contribute unique insights about social determinants of EMR impact in slum settings, including the challenge of multiple-identity management and development of meaningful incentives to staff compliance. This study exposes front-line experiences with opportunities and shortcomings of EMR implementations in urban slum primary care clinics. Although the promise is great, there are a number of unique system, software and social challenges that EMR advocates should address before expecting sustainable EMR use in resource-constrained settings. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

PubMed

Rajagopalan, Ramesh; Litvan, Irene; Jung, Tzyy-Ping

2017-11-01

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems.

[Systems epidemiology].

PubMed

Huang, T; Li, L M

2018-05-10

The era of medical big data, translational medicine and precision medicine brings new opportunities for the study of etiology of chronic complex diseases. How to implement evidence-based medicine, translational medicine and precision medicine are the challenges we are facing. Systems epidemiology, a new field of epidemiology, combines medical big data with system biology and examines the statistical model of disease risk, the future risk simulation and prediction using the data at molecular, cellular, population, social and ecological levels. Due to the diversity and complexity of big data sources, the development of study design and analytic methods of systems epidemiology face new challenges and opportunities. This paper summarizes the theoretical basis, concept, objectives, significances, research design and analytic methods of systems epidemiology and its application in the field of public health.

On the Adaptive Protection of Microgrids: A Review on How to Mitigate Cyber Attacks and Communication Failures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Habib, Hany F; Lashway, Christopher R; Mohammed, Osama A

One main challenge in the practical implementation of a microgrid is the design of an adequate protection scheme in both grid connected and islanded modes. Conventional overcurrent protection schemes face selectivity and sensitivity issues during grid and microgrid faults since the fault current level is different in both cases for the same relay. Various approaches have been implemented in the past to deal with this problem, yet the most promising ones are the implementation of adaptive protection techniques abiding by the IEC 61850 communication standard. This paper presents a critical review of existing adaptive protection schemes, the technical challenges formore » the use of classical protection techniques and the need for an adaptive, smart protection system. However, the risk of communication link failures and cyber security threats still remain a challenge in implementing a reliable adaptive protection scheme. A contingency is needed where a communication issue prevents the relay from adjusting to a lower current level during islanded mode. An adaptive protection scheme is proposed that utilizes energy storage (ES) and hybrid ES (HESS) already available in the network as a mechanism to source the higher fault current. Four common grid ES and HESS are reviewed for their suitability in feeding the fault while some solutions are proposed.« less

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PubMed Central

Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-01-01

Abstract Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. PMID:28369396

Feasibility Study for Implementing Magnetic Suspension in the Glenn Research Center 225 cm2 Supersonic Wind Tunnel for Testing the Dynamic Stability of Blunt Bodies

NASA Technical Reports Server (NTRS)

Sevier, Abigail; Davis, David O.; Schoenenberger, Mark; Barnhart, Paul

2016-01-01

The implementation of a magnetic suspension system in the NASA Glenn Research Center (GRC) 225 cm2 Supersonic Wind Tunnel would be a powerful test technique that could accurately determine the dynamic stability of blunt body entry vehicles with no sting interference. This paper explores initial design challenges to be evaluated before implementation, including defining the lowest possible operating dynamic pressure and corresponding model size, developing a compatible video analysis technique, and incorporating a retractable initial support sting.

Implementation Challenges for Sintered Silicon Carbide Fiber Bonded Ceramic Materials for High Temperature Applications

NASA Technical Reports Server (NTRS)

Singh, M.

2011-01-01

During the last decades, a number of fiber reinforced ceramic composites have been developed and tested for various aerospace and ground based applications. However, a number of challenges still remain slowing the wide scale implementation of these materials. In addition to continuous fiber reinforced composites, other innovative materials have been developed including the fibrous monoliths and sintered fiber bonded ceramics. The sintered silicon carbide fiber bonded ceramics have been fabricated by the hot pressing and sintering of silicon carbide fibers. However, in this system reliable property database as well as various issues related to thermomechanical performance, integration, and fabrication of large and complex shape components has yet to be addressed. In this presentation, thermomechanical properties of sintered silicon carbide fiber bonded ceramics (as fabricated and joined) will be presented. In addition, critical need for manufacturing and integration technologies in successful implementation of these materials will be discussed.

Lessons learned: mobile device encryption in the academic medical center.

PubMed

Kusche, Kristopher P

2009-01-01

The academic medical center is faced with the unique challenge of meeting the multi-faceted needs of both a modern healthcare organization and an academic institution, The need for security to protect patient information must be balanced by the academic freedoms expected in the college setting. The Albany Medical Center, consisting of the Albany Medical College and the Albany Medical Center Hospital, was challenged with implementing a solution that would preserve the availability, integrity and confidentiality of business, patient and research data stored on mobile devices. To solve this problem, Albany Medical Center implemented a mobile encryption suite across the enterprise. Such an implementation comes with complexities, from performance across multiple generations of computers and operating systems, to diversity of application use mode and end user adoption, all of which requires thoughtful policy and standards creation, understanding of regulations, and a willingness and ability to work through such diverse needs.

Strategies For Clinical Implementation: Precision Oncology At Three Distinct Institutions.

PubMed

Nadauld, Lincoln D; Ford, James M; Pritchard, Daryl; Brown, Thomas

2018-05-01

Despite rapid advances in molecular diagnostics and targeted therapeutics, the adoption of precision medicine into clinical oncology workflows has been slow. Questions about clinical utility, inconsistent reimbursement for molecular diagnostics, and limited access to targeted therapies are some of the major hurdles that have hampered clinical adoption. Despite these challenges, providers have invested in precision medicine programs in an ongoing search for innovative care models to deliver improved patient outcomes and achieve economic gains. We describe the precision oncology medicine programs implemented by an integrated delivery system, a community care center, and an academic medical center, to demonstrate the approaches and challenges associated with clinical implementation efforts designed to advance this treatment paradigm. Payer policies that include coverage for broad genomic testing panels would support the broader application of precision medicine, deepen research benefits, and bring targeted therapies to more patients with advanced cancer.

Working in a 'third space': a closer look at the hybridity, identity and agency of nurse practitioners.

PubMed

Chulach, Teresa; Gagnon, Marilou

2016-03-01

Nurse practitioners (NPs), as advanced practice nurses, have evolved over the years to become recognized as an important and growing trend in Canada and worldwide. In spite of sound evidence as to the effectiveness of NPs in primary care and other care settings, role implementation and integration continue to pose significant challenges. This article utilizes postcolonial theory, as articulated by Homi Bhabha, to examine and challenge traditional ideologies and structures that have shaped the development, implementation and integration of the NP role to this day. Specifically, we utilize Bhabha's concepts of third space, hybridity, identity and agency in order to further conceptualize the nurse practitioner role, to examine how the role challenges some of the inherent assumptions within the healthcare system and to explore how development of each to these concepts may prove useful in integration of nurse practitioners within the healthcare system. Our analysis casts light on the importance of a broader, power structure analysis and illustrates how colonial assumptions operating within our current healthcare system entrench, expand and re-invent, as well as mask the structures and practices that serve to impede nurse practitioner full integration and contributions. Suggestions are made for future analysis and research. © 2015 John Wiley & Sons Ltd.

Implementing OpenMRS for patient monitoring in an HIV/AIDS care and treatment program in rural Mozambique.

PubMed

Manders, Eric-Jan; José, Eurico; Solis, Manuel; Burlison, Janeen; Nhampossa, José Leopoldo; Moon, Troy

2010-01-01

We have adopted the Open Medical Record System (OpenMRS) framework to implement an electronic patient monitoring system for an HIV care and treatment program in Mozambique. The program provides technical assistance to the Ministry of Health supporting the scale up of integrated HIV care and support services in health facilities in rural resource limited settings. The implementation is in use for adult and pediatric programs, with ongoing roll-out to cover all supported sites. We describe early experiences in adapting the system to the program needs, addressing infrastructure challenges, creating a regional support team, training data entry staff, migrating a legacy database, deployment, and current use. We find that OpenMRS offers excellent prospects for in-country development of health information systems, even in severely resource limited settings. However, it also requires considerable organizational infrastructure investment and technical capacity building to ensure continued local support.

Patient-Centered Precision Health In A Learning Health Care System: Geisinger's Genomic Medicine Experience.

PubMed

Williams, Marc S; Buchanan, Adam H; Davis, F Daniel; Faucett, W Andrew; Hallquist, Miranda L G; Leader, Joseph B; Martin, Christa L; McCormick, Cara Z; Meyer, Michelle N; Murray, Michael F; Rahm, Alanna K; Schwartz, Marci L B; Sturm, Amy C; Wagner, Jennifer K; Williams, Janet L; Willard, Huntington F; Ledbetter, David H

2018-05-01

Health care delivery is increasingly influenced by the emerging concepts of precision health and the learning health care system. Although not synonymous with precision health, genomics is a key enabler of individualized care. Delivering patient-centered, genomics-informed care based on individual-level data in the current national landscape of health care delivery is a daunting challenge. Problems to overcome include data generation, analysis, storage, and transfer; knowledge management and representation for patients and providers at the point of care; process management; and outcomes definition, collection, and analysis. Development, testing, and implementation of a genomics-informed program requires multidisciplinary collaboration and building the concepts of precision health into a multilevel implementation framework. Using the principles of a learning health care system provides a promising solution. This article describes the implementation of population-based genomic medicine in an integrated learning health care system-a working example of a precision health program.

Triple Aim in Canada: developing capacity to lead to better health, care and cost.

PubMed

Farmanova, Elina; Kirvan, Christine; Verma, Jennifer; Mukerji, Geetha; Akunov, Nurdin; Phillips, Kaye; Samis, Stephen

2016-12-01

Many modern health systems strive for 'Triple Aim' (TA)-better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not. Limited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems. To support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community. Structured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale. A summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI. Delivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care.

NMESys: An expert system for network fault detection

NASA Technical Reports Server (NTRS)

Nelson, Peter C.; Warpinski, Janet

1991-01-01

The problem of network management is becoming an increasingly difficult and challenging task. It is very common today to find heterogeneous networks consisting of many different types of computers, operating systems, and protocols. The complexity of implementing a network with this many components is difficult enough, while the maintenance of such a network is an even larger problem. A prototype network management expert system, NMESys, implemented in the C Language Integrated Production System (CLIPS). NMESys concentrates on solving some of the critical problems encountered in managing a large network. The major goal of NMESys is to provide a network operator with an expert system tool to quickly and accurately detect hard failures, potential failures, and to minimize or eliminate user down time in a large network.

Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system.

PubMed

Mohd-Tahir, Nurul-Ain; Paraidathathu, Thomas; Li, Shu-Chuen

2015-01-01

Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients' demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders are necessary to further strengthen the Malaysian healthcare system effectively.

Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system

PubMed Central

Mohd-Tahir, Nurul-Ain; Paraidathathu, Thomas

2015-01-01

Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients’ demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders are necessary to further strengthen the Malaysian healthcare system effectively. PMID:26770795

Teaching undergraduate nursing students critical thinking: An innovative informatics strategy.

PubMed

Warren, Judith J; Connors, Helen R; Weaver, Charlotte; Simpson, Roy

2006-01-01

Simulated e-Health Delivery System (SEEDS) uses a clinical information system (CIS) to teach students how to process data from virtual patient case studies and work with information technology. SEEDS was developed in response to the Institute of Medicine recommendation that students be taught about information systems in order to improve quality patient care and reduce errors. Curriculum implications, implementation of the system, and technology challenges are discussed.

Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm.

PubMed

Kirkendall, E S; Spires, W L; Mottes, T A; Schaffzin, J K; Barclay, C; Goldstein, S L

2014-01-01

Nephrotoxic medication-associated acute kidney injury (NTMx-AKI) is a costly clinical phenomenon and more common than previously recognized. Prior efforts to use technology to identify AKI have focused on detection after renal injury has occurred. Describe an approach and provide a technical framework for the creation of risk-stratifying AKI triggers and the development of an application to manage the AKI trigger data. Report the performance characteristics of those triggers and the refinement process and on the challenges of implementation. Initial manual trigger screening guided design of an automated electronic trigger report. A web-based application was designed to alleviate inefficiency and serve as a user interface and central workspace for the project. Performance of the NTMx exposure trigger reports from September 2011 to September 2013 were evaluated using sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV). Automated reports were created to replace manual screening for NTMx-AKI. The initial performance of the NTMx exposure triggers for SN, SP, PPV, and NPV all were ≥0.78, and increased over the study, with all four measures reaching ≥0.95 consistently. A web-based application was implemented that simplifies data entry and couriering from the reports, expedites results viewing, and interfaces with an automated data visualization tool. Sociotechnical challenges were logged and reported. We have built a risk-stratifying system based on electronic triggers that detects patients at-risk for NTMx-AKI before injury occurs. The performance of the NTMx-exposed reports has neared 100% through iterative optimization. The complexity of the trigger logic and clinical workflows surrounding NTMx-AKI led to a challenging implementation, but one that has been successful from technical, clinical, and quality improvement standpoints. This report summarizes the construction of a trigger-based application, the performance of the triggers, and the challenges uncovered during the design, build, and implementation of the system.

Connecting Medical Records: An Evaluation of Benefits and Challenges for Primary Care Practices.

PubMed

Compeau, Deborah Ruth; Terry, Amanda

2017-06-30

Implementation of systems to support health information sharing has lagged other areas of healthcare IT, yet offers a strong possibility for benefit.  Clinical acceptance is a key limiting factor in health IT adoption. To assess the benefits and challenges experienced by clinicians using a custom-developed health information exchange system, and to show how perceptions of benefits and challenges influence perceptions of productivity and care-related outcomes. We used a mixed methods design with two phases. First, we conducted interviews with stakeholders who were familiar with the health information exchange system to inform the development of a measure of benefits and challenges of the use of this system. Second, using this measure we conducted a survey of current and former users of the health information exchange system using a modified Dillman method. 105 current and former users completed the survey. The results showed information quality, ease of completing tasks and clinical process improvement as key benefits that reduced workload and improved patient care.  Challenges related to system reliability, quality of reports and service quality increased workload and decreased impact on care, though the effect of the challenges was smaller than that of the benefits.  Even very limited health information exchange capabilities can improve outcomes for primary care users.  Improving perceptions of benefits may be even more important the removing challenges to use, though it is likely that a threshold of quality must be achieved for this to be true.

Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby.

PubMed

Kerber, Kate J; Mathai, Matthews; Lewis, Gwyneth; Flenady, Vicki; Erwich, Jan Jaap H M; Segun, Tunde; Aliganyira, Patrick; Abdelmegeid, Ali; Allanson, Emma; Roos, Nathalie; Rhoda, Natasha; Lawn, Joy E; Pattinson, Robert

2015-01-01

While there is widespread acknowledgment of the need for improved quality and quantity of information on births and deaths, there has been less movement towards systematically capturing and reviewing the causes and avoidable factors linked to deaths, in order to affect change. This is particularly true for stillbirths and neonatal deaths which can fall between different health care providers and departments. Maternal and perinatal mortality audit applies to two of the five objectives in the Every Newborn Action Plan but data on successful approaches to overcome bottlenecks to scaling up audit are lacking. We reviewed the current evidence for facility-based perinatal mortality audit with a focus on low- and middle-income countries and assessed the status of mortality audit policy and implementation. Based on challenges identified in the literature, key challenges to completing the audit cycle and affecting change were identified across the WHO health system building blocks, along with solutions, in order to inform the process of scaling up this strategy with attention to quality. Maternal death surveillance and review is moving rapidly with many countries enacting and implementing policies and with accountability beyond the single facility conducting the audits. While 51 priority countries report having a policy on maternal death notification in 2014, only 17 countries have a policy for reporting and reviewing stillbirths and neonatal deaths. The existing evidence demonstrates the potential for audit to improve birth outcomes, only if the audit cycle is completed. The primary challenges within the health system building blocks are in the area of leadership and health information. Examples of successful implementation exist from high income countries and select low- and middle-income countries provide valuable learning, especially on the need for leadership for effective audit systems and on the development and the use of clear guidelines and protocols in order to ensure that the audit cycle is completed. Health workers have the power to change health care routines in daily practice, but this must be accompanied by concrete inputs at every level of the health system. The system requires data systems including consistent cause of death classification and use of best practice guidelines to monitor performance, as well as leaders to champion the process, especially to ensure a no-blame environment, and to access change agents at other levels to address larger, systemic challenges.

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective.

PubMed

Sidek, Yusof Haji; Martins, Jorge Tiago

2017-11-01

Electronic health records (EHR) make health care more efficient. They improve the quality of care by making patients' medical history more accessible. However, little is known about the factors contributing to the successful EHR implementation in dental clinics. This article aims to identify the perceived critical success factors of EHR system implementation in a dental clinic context. We used Grounded Theory to analyse data collected in the context of Brunei's national EHR - the Healthcare Information and Management System (Bru-HIMS). Data analysis followed the stages of open, axial and selective coding. Six perceived critical success factors emerged: usability of the system, emergent behaviours, requirements analysis, training, change management, and project organisation. The study identified a mismatch between end-users and product owner/vendor perspectives. Workflow changes were significant challenges to clinicians' confident use, particularly as the system offered limited modularity and configurability. Recommendations are made for all the parties involved in healthcare information systems implementation to manage the change process by agreeing system goals and functionalities through wider consensual debate, and participated supporting strategies realised through common commitment. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Developing a charging system for a nursing specialty: ET nursing.

PubMed

Lowery, G E; Gage, J; Lowenstein, A

1994-05-01

Because of limited resources and economic constraints, justifying the existence of ET nurses has become an economic challenge for hospitals and nurses. To justify the role of the ET nurse, a charging system for enterostomal therapy was developed at a corporate, for-profit hospital. Three months after implementation, an evaluation of the system demonstrated that revenue was generated in excess of the ET nurse's salary.

The Power of the Frame: Systems Transformation Framework for Health Care Leaders.

PubMed

Scott, Kathy A; Pringle, Janice

Health care leaders are responsible for oversight of multiple and competing change interventions. These interventions regularly fail to achieve the desired outcomes and/or sustainable results. This often occurs because of the mental models and approaches that are used to plan, design, implement, and evaluate the system. These do not account for inherent characteristics that determine the system's likely ability to innovate while maintaining operational effectiveness. Theories exist on how to assess a system's readiness to change, but the definitions, constructs, and assessments are diverse and often look at facets of systems in isolation. The Systems Transformation Framework prescriptively defines and characterizes system domains on the basis of complex adaptive systems theory so that domains can be assessed in tandem. As a result, strengths and challenges to implementation are recognized before implementation begins. The Systems Transformation Framework defines 8 major domains: vision, leadership, organizational culture, organizational behavior, organizational structure, performance measurements, internal learning, and external learning. Each domain has principles that are critical for creating the conditions that lead to successful organizational adaptation and change. The Systems Transformation Framework can serve as a guide for health care leaders at all levels of the organization to (1) create environments that are change ready and (2) plan, design, implement, and evaluate change within complex adaptive systems.

Parallel asynchronous systems and image processing algorithms

NASA Technical Reports Server (NTRS)

Coon, D. D.; Perera, A. G. U.

1989-01-01

A new hardware approach to implementation of image processing algorithms is described. The approach is based on silicon devices which would permit an independent analog processing channel to be dedicated to evey pixel. A laminar architecture consisting of a stack of planar arrays of the device would form a two-dimensional array processor with a 2-D array of inputs located directly behind a focal plane detector array. A 2-D image data stream would propagate in neuronlike asynchronous pulse coded form through the laminar processor. Such systems would integrate image acquisition and image processing. Acquisition and processing would be performed concurrently as in natural vision systems. The research is aimed at implementation of algorithms, such as the intensity dependent summation algorithm and pyramid processing structures, which are motivated by the operation of natural vision systems. Implementation of natural vision algorithms would benefit from the use of neuronlike information coding and the laminar, 2-D parallel, vision system type architecture. Besides providing a neural network framework for implementation of natural vision algorithms, a 2-D parallel approach could eliminate the serial bottleneck of conventional processing systems. Conversion to serial format would occur only after raw intensity data has been substantially processed. An interesting challenge arises from the fact that the mathematical formulation of natural vision algorithms does not specify the means of implementation, so that hardware implementation poses intriguing questions involving vision science.

Implementation of the Risk-Need-Responsivity Framework across the Juvenile Justice Agencies in Singapore.

PubMed

Chua, Jonathan Raphacis; Chu, Chi Meng; Yim, Grace; Chong, Dominic; Teoh, Jennifer

2014-11-02

The Risk-Need-Responsivity (RNR) framework is regarded as the forefront of offender rehabilitation in guiding youth offender risk assessment and interventions. This article discusses the juvenile justice system in Singapore and the local research that has been conducted in relation to the RNR framework and the associated Youth Level of Service (YLS) measures. It describes a journey that saw the implementation of the RNR framework across the juvenile justice agencies and highlights the challenges that were faced during the implementation process on the ground. Finally, the article concludes by providing future directions for the implementation of the RNR framework in Singapore.

Implementation of the Risk–Need–Responsivity Framework across the Juvenile Justice Agencies in Singapore

PubMed Central

Chua, Jonathan Raphacis; Chu, Chi Meng; Yim, Grace; Chong, Dominic; Teoh, Jennifer

2014-01-01

The Risk–Need–Responsivity (RNR) framework is regarded as the forefront of offender rehabilitation in guiding youth offender risk assessment and interventions. This article discusses the juvenile justice system in Singapore and the local research that has been conducted in relation to the RNR framework and the associated Youth Level of Service (YLS) measures. It describes a journey that saw the implementation of the RNR framework across the juvenile justice agencies and highlights the challenges that were faced during the implementation process on the ground. Finally, the article concludes by providing future directions for the implementation of the RNR framework in Singapore. PMID:25866464

Development and Implementation of a Surveillance Network System for Emerging Infectious Diseases in the Caribbean (ARICABA).

PubMed

Kim, Wongyu Lewis; Anneducharme, Chelsea; Bucher, Bernard Jean-Marie Philippe

2011-01-01

Dengue fever, including dengue hemorrhagic fever, has become a re-emerging public health threat in the Caribbean in the absence of a comprehensive regional surveillance system. In this deficiency, a project entitled ARICABA, strives to implement a pilot surveillance system across three islands: Martinique, St. Lucia, and Dominica. The aim of this project is to establish a network for epidemiological surveillance of infectious diseases, utilizing information and communication technology. This paper describes the system design and development strategies of a "network of networks" surveillance system for infectious diseases in the Caribbean. Also described are benefits, challenges, and limitations of this approach across the three island nations identified through direct observation, open-ended interviews, and email communications with an on-site IT consultant, key informants, and the project director. Identified core systems design of the ARICABA data warehouse include a disease monitoring system and a syndromic surveillance system. Three components comprise the development strategy: the data warehouse server, the geographical information system, and forecasting algorithms; these are recognized technical priorities of the surveillance system. A main benefit of the ARICABA surveillance system is improving responsiveness and representativeness of existing health systems through automated data collection, process, and transmission of information from various sources. Challenges include overcoming technology gaps between countries; real-time data collection points; multiple language support; and "component-oriented" development approaches.

Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria.

PubMed

Eboreime, Ejemai Amaize; Abimbola, Seye; Obi, Felix Abrahams; Ebirim, Obinna; Olubajo, Olalekan; Eyles, John; Nxumalo, Nonhlanhla Lynette; Mambulu, Faith Nankasa

2017-03-21

Policy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria's decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives. Having engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach. Contrary to national government's assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of "Office Establishment" and Legislation" respectively, no state was fully compliant to "Human Resource Management" and "Funding" requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives. Our study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes.

Colorado School Finance Partnership: Report and Recommendations. Financing Colorado's Future: Assessing Our School Finance System

ERIC Educational Resources Information Center

Colorado Children's Campaign, 2012

2012-01-01

Over the last decade, Colorado has emerged as a national leader in crafting innovative solutions for challenges facing its public school system. From implementing the Colorado Student Assessment Program (CSAP) and No Child Left Behind (NCLB) reforms to more recent legislation including standards and assessments for a preschool-through-college…

THE CHARACTERIZATION AND IMPLEMENTATION OF AN ENHANCED ACTIVATED ALUMINA FOR THE REMOVAL OF DISSOLVED ARSENIC AT THE POINT OF ENTRY

EPA Science Inventory

Technical Challenge: Nearly 5.5% of the water systems in the United States are expected to exceed the new 10 ppb arsenic maximum contaminant level. Many of these systems are in small communities that require an affordable means of meeting these arsenic standards. ...

Learning from Teacher Observations: Challenges and Opportunities Posed by New Teacher Evaluation Systems

ERIC Educational Resources Information Center

Hill, Heather C.; Grossman, Pam

2013-01-01

In this article, Heather C. Hill and Pam Grossman discuss the current focus on using teacher observation instruments as part of new teacher evaluation systems being considered and implemented by states and districts. They argue that if these teacher observation instruments are to achieve the goal of supporting teachers in improving instructional…

Embracing Big Data in Complex Educational Systems: The Learning Analytics Imperative and the Policy Challenge

ERIC Educational Resources Information Center

Macfadyen, Leah P.; Dawson, Shane; Pardo, Abelardo; Gaševic, Dragan

2014-01-01

In the new era of big educational data, learning analytics (LA) offer the possibility of implementing real-time assessment and feedback systems and processes at scale that are focused on improvement of learning, development of self-regulated learning skills, and student success. However, to realize this promise, the necessary shifts in the…

iSTART Therefore I Understand: But Metacognitive Supports Did Not Enhance Comprehension Gains

ERIC Educational Resources Information Center

McCarthy, Kathryn S.; Jacovina, Matthew E.; Snow, Erica L.; Guerrero, Tricia A.; McNamara, Danielle S.

2017-01-01

iSTART is an intelligent tutoring system designed to provide self-explanation instruction and practice to improve students' comprehension of complex, challenging text. This study examined the effects of extended game-based practice within the system as well as the effects of two metacognitive supports implemented within this practice. High school…

Implementation of consumer providers into mental health intensive case management teams.

PubMed

Hamilton, Alison B; Chinman, Matthew; Cohen, Amy N; Oberman, Rebecca Shoai; Young, Alexander S

2015-01-01

In mental health care, consumer providers (CPs) are individuals with serious mental illness (SMI) who draw upon their lived experiences while providing services to others with SMI. Implementation of CPs has proven to be challenging in a variety of settings. The PEER project (Peers Enhancing Recovery) involved rolling out CPs using an implementation science model and evaluating implementation and impact in mental health treatment settings (three intervention, three control). In qualitative interviews, facilitators and challenges to implementation were described by the CPs, their team members, clients, and study researchers. Site preparation, external facilitation, and positive, reinforcing experiences with CPs facilitated implementation. Role definitions and deficiencies in CPs' technical knowledge posed challenges to implementation. Sustainability was not realized due to insufficient resources. However, implementation was positive overall, characterized by diffusion of innovation concepts of high relative advantage, strong trialability, compatibility with prevailing norms, compelling observability, and relatively low complexity. By preparing and working systematically with intervention sites to incorporate new services, implementation was strengthened and challenges were minimized.

DPLL implementation in carrier acquisition and tracking for burst DS-CDMA receivers.

PubMed

Guan, Yun-feng; Zhang, Zhao-yang; Lai, Li-feng

2003-01-01

This paper presents the architectures, algorithms, and implementation considerations of the digital phase locked loop (DPLL) used for burst-mode packet DS-CDMA receivers. As we know, carrier offset is a rather challenging problem in CDMA system. According to different applications, different DPLL forms should be adopted to correct different maximum carrier offset in CDMA systems. One classical DPLL and two novel DPLL forms are discussed in the paper. The acquisition range of carrier offset can be widened by using the two novel DPLL forms without any performance degradation such as longer acquisition time or larger variance of the phase error. The maximum acquisition range is 1/(4T), where T is the symbol period. The design can be implemented by FPGA directly.

Implementation of Emergency Medical Text Classifier for Syndromic Surveillance

PubMed Central

Travers, Debbie; Haas, Stephanie W.; Waller, Anna E.; Schwartz, Todd A.; Mostafa, Javed; Best, Nakia C.; Crouch, John

2013-01-01

Public health officials use syndromic surveillance systems to facilitate early detection and response to infectious disease outbreaks. Emergency department clinical notes are becoming more available for surveillance but present the challenge of accurately extracting concepts from these text data. The purpose of this study was to implement a new system, Emergency Medical Text Classifier (EMT-C), into daily production for syndromic surveillance and evaluate system performance and user satisfaction. The system was designed to meet user preferences for a syndromic classifier that maximized positive predictive value and minimized false positives in order to provide a manageable workload. EMT-C performed better than the baseline system on all metrics and users were slightly more satisfied with it. It is vital to obtain user input and test new systems in the production environment. PMID:24551413

Managing change: an overview.

PubMed

Lorenzi, N M; Riley, R T

2000-01-01

As increasingly powerful informatics systems are designed, developed, and implemented, they inevitably affect larger, more heterogeneous groups of people and more organizational areas. In turn, the major challenges to system success are often more behavioral than technical. Successfully introducing such systems into complex health care organizations requires an effective blend of good technical and good organizational skills. People who have low psychological ownership in a system and who vigorously resist its implementation can bring a "technically best" system to its knees. However, effective leadership can sharply reduce the behavioral resistance to change-including to new technologies-to achieve a more rapid and productive introduction of informatics technology. This paper looks at four major areas-why information system failures occur, the core theories supporting change management, the practical applications of change management, and the change management efforts in informatics.

Implementation of Emergency Medical Text Classifier for syndromic surveillance.

PubMed

Travers, Debbie; Haas, Stephanie W; Waller, Anna E; Schwartz, Todd A; Mostafa, Javed; Best, Nakia C; Crouch, John

2013-01-01

Public health officials use syndromic surveillance systems to facilitate early detection and response to infectious disease outbreaks. Emergency department clinical notes are becoming more available for surveillance but present the challenge of accurately extracting concepts from these text data. The purpose of this study was to implement a new system, Emergency Medical Text Classifier (EMT-C), into daily production for syndromic surveillance and evaluate system performance and user satisfaction. The system was designed to meet user preferences for a syndromic classifier that maximized positive predictive value and minimized false positives in order to provide a manageable workload. EMT-C performed better than the baseline system on all metrics and users were slightly more satisfied with it. It is vital to obtain user input and test new systems in the production environment.

Rethinking Environmental Protection: Meeting the Challenges of a Changing World.

PubMed

Burke, Thomas A; Cascio, Wayne E; Costa, Daniel L; Deener, Kacee; Fontaine, Thomas D; Fulk, Florence A; Jackson, Laura E; Munns, Wayne R; Orme-Zavaleta, Jennifer; Slimak, Michael W; Zartarian, Valerie G

2017-03-01

From climate change to hydraulic fracturing, and from drinking water safety to wildfires, environmental challenges are changing. The United States has made substantial environmental protection progress based on media-specific and single pollutant risk-based frameworks. However, today’s environmental problems are increasingly complex and new scientific approaches and tools are needed to achieve sustainable solutions to protect the environment and public health. In this article, we present examples of today’s environmental challenges and offer an integrated systems approach to address them. We provide a strategic framework and recommendations for advancing the application of science for protecting the environment and public health. We posit that addressing 21st century challenges requires transdisciplinary and systems approaches, new data sources, and stakeholder partnerships. To address these challenges, we outline a process driven by problem formulation with the following steps: a ) formulate the problem holistically, b ) gather and synthesize diverse information, c ) develop and assess options, and d ) implement sustainable solutions. This process will require new skills and education in systems science, with an emphasis on science translation. A systems-based approach can transcend media- and receptor-specific bounds, integrate diverse information, and recognize the inextricable link between ecology and human health.

Rethinking Environmental Protection: Meeting the Challenges of a Changing World

PubMed Central

Burke, Thomas A.; Cascio, Wayne E.; Costa, Daniel L.; Deener, Kacee; Fontaine, Thomas D.; Fulk, Florence A.; Jackson, Laura E.; Munns, Wayne R.; Orme-Zavaleta, Jennifer; Slimak, Michael W.; Zartarian, Valerie G.

2017-01-01

Summary: From climate change to hydraulic fracturing, and from drinking water safety to wildfires, environmental challenges are changing. The United States has made substantial environmental protection progress based on media-specific and single pollutant risk-based frameworks. However, today’s environmental problems are increasingly complex and new scientific approaches and tools are needed to achieve sustainable solutions to protect the environment and public health. In this article, we present examples of today’s environmental challenges and offer an integrated systems approach to address them. We provide a strategic framework and recommendations for advancing the application of science for protecting the environment and public health. We posit that addressing 21st century challenges requires transdisciplinary and systems approaches, new data sources, and stakeholder partnerships. To address these challenges, we outline a process driven by problem formulation with the following steps: a) formulate the problem holistically, b) gather and synthesize diverse information, c) develop and assess options, and d) implement sustainable solutions. This process will require new skills and education in systems science, with an emphasis on science translation. A systems-based approach can transcend media- and receptor-specific bounds, integrate diverse information, and recognize the inextricable link between ecology and human health. PMID:28248180

System-Level Virtualization for High Performance Computing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vallee, Geoffroy R; Naughton, III, Thomas J; Engelmann, Christian

2008-01-01

System-level virtualization has been a research topic since the 70's but regained popularity during the past few years because of the availability of efficient solution such as Xen and the implementation of hardware support in commodity processors (e.g. Intel-VT, AMD-V). However, a majority of system-level virtualization projects is guided by the server consolidation market. As a result, current virtualization solutions appear to not be suitable for high performance computing (HPC) which is typically based on large-scale systems. On another hand there is significant interest in exploiting virtual machines (VMs) within HPC for a number of other reasons. By virtualizing themore » machine, one is able to run a variety of operating systems and environments as needed by the applications. Virtualization allows users to isolate workloads, improving security and reliability. It is also possible to support non-native environments and/or legacy operating environments through virtualization. In addition, it is possible to balance work loads, use migration techniques to relocate applications from failing machines, and isolate fault systems for repair. This document presents the challenges for the implementation of a system-level virtualization solution for HPC. It also presents a brief survey of the different approaches and techniques to address these challenges.« less

Electronic Chemotherapy Order Entry: A Major Cancer Center's Implementation

PubMed Central

Sklarin, Nancy T.; Granovsky, Svetlana; O'Reilly, Eileen M.; Zelenetz, Andrew D.

2011-01-01

Implementation of a computerized provider order entry system for complex chemotherapy regimens at a large cancer center required intense effort from a multidisciplinary team of clinical and systems experts with experience in all facets of the chemotherapy process. The online tools had to resemble the paper forms used at the time and parallel the successful established process as well as add new functionality. Close collaboration between the institution and the vendor was necessary. This article summarizes the institutional efforts, challenges, and collaborative processes that facilitated universal chemotherapy computerized electronic order entry across multiple sites during a period of several years. PMID:22043182

Electronic Chemotherapy Order Entry: A Major Cancer Center's Implementation.

PubMed

Sklarin, Nancy T; Granovsky, Svetlana; O'Reilly, Eileen M; Zelenetz, Andrew D

2011-07-01

Implementation of a computerized provider order entry system for complex chemotherapy regimens at a large cancer center required intense effort from a multidisciplinary team of clinical and systems experts with experience in all facets of the chemotherapy process. The online tools had to resemble the paper forms used at the time and parallel the successful established process as well as add new functionality. Close collaboration between the institution and the vendor was necessary. This article summarizes the institutional efforts, challenges, and collaborative processes that facilitated universal chemotherapy computerized electronic order entry across multiple sites during a period of several years.

Accounting and reimbursement schemes for inpatient care in France.

PubMed

Bellanger, Martine M; Tardif, Laurent

2006-08-01

The new French case-mix system of hospital payment was adopted in 2004 for public hospitals and in March 2005 for private-for-profit hospitals. Implementing this reform requires a period of transition but the challenges ahead can already be predicted. Prices will have to change before this mode of reimbursement can have any real impact. This requires producing more detailed hospital cost data and using fine measuring tools such as the cost accounting method developed for use in this context. This article describes and analyses the main tools and methods selected to implement the new French prospective payment system.

Identifying the challenges and facilitators of implementing a COPD care bundle.

PubMed

Lennox, Laura; Green, Stuart; Howe, Cathy; Musgrave, Hannah; Bell, Derek; Elkin, Sarah

2014-01-01

Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to overcoming these barriers provides an opportunity to mitigate issues that waste time and resources, and ensures that training can be tailored to the anticipated challenges.

Next-Generation Climate Modeling Science Challenges for Simulation, Workflow and Analysis Systems

NASA Astrophysics Data System (ADS)

Koch, D. M.; Anantharaj, V. G.; Bader, D. C.; Krishnan, H.; Leung, L. R.; Ringler, T.; Taylor, M.; Wehner, M. F.; Williams, D. N.

2016-12-01

We will present two examples of current and future high-resolution climate-modeling research that are challenging existing simulation run-time I/O, model-data movement, storage and publishing, and analysis. In each case, we will consider lessons learned as current workflow systems are broken by these large-data science challenges, as well as strategies to repair or rebuild the systems. First we consider the science and workflow challenges to be posed by the CMIP6 multi-model HighResMIP, involving around a dozen modeling groups performing quarter-degree simulations, in 3-member ensembles for 100 years, with high-frequency (1-6 hourly) diagnostics, which is expected to generate over 4PB of data. An example of science derived from these experiments will be to study how resolution affects the ability of models to capture extreme-events such as hurricanes or atmospheric rivers. Expected methods to transfer (using parallel Globus) and analyze (using parallel "TECA" software tools) HighResMIP data for such feature-tracking by the DOE CASCADE project will be presented. A second example will be from the Accelerated Climate Modeling for Energy (ACME) project, which is currently addressing challenges involving multiple century-scale coupled high resolution (quarter-degree) climate simulations on DOE Leadership Class computers. ACME is anticipating production of over 5PB of data during the next 2 years of simulations, in order to investigate the drivers of water cycle changes, sea-level-rise, and carbon cycle evolution. The ACME workflow, from simulation to data transfer, storage, analysis and publication will be presented. Current and planned methods to accelerate the workflow, including implementing run-time diagnostics, and implementing server-side analysis to avoid moving large datasets will be presented.

Human Resource Information System implementation readiness in the Ethiopian health sector: a cross-sectional study.

PubMed

Dilu, Eyilachew; Gebreslassie, Measho; Kebede, Mihiretu

2017-12-20

Health workforce information systems in low-income countries tend to be defective with poor relationship to information sources. Human Resource Information System (HRIS) is currently in a pilot implementation phase in the Federal Ministry of Health and Regional Health Bureaus of Ethiopia. Before scaling up the implementation, it is important to understand the implementation readiness of hospitals and health departments. The aims of this study were to assess the readiness for HRIS implementation, identify associated factors, and explore the implementation challenges in public hospitals and health departments of the Amhara National Regional State, Ethiopia. An institution-based cross-sectional study supplemented with a qualitative study was conducted from the 15th of February to the 30th of March 2016 in 19 public hospitals and health departments of the Amhara National Regional State, Ethiopia. A self-administered questionnaire was used to collect the data. The questionnaire includes items on socio-demographic characteristics and questions measuring technical, personal, and organizational factors adapted from the 32-item questionnaire of the Management Science for Health (MSH) HRIS readiness assessment tool. The data were entered and analyzed with statistical software. Descriptive statistics and bivariate and multivariable logistic regression analyses were performed. Odds ratios with 95% confidence interval were computed to identify the factors statistically associated with readiness of HRIS implementation. In-depth interviews and observation checklists were used to collect qualitative data. Thematic content analysis was used to analyze the qualitative data. A total of 246 human resource (HR) employees and 16 key informants have been included in the study. The HR employee's level of readiness for HRIS implementation in this study was 35.8%. Employee's Internet access (AOR = 2.59, 95%CI = 1.19, 5.62), availability of separate HR section (AOR = 8.08, 95%CI = 3.69, 17.70), basic computer skills (AOR = 6.74, 95%CI = 2.75, 16.56), and fear of unemployment (AOR = 2.83, 95%CI = 1.27, 6.32) were associated with readiness of HRIS implementation. Poor logistic supply, lack of competency, poor commitment, and shortage of finance were the challenges of HRIS implementation. In this study, readiness of HRIS implementation was low. Strategies targeting to improve skills, awareness, and attitude of HR employees would facilitate the implementation process.

Opportunities and challenges of resident specialists’ attendance plan guidelines (health-care transformation plan) in Isfahan university hospitals in 2015

PubMed Central

Moradi, Reza; Karimi, Saeid; Yarmohammadian, Mohammad Hossein; Kiaei, Mohammad Zakaria; Mazaheri, Elaheh

2018-01-01

BACKGROUND: Given new reforms in Iran's health-care system and due to the need for gathering evidence regarding the implementation of this plan, this study aimed to investigate opportunities and challenges created by resident specialist attendance plan guidelines in university hospitals. MATERIALS AND METHODS: This study used the qualitative method. Semi-structured interviews were used for data gathering. The study population included all experts of Isfahan University of Medical Science. Sampling was carried out using purposeful sampling method and continued until data saturation was reached. In total, 16 experts were interviewed. Criteria such as “reliability of information,” “trustworthiness,” and “verifiability of the information” were considered. Interviewees were assured that their names would keep hidden and that all information is confidential. Subject analysis method was used for data analysis. RESULTS: The findings of this study based on subject analysis led to extracting three themes in regards of challenges in the implementation of resident (specialist or fellowship) plan in hospitals including structural, management, and resource challenges and one theme in the area of opportunities which were improved quality and timely provision of services. CONCLUSION: The findings showed that despite the strengths of this guideline, there are some fundamental challenges in various areas and need better attention by national level policymakers. These results help health-care policymakers to evaluate the problem with a better attitude and improve the necessary plans for implementation of these guidelines. PMID:29619390

Implementation of HIV and Tuberculosis Diagnostics: The Importance of Context.

PubMed

Dominique, Joyelle K; Ortiz-Osorno, Alberto A; Fitzgibbon, Joseph; Gnanashanmugam, Devasena; Gilpin, Christopher; Tucker, Timothy; Peel, Sheila; Peter, Trevor; Kim, Peter; Smith, Steven

2015-10-15

Novel diagnostics have been widely applied across human immunodeficiency virus (HIV) and tuberculosis prevention and treatment programs. To achieve the greatest impact, HIV and tuberculosis diagnostic programs must carefully plan and implement within the context of a specific healthcare system and the laboratory capacity. A workshop was convened in Cape Town in September 2014. Participants included experts from laboratory and clinical practices, officials from ministries of health, and representatives from industry. The article summarizes best practices, challenges, and lessons learned from implementation experiences across sub-Saharan Africa for (1) building laboratory programs within the context of a healthcare system; (2) utilizing experience of clinicians and healthcare partners in planning and implementing the right diagnostic; and (3) evaluating the effects of new diagnostics on the healthcare system and on patient health outcomes. The successful implementation of HIV and tuberculosis diagnostics in resource-limited settings relies on careful consideration of each specific context. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Challenges for IT-supported shared care: a qualitative analyses of two shared care initiatives for diabetes treatment in Denmark “I'll never use it” (GP5).

PubMed Central

Granlien, Maren Fich; Simonsen, Jesper

2007-01-01

Purpose To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care. Case study The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care. Discussion and conclusion The two cases faced the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general practitioners which hinder bridging the primary sector (general practitioners) and the secondary sector (hospitals and outpatient clinics). Especially the needs associated with the primary sector were not being satisfied. We discovered three main challenges related to bridging the gap between the two sectors: (1) Poor integration with the general practitioners' existing IT systems; (2) low compatibility with general practitioners' work ethic; (3) and discrepancy between the number of diabetes patients and the related need for shared care. We conclude that development of IT-supported shared care must recognise the underlying and significant differences between the primary and secondary care sectors: If IT-supported shared care does not meet the needs of the general practitioners as well as the needs of the secondary care sector the initiative will fail. PMID:17627300

Implementation outcomes of Multidimensional Family Therapy-Detention to Community: a reintegration program for drug-using juvenile detainees.

PubMed

Liddle, Howard A; Dakof, Gayle A; Henderson, Craig; Rowe, Cindy

2011-06-01

Responding to urgent calls for effective interventions to address young offenders' multiple and interconnected problems, a new variant of an existing empirically-validated intervention for drug-using adolescents, Multidimensional Family Therapy (MDFT)-Detention to Community (DTC) was tested in a two-site controlled trial. This article (a) outlines the rationale and protocol basics of the MDFT-DTC intervention, a program for substance-using juvenile offenders that links justice and substance abuse treatment systems to facilitate adolescents' post-detention community reintegration; (b) presents implementation outcomes, including fidelity, treatment engagement and retention rates, amount of services received, treatment satisfaction, and substance abuse-juvenile justice system collaboration outcomes; and (c) details the implementation and sustainability challenges in a cross-system (substance abuse treatment and juvenile justice) adolescent intervention. Findings support the effectiveness of the MDFT-DTC intervention, and the need to develop a full implementation model in which transfer and dissemination issues could be explored more fully, and tested experimentally.

Development and implementation of a psychotherapy tracking database in primary care.

PubMed

Craner, Julia R; Sawchuk, Craig N; Mack, John D; LeRoy, Michelle A

2017-06-01

Although there is a rapid increase in the integration of behavioral health services in primary care, few studies have evaluated the effectiveness of these services in real-world clinical settings, in part due to the difficulty of translating traditional mental health research designs to this setting. Accordingly, innovative approaches are needed to fit the unique challenges of conducting research in primary care. The development and implementation of one such approach is described in this article. A continuously populating database for psychotherapy services was implemented across 5 primary care clinics in a large health system to assess several levels of patient care, including service utilization, symptomatic outcomes, and session-by-session use of psychotherapy principles by providers. Each phase of implementation revealed challenges, including clinician time, dissemination to clinics with different resources, and fidelity of data collection strategy across providers, as well as benefits, including the generation of useful data to inform clinical care, program development, and empirical research. The feasible and sustainable implementation of data collection for routine clinical practice in primary care has the potential to fuel the evidence base around integrated care. The current project describes the development of an innovative approach that, with further empirical study and refinement, could enable health care professionals and systems to understand their population and clinical process in a way that addresses essential gaps in the integrated care literature. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.

PubMed

Garg, Sachin K; Lyles, Courtney R; Ackerman, Sara; Handley, Margaret A; Schillinger, Dean; Gourley, Gato; Aulakh, Veenu; Sarkar, Urmimala

2016-02-06

Text messaging is an affordable, ubiquitous, and expanding mobile communication technology. However, safety net health systems in the United States that provide more care to uninsured and low-income patients may face additional financial and infrastructural challenges in utilizing this technology. Formative evaluations of texting implementation experiences are limited. We interviewed safety net health systems piloting texting initiatives to study facilitators and barriers to real-world implementation. We conducted telephone interviews with various stakeholders who volunteered from each of the eight California-based safety net systems that received external funding to pilot a texting-based program of their choosing to serve a primary care need. We developed a semi-structured interview guide based partly on the Consolidated Framework for Implementation Research (CFIR), which encompasses several domains: the intervention, individuals involved, contextual factors, and implementation process. We inductively and deductively (using CFIR) coded transcripts, and categorized themes into facilitators and barriers. We performed eight interviews (one interview per pilot site). Five sites had no prior texting experience. Sites applied texting for programs related to medication adherence and monitoring, appointment reminders, care coordination, and health education and promotion. No site texted patient-identifying health information, and most sites manually obtained informed consent from each participating patient. Facilitators of implementation included perceived enthusiasm from patients, staff and management belief that texting is patient-centered, and the early identification of potential barriers through peer collaboration among grantees. Navigating government regulations that protect patient privacy and guide the handling of protected health information emerged as a crucial barrier. A related technical challenge in five sites was the labor-intensive tracking and documenting of texting communications due to an inability to integrate texting platforms with electronic health records. Despite enthusiasm for the texting programs from the involved individuals and organizations, inadequate data management capabilities and unclear privacy and security regulations for mobile health technology slowed the initial implementation and limited the clinical use of texting in the safety net and scope of pilots. Future implementation work and research should investigate how different texting platform and intervention designs affect efficacy, as well as explore issues that may affect sustainability and the scalability.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cutler, Dylan; Frank, Stephen; Slovensky, Michelle

Rich, well-organized building performance and energy consumption data enable a host of analytic capabilities for building owners and operators, from basic energy benchmarking to detailed fault detection and system optimization. Unfortunately, data integration for building control systems is challenging and costly in any setting. Large portfolios of buildings--campuses, cities, and corporate portfolios--experience these integration challenges most acutely. These large portfolios often have a wide array of control systems, including multiple vendors and nonstandard communication protocols. They typically have complex information technology (IT) networks and cybersecurity requirements and may integrate distributed energy resources into their infrastructure. Although the challenges are significant,more » the integration of control system data has the potential to provide proportionally greater value for these organizations through portfolio-scale analytics, comprehensive demand management, and asset performance visibility. As a large research campus, the National Renewable Energy Laboratory (NREL) experiences significant data integration challenges. To meet them, NREL has developed an architecture for effective data collection, integration, and analysis, providing a comprehensive view of data integration based on functional layers. The architecture is being evaluated on the NREL campus through deployment of three pilot implementations.« less

A common evaluation framework for the African Health Initiative

PubMed Central

2013-01-01

Background The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. Methods This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. Results and conclusions The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results. PMID:23819778

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

PubMed

Stergiopoulos, Vicky; Saab, Dima; Francombe Pridham, Kate; Aery, Anjana; Nakhost, Arash

2018-01-24

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Implementation of a departmental picture archiving and communication system: a productivity and cost analysis.

PubMed

Macyszyn, Luke; Lega, Brad; Bohman, Leif-Erik; Latefi, Ahmad; Smith, Michelle J; Malhotra, Neil R; Welch, William; Grady, Sean M

2013-09-01

Digital radiology enhances productivity and results in long-term cost savings. However, the viewing, storage, and sharing of outside imaging studies on compact discs at ambulatory offices and hospitals pose a number of unique challenges to a surgeon's efficiency and clinical workflow. To improve the efficiency and clinical workflow of an academic neurosurgical practice when evaluating patients with outside radiological studies. Open-source software and commercial hardware were used to design and implement a departmental picture archiving and communications system (PACS). The implementation of a departmental PACS system significantly improved productivity and enhanced collaboration in a variety of clinical settings. Using published data on the rate of information technology problems associated with outside studies on compact discs, this system produced a cost savings ranging from $6250 to $33600 and from $43200 to $72000 for 2 cohorts, urgent transfer and spine clinic patients, respectively, therefore justifying the costs of the system in less than a year. The implementation of a departmental PACS system using open-source software is straightforward and cost-effective and results in significant gains in surgeon productivity when evaluating patients with outside imaging studies.

Innovation Inspired by Nature: Capabilities, Potentials and Challenges

NASA Technical Reports Server (NTRS)

Bar-Cohen, Yoseph

2012-01-01

Through evolution, nature came up with many effective solutions to its challenges and continually improving them. By mimicking, coping and being inspired, humans have been using Nature's solutions to address their own challenges. In recent years, the implementation of nature's capabilities has intensified with our growing understanding of the various biological and nastic mechanisms and processes. Successes include even the making of humanlike robots that perform such lifelike tasks as walking, talking, making eye-contact, interpreting speech and facial expressions, as well as many other humanlike functions. Generally, once humans are able to implement a function then, thru rapid advances in technology, capabilities are developed that can significantly exceed the original source of inspiration in Nature. Examples include flight where there is no species that can fly as high, carry so much mass, has so large dimensions and fly so fast, and operate at as such extreme conditions as our aircraft and other aerospace systems. However, using the capabilities of today's technology, there are many challenges that are not feasible to address in mimicking characteristics of species and plants. In this manuscript, state-of-the-art of biomimetic capabilities, potentials and challenges are reviewed.

Practical guide for implementing hybrid PET/MR clinical service: lessons learned from our experience

PubMed Central

Parikh, Nainesh; Friedman, Kent P.; Shah, Shetal N.; Chandarana, Hersh

2015-01-01

Positron emission tomography (PET) and magnetic resonance imaging, until recently, have been performed on separate PET and MR systems with varying temporal delay between the two acquisitions. The interpretation of these two separately acquired studies requires cognitive fusion by radiologists/nuclear medicine physicians or dedicated and challenging post-processing. Recent advances in hardware and software with introduction of hybrid PET/MR systems have made it possible to acquire the PET and MR images simultaneously or near simultaneously. This review article serves as a road-map for clinical implementation of hybrid PET/MR systems and briefly discusses hardware systems, the personnel needs, safety and quality issues, and reimbursement topics based on experience at NYU Langone Medical Center and Cleveland Clinic. PMID:25985966

Wireless communication and spectrum sharing for public safety in the United States.

PubMed

Kapucu, Naim; Haupt, Brittany; Yuksel, Murat

2016-01-01

With the vast number of fragmented, independent public safety wireless communication systems, the United States is encountering major challenges with enhancing interoperability and effectively managing costs while sharing limited availability of critical spectrum. The traditional hierarchical approach of emergency management does not always allow for needed flexibility and is not a mandate. A national system would reduce equipment needs, increase effectiveness, and enrich quality and coordination of response; however, it is dependent on integrating the commercial market. This article discusses components of an ideal national wireless public safety system consists along with key policies in regulating wireless communication and spectrum sharing for public safety and challenges for implementation.

Ares I Flight Control System Overview

NASA Technical Reports Server (NTRS)

Hall, Charles; Lee, Chong; Jackson, Mark; Whorton, Mark; West, mark; Brandon, Jay; Hall, Rob A.; Jang, Jimmy; Bedrossian, Naz; Compton, Jimmy;

Zero to Integration in Eight Months, the Dawn Ground Data System Engineering Challenge

NASA Technical Reports Server (NTRS)

Dubon, Lydia P.

2006-01-01

The Dawn Project has presented the Ground Data System (GDS) with technical challenges driven by cost and schedule constraints commonly associated with National Aeronautics and Space Administration (NASA) Discovery Projects. The Dawn mission consists of a new and exciting Deep Space partnership among: the Jet Propulsion Laboratory (JPL), manages the project and is responsible for flight operation; Orbital Sciences Corporation (OSC), is the spacecraft builder and is responsible for flight system test and integration; and the University of California, at Los Angeles (UCLA), is responsible for science planning and operations. As a cost-capped mission, one of Dawn's implementation strategies is to leverage from both flight and ground heritage. OSC's ground data system is used for flight system test and integration as part of the flight heritage strategy. Mission operations, however, are to be conducted with JPL's ground system. The system engineering challenge of dealing with two heterogeneous ground systems emerged immediately. During the first technical interchange meeting between the JPL's GDS Team and OSC's Flight Software Team, August 2003, the need to integrate the ground system with the flight software was brought to the table. This need was driven by the project's commitment to enable instrument engineering model integration in a spacecraft simulator environment, for both demonstration and risk mitigation purposes, by April 2004. This paper will describe the system engineering approach that was undertaken by JPL's GDS Team in order to meet the technical challenge within a non-negotiable eight-month schedule. Key to the success was adherence to fundamental systems engineering practices: decomposition of the project request into manageable requirements; integration of multiple ground disciplines and experts into a focused team effort; definition of a structured yet flexible development process; definition of an in-process risk reduction plan; and aggregation of the intermediate products to an integrated final product. In addition, this paper will highlight the role of lessons learned from the integration experience. The lessons learned from an early GDS deployment have served as the foundation for the design and implementation of the Dawn Ground Data System.

Proposal for the creation of a national strategy for precision medicine in cancer: a position statement of SEOM, SEAP, and SEFH.

PubMed

Garrido, P; Aldaz, A; Vera, R; Calleja, M A; de Álava, E; Martín, M; Matías-Guiu, X; Palacios, J

2018-04-01

Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person. Precision medicine is transforming clinical and biomedical research, as well as health care itself from a conceptual, as well as a methodological viewpoint, providing extraordinary opportunities to improve public health and lower the costs of the healthcare system. However, the implementation of precision medicine poses ethical-legal, regulatory, organizational, and knowledge-related challenges. Without a national strategy, precision medicine, which will be implemented one way or another, could take place without the appropriate planning that can guarantee technical quality, equal access of all citizens to the best practices, violating the rights of patients and professionals, and jeopardizing the solvency of the healthcare system. With this paper from the Spanish Societies of Medical Oncology, Pathology, and Hospital Pharmacy, we highlight the need to institute a consensual national strategy for the development of precision medicine in our country, review the national and international context, comment on the opportunities and challenges for implementing precision medicine, and outline the objectives of a national strategy on precision medicine in cancer.

Intermediate Outcomes, Strategies, and Challenges of Eight Healthy Start Projects

PubMed Central

Walker, Deborah Klein; Hargreaves, Margaret; Rosenbach, Margo

2008-01-01

Site visits were conducted for the evaluation of the national Healthy Start program to gain an understanding of how projects design and implement five service components (outreach, case management, health education, depression screening and interconceptional care) and four system components (consortium, coordination/collaboration, local health system action plan and sustainability) as well as program staff’s perceptions of these components’ influence on intermediate outcomes. Interviews with project directors, case managers, local evaluators, clinicians, consortium members, outreach/lay workers and other stakeholders were conducted during 3-day in-depth site visits with eight Healthy Start grantees. Grantees reported that both services and systems components were related to self-reported service achievements (e.g. earlier entry into prenatal care) and systems achievements (e.g. consumer involvement). Outreach, case management, and health education were perceived as the service components that contributed most to their achievements while consortia was perceived as the most influential systems component in reaching their goals. Furthermore, cultural competence and community voice were overarching project components that addressed racial/ethnic disparities. Finally, there was great variability across sites regarding the challenges they faced, with poor service availability and limited funding the two most frequently reported. Service provision and systems development are both critical for successful Healthy Start projects to achieve intermediate program outcomes. Unique contextual and community issues influence Healthy Start project design, implementation and reported accomplishments. All eight projects implement the required program components yet outreach, case management, and health education are cited most frequently for contributing to their perceived achievements. PMID:19011959

Implementation strategies of Systems Medicine in clinical research and home care for cardiovascular disease patients.

PubMed

Montecucco, Fabrizio; Carbone, Federico; Dini, Frank Lloyd; Fiuza, Manuela; Pinto, Fausto J; Martelli, Antonietta; Palombo, Domenico; Sambuceti, Gianmario; Mach, François; De Caterina, Raffaele

2014-11-01

Insights from the "-omics" science have recently emphasized the need to implement an overall strategy in medical research. Here, the development of Systems Medicine has been indicated as a potential tool for clinical translation of basic research discoveries. Systems Medicine also gives the opportunity of improving different steps in medical practice, from diagnosis to healthcare management, including clinical research. The development of Systems Medicine is still hampered however by several challenges, the main one being the development of computational tools adequate to record, analyze and share a large amount of disparate data. In addition, available informatics tools appear not yet fully suitable for the challenge because they are not standardized, not universally available, or with ethical/legal concerns. Cardiovascular diseases (CVD) are a very promising area for translating Systems Medicine into clinical practice. By developing clinically applied technologies, the collection and analysis of data may improve CV risk stratification and prediction. Standardized models for data recording and analysis can also greatly broaden data exchange, thus promoting a uniform management of CVD patients also useful for clinical research. This advance however requires a great organizational effort by both physicians and health institutions, as well as the overcoming of ethical problems. This narrative review aims at providing an update on the state-of-art knowledge in the area of Systems Medicine as applied to CVD, focusing on current critical issues, providing a road map for its practical implementation. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Space Launch System Implementation of Adaptive Augmenting Control

NASA Technical Reports Server (NTRS)

Wall, John H.; Orr, Jeb S.; VanZwieten, Tannen S.

2014-01-01

Given the complex structural dynamics, challenging ascent performance requirements, and rigorous flight certification constraints owing to its manned capability, the NASA Space Launch System (SLS) launch vehicle requires a proven thrust vector control algorithm design with highly optimized parameters to provide stable and high-performance flight. On its development path to Preliminary Design Review (PDR), the SLS flight control system has been challenged by significant vehicle flexibility, aerodynamics, and sloshing propellant. While the design has been able to meet all robust stability criteria, it has done so with little excess margin. Through significant development work, an Adaptive Augmenting Control (AAC) algorithm has been shown to extend the envelope of failures and flight anomalies the SLS control system can accommodate while maintaining a direct link to flight control stability criteria such as classical gain and phase margin. In this paper, the work performed to mature the AAC algorithm as a baseline component of the SLS flight control system is presented. The progress to date has brought the algorithm design to the PDR level of maturity. The algorithm has been extended to augment the full SLS digital 3-axis autopilot, including existing load-relief elements, and the necessary steps for integration with the production flight software prototype have been implemented. Several updates which have been made to the adaptive algorithm to increase its performance, decrease its sensitivity to expected external commands, and safeguard against limitations in the digital implementation are discussed with illustrating results. Monte Carlo simulations and selected stressing case results are also shown to demonstrate the algorithm's ability to increase the robustness of the integrated SLS flight control system.

Integrated Data Modeling and Simulation on the Joint Polar Satellite System Program

NASA Technical Reports Server (NTRS)

Roberts, Christopher J.; Boyce, Leslye; Smith, Gary; Li, Angela; Barrett, Larry

2012-01-01

The Joint Polar Satellite System is a modern, large-scale, complex, multi-mission aerospace program, and presents a variety of design, testing and operational challenges due to: (1) System Scope: multi-mission coordination, role, responsibility and accountability challenges stemming from porous/ill-defined system and organizational boundaries (including foreign policy interactions) (2) Degree of Concurrency: design, implementation, integration, verification and operation occurring simultaneously, at multiple scales in the system hierarchy (3) Multi-Decadal Lifecycle: technical obsolesce, reliability and sustainment concerns, including those related to organizational and industrial base. Additionally, these systems tend to become embedded in the broader societal infrastructure, resulting in new system stakeholders with perhaps different preferences (4) Barriers to Effective Communications: process and cultural issues that emerge due to geographic dispersion and as one spans boundaries including gov./contractor, NASA/Other USG, and international relationships.

[Organizational capacity for continuous improvement of health services].

PubMed

Saturno-Hernández, Pedro J; Hernández-Avila, Mauricio; Magaña-Valladares, Laura; Garcia-Saisó, Sebastián; Vertiz-Ramírez, José de Jesús

2015-01-01

While the Mexican health system has achieved significant progress, as reflected in the growing improvement in population health, heterogeneity in the quality of services and its impact on health in different population groups is still a challenge. The costs or poor quality represent about 20 to 40% of the health system's expenditure. We need to develop organizational capacity to implement quality management systems in order to identify, evaluate, prevent and eventually overcome the health system's challenges. A competency-based comprehensive strategy for training human resources is proposed including undergraduate and graduate education as well as continuing education, which will contribute to improve the quality function at the various levels of responsibility in the health system. The proposed strategy responds to the context of the Mexican health system, but it could be adapted to other systems and contexts.

Health system strengthening: a qualitative evaluation of implementation experience and lessons learned across five African countries.

PubMed

Rwabukwisi, Felix Cyamatare; Bawah, Ayaga A; Gimbel, Sarah; Phillips, James F; Mutale, Wilbroad; Drobac, Peter

2017-12-21

Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation's (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions. We used qualitative data from key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through AHI in Ghana, Mozambique, Rwanda, Tanzania, and Zambia. Four major overarching lessons were highlighted. First, variety and inclusiveness of concerned key players (public, academic and private) are necessary to address complex health system issues at all levels. Second, a learning culture that promotes evidence creation and ability to efficiently adapt were key in order to meet changing contextual needs. Third, inclusion of strong implementation science tools and strategies allowed informed and measured learning processes and efficient dissemination of best practices. Fourth, five to seven years was the minimum time frame necessary to effectively implement complex health system strengthening interventions and generate the evidence base needed to advocate for sustainable change for the PHIT partnership projects. The AHI experience has raised remaining, if not overlooked, challenges and potential solutions to address complex health systems strengthening intervention designs and implementation issues, while aiming to measurably accomplish sustainable positive change in dynamic, learning, and varied contexts.

Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions

PubMed Central

Rajagopalan, Ramesh; Jung, Tzyy-Ping

2017-01-01

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems. PMID:29104256

URBAN WET-WEATHER FLOW POLLUTION MANAGEMENT AND CONTROL

EPA Science Inventory

One of the challenges in protecting urban watersheds lies in effectively controlling the contaminants in both overland runoff and sewerage system overflows during wet-weather events. Abatement of wet-weather flow (WWF) pollution can be implemented at the source by land managemen...

MODELING CONTAMINANT PROPAGATION IN DRINKING WATER DISTRIBUTION SYSTEMS

EPA Science Inventory

The Safe Drinking Water Act and its Amendments (SDWAA) will pose a massive challenge for the drinking-water industry in the United States. As the SDWAA regulations reach implementation, increasing effort will be devoted to understanding the factors causing deterioration of water ...

Enhancing implementation science by applying best principles of systems science.

PubMed

Northridge, Mary E; Metcalf, Sara S

2016-10-04

Implementation science holds promise for better ensuring that research is translated into evidence-based policy and practice, but interventions often fail or even worsen the problems they are intended to solve due to a lack of understanding of real world structures and dynamic complexity. While systems science alone cannot possibly solve the major challenges in public health, systems-based approaches may contribute to changing the language and methods for conceptualising and acting within complex systems. The overarching goal of this paper is to improve the modelling used in dissemination and implementation research by applying best principles of systems science. Best principles, as distinct from the more customary term 'best practices', are used to underscore the need to extract the core issues from the context in which they are embedded in order to better ensure that they are transferable across settings. Toward meaningfully grappling with the complex and challenging problems faced in adopting and integrating evidence-based health interventions and changing practice patterns within specific settings, we propose and illustrate four best principles derived from our systems science experience: (1) model the problem, not the system; (2) pay attention to what is important, not just what is quantifiable; (3) leverage the utility of models as boundary objects; and (4) adopt a portfolio approach to model building. To improve our mental models of the real world, system scientists have created methodologies such as system dynamics, agent-based modelling, geographic information science and social network simulation. To understand dynamic complexity, we need the ability to simulate. Otherwise, our understanding will be limited. The practice of dynamic systems modelling, as discussed herein, is the art and science of linking system structure to behaviour for the purpose of changing structure to improve behaviour. A useful computer model creates a knowledge repository and a virtual library for internally consistent exploration of alternative assumptions. Among the benefits of systems modelling are iterative practice, participatory potential and possibility thinking. We trust that the best principles proposed here will resonate with implementation scientists; applying them to the modelling process may abet the translation of research into effective policy and practice.

Computerized provider order entry in the clinical laboratory

PubMed Central

Baron, Jason M.; Dighe, Anand S.

2011-01-01

Clinicians have traditionally ordered laboratory tests using paper-based orders and requisitions. However, paper orders are becoming increasingly incompatible with the complexities, challenges, and resource constraints of our modern healthcare systems and are being replaced by electronic order entry systems. Electronic systems that allow direct provider input of diagnostic testing or medication orders into a computer system are known as Computerized Provider Order Entry (CPOE) systems. Adoption of laboratory CPOE systems may offer institutions many benefits, including reduced test turnaround time, improved test utilization, and better adherence to practice guidelines. In this review, we outline the functionality of various CPOE implementations, review the reported benefits, and discuss strategies for using CPOE to improve the test ordering process. Further, we discuss barriers to the implementation of CPOE systems that have prevented their more widespread adoption. PMID:21886891

Haptic control of a pneumatic muscle actuator to provide resistance for simulated isokinetic exercise; part II: control development and testing.

PubMed

Hall, Kara L; Phillips, Chandler A; Reynolds, David B; Mohler, Stanley R; Rogers, Dana B; Neidhard-Doll, Amy T

2015-01-01

Pneumatic muscle actuators (PMAs) have a high power to weight ratio and possess unique characteristics which make them ideal actuators for applications involving human interaction. PMAs are difficult to control due to nonlinear dynamics, presenting challenges in system implementation. Despite these challenges, PMAs have great potential as a source of resistance for strength training and rehabilitation. The objective of this work was to control a PMA for use in isokinetic exercise, potentially benefiting anyone in need of optimal strength training through a joint's range of motion. The controller, based on an inverse three-element phenomenological model and adaptive nonlinear control, allows the system to operate as a type of haptic device. A human quadriceps dynamic simulator was developed (as described in Part I of this work) so that control effectiveness and accommodation could be tested prior to human implementation. Tracking error results indicate that the control system is effective at producing PMA displacement and resistance necessary for a scaled, simulated neuromuscular actuator to maintain low-velocity isokinetic movement during simulated concentric and eccentric knee extension.

Containment system for experiments on radioactive and other hazardous materials in a Paris-Edinburgh press

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jacobsen, M. K., E-mail: mjacobsen@lanl.gov; Velisavljevic, N.

2015-11-15

Recent technical developments using the large volume Paris-Edinburgh press platform have enabled x-ray synchrotron studies at high pressure and temperature conditions. However, its application to some materials of interest, such as high hazard materials that require special handling due to safety issues, reactivity, or other challenges, has not been feasible without the introduction of special containment systems to eliminate the hazards. However, introduction of a containment system is challenging due to the requirement to provide full safety containment for operation in the variety of environments available, while not hindering any of the experimental probes that are available for inert samplemore » measurement. In this work, we report on the development and implementation of a full safety enclosure for a Paris-Edinburgh type press. During the initial development and subsequent application stage of work, experiments were performed on both cerium dioxide (CeO{sub 2}) and uranium (U). This device allows for full implementation of all currently available experimental probes involving the Paris-Edinburgh press at the High Pressure Collaborative Access Team sector of the Advanced Photon Source.« less

Scheduling-capable autonomic manager for policy-based IT change management system

NASA Astrophysics Data System (ADS)

AbdelSalam, Hady S.; Maly, Kurt; Mukkamala, Ravi; Zubair, Mohammad; Kaminsky, David

2010-11-01

Managing large IT environments is expensive and labour intensive. Maintaining and upgrading with minimal disruption and administrative support has always been a challenging task for system administrators. One challenge faced by IT administrators is arriving at schedules for applying one or more change requests to one of the system components. Most of the time, the impact analysis of the proposed changes is done by humans and is often laborious and error-prone. Although this methodology might be suitable to handle changes that are planned way ahead in time, it is completely inappropriate for changes that need to be done sooner. In addition, such manual handling does not scale well with the size of the IT infrastructure. In this article, the focus is on the problem of scheduling change requests in the presence of organisational policies governing the use of its resources. The authors propose two approaches for change management scheduling and present the implementation details of two prototypes that prove the feasibility of the proposed approaches. Their implementation is integrated with an autonomic manager which they had described in their earlier work.

Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center.

PubMed

Rizer, Milisa K; Kaufman, Beth; Sieck, Cynthia J; Hefner, Jennifer L; McAlearney, Ann Scheck

2015-01-01

Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation.

Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center

PubMed Central

Rizer, Milisa K.; Kaufman, Beth; Sieck, Cynthia J.; Hefner, Jennifer L.; McAlearney, Ann Scheck

2015-01-01

Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation. PMID:26396558

e-Health promises and challenges: some ethical considerations.

PubMed

Kluge, Eike-Henner W

2011-01-01

eHealth is a cost-effective and efficient way of providing health care to patients who would otherwise be excluded or underserviced. However, eHealth also presents a series of ethical and legal challenges which, if not met before its implementation, can undermine its success. Among other things, privacy, consent and liability are implicated, as are changes in the health care professional-patient relationship and in the role of health informatics professionals. Legacy systems and interoperability present further challenges, and outsourcing may pose special problems. This paper highlights some of these issues and outlines their implications.

Enhanced Communication Network Solution for Positive Train Control Implementation

NASA Technical Reports Server (NTRS)

Fatehi, M. T.; Simon, J.; Chang, W.; Chow, E. T.; Burleigh, S. C.

2011-01-01

The commuter and freight railroad industry is required to implement Positive Train Control (PTC) by 2015 (2012 for Metrolink), a challenging network communications problem. This paper will discuss present technologies developed by the National Aeronautics and Space Administration (NASA) to overcome comparable communication challenges encountered in deep space mission operations. PTC will be based on a new cellular wireless packet Internet Protocol (IP) network. However, ensuring reliability in such a network is difficult due to the "dead zones" and transient disruptions we commonly experience when we lose calls in commercial cellular networks. These disruptions make it difficult to meet PTC s stringent reliability (99.999%) and safety requirements, deployment deadlines, and budget. This paper proposes innovative solutions based on space-proven technologies that would help meet these challenges: (1) Delay Tolerant Networking (DTN) technology, designed for use in resource-constrained, embedded systems and currently in use on the International Space Station, enables reliable communication over networks in which timely data acknowledgments might not be possible due to transient link outages. (2) Policy-Based Management (PBM) provides dynamic management capabilities, allowing vital data to be exchanged selectively (with priority) by utilizing alternative communication resources. The resulting network may help railroads implement PTC faster, cheaper, and more reliably.

GPAW - massively parallel electronic structure calculations with Python-based software.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Enkovaara, J.; Romero, N.; Shende, S.

2011-01-01

Electronic structure calculations are a widely used tool in materials science and large consumer of supercomputing resources. Traditionally, the software packages for these kind of simulations have been implemented in compiled languages, where Fortran in its different versions has been the most popular choice. While dynamic, interpreted languages, such as Python, can increase the effciency of programmer, they cannot compete directly with the raw performance of compiled languages. However, by using an interpreted language together with a compiled language, it is possible to have most of the productivity enhancing features together with a good numerical performance. We have used thismore » approach in implementing an electronic structure simulation software GPAW using the combination of Python and C programming languages. While the chosen approach works well in standard workstations and Unix environments, massively parallel supercomputing systems can present some challenges in porting, debugging and profiling the software. In this paper we describe some details of the implementation and discuss the advantages and challenges of the combined Python/C approach. We show that despite the challenges it is possible to obtain good numerical performance and good parallel scalability with Python based software.« less

Opportunities to meet challenges in rural prevention research: findings from an evolving community-university partnership model.

PubMed

Spoth, Richard

2007-01-01

Various rural prevention research challenges have been articulated through a series of sessions convened since the mid 1990s by the National Institutes of Health, particularly the National Institute on Drug Abuse. Salient in this articulation was the need for effective collaboration among rural practitioners and scientists, with special consideration of accommodating the diversity of rural areas and surmounting barriers to implementation of evidence-based interventions. This paper summarizes the range of challenges in rural prevention research and describes an evolving community-university partnership model addressing them. The model entails involvement of public school staff and other rural community stakeholders, linked with scientists by Land Grant University-based Extension system staff. Examples of findings from over 16 years of partnership-based intervention research projects include those on engagement of rural residents, quality implementation of evidence-based interventions, and long-term community-level outcomes, as well as factors in effectiveness of the partnerships. Findings suggest a future focus on building capacity for practitioner-scientist collaboration and developing a network for more widespread implementation of the partnership model in a manner informed by lessons learned from partnership-based research to date.

NASA Perspective on Requirements for Development of Advanced Methods Predicting Unsteady Aerodynamics and Aeroelasticity

NASA Technical Reports Server (NTRS)

Schuster, David M.

2008-01-01

Over the past three years, the National Aeronautics and Space Administration (NASA) has initiated design, development, and testing of a new human-rated space exploration system under the Constellation Program. Initial designs within the Constellation Program are scheduled to replace the present Space Shuttle, which is slated for retirement within the next three years. The development of vehicles for the Constellation system has encountered several unsteady aerodynamics challenges that have bearing on more traditional unsteady aerodynamic and aeroelastic analysis. This paper focuses on the synergy between the present NASA challenges and the ongoing challenges that have historically been the subject of research and method development. There are specific similarities in the flows required to be analyzed for the space exploration problems and those required for some of the more nonlinear unsteady aerodynamic and aeroelastic problems encountered on aircraft. The aggressive schedule, significant technical challenge, and high-priority status of the exploration system development is forcing engineers to implement existing tools and techniques in a design and application environment that is significantly stretching the capability of their methods. While these methods afford the users with the ability to rapidly turn around designs and analyses, their aggressive implementation comes at a price. The relative immaturity of the techniques for specific flow problems and the inexperience with their broad application to them, particularly on manned spacecraft flight system, has resulted in the implementation of an extensive wind tunnel and flight test program to reduce uncertainty and improve the experience base in the application of these methods. This provides a unique opportunity for unsteady aerodynamics and aeroelastic method developers to test and evaluate new analysis techniques on problems with high potential for acquisition of test and even flight data against which they can be evaluated. However, researchers may be required to alter the geometries typically used in their analyses, the types of flows analyzed, and even the techniques by which computational tools are verified and validated. This paper discusses these issues and provides some perspective on the potential for new and innovative approaches to the development of methods to attack problems in nonlinear unsteady aerodynamics.

Study of heterogeneous and reconfigurable architectures in the communication domain

NASA Astrophysics Data System (ADS)

Feldkaemper, H. T.; Blume, H.; Noll, T. G.

2003-05-01

One of the most challenging design issues for next generations of (mobile) communication systems is fulfilling the computational demands while finding an appropriate trade-off between flexibility and implementation aspects, especially power consumption. Flexibility of modern architectures is desirable, e.g. concerning adaptation to new standards and reduction of time-to-market of a new product. Typical target architectures for future communication systems include embedded FPGAs, dedicated macros as well as programmable digital signal and control oriented processor cores as each of these has its specific advantages. These will be integrated as a System-on-Chip (SoC). For such a heterogeneous architecture a design space exploration and an appropriate partitioning plays a crucial role. On the exemplary vehicle of a Viterbi decoder as frequently used in communication systems we show which costs in terms of ATE complexity arise implementing typical components on different types of architecture blocks. A factor of about seven orders of magnitude spans between a physically optimised implementation and an implementation on a programmable DSP kernel. An implementation on an embedded FPGA kernel is in between these two representing an attractive compromise with high flexibility and low power consumption. Extending this comparison to further components, it is shown quantitatively that the cost ratio between different implementation alternatives is closely related to the operation to be performed. This information is essential for the appropriate partitioning of heterogeneous systems.

Development and implementation of the Caribbean Laboratory Quality Management Systems Stepwise Improvement Process (LQMS-SIP) Towards Accreditation.

PubMed

Alemnji, George; Edghill, Lisa; Guevara, Giselle; Wallace-Sankarsingh, Sacha; Albalak, Rachel; Cognat, Sebastien; Nkengasong, John; Gabastou, Jean-Marc

2017-01-01

Implementing quality management systems and accrediting laboratories in the Caribbean has been a challenge. We report the development of a stepwise process for quality systems improvement in the Caribbean Region. The Caribbean Laboratory Stakeholders met under a joint Pan American Health Organization/US Centers for Disease Control and Prevention initiative and developed a user-friendly framework called 'Laboratory Quality Management System - Stepwise Improvement Process (LQMS-SIP) Towards Accreditation' to support countries in strengthening laboratory services through a stepwise approach toward fulfilling the ISO 15189: 2012 requirements. This approach consists of a three-tiered framework. Tier 1 represents the minimum requirements corresponding to the mandatory criteria for obtaining a licence from the Ministry of Health of the participating country. The next two tiers are quality improvement milestones that are achieved through the implementation of specific quality management system requirements. Laboratories that meet the requirements of the three tiers will be encouraged to apply for accreditation. The Caribbean Regional Organisation for Standards and Quality hosts the LQMS-SIP Secretariat and will work with countries, including the Ministry of Health and stakeholders, including laboratory staff, to coordinate and implement LQMS-SIP activities. The Caribbean Public Health Agency will coordinate and advocate for the LQMS-SIP implementation. This article presents the Caribbean LQMS-SIP framework and describes how it will be implemented among various countries in the region to achieve quality improvement.

Labview Implementation of Image Processing and Phasing Control for the SIBOA Segmented Mirror Testbed

NASA Technical Reports Server (NTRS)

Partridge, James D.

2002-01-01

'NASA is preparing to launch the Next Generation Space Telescope (NGST). This telescope will be larger than the Hubble Space Telescope, be launched on an Atlas missile rather than the Space Shuttle, have a segmented primary mirror, and be placed in a higher orbit. All these differences pose significant challenges.' This effort addresses the challenge of implementing an algorithm for aligning the segments of the primary mirror during the initial deployment that was designed by Philip Olivier and members of SOMTC (Space Optics Manufacturing Technology Center). The implementation was to be performed on the SIBOA (Systematic Image Based Optical Alignment) test bed. Unfortunately, hardware/software aspect concerning SIBOA and an extended time period for algorithm development prevented testing before the end of the study period. Properties of the digital camera were studied and understood, resulting in the current ability of selecting optimal settings regarding saturation. The study was successful in manually capturing several images of two stacked segments with various relative phases. These images can be used to calibrate the algorithm for future implementation. Currently the system is ready for testing.

Enhancing public health outcomes in developing countries: from good policies and best practices to better implementation.

PubMed

Woolcock, Michael

2018-06-01

In rich and poor countries alike, a core challenge is building the state's capability for policy implementation. Delivering high-quality public health and health care-affordably, reliably and at scale, for all-exemplifies this challenge, since doing so requires deftly integrating refined technical skills (surgery), broad logistics management (supply chains, facilities maintenance), adaptive problem solving (curative care), and resolving ideological differences (who pays? who provides?), even as the prevailing health problems themselves only become more diverse, complex, and expensive as countries become more prosperous. However, the current state of state capability in developing countries is demonstrably alarming, with the strains and demands only likely to intensify in the coming decades. Prevailing "best practice" strategies for building implementation capability-copying and scaling putative successes from abroad-are too often part of the problem, while individual training ("capacity building") and technological upgrades (e.g. new management information systems) remain necessary but deeply insufficient. An alternative approach is outlined, one centered on building implementation capability by working iteratively to solve problems nominated and prioritized by local actors.

From development to implementation-A smartphone and email-based discharge follow-up program for pediatric patients after hospital discharge.

PubMed

Hopkins, Israel Green; Dunn, Kelly; Bourgeois, Fabienne; Rogers, Jayne; Chiang, Vincent W

2016-06-01

The purpose of this case study was to investigate opportunities to electronically enhance the transitions of care for both patients and providers and to describe the process of development and implementation of such tools. We describe the current challenges and fragmentation of care for pediatric patients and families being discharged from inpatient stays, and review barriers to change in practice. Care transitions vary in the complexity of the clinical and social scenarios and no one-size-fits-all approach works for every patient, provider or hospital system. A substantial challenge that providers who are designing and implementing digital tools for patients surrounds the complexity in building such tools to apply to such broad populations. Our case study provides a framework using a multidisciplinary approach, brainstorming and rapid digital prototyping to build an in-house electronic discharge follow-up platform. In describing this process, we review design and implementation measures that may further support digital tool development in other areas. Copyright © 2015 Elsevier Inc. All rights reserved.

Implementing HIPAA security in a membership organization.

PubMed

Hillabrant, L P; Gaignard, K E

2000-01-01

The upcoming HIPAA security regulations are forcing a change in business and operating procedures that many, if not most, healthcare organizations are ill-prepared to tackle. Of all healthcare organizational structures, membership organizations will most likely face the greatest number of obstacles in preparing for and implementing the HIPAA security regulations. This is because the membership organization as a whole must find a way to accommodate the disparate technologies, business and operating methodologies and processes, and available, limited resources of its individual member organizations, and integrate these into a uniform implementation plan. Compounding these obvious difficulties is the unique challenge of enforcement authority. The individual member organizations are autonomous business entities, whereas the membership organization as a whole merely acts as an advisor or consultant, and has only limited enforcement authority over any individual member organization. This article explores this unique situation in depth. We focus on PROMINA Health System, a nonprofit healthcare membership organization that consists of five disparate member healthcare organizations. We examine the challenges PROMINA has encountered in its quest to institute an organization-wide HIPAA security program and its methodology for accomplishing program implementation.

Delivery of health services in Arab countries: a review.

PubMed

Kronfol, N M

2012-12-01

This paper reviews the essential components of health care delivery systems in Arab countries and their development over the past 3 decades. The changes and challenges which evolved during the last half of the 20th century have had a significant impact on health systems and on health outcomes. An adequate network of hospitals and primary health care facilities has been established in most Arab countries of the Region. The increased participation of civil society has impacted positively on health systems. However, the main challenge is represented by the move towards market economies. In many developing economies, macroeconomic reforms have often necessitated cuts in public spending on social sectors. Cost-sharing policies have been implemented in order to compensate for diminishing government budgets allocated to health. However, this is not to minimize the enormous strides that have been made in all countries nor the important challenges that need to be addressed.

Health care financing in Asia: key issues and challenges.

PubMed

Kwon, Soonman

2011-09-01

This article examines the major elements of health care financing such as financial risk protection, resource generation, resource pooling, and purchasing and payment; provides key lessons; and discusses the challenges for health care financing systems of Asian countries. With the exception of Japan, Korea, Taiwan, and Thailand, most health care systems of Asia provide very limited financial risk protection. The role of public prepaid schemes such as tax and social health insurance is minimal, and out-of-pocket payment is a major source of financing. The large informal sector is a major challenge to the extension of population coverage in many low-income countries of Asia, which must seek the optimal mix of tax subsidy and health insurance for universal coverage. Implementation of effective payment systems to control the behavior of health care providers is also a key factor in the success of health care financing reform in Asia.

Affordable Electro-Magnetic Interference (EMI) Testing on Large Space Vehicles

NASA Technical Reports Server (NTRS)

Aldridge, Edward; Curry, Bruce; Scully, Robert

2015-01-01

Objective: Perform System-Level EMI testing of the Orion Exploration Flight Test-1 (EFT-1) spacecraft in situ in the Kennedy Space Center's Neil Armstrong Operations & Checkout (O&C) Facility in 6 days. The only way to execute the system-level EMI testing and meet this schedule challenge was to perform the EMI testing in situ in the Final Assembly & System Test (FAST) Cell in a reverberant mode, not the direct illumination mode originally planned. This required the unplanned construction of a Faraday Cage around the vehicle and FAST Cell structure. The presence of massive steel platforms created many challenges to developing an efficient screen room to contain the RF energy and yield an effective reverberant chamber. An initial effectiveness test showed marginal performance, but improvements implemented afterward resulted in the final test performing surprisingly well! The paper will explain the design, the challenges, and the changes that made the difference in performance!

Towards agile large-scale predictive modelling in drug discovery with flow-based programming design principles.

PubMed

Lampa, Samuel; Alvarsson, Jonathan; Spjuth, Ola

2016-01-01

Predictive modelling in drug discovery is challenging to automate as it often contains multiple analysis steps and might involve cross-validation and parameter tuning that create complex dependencies between tasks. With large-scale data or when using computationally demanding modelling methods, e-infrastructures such as high-performance or cloud computing are required, adding to the existing challenges of fault-tolerant automation. Workflow management systems can aid in many of these challenges, but the currently available systems are lacking in the functionality needed to enable agile and flexible predictive modelling. We here present an approach inspired by elements of the flow-based programming paradigm, implemented as an extension of the Luigi system which we name SciLuigi. We also discuss the experiences from using the approach when modelling a large set of biochemical interactions using a shared computer cluster.Graphical abstract.

Feedback control system based on a remote operated PID controller implemented using mbed NXP LPC1768 development board

NASA Astrophysics Data System (ADS)

Pricop, Emil; Zamfir, Florin; Paraschiv, Nicolae

2015-11-01

Process control is a challenging research topic for both academia and industry for a long time. Controllers evolved from the classical SISO approach to modern fuzzy or neuro-fuzzy embedded devices with networking capabilities, however PID algorithms are still used in the most industrial control loops. In this paper, we focus on the implementation of a PID controller using mbed NXP LPC1768 development board. This board integrates a powerful ARM Cortex- M3 core and has networking capabilities. The implemented controller can be remotely operated by using an Internet connection and a standard Web browser. The main advantages of the proposed embedded system are customizability, easy operation and very low power consumption. The experimental results obtained by using a simulated process are analysed and shows that the implementation can be done with success in industrial applications.

Design and Implementation of a Threaded Search Engine for Tour Recommendation Systems

NASA Astrophysics Data System (ADS)

Lee, Junghoon; Park, Gyung-Leen; Ko, Jin-Hee; Shin, In-Hye; Kang, Mikyung

This paper implements a threaded scan engine for the O(n!) search space and measures its performance, aiming at providing a responsive tour recommendation and scheduling service. As a preliminary step of integrating POI ontology, mobile object database, and personalization profile for the development of new vehicular telematics services, this implementation can give a useful guideline to design a challenging and computation-intensive vehicular telematics service. The implemented engine allocates the subtree to the respective threads and makes them run concurrently exploiting the primitives provided by the operating system and the underlying multiprocessor architecture. It also makes it easy to add a variety of constraints, for example, the search tree is pruned if the cost of partial allocation already exceeds the current best. The performance measurement result shows that the service can run even in the low-power telematics device when the number of destinations does not exceed 15, with an appropriate constraint processing.

Current status of waste management in Botswana: A mini-review.

PubMed

Mmereki, Daniel

2018-05-01

Effective waste management practices are not all about legislative solutions, but a combination of the environmental, social, technical, technically skilled human resources, financial and technological resources, resource recycling, environmental pollution awareness programmes and public participation. As a result of insufficient resources, municipal solid waste (MSW) in transition and developing countries like Botswana remains a challenge, and it is often not yet given highest priority. In Botswana, the environment, public health and other socio-economic aspects are threatened by waste management practices due to inadequate implementation and enforcement mechanisms of waste management policy. This mini-review paper describes the panorama of waste management practices in Botswana and provides information to competent authorities responsible for waste management and to researchers to develop and implement an effective waste management system. Waste management practices in Botswana are affected by: lack of effective implementation of national waste policy, fragmented tasks and overlapping mandates among relevant institutions; lack of clear guidelines on the responsibilities of the generators and public authorities and on the associated economic incentives; and lack of consistent and comprehensive solid waste management policies; lack of intent by decision-makers to prepare national waste management plans and systems, and design and implement an integrated sustainable municipal solid waste management system. Due to these challenges, there are concerns over the growing trend of the illegal dumping of waste, creating mini dumping sites all over the country, and such actions jeopardize the efforts of lobbying investors and tourism business. Recommendations for concerted efforts are made to support decision makers to re-organize a sustainable waste management system, and this paper provides a reference to other emerging economies in the region and the world.

Streamlining the Capstone Process: A Time-Saving Approval System for Graduate Theses/Projects

ERIC Educational Resources Information Center

Grooms, James; Kline, Douglas; Cummings, Jeffrey

2016-01-01

Capstones have become an integral part of many information systems programs, both at the undergraduate and graduate level. One of the challenges can be tracking the process from the start of the capstone to completion. This paper describes the analysis, design and implementation of a web application for the approval workflow of a master's program…

Trauma-Informed Part C Early Intervention: A Vision, A Challenge, A New Reality

ERIC Educational Resources Information Center

Gilkerson, Linda; Graham, Mimi; Harris, Deborah; Oser, Cindy; Clarke, Jane; Hairston-Fuller, Tody C.; Lertora, Jessica

2013-01-01

Federal directives require that any child less than 3 years old with a substantiated case of abuse be referred to the early intervention (EI) system. This article details the need and presents a vision for a trauma-informed EI system. The authors describe two exemplary program models which implement this vision and recommend steps which the field…

An Integrated Performance Support System (IPSS). How It Can Help Develop a Competitive Workforce in the '90s.

ERIC Educational Resources Information Center

Courseware/Andersen Consulting, San Diego, CA.

This concept paper begins by arguing that Integrated Performance Support Systems (IPSS) are an imperative for boosting productivity in the workplace and gaining competitive advantage in the marketplace. It then presents the framework for an IPSS solution to meet the challenges of the 1990s. Discussion of the implementation of an IPSS solution…

Workflow Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper.

PubMed

Towbin, Alexander J; Roth, Christopher J; Bronkalla, Mark; Cram, Dawn

2016-10-01

With the advent of digital cameras, there has been an explosion in the number of medical specialties using images to diagnose or document disease and guide interventions. In many specialties, these images are not added to the patient's electronic medical record and are not distributed so that other providers caring for the patient can view them. As hospitals begin to develop enterprise imaging strategies, they have found that there are multiple challenges preventing the implementation of systems to manage image capture, image upload, and image management. This HIMSS-SIIM white paper will describe the key workflow challenges related to enterprise imaging and offer suggestions for potential solutions to these challenges.

Signal processing: opportunities for superconductive circuits

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ralston, R.W.

1985-03-01

Prime motivators in the evolution of increasingly sophisticated communication and detection systems are the needs for handling ever wider signal bandwidths and higher data processing speeds. These same needs drive the development of electronic device technology. Until recently the superconductive community has been tightly focused on digital devices for high speed computers. The purpose of this paper is to describe opportunities and challenges which exist for both analog and digital devices in a less familiar area, that of wideband signal processing. The function and purpose of analog signal-processing components, including matched filters, correlators and Fourier transformers, will be described andmore » examples of superconductive implementations given. A canonic signal-processing system is then configured using these components in combination with analog/digital converters and digital output circuits to highlight the important issues of dynamic range, accuracy and equivalent computation rate. Superconductive circuits hold promise for processing signals of 10-GHz bandwidth. Signal processing systems, however, can be properly designed and implemented only through a synergistic combination of the talents of device physicists, circuit designers, algorithm architects and system engineers. An immediate challenge to the applied superconductivity community is to begin sharing ideas with these other researchers.« less

Modernization of the Cassini Ground System

NASA Technical Reports Server (NTRS)

Razo, Gus; Fujii, Tammy J.

2014-01-01

The Cassini Spacecraft and its ground system have been operational for over 16 years. Modernization presents several challenges due to the personnel, processes, and tools already invested and embedded into the current ground system structure. Every mission's ground system has its own unique complexities and challenges, involving various organizational units. As any mission from its inception to its execution, schedules are always tight. This forces GDS engineers to implement a working ground system that is not necessarily fully optimized. Ground system challenges increase as technology evolves and cyber threats become more sophisticated. Cassini's main challenges were due to its ground system existing before many security requirements were levied on the multi-mission tools and networks. This caused a domino effect on Cassini GDS tools that relied on outdated technological features. In the aerospace industry reliable and established technology is preferred over innovative yet less proven technology. Loss of data for a spacecraft mission can be catastrophic; therefore, there is a reluctance to make changes and updates to the ground system. Nevertheless, all missions and associated teams face the need to modernize their processes and tools. Systems development methods from well-known system analysis and design principles can be applied to many missions' ground systems. Modernization should always be considered, but should be done in such a way that it does not affect flexibility nor interfere with established practices. Cassini has accomplished a secure and efficient ground data system through periodic updates. The obstacles faced while performing the modernization of the Cassini ground system will be outlined, as well as the advantages and challenges that were encountered.

A retrospective content analysis of studies on factors constraining the implementation of health sector reform in Ghana.

PubMed

Sakyi, E Kojo

2008-01-01

Ghana has undertaken many public service management reforms in the past two decades. But the implementation of the reforms has been constrained by many factors. This paper undertakes a retrospective study of research works on the challenges to the implementation of reforms in the public health sector. It points out that most of the studies identified: (1) centralised, weak and fragmented management system; (2) poor implementation strategy; (3) lack of motivation; (4) weak institutional framework; (5) lack of financial and human resources and (6) staff attitude and behaviour as the major causes of ineffective reform implementation. The analysis further revealed that quite a number of crucial factors obstructing reform implementation which are particularly internal to the health system have either not been thoroughly studied or overlooked. The analysis identified lack of leadership; weak communication and consultation; lack of stakeholder participation, corruption and unethical professional behaviour as some of the missing variables in the literature. The study, therefore, indicated that there are gaps in the literature that needed to be filled through rigorous reform evaluation based on empirical research particularly at district, sub-district and community levels. It further suggested that future research should be concerned with the effects of both systems and structures and behavioural factors on reform implementation.