Health information exchange: Using metrics to address quality of care and return on investment

Health Information Exchange (HIE) will play a key part in our nation’s effort to improve healthcare. The evidence of HIEs transformational role in healthcare delivery systems is quite limited. The lack of such evidence led us to explore what exists in the healthcare industry that may provide evidence of effectiveness and efficiency of HIEs. The objective of the study was to find out how many fully functional HIEs are using any measurements or metrics to gauge impact of HIE on quality improvement (QI) and on return on investment (ROI).^ A web-based survey was used to determine the number of operational HIEs using metrics for QI and ROI. Our study highlights the fact that only 50 percent of the HIEs who responded use or plan to use metrics. However, 95 percent of the respondents believed HIEs improve quality of care while only 56 percent believed HIE showed positive ROI. Although operational HIEs present numerous opportunities to demonstrate the business model for improving health care quality, evidence to document the impact of HIEs is lacking. ^

Modification and Developer Metrics at the Function Level: Metrics for the Study of the Evolution of a Software Project

Software evolution, and particularly its growth, has been mainly studied at the file (also sometimes referred as module) level. In this paper we propose to move from the physical towards a level that includes semantic information by using functions or methods for measuring the evolution of a software system. We point out that use of functions-based metrics has many advantages over the use of files or lines of code. We demonstrate our approach with an empirical study of two Free/Open Source projects: a community-driven project, Apache, and a company-led project, Novell Evolution. We discovered that most functions never change; when they do their number of modifications is correlated with their size, and that very few authors who modify each; finally we show that the departure of a developer from a software project slows the evolution of the functions that she authored.

Intensive Metrics for the Study of the Evolution of Open Source Projects: Case Studies from Apache Software Foundation Projects

Based on the empirical evidence that the ratio of email messages in public mailing lists to versioning system commits has remained relatively constant along the history of the Apache Software Foundation (ASF), this paper has as goal to study what can be inferred from such a metric for projects of the ASF. We have found that the metric seems to be an intensive metric as it is independent of the size of the project, its activity, or the number of developers, and remains relatively independent of the technology or functional area of the project. Our analysis provides evidence that the metric is related to the technical effervescence and popularity of project, and as such can be a good candidate to measure its healthy evolution. Other, similar metrics -like the ratio of developer messages to commits and the ratio of issue tracker messages to commits- are studied for several projects as well, in order to see if they have similar characteristics.

Relevance of motion-related assessment metrics in laparoscopic surgery

INTRODUCTION: Motion metrics have become an important source of information when addressing the assessment of surgical expertise. However, their direct relationship with the different surgical skills has not been fully explored. The purpose of this study is to investigate the relevance of motion-related metrics in the evaluation processes of basic psychomotor laparoscopic skills, as well as their correlation with the different abilities sought to measure. METHODS: A framework for task definition and metric analysis is proposed. An explorative survey was first conducted with a board of experts to identify metrics to assess basic psychomotor skills. Based on the output of that survey, three novel tasks for surgical assessment were designed. Face and construct validation study was performed, with focus on motion-related metrics. Tasks were performed by 42 participants (16 novices, 22 residents and 4 experts). Movements of the laparoscopic instruments were registered with the TrEndo tracking system and analyzed. RESULTS: Time, path length and depth showed construct validity for all three tasks. Motion smoothness and idle time also showed validity for tasks involving bi-manual coordination and tasks requiring a more tactical approach respectively. Additionally, motion smoothness and average speed showed a high internal consistency, proving them to be the most task-independent of all the metrics analyzed. CONCLUSION: Motion metrics are complementary and valid for assessing basic psychomotor skills, and their relevance depends on the skill being evaluated. A larger clinical implementation, combined with quality performance information, will give more insight on the relevance of the results shown in this study.

Complexity in the Optimisation of ATM Performance Metrics

Today's motivation for autonomous systems research stems out of the fact that networked environments have reached a level of complexity and heterogeneity that make their control and management by solely human administrators more and more difficult. The optimisation of performance metrics for the air traffic management system, like in other networked system, has become more complex with increasing number of flights, capacity constraints, environmental factors and safety regulations. It is anticipated that a new structure of planning layers and the introduction of higher levels of automation will reduce complexity and will optimise the performance metrics of the air traffic management system. This paper discusses the complexity of optimising air traffic management performance metrics and proposes a way forward based on higher levels of automation.

Performance metrics for small-signal stability assessment of DC-distributed power-system-architecture comparisons

The objective of this paper is to provide performance metrics for small-signal stability assessment of a given system architecture. The stability margins are stated utilizing a concept of maximum peak criteria (MPC) derived from the behavior of an impedance-based sensitivity function. For each minor-loop gain defined at every system interface, a single number to state the robustness of stability is provided based on the computed maximum value of the corresponding sensitivity function. In order to compare various power-architecture solutions in terms of stability, a parameter providing an overall measure of the whole system stability is required. The selected figure of merit is geometric average of each maximum peak value within the system. It provides a meaningful metrics for system comparisons: the best system in terms of robust stability is the one that minimizes this index. In addition, the largest peak value within the system interfaces is given thus detecting the weakest point of the system in terms of robustness.

A Schwarz lemma for Kahler affine metrics and the canonical potential of a proper convex cone

This is an account of some aspects of the geometry of Kahler affine metrics based on considering them as smooth metric measure spaces and applying the comparison geometry of Bakry-Emery Ricci tensors. Such techniques yield a version for Kahler affine metrics of Yau s Schwarz lemma for volume forms. By a theorem of Cheng and Yau, there is a canonical Kahler affine Einstein metric on a proper convex domain, and the Schwarz lemma gives a direct proof of its uniqueness up to homothety. The potential for this metric is a function canonically associated to the cone, characterized by the property that its level sets are hyperbolic affine spheres foliating the cone. It is shown that for an n -dimensional cone, a rescaling of the canonical potential is an n -normal barrier function in the sense of interior point methods for conic programming. It is explained also how to construct from the canonical potential Monge-Ampère metrics of both Riemannian and Lorentzian signatures, and a mean curvature zero conical Lagrangian submanifold of the flat para-Kahler space.

Objective metrics for functional evaluation of upper limb during the ADL of drinking: application in SCI

Three-dimensional kinematic analysis provides quantitative assessment of upper limb motion and is used as an outcome measure to evaluate movement disorders. The aim of the present study is to present a set of kinematic metrics for quantifying characteristics of movement performance and the functional status of the subject during the execution of the activity of daily living (ADL) of drinking from a glass. Then, the objective is to apply these metrics in healthy people and a population with cervical spinal cord injury (SCI), and to analyze the metrics ability to discriminate between healthy and pathologic people. 19 people participated in the study: 7 subjects with metameric level C6 tetraplegia, 4 subjects with metameric level C7 tetraplegia and 8 healthy subjects. The movement was recorded with a photogrammetry system. The ADL of drinking was divided into a series of clearly identifiable phases to facilitate analysis. Metrics describing the time of the reaching phase, the range of motion of the joints analyzed, and characteristics of movement performance such as the efficiency, accuracy and smoothness of the distal segment and inter-joint coordination were obtained. The performance of the drinking task was more variable in people with SCI compared to the control group in relation to the metrics measured. Reaching time was longer in SCI groups. The proposed metrics showed capability to discriminate between healthy and pathologic people. Relative deficits in efficiency were larger in SCI people than in controls. These metrics can provide useful information in a clinical setting about the quality of the movement performed by healthy and SCI people during functional activities.

Canonical Correlation Analysis for Interpreting Airborne Laser Scanning Metrics along the Lorenz Curve of Tree Size Inequality

Canonical Correlation Analysis for Interpreting Airborne Laser Scanning Metrics along the Lorenz Curve of Tree Size Inequality

Evidence of the presence of bias in subjective metrics: analysis within a family of experiments

Context: Measurement is crucial and important to empirical software engineering. Although reliability and validity are two important properties warranting consideration in measurement processes, they may be influenced by random or systematic error (bias) depending on which metric is used. Aim: Check whether, the simple subjective metrics used in empirical software engineering studies are prone to bias. Method: Comparison of the reliability of a family of empirical studies on requirements elicitation that explore the same phenomenon using different design types and objective and subjective metrics. Results: The objectively measured variables (experience and knowledge) tend to achieve more reliable results, whereas subjective metrics using Likert scales (expertise and familiarity) tend to be influenced by systematic error or bias. Conclusions: Studies that predominantly use variables measured subjectively, like opinion polls or expert opinion acquisition.

Defining and Measuring Metrics for a Multinational Human Resources Department

Successful HR departments should support key business objectives by establishing metrics that determine the effectiveness of their processes. Functions such as recruiting, benefits, and training are processes that should have metrics. Understanding who measures what, when, and how often is the first step in measuring how much it costs to run HR. The next step is determining which processes are most critical, and then determining the metrics that fit the business needs. Slight adjustments will need to be made as business needs change, but the process for measuring outcomes should not change. This paper will focus on multinational corporations that employ at least ten thousand employees and have a ratio of one HR professional to every hundred fulltime equivalents (FTEs).

Convergence analysis and validation of low cost distance metrics for computational cost reduction of the Iterative Closest Point algorithm

The Iterative Closest Point algorithm (ICP) is commonly used in engineering applications to solve the rigid registration problem of partially overlapped point sets which are pre-aligned with a coarse estimate of their relative positions. This iterative algorithm is applied in many areas such as the medicine for volumetric reconstruction of tomography data, in robotics to reconstruct surfaces or scenes using range sensor information, in industrial systems for quality control of manufactured objects or even in biology to study the structure and folding of proteins. One of the algorithm’s main problems is its high computational complexity (quadratic in the number of points with the non-optimized original variant) in a context where high density point sets, acquired by high resolution scanners, are processed. Many variants have been proposed in the literature whose goal is the performance improvement either by reducing the number of points or the required iterations or even enhancing the complexity of the most expensive phase: the closest neighbor search. In spite of decreasing its complexity, some of the variants tend to have a negative impact on the final registration precision or the convergence domain thus limiting the possible application scenarios. The goal of this work is the improvement of the algorithm’s computational cost so that a wider range of computationally demanding problems from among the ones described before can be addressed. For that purpose, an experimental and mathematical convergence analysis and validation of point-to-point distance metrics has been performed taking into account those distances with lower computational cost than the Euclidean one, which is used as the de facto standard for the algorithm’s implementations in the literature. In that analysis, the functioning of the algorithm in diverse topological spaces, characterized by different metrics, has been studied to check the convergence, efficacy and cost of the method in order to determine the one which offers the best results. Given that the distance calculation represents a significant part of the whole set of computations performed by the algorithm, it is expected that any reduction of that operation affects significantly and positively the overall performance of the method. As a result, a performance improvement has been achieved by the application of those reduced cost metrics whose quality in terms of convergence and error has been analyzed and validated experimentally as comparable with respect to the Euclidean distance using a heterogeneous set of objects, scenarios and initial situations.

Bioindicators as metrics for environmental monitoring of desalination plant discharges

Development of desalination projects requires simple methodologies and tools for cost-effective and environmentally-sensitive management. Sentinel taxa and biotic indices are easily interpreted in the perspective of environment management. Echinoderms are potential sentinel taxon to gauge the impact produced by brine discharge and the BOPA index is considered an effective tool for monitoring different types of impact. Salinity increase due to desalination brine discharge was evaluated in terms of these two indicators. They reflected the environmental impact and recovery after implementation of a mitigation measure. Echinoderms disappeared at the station closest to the discharge during the years with highest salinity and then recovered their abundance after installation of a diffuser reduced the salinity increase. In the same period, BOPA responded due to the decrease in sensitive amphipods and the increase in tolerant polychaete families when salinities rose. Although salinity changes explained most of the observed variability in both indicators, other abiotic parameters were also significant in explaining this variability.