Topic 4: Computer Software

Software issues The importance of software in computer systems has brought new issues to the forefront for organizational managers. These issues include software defects (bugs), software evaluation and selection, licensing, open systems, and opensource software. Software defectsAll too often, computer program code is inefficient, poorly designed, and riddled with errors. The Software Engineering Institute (SEI) at Carnegie Mellon University in Pittsburgh defines good software as usable, reliable, defect free, cost effective, and maintainable. As we become increasingly dependent on computers and networks, the risks associated with software defects are getting worse.Software licensing Although many people do so routinely, copying software is illegal. The Business Software Alliance (BSA) (www.bsa. org) has calculated that software piracy costs software vendors around the world billions of dollars annually.

Software evaluation and selection

Open systems The concept of open systems refers to a model of computing products that work together. To achieving this goal, the same operating system with compatible software must be installed on all the different computers that interact with one another within an organization.

A complementary approach is to produce application software that will run across all computer platforms. If hardware, operating systems, and application software are designed as open systems, the user will be able to purchase the best software, called best of breed, for the job without worrying whether it will run on particular hardware.Open source software There is a trend within the software industry away from proprietary software toward open-source software. Proprietary software is software that has been developed by a company and has restrictions on its use, copying, and modification. The company developing such software spends money and time on research and development of its software product, and then sells it in the marketplace. The proprietary nature of the software means that the company keeps the source codethe actual computer instructionsprivate (as Coca-Cola does with its formula). In contrast, the source code for open-source software is available at no cost to developers or users. Open-source software is not shareware or freeware. Shareware typically allows no access to the underlying source code. Freeware is copyrighted software that is made available to the user free of charge for an unlimited time. In contrast, open-source software is copyrighted and distributed with license terms ensuring that the source code will always be available. Open-source software products have worldwide "communities of developers who write and maintain the code. Inside each community however, only a small group of developers, called core developers, is allowed to modify or submit changes to the code. Other developers submit code to the core developers.

Application software Application software consists of instructions that direct a computer system to perform specific information processing activities and that provide functionality for users. Because there are so many different uses for computers, there are a correspondingly large number of application software programs.

Types of application software Proprietary application software addresses a specific or unique business need for a company. This type of software may be developed in-house by the organizations information systems personnel, or it may be commissioned from a software vendor. Specific software programs developed for a particular company by a vendor are called contract software. Alternatively, offthe-shelf application software can be purchased, leased, or rented from a vendor that develops programs and sells them to many organizations. Off-theshelf software may be a standard package, or it may be customizable, Specialpurpose programs or packages" can be tailored for a specific purpose, such as inventory control or payroll. The word package is a commonly used term for a computer program (or group of programs) that has been developed by a vendor and is available for purchase in a prepackaged form.

Categories of personal application software

Programming languages

Programming languages allow people to write instructions that tell computers what to do. They are the means by which all systems and application software are developed. Because computers do exactly what they are told, programming languages require a high degree of precision and completeness. Also, digital computers only understand 0s and 1s, or binary digits. Therefore, all computer languages, except machine language, must be translated into binary digits for processing. This process is accomplished by a type of systems software called a compiler.

Software in the Hospital Environment

Every day, specific programs help physicians, nurses and other hospital staff to do their work. Dedicated applications support a wide variety of processes, such as patient admission, transfer, and discharge; ordering medication and procedures; as well as administrative function such as billing, controlling, or purchasing. In radiology, for example, clinical applications for image post-processing considerably facilitate the diagnostic process.

Clinical and managerial decision support Health care executives and providers are faced with decisions every day, multiple times per day. The success of any health care organization literally depends on these large and small decisions. In this section we will describe technologies that support decision making in health care today, for both clinical and managerial decisions. The types of systems that we examine are:- Decisionsupport systems (DSS) Artificial intelligence systems, including expert systems, natural language processing, fuzzy logic, and neural networksNobel Prizewinning economist Herbert Simon described decision making as a threestep process (Oz, 2004; Stair & Reynolds, 2003). The steps involvei. Intelligence: collecting facts, beliefs, and ideas. In health care these facts may be stored as data elements in a variety of data stores.ii. Design: designing the methods with which to consider the data collected during intelligence. These methods may be models, formulas, algorithms, or other analytical tools. Methods are selected that will reduce the number of viable alternatives.iii. Choice: making the most promising choice from the limited set of alternatives.

Problems that face health care executives and clinicians may be structured, unstructured, or semi structured. Structured problems are also referred to as programmable problems, because a computer program can be written with relative ease to solve this kind of problem. Transactionbased applications can be used to solve structured, or programmable, problems. For example, a payroll system is based on known facts about each employees salary, deductions, and so on. The decision of how much to write the monthly paycheck for is fairly straightforward. The unstructured and semi structured problems present much more of a challenge for computer application developers.

Decision support systems

How do we harness the power of a computer to solve a problem or make a decision about a solution when the situation is not easily structured with a simple algorithm (sequence of logical steps)? The computer systems developed to tackle the unstructured or semi structured problem are called decision-support systems (DSS). Decisionsupport system is another term that can mean slightly different things to different vendors or users. In this section we are referring primarily to the traditional, standalone DSS: in other words, an application that is designed for the purpose of supporting decisions. This is not the only form of decision support available to health care executives and providers today. For example, patient care or administrative applications may have components, such as data mining, that aid in decision making, but these applications might not be classified as fullblown DSS. An electronic spreadsheet, such as Excel, can also be used as a decision-support tool. Spreadsheets have builtin functions as well as the ability to use what-if statements.

The stand-alone DSS generally has three distinct components: The data management module, which is an existing or builtin transactional database or data warehouse. In a clinical DSS, the data module could be a clinical data repository.

The model management module, which allows the user to select a model to be applied to the problem at hand. Models can be mathematical, statistical, or based on expert knowledge. The model management module of a DSS is its most complex component and may seem like a "black box" to the health care executive.

The dialog module, which is the user interface. This module allows the user to pose the problem to the system by selecting the data and the decision model to use on the data. The dialog module also displays results, generally in text and graphical formats.

Executive information systems (EIS) are decision-support systems specifically designed for the higher-level manager. Most of these systems have drilldown capability to allow the executive to examine a problem at different levels of granularity, and many are tied to data warehouses (Oz, 2004).

Artificial intelligence (AI) is a branch of computer science devoted to emulating the human mind. One very common use of AI today is incorporated into the Google search engine. When the user types a misspelled word in a string of keywords, Google will suggest alternative keywords based on the context of the query (Oz, 2004). AI is a broad field with many different types of technology. We introduce a few types of AI that may be found in health care settings.

Expert Systems The hallmark of expert systems is that they use heuristics, or "rules of thumb," collected from experts in the particular field for which the system was built. Expert systems comprise

A knowledge base, which stores all the relevant information, data, rules, and cases that will be used by the system. lt is similar to a database, but the relationships are designed to match those dictated by the human experts. One of the challenges of building the knowledge base is getting the expert knowledge. Experts. Being people, do not always agree on the way to approach a problem. An inference engine, which provides the expert advice from the knowledge base. An explanation facility, which allows the user to understand how the inference engine arrived at the advice it is presenting. A knowledge acquisition facility, which allows the user to update the knowledge base with new or additional expert information (Stair & Reynolds. 2003).

Natural Language Processing Natural language processing (NLP) programs take human language (typed as text or input as voice) and translate it into a standard computer instructions, such as SQL. Suppose you typed this text into an application:List the names of all drugs that will treat shingles for less than $60 per month.or:What are the names of the drugs that will treat shingles for less than $60 per month?A NLP program might recognize either form of this sentence in context and convert it to an SQL statement similar to this:SELECT NAME FROM DRUGSWHERE DISEASE="SHINGLES"AND COST 60