Recently I’ve been looking at collaborative decision-making in mental health, with the aim of identifying the technology requirements to support shared decision-making. Details of this project are here). One conclusion is that the underlying IT infrastructure needs to be considered, and in particular its reliability.

In general, a collaborative IT system can be understood as a distributed system with a particular purpose, where users with different roles collaborate to achieve a common goal. Examples include university research collaboration, public transport and e-government. In the example of health IT, a medical practice might have an IT system where a patient makes an appointment, medical records are inspected and updated, treatment decisions are made and recorded, and the patient may be referred to a specialist.

IT resilience and dependability
The resilience of an IT system is its capability to satisfy service requirements if some of its components fail or are changed. If parts of the system fail due to faults, design errors or cyber-attack, the system continues to deliver the required services. Similarly, if a software update is made, the system services should not be adversely affected. Resilience is an important aspect of dependability, which is defined precisely in terms of availability, reliability, safety, security and maintainability [Avizienis et al. 2004]. Importantly, dependability is not just about resilience, but also about trust and integrity.

IT dependability is usually understood on a technical level (the network or the software) and does not consider the design of the organisation (for example, if an error occurs due to lack of training).

Organisational resilience and dependability
Just as an IT system can be resilient on a technical level, an organisation (such as a health provider) can also be resilient and dependable in meeting high-level organisational requirements. Organisational requirements are defined in terms of an organisation, and are independent of IT. For example, they may be defined in terms of business processes or workflows. I think the idea of dependability requirements for an organisation is also useful and these may be specified separately. In healthcare, they might include the following:

• implementation – ensure that agreed decisions are actually carried out.
• avoidance of error – e.g. avoid excessive workloads.
• timeliness (e.g. for cancer diagnosis)
• transparency – e.g. is there an audit trail of critical decisions and actions?
• accountability – e.g. is it possible to challenge decisions?

Technology can help to ensure that these dependability requirements are satisfied. For example, excessive workload may be detectable by automated monitoring (e.g. one person doing too many tasks) in the same way that technical faults or security violations can be detected.

In Part 2, I will discuss the need for a test and simulation environment.

References
[Avizienis et al. 2004] Avizienis A, Laprie J-C, Randell B, and Landwehr C, “Basic concepts and taxonomy of dependable and secure computing,” IEEE Transactions on Dependable and Secure Computing, vol. 1, no. 1, pp. 11-33, Jan.-March 2004.