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 defects
All 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 opensource 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:o Decisionsupport systems (DSS)
o Artificial intelligence systems, including expert systems, natural language processing,
fuzzy logic, and neural networks
Nobel Prizewinning economist Herbert Simon described decision making as a threestep process
(Oz, 2004; Stair & Reynolds, 2003). The steps involve
i.
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 full
blown 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 DRUGS
WHERE DISEASE="SHINGLES"
AND COST 60