Integrating Users Logic Into Requirements Engineering for Connected

Healthcare co-Design

Soﬁa Ouhbi

, Maria Karampela

and Minna Isomursu

Computer Science & Software Engineering Department, CIT, UAE University, U.A.E.

IT University of Copenhagen, Copenhagen, Denmark

Keywords:

Requirements Engineering, Service-dominant Logic, Connected Health, Value co-Creation.

Abstract:

The ongoing transformation in healthcare requires the creation of agile systems to meet the growing needs of

patients. An approach to develop such systems requires the elicitation of end-users’ perspectives to software

development life circle. The current requirements development process does not emphasis on the importance

of end-users’ participation in the requirements elicitation phase. The present study proposes an approach uti-

lizing Service-Dominant (S-D) logic framework to contribute to the co-design of connected health services.

Value co-creation practices when combined with requirements engineering best practices can contribute to-

wards the development of usable software for connected healthcare systems.

1 INTRODUCTION

Population age distribution is shifting towards an in-

crease of the elderly. World Health Organization

(WHO) has announced that between 2015 and 2050

the population aged over 60 years will surpass the

children younger than 5 years (Organization, 2015).

The increasingly aging population worldwide arises

various challenges to healthcare systems, among oth-

ers pertinent to support costs and service provision

(Chouvarda et al., 2015). Future healthcare systems

will have to deliver services to a larger number of pa-

tients with chronic conditions and multimorbidities.

Therefore, they have to accommodate the needs of a

population with interrelated and complex health con-

ditions from different backgrounds, while sustaining

cost effective services (Ouhbi et al., 2017).

These challenges have sparked innovation in

healthcare management models shifting traditional

management approaches towards more agile solu-

tions. Connected health model revolves around pa-

tients’ needs, utilizing the latest technological ad-

vancements to facilitate efﬁcient management of dis-

eases (Ouhbi et al., 2018). Patients and health data

are in the spotlight of the healthcare model, that uses

information technology to enable active participation

of all actors (citizens, patients, healthcare profession-

als, and policy makers) to decision-making (Caulﬁeld

and Donnelly, 2013; Karampela et al., 2019). Effec-

tive utilization of health data means that “the correct

information” is available “to the correct person at the

correct time” (Chouvarda et al., 2015). Connected

health paradigm encompasses a range of technologies

such as e-Health, m-Health and remote patient moni-

toring solutions (Caulﬁeld and Donnelly, 2013).

User involvement in the healthcare management

paradigm is only an aspect of users’ participation in

healthcare provision. Propositions of active involve-

ment of users’ on the design of health devices sup-

ports further the argument that users’ contribution can

improve not only services but also products (Harte

et al., 2014; Hardyman et al., 2015). But what is the

difference between services and products? According

to Vargo and Lusch services and products have more

similarities or commonalities than differences (Vargo

and Lusch, 2004b). They argue that “goods are dis-

tribution mechanisms for service provision” and that

“economic exchange is fundamentally about service

provision” (Vargo and Lusch, 2004b), p.326. In the

same vein, Gummesson suggested that “customers do

not buy goods or services: they buy offerings, which

render services, which create value” (Gummesson,

1993).

Service-Dominant (S-D) logic, proposed by Vargo

and Lurch, places service as the core value of both

services and products. Value co-creation has been

the centre of the S-D logic literature. According to

Vargo et al. (2008) “The customer is always a co-

creator of value”, while the value has been deﬁned

as the value-in-use (Vargo et al., 2008), p.148. In

480

Ouhbi, S., Karampela, M. and Isomursu, M.

Integrating Users Logic Into Requirements Engineering for Connected Healthcare co-Design.

DOI: 10.5220/0007754504800485

In Proceedings of the 14th International Conference on Evaluation of Novel Approaches to Software Engineering (ENASE 2019), pages 480-485

ISBN: 978-989-758-375-9

this context customers are co-creators of value (Vargo

and Lusch, 2004a; Vargo and Lusch, 2017), while

companies “cannot deliver value, but only offer value

propositions” (Vargo et al., 2008), p.148. Reﬂect-

ing upon this, companies can co-create value through

users’ involvement (Vargo and Lusch, 2004a; Vargo

and Lusch, 2017; Lusch et al., 2008).

Requirements engineering (RE) is the ﬁrst step of

the software lifecycle and plays a critical role towards

delivering quality and reliable software. This paper

relies on the requirements development process pre-

sented in RE body of knowledge (REBOK) (Nilsson,

2013) and software engineering body of knowledge

(SWEBOK) (Bourque et al., 2014) which are widely

accepted and established work in the ﬁeld of software

engineering (Ambreen et al., 2018).

Previous literature focusing on users’ involvement

into the system development cycle, points out that

their inclusion can have a positive impact on the cre-

ation of more effective services (Kujala, 2003; Ku-

jala et al., 2005; Wagner and Piccoli, 2007; Pekkola

et al., 2006; Bano and Zowghi, 2013). Nevertheless,

standardisation of users participation to the phases of

the requirements development process has been seen

as a challenge that can have an impact on the sys-

tem design process (Damodaran, 1996). According

to a recent systematic mapping study about personal

health data (Karampela et al., 2018), the majority of

the proposed solutions in healthcare services are de-

veloped without any empirical validation on patients’

data. The aim of the present study is to employ the

S-D logic framework to propose an approach to in-

crease the understanding of the value co-creation in

connected health by considering end-users’ involve-

ment in the requirements development process.

The following section will introduce the require-

ments development process, the core ideas of S-D

logic and two examples of challenges related to users

exclusion from the design process. Section 3 will dis-

cuss the approach of integrating S-D logic into RE.

Finally, the conclusion section presents future direc-

tions outlining S-D logic contribution to RE.

2 BACKGROUND

2.1 Requirements Development Process

The requirements development process includes the

four following phases: requirements elicitation, re-

quirements analysis, requirements speciﬁcation, and

requirements validation. Fig. 1 presents an overview

of the requirements development process.

Figure 1: Requirements development process.

Requirements Elicitation is a complex problem

formulation phase in which business requirements,

needs and information are gathered and identiﬁed.

In the Requirements Analysis phase, the identi-

ﬁed customers’ needs are translated and transformed

into requirements that are traceable, so that can be

measured and tested, and will be the core elements

of the design process.

Requirements Speciﬁcation results in the speci-

ﬁcation of the users and system requirements which

can establish the system requirements speciﬁcation

(SyRS) document and the software requirements

speciﬁcation (SRS) document (IEE, 2011).

Requirements Validation is the last phase of the

requirements development process and it is crucial as

mirrors the elicitation of requirements phase. This

phase validates whether the requirements of the cus-

tomers have been met or not, so that it gives a re-

ply to the question “did we create the right product?”

(Bourque et al., 2014).

This study focuses on the four aforementioned

phases proposing an approach to incorporate the S-D

logic into the requirements development process.

2.2 S-D Logic

S-D logic is a dynamic framework that continues

evolving as economic and social factors change over

time. The core idea of this framework relies upon the

notion that services are exchange of competences be-

tween actors underlined by common interests. Ser-

vices considered to be not just associations of individ-

uals to products, but dynamic relations (“service-for-

service exchange”) underpinned by commonalities.

Services include not only business and customers, but

a service ecosystem. This ecosystem of interactions

includes all the possible interrelated economic and so-

Integrating Users Logic Into Requirements Engineering for Connected Healthcare co-Design

481

cial actors of an exchange network. Service design

networks are complex and built up in three levels:

macro, meso and micro. Zooming in or out in these

levels one can examine ecosystems of services from

different perspectives, including thus various levels of

interactions. So, service ecosystems enable services

representations as networks of “holistic experiences”.

Fig 2 presents the core narrative and processes of the

S-D logic.

Figure 2: The core narrative and processes of S-D logic.

The essence of core values of the S-D logic frame-

work has been formulated into axioms. Table 1

presents the eleven foundational premises (FPs). Five

of these FPs have been considered to be the core ax-

ioms from which the other FPs can be derived. The

ﬁve axioms of the S-D logic are presented below.

Axiom1/Service is the Fundamental Basis of

Exchange. Services are exchange of resources. Re-

sources are applications of knowledge and skills,

which are the core for every exchange.

Axiom2/Value is co-Created by Multiple Ac-

tors, Always Including the Beneﬁciary. The value

is created when the beneﬁciaries use the end-product.

So, “the value-in-use” is co-created by producers and

consumers in an interactive manner through exchange

of resources (knowledge and skills).

Axiom3/All Social and Economic Actors are

Resource Integrators. All the actors of a service

have common objectives. Traditionally the term “pro-

ducer” was used for the actors who created value

and the term “customers” for the ones who destroyed

value. This notion had restricted interaction between

businesses and customers assuming that they had dif-

ferent goals. Nevertheless, all actors (businesses,

customers. etc.) that are involved in a service,

as a product of economic exchange, are “resource-

integrating, service providing enterprises” and have

a common objective to (co)-create value (Vargo and

Lusch, 2017), (p.48). What joints this network of ac-

tors is the “collective wellbeing”, in an individual and

common level as an act for achieving or maintaining

well-being.

Axiom4/Value is always Uniquely and Phe-

nomenologically Determined by the Beneﬁciary.

The value is determined by beneﬁciaries when they

use the end-services. But the value is subjective, is

based on the experiences and is dependent on the con-

text of services. The perceived value of services is

unique and related on the direct experiences of beneﬁ-

ciaries (Kujala and V

anen-Vainio-Mattila, 2009).

Axiom5/Value co-Creation is Coordinated

through Actor-generated Institutions and Institu-

tional Arrangements. In S-D logic framework the

terms institutions does not concern organizations, but

“are the humanly devised rules, norms, and beliefs

that enable and constrain action and make social

life at least somewhat predictable and meaningful”

(Vargo and Lusch, 2017), (p.49).

The S-D logic framework has been applied to var-

ious disciplines such as branding, logistics and sup-

ply chain management (Ballantyne and Aitken, 2007;

Flint and Mentzer, 2006; Tokman and Beitelspacher,

2011), consumer culture theory (Arnould, 2007), pub-

lic management (Osborne et al., 2013) and informa-

tion systems (Alter, 2010). Studies have also been

discussing applications of S-D logic to healthcare in-

formation systems (Hardyman et al., 2015; Rehman

et al., 2012).

2.3 Examples of Design Challenges Due

to Poor Requirements

The Chaos Report series conducted by the Standish

Group demonstrated that the major software project

impaired factors are incomplete requirements and

lack of user involvement (Sta, 2009).

A typical example of software failure due to exclu-

sion of users to the requirements development process

is the HealthCare.gov health insurance exchange web

service. It launched on October 2013, failed to serve

users needs due to various issues such as inaccurate

forecasting of user population which resulted to ac-

cessibility issues. Various system and software design

failures were related to poor user evaluation (BBC-

News, 2013). The failure to test scalability and in-

clude end-users to the design process resulted among

others to user dissatisfaction, delays in the project im-

plementation and growth of expenditures.

A second example concerns the National Pro-

gramme for IT in the NHS (NPfIT) in the United

Kingdom. The NPfIT web service was an effort to of-

fer a centralized electronic health record (EHR) that

ENASE 2019 - 14th International Conference on Evaluation of Novel Approaches to Software Engineering

482

Table 1: Axioms and Foundational Premises (FPs) of S-D Logic (Vargo and Lusch, 2016).

Axiom1 FP1 Service is the fundamental basis of exchange.

FP2 Indirect exchange masks the fundamental basis of exchange.

FP3 Goods are a distribution mechanism for service provision.

FP4 Operant resources are the fundamental source of strategic beneﬁt.

FP5 All economies are service economies.

Axiom2 FP6 Value is co-created by multiple actors,always including the beneﬁciary.

FP7 Actors cannot deliver value but can participate in the creation and offering of value propositions.

FP8 A service-centered view is inherently beneﬁciary oriented and relational.

Axiom3 FP9 All social and economic actors are resource integrators.

Axiom4 FP10 Value is always uniquely and phenomenologically determined by the beneﬁciary.

Axiom5 FP11 Value co-creation is coordinated through actor-generated institutions and institutional arrangements.

would be accessible by patients and also would con-

nect general practitioners and hospitals’ records. Af-

ter its implementation the software was scrapped due

to several failures such as poor functionality con-

nected to exclusion of end-users and stakeholders in

the design process (Justinia, 2017).

3 INTEGRATING THE USERS

LOGIC INTO RE

Healthcare transformation underpinned by connected

health aims to empower patients by creating services

that will “connect” all the stakeholders’ needs in an

effective manner (Caulﬁeld and Donnelly, 2013). The

challenge for requirements development process is

that it should respond to these needs by enabling

stakeholders participation to the life cycle of software

development.

Fig. 3 presents where value co-creation can be

generated in the requirements development process.

Drawing from S-D logic paradigm software can be

seen as a “service”. This means that software en-

gineers hold the responsibility to design complex

healthcare services encapsulating social and relational

norms and interactions into services. However, trans-

forming knowledge, business and users’ needs into

software components is a challenge by itself. Our pro-

posed framework based on S-D logic can contribute

on that in different ways.

Considering software in the lens of service means

that the focus of the requirements development pro-

cess should be shifted to the design of exchange of

resources, so to the design of knowledge and skills

(Axiom1, FP1) (Vargo and Lusch, 2017). In case of

healthcare services it is essential to involve patients

into the design process as their needs are often com-

plex and unique, requiring thus solutions that are sen-

sitive on that (Axiom4, FP10).

The idea of value-in-use is a notion that require-

ments development process can beneﬁt from. Ac-

Figure 3: Value co-creation in requirements development

process.

cording to this notion, value is created by the bene-

ﬁciaries of a service while using the services. More-

over, the value is co-created by multiple actors includ-

ing always the end-users (Axiom2, FP6). Based on

that, a suggestion would be to involve beneﬁciaries,

patients in this case, along the requirements develop-

ment process. Their knowledge in each step of the

requirements development process could lead to the

creation of more agile and effective solutions that will

be aligned with their needs.

The idea of a common objective for “collective

wellbeing” ampliﬁes the argument that stakeholders

involvement in the requirements development process

can have positive impact (Axiom 3, FP9). The contri-

bution of this axiom is the notion that service ecosys-

tems are environments that connect actors under a

common goal. So, more attention should be given to

the commonalities of the stakeholders of a services

than to the differences (Axiom5, FP11).

The relation of actors in a service ecology envi-

ronment is complex and develops in different levels.

One can argue that the complexity of such networks

can pose a challenge to engineers, designers or busi-

Integrating Users Logic Into Requirements Engineering for Connected Healthcare co-Design

483

ness analysts. The S-D logic suggests a frame to clus-

ter these relations into different levels (micro, meso,

macro). On this way software engineers could gain

a better understanding of this complex network of

actors focusing on different perspectives within the

same network. Mapping the actions and stakehold-

ers could contribute to better understanding of service

ecology leading to the development of more agile so-

lutions.

Although the S-D logic framework could con-

tribute towards better understanding of service ecol-

ogy and network of users, the education of the future

software engineers can also facilitate them to better

understand and reﬂect upon citizens’ needs. Design-

ing multidisciplinary education programs that will fo-

cus not only on the technical perspectives, but also

on the self-reﬂection of students has been suggested

as an innovation that can make a difference (Graham,

2018).

Another suggestion has been to reconsider the ed-

ucation of engineers (Ouhbi et al., 2015), drawing

lines towards societal and environmental challenges

that the world is facing. In addition, project-based

education and internships have been seen as a way

to shift the focus of engineers from the laboratories

to real-world challenges leading thus to better under-

standing of human nature (Graham, 2018). Software

engineers hold an essential role and an ethical respon-

sibility to serve society by contributing towards the

creation of welfare services.

4 CONCLUSION AND FUTURE

WORK

This paper presents a preliminary discussion of S-D

logic integration into the requirements development

process. It has discussed how the ﬁve core axioms

of the S-D logic, the service ecology and reformation

on education of engineers could contribute on the re-

design of the requirements development process.

Our future work will focus on the reﬁnement

of the proposed approach and the development of

a model to support software engineers to improve

the requirements development process for connected

health systems. We intend also to conduct empirical

evaluation to validate our proposed approach.

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