Information Systems in Healthcare – State and Steps towards Sustainability

R. Lenz

doi:10.1055/s-0038-1638640

Yearbook of Medical Informatics, Table of Contents

Yearb Med Inform 2009; 18(01): 63-70
DOI: 10.1055/s-0038-1638640

Original Article

Georg Thieme Verlag KG Stuttgart

Information Systems in Healthcare – State and Steps towards Sustainability

R. Lenz

¹Chair for Computer Science VI (Data Management), University of Erlangen-Nuremberg, Germany

› Author Affiliations

Abstract

Summary

Objectives To identify core challenges and first steps on the way to sustainable information systems in healthcare.

Methods Recent articles on healthcare information technology and related articles from Medical Informatics and Computer Science were reviewed and analyzed. Core challenges that couldn’t be solved over the years are identified.

Results The two core problem areas are process integration, meaning to effectively embed IT-systems into routine workflows, and systems integration, meaning to reduce the effort for interconnecting independently developed IT-components. Standards for systems integration have improved a lot, but their usefulness is limited where system evolution is needed.

Conclusions Sustainable Healthcare Information Systems should be based on system architectures that support system evolution and avoid costly system replacements every five to ten years. Some basic principles for the design of such systems are separation of concerns, loose coupling, deferred systems design, and service oriented architectures.

Keywords

Information system - systems Iitegration - medical informatics applications

Full Text

References

References
1 Institute of Medicine. To Err Is Human. Building a Safer Health System. National Academy Press; 2000
2 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press; 2001
3 Shortliffe EH, Cimino C. Biomedical Informatics - Computer Applications in Healthcare and Bio-medicine. 3rd ed.. Springer; 2006
4 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; May 16; 144 (10) 742-52.
5 McDonald CJ. Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med 1976; Dec 9; 295 (24) 1351-5.
6 McDonald CJ, Hui SL, Smith DM, Tierney WM, Cohen SJ, Weinberger M. et al. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med 1984; Jan; 100 (01) 130-8.
7 Kucher N, Koo S, Quiroz R, Cooper JM, Paterno MD, Soukonnikov B. et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005; Mar 10; 352 (10) 969-77.
8 Teich JM, Spurr CD, Schmiz JL, O’Connell EM, Thomas D. Enhancement of clinician workflow with computer order entry. Proc Annu Symp Comput Appl Med Care 1995; 459-63.
9 Lenz R, Reichert M. IT Support for Healthcare Processes - Premises, Challenges, Perspectives. Data & Knowledge Engineering 2007; 61 (01) 39-58.
10 Cimino J. Infobuttons: anticipatory passive decision support. AMIA Annu Symp Proc 2008; 1203-4.
11 Collins BJ, Speedie SM. Attaching Context Sensitive Infobuttons to an EHR Options and Issues. AMIA Annu Symp Proc 2008; 914.
12 Hogan WR, Wagner MM. Accuracy of Data in Computer-based Patient Records. Journal of the American Medical Informatics Association 1997; 04 (05) 342-54.
13 Scannapieco M, Missier P, Batini C. Data Quality at a Glance. Datenbank Spektrum 2005; 14: 6-14.
14 Chen HT, Ma WC, Liou DM. Design and implementation of a real-time clinical alerting system for intensive care unit. Proc Amia Symp 2002; 131-5.
15 Ambrisko TD, Nemeth T. A computer program for calculation of doses and prices of injectable medications based on body weight or body surface area. Can J Vet Res 2004; Jan; 68 (01) 62-5.
16 Muller T. Typical medication errors in oncology: analysis and prevention strategies. Onkologie 2003; Dec; 26 (06) 539-44.
17 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE. et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; Mar 9; 293 (10) 1197203.
18 Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review. J Am Med Inform Assoc 2008; Sep; 15 (05) 585-600.
19 Hejlesen OK, Olesen KG, Dessau R, Beltoft I, Trangeled M. Decision support for diagnosis of lyme disease. Stud Health Technol Inform 2005; 205-10.
20 Demiris G. Electronic home healthcare: concepts and challenges. Int J Electron Healthc 2004; 01 (01) 4-16.
21 Demiris G, Hensel BK. Technologies for an aging society: a systematic review of “smart home” applications. Yearb Med Inform 2008; 33-40.
22 Prokosch HU, Ganslandt T. Perspectives for medical informatics. Reusing the electronic medical record for clinical research. Methods Inf Med 2009; 48 (01) 38-44.
23 Haux R. Health information systems - past, present, future. Int J Med Inform 2006; Mar; 75 (3-4) 268-81.
24 Kuhn KA, Giuse DA, Lapao L, Wurst SH. Expanding the scope of health information systems - from hospitals to regional networks, to national infrastructures, and beyond. Methods Inf Med 2007; 46 (04) 500-2.
25 Aarts J, Berg M. Same Systems, Different Out-comes. Methods Inf Med 2006; 45 (01) 53-61.
26 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc 2004; Mar; 11 (02) 104-12.
27 Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of Unintended Consequences Related to Computerized Provider Order Entry. J Am Med Inform Assoc 2006; 13 (05) 547-56.
28 Ash JS, Sittig DF, Dykstra R, Campbell E, Guappone K. The unintended consequences of computerized provider order entry: Findings from a mixed methods exploration. Int J Med Inform 2009; Apr;78 Suppl 1: S69-76.
29 DeLone WH, McLean ER. The DeLone and McLean Model of Information Systems Success: A Ten-Year Update. Journal of Management Information Systems 2003; 19 (04) 9-30.
30 Tierney WM, Overhage JM, McDonald CJ. Computerizing guidelines: factors for success. Proc AMIA Annu Fall Symp 1996; 459-62.
31 Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: the importance of special people. Int J Med Inf 2003; Mar; 69 2-3 235-50.
32 Lorenzi NM, Smith JB, Conner SR, Campion TR. The Success Factor Profile(c) for Clinical Computer Innovation. Medinfo 2004; 1077-80.
33 Sauer C. Deciding the future for IS failures: not the choice you might think. In: Currie WL, Galliers B. editors. Rethinking Management Information Systems. Oxford University Press; 1999: 279-309.
34 Al-Mashari M, Zairi M. BPR implementation process: an analysis of key success and failure factors. Business Process Management Journal 1999; 05 (01) 87-112.
35 Luftman JN, Papp R, Brier T. Enablers and Inhibitors of Business-IT Alignment. Communications of the Association for Information Systems. 1999 1(11).
36 Brender J, Ammenwerth E, Nykanen P, Talmon J. Factors influencing success and failure of health informatics systems—a pilot Delphi study. Methods Inf Med 2006; 45 (01) 125-36.
37 Kuhn KA, Giuse DA. From hospital information systems to health information systems. Problems, challenges, perspectives. Methods Inf Med 2001; 40 (04) 275-87.
38 Kuhn KA, Wurst SH, Bott OJ, Giuse DA. Expanding the scope of health information systems. Challenges and developments. Yearb Med Inform 2006; 43-52.
39 Sundblad S, Sundblad P. Business Improvement Through Better Software Architecture. Microsoft Architecture Journal 2007; 10 (January 2007): 36-41.
40 Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L. et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003; Nov; 10 (06) 523-30.
41 Maviglia SM, Zielstorff RD, Paterno M, Teich JM, Bates DW, Kuperman GJ. Automating complex guidelines for chronic disease: lessons learned. J Am Med Inform Assoc 2003; Mar; 10 (02) 154-65.
42 Versteegen G. Projektmanagement mit dem Rational Unified Process. Springer; 2000
43 Beck K. Extreme Programming. Addison-Wesley; 2000
44 Preece J, Rogers Y, Sharp H. Interaction Design - Beyond Human Computer Interaction. Addison-Wesley; 2002
45 Carver L, Turoff M. Human-Computer Interaction: The Human and Computer as a Team in Emergency Management Information Systems. Communications of the ACM 2007; 50 (03) 33-8.
46 Timpka T, Sjoberg C, Hallberg N, Eriksson H, Lindblom P, Hedblom P. et al. Participatory design of computer-supported organizational learning in health care: methods and experiences. Proc Annu Symp Comput Appl Med Care 1995; 800-4.
47 Sjoberg C, Timpka T. Participatory design of information systems in health care. J Am Med Inform Assoc 1998; Mar; 05 (02) 177-83.
48 Lenz R, Blaser R, Beyer M, Heger O, Biber C, Bäumlein M. IT-support for clinical pathways - lessons learned. Int J Med Inf 2007; 76: 397-402.
49 Lehman MM, Belady LA. Program Evolution - Processes of Software Change. Academic Press; 1985
50 Lechleitner G, Pfeiffer KP, Wilhelmy I, Ball M. Cerner Millennium: the Innsbruck experience. Methods Inf Med 2003; 42 (01) 8-15.
51 Gell G, Schmücker P, Pedevilla M, Leitner H, Naumann J, Fuchs H. et al. SAP and partners: ISH and IS-H* MED. Methods Inf Med 2003; 42 (01) 16-24.
52 Kuhn KA, Lenz R, Elstner T, Siegele H, Moll R. Experiences with a generator tool for building clinical application modules. Methods Inf Med 2003; 42 (01) 37-44.
53 Ammenwerth E, de Keizer N. A viewpoint on evidence-based health informatics, based on a pilot survey on evaluation studies in health care informatics. J Am Med Inform Assoc 2007; May; 14 (03) 368-71.
54 Blaser R, Kuhn KA, Overath M, Dietz F, Opitz E, Lenz R. Towards responsive IT-infrastructures - assessment of a health information system. Medinfo 2004; 2004: 1178-82.
55 Date CJ. An Introduction to Database Systems. 6 ed.. Addison-Wesley; 1995
56 Parnas DL. Software Aging. Proceedings of ICSE, Sorento, Italy 1994; 16: 279-87.
57 Lenz R, Kuhn KA. Intranet meets hospital information systems: the solution to the integration problem?. Methods Inf Med 2001; May; 40 (02) 99-105.
58 Lenz R, Beyer M, Kuhn KA. Semantic Integration in Healthcare Networks. Int J Med Inform 2007; 76 (2-3) 201-7.
59 Mead CN. Data interchange standards in healthcare IT—computable semantic interoperability: now possible but still difficult, do we really need a better mousetrap?. J Healthc Inf Manag 2006; 20 (01) 71-8.
60 Dolin RH, Alschuler L, Beebe C, Biron PV, Boyer SL, Essin D. et al. The HL7 clinical document architecture. J Am Med Inform Assoc 2001; Nov; 08 (06) 552-69.
61 Muller ML, Uckert F, Burkle T, Prokosch HU. Cross-institutional data exchange using the clinical document architecture (CDA). Int J Med Inform 2005; Mar; 74 (2-4) 245-56.
62 Vegoda P. Introducing the IHE (Integrating the Healthcare Enterprise) concept. J Healthc Inf Manag 2002; 16 (01) 22-4.
63 Blobel B, Roger-France F. A systematic approach for analysis and design of secure health information systems. Int J Med Inf 2001; 62 (01) 51-78.
64 Lenz R, Kuhn KA. Towards a continuous evolution and adaptation of information systems in healthcare. Int J Med Inf 2004; 73 (01) 75-89.
65 Beale T. Archetypes and the EHR. Stud Health Technol Inform 2003; 96: 238-44.
66 Beale T. Archetypes: Constraint-based Domain Models for Future-proof Information Systems. OOPSLA; 2002
67 Patel N. Adaptive Evolutionary Information Systems. Idea Group Publishing; 2003
68 Dogac A, Laleci GB, Aden T, Eichelberg M. Enhancing IHE XDS for federated clinical affinity domain support. IEEE Trans Inf Technol Biomed 2007; Mar; 11 (02) 213-21.
69 Fielding RT. Architectural Styles and the Design of Network-based Software Architectures University of California. 2000
70 Khare R, Taylor RN. Extending the Representational State Transfer (REST) Architectural Style for Decentralized Systems. International Conference on Software Engineering; 2004: 428-37.