A three-tier clinical information systems design model

[The telemedical service centre as an essential element of the conceptual approach for telemonitoring of cardiac patients : Requirements on the service, quality, and technical realization of telemonitoring]

Telemonitoring as part of a treatment strategy supports and facilitates the monitoring, disease management and education of patients with heart failure and cardiac arrhythmias. Therefore, telemonitoring affects quality and success of the therapy. Thus, meeting the needs of the patients and of the involved health care professionals is important for the success of the telemonitoring service. Moreover, a high quality of the service has to be ensured. The following article describes several configuration options for telemonitoring services considering technical as well as quality- and service-related aspects.

A Bridging Opportunities Work-frame to develop mobile applications for clinical decision making

Background:

Mobile applications (apps) providing clinical decision support (CDS) may show the greatest promise when created by and for frontline clinicians. Our aim was to create a generic model enabling healthcare providers to direct the development of CDS apps.

Methods:

We combined Change Management with a three-tier information technology architecture to stimulate CDS app development.

Results:

A Bridging Opportunities Work-frame model was developed. A test case was used to successfully develop an app.

Conclusion:

Healthcare providers can re-use this globally applicable model to actively create and manage regional decision support applications to translate evidence-based medicine in the use of emerging medication or novel treatment regimens.

Medical information needs to be structured in a way that it can be used in a time-constrained environment. This project looked at the process of creating mobile applications (apps), to help medical professionals rapidly apply new knowledge to better treat patients. We developed a novel system that allowed medical professionals to have a leading role in development. With the input from a pharmacist we created an app to deal with pharmacy and patient-related decisions surrounding newly available anticancer pills. Other medical professionals could also use this method to make apps to provide information with relevance to their medical decisions.

A healthcare management system for Turkey based on a service-oriented architecture

The current Turkish healthcare management system has a structure that is extremely inordinate, cumbersome and inflexible. Furthermore, this structure has no common point of view and thus has no interoperability and responds slowly to innovations. The purpose of this study is to show that using which methods can the Turkish healthcare management system provide a structure that could be more modern, more flexible and more quick to respond to innovations and changes taking advantage of the benefits given by a service-oriented architecture (SOA). In this paper, the Turkish healthcare management system is chosen to be examined since Turkey is considered as one of the Third World countries and the information architecture of the existing healthcare management system of Turkey has not yet been configured with SOA, which is a contemporary innovative approach and should provide the base architecture of the new solution. The innovation of this study is the symbiosis of two main integration approaches, SOA and Health Level 7 (HL7), for integrating divergent healthcare information systems. A model is developed which is based on SOA and enables obtaining a healthcare management system having the SSF standards (HSSP Service Specification Framework) developed by the framework of the HSSP (Healthcare Services Specification Project) under the leadership of HL7 and the Object Management Group.

Experiences from the Architectural Migration of a Joint Replacement Surgery Information System

The goal of this study is to present the experiences gathered from the migration of an existing and deployed joint replacement surgery information system from a classical 2-tier architecture to a 4-tier architecture. These include discussion on the motivation for the migration and on the technical benefits of the chosen technical migration path and an evaluation of user experiences. The results from the analysis of clinical end-user and administrator experiences show an increase in the perceived performance and maintainability of the system and a high level of acceptance for the new system version.

Modeling a terminology-based electronic nursing record system: An object-oriented approach

OBJECTIVE

The aim of this study was to present our perspectives on healthcare information analysis at a conceptual level and the lessons learned from our experience with the development of a terminology-based enterprise electronic nursing record system - which was one of components in an EMR system at a tertiary teaching hospital in Korea - using an object-oriented system analysis and design concept.

METHODS

To ensure a systematic approach and effective collaboration, the department of nursing constituted a system modeling team comprising a project manager, systems analysts, user representatives, an object-oriented methodology expert, and healthcare informaticists (including the authors). A rational unified process (RUP) and the Unified Modeling Language were used as a development process and for modeling notation, respectively.

RESULTS

From the scenario and RUP approach, user requirements were formulated into use case sets and the sequence of activities in the scenario was depicted in an activity diagram. The structure of the system was presented in a class diagram.

CONCLUSION

This approach allowed us to identify clearly the structural and behavioral states and important factors of a terminology-based ENR system (e.g., business concerns and system design concerns) according to the viewpoints of both domain and technical experts.

An integrated approach to breast diseases and breast cancer registry and research: BDRS as a web-based multi-institutional model

Accurate, complete, and timely health data sources are essential for progress in health care. Registry and research systems are foundations for conducting clinical and epidemiological research. Developing countries lack these systems due to the scarcity of the resources allocated for health information systems. In this study, we provide an integrated model for Turkey in order to optimize the utilization of resources. The Breast Diseases Registry system (BDRS) is implemented as an integrated disease-specific system for breast diseases in order to obtain a comprehensive use of patient health data for research and Breast Cancer Registry as well as an ancillary clinical tool.

A process for specifying integration for multi-tier applications in healthcare

Integration of the heterogeneous application systems in healthcare is needed to support the clinical and administrative work, patient-centric care, regional interoperability and utilisation of both valuable legacy systems and new technologies. The integration activity is complicated, and must be supported by flexible processes and methods. The integration methods should support the evaluation and specification of different integration approaches, standards and technologies on many interoperability levels. We introduce a process for specifying many integration decisions for a given integration situation. The process is part of an integration method, which is validated in PlugIT project in Finland.