A process model basis for evolving hospital information systems

Specification of an integrated information architecture for a mobile teleoperated robot for home telecare

OBJECTIVE

The objective of this study was to design effectively integrated information architecture for a mobile teleoperated robot in remote assistance to the delivery of home health care.

METHODS

Three role classes were identified related to the deployment of a telerobot, namely, engineer, technology integrator, and health professional. Patients and natural caregivers were indirectly considered, this being a component of future field studies. Interviewing representatives of each class provided the functions, and information content and flows for each function. Interview transcripts enabled the formulation of UML (Universal Modeling Language) diagrams for feedback from participants. The proposed information architecture was validated with a use-case scenario.

RESULTS

The integrated information architecture incorporates progressive design, ergonomic integration, and the home care needs from medical specialist, nursing, physiotherapy, occupational therapy, and social worker care perspectives. The integrated architecture iterative process promoted insight among participants. The use-case scenario evaluation showed the design's robustness.

CONCLUSIONS

Complex innovation such as a telerobot must coherently mesh with health-care service delivery needs. The deployment of integrated information architecture bridging development, with specialist and home care applications, is necessary for home care technology innovation. It enables continuing evolution of robot and novel health information design in the same integrated architecture, while accounting for patient ecological need.

Understanding business intelligence in the context of healthcare

In today's fast changing healthcare sector, decision makers are facing a growing demand for both clinical and administrative information in order to comply with legal and customer-specific requirements. The use of business intelligence (BI) is seen as a possible solution to this actual challenge. As the existing research about BI is primarily focused on the industrial sector, it is the aim of this contribution to translate and adapt the current findings for the healthcare context. For this purpose, different definitions of BI are examined and condensed in a framework. Furthermore, the sector-specific preconditions for the effective use and future role of BI are discussed.

On designing a usable interactive system to support transplant nursing

Solid organ transplant has been steadily increasing in number both nationally and internationally. Caring for the transplant patients in the hospital setting, right after the patient is moved from the intensive care unit to the ward, is one of the most challenging tasks in nursing. It involves many procedures, rigid protocols, tight monitoring, and intensive data gathering for use by the other coordinating healthcare professionals. The complexity is further increased when a nurse has to take care of several transplant patients in a single shift. Of late, there has been a growth of computer applications in nursing and clinical information systems. Their acceptability and usability determine the ultimate success of computer support for this complex task. In this paper, we present a case study in which we combine two well-known software engineering techniques--namely, agile programming and user centered design--toward the goal of developing an interactive system for supporting the activities of transplant nurses in a hospital setting. This has resulted in a usable end-product and the user centered approach has motivated the nurses to move towards the use of computers in their jobs for better productivity. The product's usability was formally evaluated and is reported herein. The strengths and limitations of this approach are also discussed. The software product developed has been well accepted and is currently being planned to replace the manual methods followed in the transplant ward of a large metropolitan hospital.

Mapping care processes within a hospital: from theory to a web-based proposal merging enterprise modelling and ISO normative principles

Today, the economic and regulatory environment, involving activity-based and prospective payment systems, healthcare quality and risk analysis, traceability of the acts performed and evaluation of care practices, accounts for the current interest in clinical and hospital information systems. The structured gathering of information relative to users' needs and system requirements is fundamental when installing such systems. This stage takes time and is generally misconstrued by caregivers and is of limited efficacy to analysts. We used a modelling technique designed for manufacturing processes (IDEF0/SADT). We enhanced the basic model of an activity with descriptors extracted from the Ishikawa cause-and-effect diagram (methods, men, materials, machines, and environment). We proposed an object data model of a process and its components, and programmed a web-based tool in an object-oriented environment. This tool makes it possible to extract the data dictionary of a given process from the description of its elements and to locate documents (procedures, recommendations, instructions) according to each activity or role. Aimed at structuring needs and storing information provided by directly involved teams regarding the workings of an institution (or at least part of it), the process-mapping approach has an important contribution to make in the analysis of clinical information systems.

Measuring disparities in information capture timeliness across healthcare settings: effects on data quality

The emergence of evidence-based medicine in the United States has created an industry-wide environment where the quality of data maintained by healthcare organizations is becoming a critical factor in the delivery of medical care. Such a transition necessitates a corresponding need for consistent data collection and maintenance methods. In this study results of a national survey of health information managers were used to assess prevalence of a standard data quality practice, the adoption of policies related to timeliness of data capture. Findings from this survey show that, on a national level, only a slight majority of respondents indicated adoption of timeliness policies. About 61% of respondents indicate they have policies and procedures addressing data timeliness, although persistent patterns of nonadoption were found. We examine how the timeliness of data collection might serve as part of an overall data collection strategy that managers can employ to improve the quality of their information.

Specifying workflow process requirements for an emergency medical service

Recent trends in healthcare delivery have led to a gradual shift in the conceptualisation of healthcare information systems towards supporting healthcare processes in a more direct way. The move towards integrated and managed care, which requires designing healthcare processes around patient needs and incorporating efficiency considerations has led to an increased interest in process-oriented healthcare information systems based on workflow technology. This means to actively deliver the tasks to be performed to the right persons at the right time with the necessary information and the application functions needed. Moreover, workflow technology promotes a component-oriented development whereby the process logic is separated from application logic. This paper presents an approach to capturing process logic requirements for healthcare workflow systems with a view to design a system that is easily adjustable to process changes and to evolving organizational structures at a reasonable cost.

Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States

This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

Progress with formalization in medical informatics?

The prevailing view of medical informatics as a primarily subservient discipline in health care is challenged. Developments in both general informatics and medical informatics are described to identify desirable properties of modeling languages and tools needed to solve key problems in the application field. For progress in medical informatics, it is considered essential to develop far more formal modeling languages, modeling techniques, and tools. A major aim of this development should be to expel ambiguity from concepts essential to medicine, positioning medical informatics "at the heart of health care."

Tutorial on technology transfer and survey design and data collection for measuring Internet and Intranet existence, usage, and impact (survey-2000) in acute care hospitals in the United States

This paper provides a tutorial of technology transfer for management information systems in health care. Additionally it describes the process for a national survey of acute care hospitals using a random sample of 813 hospitals. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business to business and with customers. The relationships with systems approaches, user involvement, user satisfaction and decision-making will be studied. Changes with results of a prior survey conducted in 1997 can be studied and enabling and inhabiting factors identified. This information will provide benchmarks for hospitals to plan their network technology position and to set goals.

Using a descriptive model of change when implementing large scale clinical information systems to identify priorities for further research

In this paper we identify domains for research based on a model that describes the stages of change when designing and implementing large scale information and communication technology throughout a healthcare organization. We use the model in the case of the electronic patient record systems. We suggest that the research agenda should include approaches from the social and business sciences.

Information systems' approaches and designs and facility information: survey of acute care hospitals in the United States

These survey results are based on a national survey of acute care hospitals. A random sample of 813 hospitals was selected with 115 responding and 33 incorrect address returns resulting in a 15% response rate. The purpose of the study was to measure the extent of information systems integration in the financial, medical, and administrative systems of the hospitals. The rate of adoption of information technology or technology transfer is discussed. Facility demographics are presented. Characteristics of information systems' approaches and designs are reviewed and their implications discussed. This information will provide benchmarks for hospitals to determine their information systems position and to set goals.