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Towards a flexible, process-oriented IT architecture for an integrated healthcare network

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Published:14 March 2004Publication History

ABSTRACT

Healthcare information systems play an important role in improving healthcare quality. As providing healthcare increasingly changes from isolated treatment episodes towards a continuous medical process involving multiple healthcare professionals and institutions, there is an obvious need for an information system to support processes and span the whole healthcare network. A suitable architecture for such an information system must take into account that it has to work as an integral part of a complex socio-technical system with changing conditions and requirements. We have surveyed the core requirements of healthcare professionals and analysed the literature for known problems and information needs. We consolidated the results to define use cases for an integrated information system as communication patterns, from which general implications on the required properties of a helathcare network information system could be derived. Key issues are flexibility, adaptability, robustness, integration of existing systems and standards, semantic compatibility, security and process orientation. Based on these results an IT architecture is being designed that is capable of addressing the requirements mostly on the basis of well-established standards and concepts.

References

  1. J. G. Anderson. Clearing the way for physicians' use of clinical information systems. Communications of the ACM, 40(8):83--90, 1997. Google ScholarGoogle ScholarDigital LibraryDigital Library
  2. D. W. Bates, M. Cohen, L. L. Leape, J. M. Overhage, M. M. Shabot, and T. Sheridan. Reducing the frequency of errors in medicine using information technology. J Am Med Inform Assoc, 8(4):299--308, 2001.Google ScholarGoogle ScholarCross RefCross Ref
  3. D. W. Bates, A. C. O'Neil, D. Boyle, J. Teich, G. M. Chertow, A. L. Komaroff, and T. A. Brennan. Potential identifiability and preventability of adverse events using information systems. J Am Med Inform Assoc, 1(5):404--411, 1994.Google ScholarGoogle ScholarCross RefCross Ref
  4. A. Bhasale. The wrong diagnosis: identifying causes of potentially adverse events in general practice using incident monitoring. Fam. Pract., 15(4):308--318, 1998.Google ScholarGoogle ScholarCross RefCross Ref
  5. P. Bolton, M. Mira, P. Kennedy, and M. M. Lahra. The quality of communication between hospitals and general practitioners: an assessment. J Qual Clin Pract, 18(4):241--247, 1998.Google ScholarGoogle ScholarCross RefCross Ref
  6. J. O. Borchers. A pattern approach to interaction design. Proceedings of the conference on Designing interactive systems: processes, practices, methods, and techniques, 2002. Google ScholarGoogle ScholarDigital LibraryDigital Library
  7. T. A. Brennan, L. L. Leape, N. M. Laird, L. Hebert, A. R. Localio, A. G. Lawthers, J. P. Newhouse, P. C. Weiler, and H. H. Hiatt. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med, 324(6):370--376, 1991.Google ScholarGoogle ScholarCross RefCross Ref
  8. J. J. Cimino. From data to knowledge through concept-oriented terminologies: experience with the medical entities dictionary. J Am Med Inform Assoc, 7(3):288--297, 2000.Google ScholarGoogle ScholarCross RefCross Ref
  9. R. M. Colomb. Impact of semantic heterogeneity on federating databases. The Computer Journal, 40(5):235--244, 1997.Google ScholarGoogle ScholarCross RefCross Ref
  10. R. S. Dick and E. B. Steen, editors. The Computer-Based Patient Record. National Academy Press, Washington, D.C., 1991. Google ScholarGoogle ScholarDigital LibraryDigital Library
  11. R. H. Dolin, L. Alschuler, C. Beebe, P. V. Biron, S. L. Boyer, D. Essin, E. Kimber, T. Lincoln, and J. E. Mattison. The HL7 Clinical Document Architecture. J Am Med Inform Assoc, 8(6):552--569, 2001.Google ScholarGoogle ScholarCross RefCross Ref
  12. A. Elmagarmid, M. Rusinkiewicz, and A. Sheth, editors. Management of Heterogeneous and Autonomous Database Systems. Morgan Kaufmann Publishers, San Francisco, California, 1999. Google ScholarGoogle ScholarDigital LibraryDigital Library
  13. E. Gamma, R. Helm, R. Johnson, and J. Vlissides. Design Patterns. Addison-Wesley, 1995.Google ScholarGoogle ScholarDigital LibraryDigital Library
  14. L. E. Garrett, Jr., W. E. Hammond, and W. W. Stead. The effects of computerized medical records on provider efficiency and quality of care. Methods Inf Med, 25(3):151--157, 1986.Google ScholarGoogle ScholarCross RefCross Ref
  15. (IJMI special issue on legacy systems). Int J Med Inf, 54:155--262, 1999.Google ScholarGoogle Scholar
  16. Institute of Medicine. Crossing the Quality Chasm. National Academic Press, Washington, D.C., 2001.Google ScholarGoogle Scholar
  17. S. Jablonski and C. Bussler. Workflow management -- modeling concepts, architecture and implementation. International Thomson Computer Press, London, 1996.Google ScholarGoogle Scholar
  18. S. Jablonski, R. Lay, and C. Meiler. Process-oriented web content management in e-healthcare. In Proceedings of e-Society 2003 IADIS International Conference, 2003.Google ScholarGoogle Scholar
  19. KBV (Kassenärztliche Bundesvereinigung Deutschland). {Table of interfaces} (german, 'Tabelle der Schnittstellen'). http://www.kbv.de/it/schnittstellen.htm, Jun 2003.Google ScholarGoogle Scholar
  20. KBV (Kassenärztliche Bundesvereinigung Deutschland). xDT -- Synonym für elektronischen Datenaustausch in der Arztpraxis (german). http://www.kbv.de/it/xdtinfo.htm, Jun 2003.Google ScholarGoogle Scholar
  21. K. A. Kuhn and D. A. Giuse. From hospital information systems to health information systems. Problems, challenges, perspectives. Methods Inf Med, 40(4):275--287, 2001.Google ScholarGoogle ScholarCross RefCross Ref
  22. K. A. Kuhn, D. A. Giuse, and J. L. Talmon. The Heidelberg Conference: Setting an agenda for the IMIA working group on health information systems. Int J Med Inf, 69(2--3):77--82, 2003.Google ScholarGoogle Scholar
  23. KV Nordrhein. D2D - Die Telematik-Initiative der KV Nordrhein (german). http://www.kvno.de/texte/kvno/d2d/idx_d2d.htm, Jun 2003.Google ScholarGoogle Scholar
  24. L. L. Leape, T. A. Brennan, N. Laird, A. G. Lawthers, A. R. Localio, B. A. Barnes, L. Hebert, J. P. Newhouse, P. C. Weiler, and H. Hiatt. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med, 324(6):377--384, 1991.Google ScholarGoogle ScholarCross RefCross Ref
  25. R. Lenz and K. A. Kuhn. Intranet meets hospital information systems: the solution to the integration problem? Methods Inf Med, 40(2):99--105, 2001.Google ScholarGoogle ScholarCross RefCross Ref
  26. C. J. McDonald. The barriers to electronic medical record systems and how to overcome them. Journal of the American Medical Informatics Association, 4(3):213--221, 1997.Google ScholarGoogle ScholarCross RefCross Ref
  27. C. Moore, J. Wisnivesky, S. Williams, and T. McGinn. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med, 18(8):646--651, 2003.Google ScholarGoogle ScholarCross RefCross Ref
  28. M. A. Musen. Domain ontologies in software engineering: use of Protege with the EON architecture. Methods Inf Med, 37(4--5):540--550, 1998.Google ScholarGoogle Scholar
  29. W. A. Nowlan, A. L. Rector, T. W. Rush, and W. D. Solomon. From terminology to terminology services. Proc. Annu. Symp. Comput. Appl. Med. Care, pages 150--154, 1994.Google ScholarGoogle Scholar
  30. PICNIC homepages. http://picnic.euspirit.org; http://www.medcom.dk/picnic, Jun 2003.Google ScholarGoogle Scholar
  31. E. Rahm and P. A. Bernstein. A survey of approaches to automatic schema matching. The VLDB Journal, 2001(10):334--350, 2001. Google ScholarGoogle ScholarDigital LibraryDigital Library
  32. C. Safran, D. Z. Sands, and D. M. Rind. Online medical records: a decade of experience. Methods Inf Med, 38(4--5):308--312, 1999.Google ScholarGoogle Scholar
  33. N. Saranummi. Interim System Architecture for PICNIC (D2.3). http://www.medcom.dk/picnic/deliverables/d2.3%20int%20sysarch%20v20.doc, May 2003.Google ScholarGoogle Scholar
  34. G. Schadow, U. Fohring, and T. Tolxdorff. Implementing HL7: from the standard's specification to production application. Methods Inf Med, 37(1):119--123, 1998.Google ScholarGoogle ScholarCross RefCross Ref
  35. SCIPHOX homepage. http://www.sciphox.org, Jun 2003.Google ScholarGoogle Scholar
  36. A. Sheth and J. Larson. Federated database systems for managing distributed, heterogeneous, and autonomous databases. ACM Computing Surveys, 22(3):183--235, 1990. Google ScholarGoogle ScholarDigital LibraryDigital Library
  37. J. M. Teich. Clinical information systems for integrated healthcare networks. Proc. AMIA Symp., pages 19--28, 1998.Google ScholarGoogle Scholar
  38. C. van Walraven, R. Seth, and A. Laupacis. Dissemination of discharge summaries. Not reaching follow-up physicians. Can Fam Physician, 48:737--742, 2002.Google ScholarGoogle Scholar
  39. C. van Walraven and A. L. Weinberg. Quality assessment of a discharge summary system. CMAJ, 152(9):1437--1442, 1995.Google ScholarGoogle Scholar
  40. VDAP (Verband Deutscher Arztpraxis-Softwarehersteller e.V.). VCS - Der neue Standard für die elektronische Arzt-Arzt-Kommunikation (german). http://www.vdap.de/html/vcs/vcsstand.html, Jun 2003.Google ScholarGoogle Scholar
  41. R. M. Wilson, B. T. Harrison, R. W. Gibberd, and J. D. Hamilton. An analysis of the causes of adverse events from the quality in australian health care study. Med J Aust, 170(9):411--415, 1999.Google ScholarGoogle ScholarCross RefCross Ref
  42. S. Wilson, W. Ruscoe, M. Chapman, and R. Miller. General practitioner-hospital communications: a review of discharge summaries. J Qual Clin Pract, 21(4):104--108, 2001.Google ScholarGoogle ScholarCross RefCross Ref

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        cover image ACM Conferences
        SAC '04: Proceedings of the 2004 ACM symposium on Applied computing
        March 2004
        1733 pages
        ISBN:1581138121
        DOI:10.1145/967900

        Copyright © 2004 ACM

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        • Published: 14 March 2004

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