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PubMed2001

Linking personal and public health information: a vision for community-centered health information systems.

As health care in the U.S. and worldwide has shifted from a centralized, institution-based model to a distributed process occurring largely in the communities, Integrated Advanced Information Management Systems (IAIMS) initiatives must also move toward addressing the challenges of integrating health information at the community level. The Wisconsin IAIMS initiative strives to create such a solution, anchoring its efforts in a regional health information technology architecture by partnering with Wisconsin-area communities as the foundation that will ensure the establishment of the appropriate collaborations to gain adequate investment and generate sustainable solutions for health information integration.

Community Networks↗
PubMed1976

A data structure model for a health information system.

The Ministry of Health and Environmental Control of Berlin is developing a Health Information System (HIS) on the basis of a multi-satellite network system, comprising a central, regional, local and functional unit level. The main part of this paper describes the conceptual structure of the Common Data Base (CDB) of HIS with special regard to the patient-oriented medical information originating from the various institutions of the health care system. This structure comprises the following five levels: 1. PATIENT 2. PROBLEM 3. CASE 4. EVENT 5. ACT Each of the levels represents a node in the structure model. A node is an entity with a set of "local properties" being specified for each level, referring to selected data on inferior levels. The structures of these five levels are described in detail. In the last part, so-called "data-manipulation procedures" are treated. These are descriptions covering any data manipulation and represent the basis of data integrity through system controlled transaction with the data base.

Berlin↗
PubMed2001

Economic motives to use a participatory design approach in the development of public-health information systems.

Within public health, there is a tradition of co-operation between researchers and communities in planning and implementation of health promotion programs. As a consequence, public-health organizations are characterized by having complex multidisciplinary structure and dynamic organizational goals. In this paper, we discuss the economic impacts from the use of Participatory Design for development of public-health information systems. Creation of systems that have both utility and usability is suggested to be highlighted as the central goal. The identified pre-requisites for a positive impact are that the new system should be of high quality, appropriate to the nature of the health promotion tasks, and to how activities are coordinated and integrated both between and within the stakeholder groups involved. We argue further that a method that minimizes the information asymmetry in the development process is necessary for avoiding market failures 1. The conclusion is that participatory design will diminish transaction costs, will help to avoid sunk costs, and will contribute to rich efficient use of human and economic resources in public-health organizations.

Community Participation↗
PubMed1998

The information needs of health agency board members: a health information system challenge.

Most hospitals and health agencies in developed countries, whether in the private or public sector, have 'advisory committees' or 'boards of management'. Members of these bodies have significant responsibilities for the management of their organisations, but usually serve on these bodies on a part-time and voluntary basis. They may or may not have specific expertise in health care or management but are often selected because they are representative of parts of the community, are members of relevant organisations (medical bodies or, perhaps, staff unions) or belong to the correct political party. In previous years the amount of information about the health care agency and health systems in general which was given to the board was usually closely controlled by the senior staff of the agency. While the information often emphasised financial statements or gross usage figures, it seldom included projections of future trends or comparisons with information for other like agencies and was frequently very out-dated by the time that it was assembled. For discussion purposes in this paper all individuals who serve on advisory or management committees as well as members of legally constituted Boards of Directors will be referred to as 'board members'. The responsibilities of these board members differ from the management responsibilities of CEOs and other senior executives, but those involved do require access to some management information if they are to adequately discharge their responsibilities. The role of such 'boards' or 'authorities' is similar to that of a board of trustees or directors in industry with many of the same responsibilities, except that healthcare agencies are 'people' agencies, not producers of 'widgets'. This paper will outline some of the information needs of board members and discuss how these needs may be addressed as part of a total management and health information system.

Australia↗
PubMed1984

Advanced occupational health information systems.

The goals of occupational health information and surveillance systems are outlined together with the components required to achieve these objectives. The various input sources (different divisions within the concerned organization) are identified and major types of output reports of the system are described. These general outlines could assist in standardizing future developments of such systems or potential customers in evaluating commercially available occupational health information systems. Potential advantages to employers and employees from incorporating these comprehensive surveillance systems are indicated. The beneficiary effects of utilizing information accumulated in a standardized, comprehensive, and longitudinal format from large groups of workers for prevention, health maintenance, or epidemiological evaluations are stressed and some specific examples given.

Information Systems↗
PubMed2004

Security middleware infrastructure for DICOM images in health information systems.

In health care, it is mandatory to maintain the privacy and confidentiality of medical data. To achieve this, a fine-grained access control and an access log for accessing medical images are two important aspects that need to be considered in health care systems. Fine-grained access control provides access to medical data only to authorized persons based on priority, location, and content. A log captures each attempt to access medical data. This article describes an overall middleware infrastructure required for secure access to Digital Imaging and Communication in Medicine (DICOM) images, with an emphasis on access control and log maintenance. We introduce a hybrid access control model that combines the properties of two existing models. A trust relationship between hospitals is used to make the hybrid access control model scalable across hospitals. We also discuss events that have to be logged and where the log has to be maintained. A prototype of security middleware infrastructure is implemented.

Access to Information↗
PubMed2003

When and how to evaluate health information systems?

AIMS: Evaluating large scale health information systems (HIS) such as hospital systems can be difficult. This article discusses the reasons we need to evaluate these systems and a range of appropriate methods to carry out evaluations. It is written in non-technical language to assist health policy makers and others commissioning or implementing such systems, with references and a web site containing information for those wishing more detail (http://www.ucl.ac.uk/kmc/evaluation/index.html). METHODS: A variety of questions relevant to HIS and qualitative and quantitative methods ranging from simple before-after to controlled before-after and fully randomised designs, are discussed. A running example--evaluating the impact of an order communications system on lab requests--is used to illustrate the potential problems, and how they can be resolved. RESULTS: The main types of biases affecting impact studies and methods to reduce them are described. The article then discusses some trade-offs between the low cost, easily conducted before-after study with its unreliable results versus the more complex, expensive but much more rigorous randomised trial. CONCLUSIONS: As would be expected, the correct methods to evaluate depend not on what technology is being evaluated--whether an information system or a drug--but on the questions the study is designed to answer, and how reliable the answers must be. Only those commissioning an evaluation study can decide these.

Hospital Information Systems↗
PubMed1999

Health information systems in developing countries: benefits, problems, and prospects.

Health information systems are important support tools in the management of health care services delivery in both developed and less developed countries. An adequate health information system is vital not only for assessing the health needs of populations and groups, but also for planning and implementation of health interventions. It is equally important in the evaluation of programmes from both the perspectives of effectiveness and coverage. This paper examines the practical difficulties of health care provision amidst inadequate statistics to inform decisions. Major obstacles to the introduction of effective health information systems in developing countries are examined, and practical suggestions on measures to overcome them discussed. It is concluded that the establishment of well co-ordinated information collection systems at the various levels of the health care system in developing countries, using appropriate staff, could contribute greatly to improvements in health care delivery.

Data Collection↗
PubMed2004

Family perspectives on integrated child health information systems.

The perspectives of families, and especially parents of children with special health care needs, need to be better understood by the government agencies, health care providers, associations, and information systems vendors that are integrating child health information systems. To date, research on children with special health care needs has not included the perspectives of parents on integrated child health information systems. Interviews were conducted with a limited number of parents of children with special health care needs and a young adult with special health care needs about their perspectives on integrated health information systems needs. The interviews revealed common themes: (1) parents have experienced the benefits of information technology for health care purposes, (2) parents believe integrated health information systems could help to coordinate their children's health care, (3) parents believe information technology can help improve accuracy and timeliness of information, (4) parents of children with special health care needs believe their children's health information should be available to those who need it, but safeguards must be in place, (5) parents believe health information systems can improve health care, but it is not the highest priority health care issue for them, and (6) parents believe that their involvement in issues related to children with special health care needs, including information technology, is critical. Parents of children with special health care needs hold strong opinions about their children's health care, including health information systems. Parents need to be central to discussions about development of integrated child health information systems if we are to develop information systems that serve the needs of children with special health care needs and their families.

Adolescent↗
PubMed1992

Quantitative indicators for a healthy city--the Rotterdam local health information system.

STUDY OBJECTIVE: The aim was to develop a local health information system for monitoring health status and for contributing to the development of local health policy. DESIGN: At district or even at neighbourhood level, data are collected on health status and factors related to health, including lifestyle, social and physical and environment, and the health care system. Data are collected from central and municipal Bureaus of Statistics, health care services, regional and municipal institutions, and by means of regularly performed local health surveys. SETTING: The 84 neighbourhoods of the Rotterdam Municipality. MAIN RESULTS: In the local health information system three sorts of data are collected: data on health status, data on health risk factors, and socioeconomic and demographic data. Two examples of data on health status are given (mortality and mental health) which were analysed. These data show differences in health status between several districts in Rotterdam, which can be related to differences in socioeconomic status between these districts. Examples are given of the influence of the project on local health policy in Rotterdam. CONCLUSIONS: The main conclusion is that the local health information system has great promise as an information system to give direction to local health policy. However if this promise is to be fulfilled, it will be necessary to obtain data from more varied sources.

Female↗
PubMed2005

Linking primary care information systems and public health information networks: lessons from the Philippines.

Community-based primary care information systems are one of the building blocks for national health information systems. In the Philippines, after the devolution of health care to local governments, we observed "health information system islands" connected to national vertical programs being implemented in devolved health units. These structures lead to a huge amount of "information work" in the transformation of health information at the community level. This paper describes work done to develop and implement the open-source Community Based Health Information Tracking System (CHITS) Project, which was implemented to address this information management problem and its outcomes. Several lessons learned from the field as well as software development strategies are highlighted in building community level information systems that link to national level health information systems.

Community Health Services↗
PubMed2006

Benefits and weaknesses of health cards used in health information systems.

The acceptance-based success of modern health information systems and health networks highly depends on the respective involvement of all relevant partners into the communication and co-operation processes characterising the medical and administrative workflow. Personal information stored in a networking environment guarantee for fast access fulfilling advanced shared care requirements whereas security token like smart cards stand for identification purposes, data protection, privacy protection, access rights, and limited person-based information storage, e.g., for emergency procedures. Linking these means of information provision allows for making use of the benefits of the different technologies without ignoring their existing weaknesses. The presented paper intends to summarise the respective categories of benefits and weaknesses allowing the reader to implement cards in health information systems as well as with the related aspects of awareness, confidence, and acceptance. Concluding this analysis, the preferred way to deal with the challenges of modern healthcare and welfare requirements shall be a well-balanced combination of cards and networks.

Diffusion of Innovation↗
PubMed1998

From legacy systems towards modern health information systems.

This article describes an approach of transferring legacy hospital information system to a modern HIS, which would support requirements of modern information age. There are several reasons, which force us to perform such a migration: from the weakness of design of legacy system to the need of covering new technologies (such as Inter/intranet) and new business conditions. The transition should be gradual, therefore a multilevel approach to the data is suggested, enabling us the transition, as well as including of the new, upcoming standards. The process of transition was started by the system covering the doctor's work. Responses to this part were very positive; therefore, we estimate that we are on the right way. We, however, know that the transitions will be neither fast nor cheap and this is the reason we shall have to find some more solutions.

Computer Communication Networks↗
PubMed2004

Assessing the impact of change in the organization of a technical support system for a health information systems (HIS).

OBJECTIVE: Evaluate the impact of the implementation of a new model of Help Desk and technical support in HIS users of the hospital. We carried an anonymous survey on a random sample of 150 users of the new system. The administrative staff (A), doctors (D) and nurses (N) were analysed by strata. We assessed the accessibility both to phone calls and through the institutional intranet; the understanding of the problems; the time taken to fully answer requests; and the degree of satisfaction concerning the change. The results showed that 94%, gained access through the intranet and that it was very satisfactory for the medical group (D80% vs A34% vs N8.7%). The different kinds of users were satisfied with the response time, above all the administrative stratum (A42% vs D38% vs N14%). All of them commented on their satisfaction with the change, above all, the doctors (D68% vs A46% vs N22%), who before this new implementation had expressed dissatisfaction with the old system. CONCLUSIONS: operational changes in the Help Desk contributed to improve how the service was perceived by its users; nevertheless both doctors and nurses required even faster response time.

Computer Communication Networks↗
PubMedDate not supplied

Regional health information systems: applying the IAIMS model.

In general, there is agreement that robust integrated information systems are the foundation for building successful regional health care delivery systems. Integrated Advanced Information Management System (IAIMS) institutions that, over the years, have developed strategies for creating cohesive institutional information systems and services are finding that IAIMS strategies work well in the even more complex regional environment. The key elements of IAIMS planning are described and lessons learned are discussed in the context of regional health information systems developed. The challenges of aligning the various information agencies and agendas in support or a regional health information system are complex; however, the potential rewards for health care in quality, efficacy, and cost savings are enormous.

Delivery of Health Care↗
PubMed2005

Development and deployment of a health information system in transitional countries (croatian experience).

Croatian Primary Health Care Information System pilot project, conducted between 2001 and 2003, aimed to develop and deploy a health information system based on the latest technologies which would improve the quality of primary health care and rationalise the consumption. 60 primary health care teams (physician and nurse) were equipped with PCs and connected via central server to the main national health insurer, state treasury and public health institute. Developed information system enabled rapid retrieval of documents, replacement of manual data input and a real-time insight into needed information as well as prompt interventions within the system. The project also introduced electronic smart cards for physicians and nurses, so that at each medical check-up the information system verified both the ensuree's and the physician's or nurse's status and rights.Based on the experiences from the pilot project, plan has been made for comprehensive health information system at national level which would connect primary health care teams, hospitals, laboratories, dentistries, health insurance companies, state treasury, public health institutes and electronic health records database. Its major goals are more rapid diagnostics, accuracy in prescribing therapy, standardisation of the good practice as well as better utilisation of capacities, shorter waiting times and shorter stays in hospitals, which would lead to improvement in overall health care quality and better control over the health care consumption. Estimated 5-year investment for installing such system would be 125 million EUR. However, information system could save substantially more and yield a return of investment in only two years.As information system for primary health care should be a strategic component of every health care reform and development plan, we can recommend our model, based on the results of the pilot project, to other transitional countries.

Delivery of Health Care↗
PubMed2004

Perspectives on integrated child health information systems: parents, providers, and public health.

The efforts of families, health care providers, and public health programs to optimize health care and health outcomes for children are often limited by the lack of timely, complete, and accurate health information. Families frequently serve as the messenger between providers in providing clinical details that they may not understand, because the paper record of previous care is unavailable. Providers believe in the value of good information, but haven't the time, training, or financial resources to create better data sharing methods. Public health programs often must rely on unacceptably slow, redundant, or otherwise limited data collection efforts to provide population-based assessments of child health problems that inform public policy and program development. Integrated child health information systems allow the appropriate, secure sharing of health data that are critical to improving these processes. Developing such systems will require a strong commitment from these 3 stakeholder groups and attention to human values as well as technical challenges.

Attitude↗