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PubMed1999

Integrated health information systems based on the RAI/MDS series of instruments.

There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.

Canada↗
PubMed1999

Managing health services: how the Population Health Information System (POPULIS) works for policymakers.

OBJECTIVES: University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for answering such questions as: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served? or do they have poor health outcomes despite being well served? Does high utilization represent overuse? or is it related to high need? More specifically, this system provides decision makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and countries, utilization review within a single hospital, and longitudinal research on health reform. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.

Community Health Planning↗
PubMed1994

Approaching safe and secure health information systems in Europe.

Information systems in health care are being utilised in more and more demanding and more clinical situations where security and safety issues become more significant. These issues are explored within the context of the UK National Health Service and the corresponding activities within the European Union.

Computer Security↗
PubMed1983

Screening the ambulatory care performance of family practice residents using a health information system.

This paper describes uses of data from a health information system for evaluating family practice residents' performance and progress through their residency programs. Because this system captures limited data from patient encounters, emphasis was placed on working closely with clinical faculty to develop information displays that they could interpret and integrate into residency program evaluations. The data displays are designed to help faculty screen residents' performances and to identify patient care problems that can be pursued further through audits on the medical records. The uses of these displays require that faculty incorporate clinical judgments into the screening process.

Ambulatory Care↗
PubMed1999

Linking the integrated management of childhood illness (IMCI) and health information system (HIS) classifications: issues and options.

Differences in the terms used to classify diseases in the Integrated Management of Childhood Illness (IMCI) guidelines and for health information system (HIS) disease surveillance could easily create confusion among health care workers. If the equivalent terms in the two classifications are not clear to health workers who are following the guidelines, they may have problems in performing the dual activities of case management and disease surveillance. These difficulties could adversely affect an individual's performance as well as the overall effectiveness of the IMCI strategy or HIS surveillance, or both. We interviewed key informants to determine the effect of these differences between the IMCI and HIS classifications on the countries that were implementing the IMCI guidelines. Four general approaches for addressing the problem were identified: translating the IMCI classifications into HIS classifications; changing the HIS list to include the IMCI classifications; using both the IMCI and HIS classification systems at the time of consultations; and doing nothing. No single approach can satisfy the needs of all countries. However, if the short-term or medium-term goal of IMCI planners is to find a solution that will reduce the problem for health workers and is also easy to implement, the approach most likely to succeed is translation of IMCI classifications into HIS classifications. Where feasible, a modification of the health information system to include the IMCI classifications may also be considered.

Case Management↗
PubMed2001

Developing a District Health Information System in South Africa: a social process or technical solution?

South Africa initiated a national District Health Information System rollout strategy in the latter half of 1999. Experience has demonstrated that the implementation of an information system as a vehicle for the delivery of accountability in the management of health services, demands organisational change within a framework of human resource development and technical support. The aim of training, to empower facility and district staff to use locally generated information to improve coverage and quality of primary health care services, can only be realized if training and innovation for change are appropriately marketed and supported. The appeal of HISP software, a locally developed application system lies in its user acceptance. While computers form a vital tool in providing easily accessible information for decision-making, their use must not be seen as a panacea for all information problems in primary health care services. Strategies for promoting sustainability of DHIS implementation lie in the social processes of human resource development, changing organisational infrastructure and the use of ongoing evaluation rather than those of technical infrastructure. South Africa has developed a variety of mechanisms to facilitate this process.

Community Networks↗
PubMed1995

Developing an integrated public health information system for Missouri.

The Missouri Department of Health realized it had a problem with 67 different information systems that ran on different platforms and could not communicate with one another. A new, integrated information system, the Missouri Health Strategic Architectures and Information Cooperative (MOHSAIC) is being developed based on information engineering (IE). This article describes IE, the process of developing MOHSAIC, and some key lessons learned in developing the system. Some of the lessons learned include the importance of executive sponsorship, tension between efficiency and program accountability, importance of confidentiality, and difficulties of funding an integrated system. The article stresses how integrated information systems will be important for the viability of public health under health care reform.

Computer Communication Networks↗
PubMed2000

Technology evaluation of a USA-Mexico health information system for epidemiological surveillance of Mexican migrant workers.

From 1994 through 1996, federal, state, and nongovernmental organizations in Mexico and in the United States of America developed and piloted a Binational Health Information System for Epidemiological Surveillance of Mexican migrant workers. The system allowed data exchange for epidemiological surveillance between the state of Guanajuato in Mexico and the Commonwealth (state) of Pennsylvania in the United States, for case detection, prevention, and treatment, through shared contact investigation and case management of communicable diseases. The target population consisted of migrant workers traveling between Guanajuato and Pennsylvania to work mainly in the mushroom industry, and their sexual partners in their Mexican communities of origin. Computerized migrant health information modules were set up in Guanajuato and in Pennsylvania. Patient information and epidemiological surveillance data were encrypted and communicated electronically between the modules, using the WONDER communications system of the U.S. Centers for Disease Control and Prevention. Evaluation of the Guanajuato-Pennsylvania Binational Health Information System showed that major barriers to binational epidemiological surveillance and control are: a) lack of communication binationally; b) interrupted medical care due to migration; c) inconsistent diagnosis and treatment criteria between the two countries; d) lack of referral clinical records from one country to the other; and e) deficient legal regulations concerning binational clinical data transfer. To our knowledge, this is the first project that has successfully demonstrated the technological feasibility of a binational disease control system linking a state in the interior of one country with a state in the interior of another country, rather than just states in the border region. The project also advanced the understanding of health service organizational issues that facilitate or hinder communication, outreach, disease prevention, and organization of health care services for migrant workers in both Mexico and the United States. Despite the unprecedented success and potential bilateral benefits demonstrated by this project, serious structural and organizational deficits in the public health systems of both countries must be addressed before epidemiological surveillance can be achieved binationally.

Information Systems↗
PubMedDate not supplied

Telematics and sentinel health information system with general practitioners in Aquitaine, southwest France.

A sentinel health information system using a telematics system to collect epidemiological data from a network of general practitioners (GPs) making up 5% of the GP population was set up in October 1986 in Aquitaine, France. In the first year, four topics were under surveillance. The GPs reported data for each case diagnosed by filling out a questionnaire displayed on their home terminal (Minitel), which transmitted the data by standard telephone lines to a central minicomputer located in the Bordeaux University Medical Centre. Regular feedback was provided to the participating GPs, public health officials and the Bordeaux Medical School. A detailed report of GP participation is presented, the reliability of our findings is discussed in terms of the motivational factors of participants, and the usefulness of the system is evaluated both for immediate teaching implications and for future research possibilities.

Computer Communication Networks↗
PubMedDate not supplied

Architecture of health information systems. State of the art and new perspectives.

In last years, requirements for health information systems have markedly increased. From essentially sectorial requirements limited to the single operational units, the need has emerged for the interaction and integration of the various components of the health care structure, within the service and over the territory. A major role in this evolutionary process is played by the architectural features of the information system. They must respond to precise requirements of standardization, modularity and openness so as to allow the integration and interaction of different, even if preexisting, applications and of different suppliers. In this article, some fundamental aspects of the architecture of health information systems are discussed based on actual experiences as well as on results of the principal approaches to standardization in Italy and Europe.

Europe↗
PubMed2001

Ethical problems in health information systems.

OBJECTIVES: To introduce term and concept of infoethics and to argue on its importance for health information systems. METHODS: To argue about our viewpoint of the dominance of the human component, which has been discussed at an IMIA working conference held in Helsinki, Finland (February 1998) devoted to the evaluation of health information systems. RESULTS AND CONCLUSIONS: Any technology sets a relationship between human beings and their environment, both physical and human. No technology can be seen as merely instrumental. This is especially relevant when dealing with large automatic information systems, developed to contribute to the management and integration of large organizations, such as hospitals. In such a context, the environment is mainly made up of humans. In evaluating such information systems, human factors preside over merely technical factors. Even if satisfying the latter is mandatory, they are never really sufficient. A perfect hard- and software system can be an absolute failure in everyday use. In any information system, the human factor is, of course, human-computer interaction, which always occurs when one person interacts with the machinery. However, in a simultaneous multi-user context, human-human interaction is the main question to tackle. The evaluation of large information systems, such as those found in hospitals, is founded in the whole concept of inter-human relationships which underlie the design and use of the system. Indeed, such an information system predominately appears as a social system, with its psychological, sociological and ethical features.

Ethics↗
PubMed2002

Review of current problems and shortcomings in the Tanzanian animal health information system with suggestions on improvement.

Livestock diseases have always been the focus of the Tanzanian Veterinary Authorities. However, they have become more important since the formation of the World Trade Organisation and subsequent implementation of the various multilateral agreements on trade. There is also a strong political desire to improve the animal health status as part of poverty alleviation strategies. As a result there is a need to develop better systems for investigating and reporting of animal diseases. In order to follow the OIE pathway and to obtain a disease free status, reliable evidence of freedom from particular diseases is becoming an issue of major interest. Assessment of the Tanzanian animal health information system revealed two major problems; firstly, the absence of disease information that accurately reflects the health status of the source population, and secondly, an inefficient information management system which is unable to provide useful information on the spatial component of animal health. A strategic approach is proposed that involves the collection of animal health information using active surveillance techniques and the introduction of a geographic information system. This approach should improve the management and reporting of animal health information.

Animal Diseases↗
PubMed2002

Integrating genomics into health information systems.

OBJECTIVE: To outline the main issues related to the impact of the data generated by the Human Genome Project on health information systems. A major challenge for medical informatics is identified, consisting of adapting traditional systems to new genetic-based diagnostic and therapeutic tools. METHODS: Reviewing and analysing the different health information levels from an organisational complexity point of view. A model is proposed to explain the interactions between health informatics, bioinformatics and molecular medicine. RESULTS: We suggest a new framework that integrates genetic data into health information systems. Using this model, new topics for future research and development are identified. CONCLUSIONS: We are witnessing the birth of a new era (post-genomics). In this era technological advancements in genomics offer new opportunities for clinical applications. Medical informaticians should play an important role in this new endeavour.

Databases, Genetic↗
PubMed2005

Designing web services in health information systems: from process to application level.

Service-oriented architectures (SOA) and web service technologies have been proposed to respond to some central interoperability challenges of heterogeneous health information systems (HIS). We propose a model, which we are using to define services and solutions for healthcare applications from the requirements in the healthcare processes. Focusing on the transition from the process level of the model to the application level, we also present some central design considerations, which can be used to guide the design of service-based interoperability and illustrate these aspects with examples from our current work in service-enabled HIS.

Computer Systems↗
PubMed2004

Towards responsive IT-infrastructures--assessment of a health information system.

Marburg University Medical Center has been introducing a comprehensive health information system since 1999, using a single-vendor application framework with an integrated generator tool for the development of clinical applications. To find out if this architecture and our participative software engineering approach can be considered a step towards a responsive infrastructure, we compared the situation after the first deployment phase (basically a holistic approach) with the situation after the system was further developed and adapted to the users' needs using the generator tool approach. We collected system statistics and conducted user satisfaction surveys in 2001/02 and 2003 using standardized measurements. The survey results showed that user involvement as well as system content were judged significantly higher after the second deployment phase. Insofar, we could demonstrate the feasibility of our approach. However, definite statements concerning the superiority of the generator tool approach to other concepts are not yet possible. We will continue our assessment, and we strongly suggest further studies in other institutions introducing comparable clinical functionality.

Academic Medical Centers↗