A process model basis for evolving hospital information systems

Paper, 2015

The diffusion of the process approach led to introduce the concept of process into the definition of an information system; it has a positive influence on the management and the behavior of these systems. Most of analysis techniques give notions to model of an information system through its processes, but according to various sights and perspectives. In the present work, we begin first of all with a definition of hospital information system, its impact and these sources of ambiguity, then we linger over a presentation of the modeling of information system directed process. We try finally to establish a reflection about the devices of modeling by process approach by means of a comparison.

Hospital management and business processes in hospitals have changed considerably over the past twenty years, as did the use of hospital information systems. In this paper a 'stages of growth' framework is developed and used to describe the relations between types of hospital management and the use of hospital information systems over time. In this paper the framework is applied in a case study of a large general hospital in the Netherlands. It was found that the use of IS in this hospital did not develop according to the needs and developments in the hospital organisation over the past decade.

International Journal of Clinical Monitoring and Computing, 1987

The phrase, 'hospital information system', is frequently used in discussions about the flow of information throughout a hospital with the assumption that everybody has the same concept in mind. Closer examination shows that this is not necessarily the case. The author draws on his experience as the Chief Information Officer at University Hospital at Stony Brook to define a hospital information system in terms of the implementation at Stony Brook. The University Hospital Information System at University Hospital (UHIS), has received international acclaim and was recently selected by the IBM Quarterly of Australia as the world leader in hospital information systems. This paper answers four questions: 1. What is a hospital information system? 2. How does a hospital information system work? 3. How do you implement a hospital information system? 4. After the system is operational, where do you go, e.g., critical care data management, physician's office management? University Hospital at Stony Brook is located on eastern Long Island and is the tertiary care referral hospital for approximately 1.4 million people. Nothing in the hospital happens without computers. Doctors, nurses, administrators and staff at all levels rely on the system daily. The system operates 24 hours per day, seven days per week. Access to the system is through 300 terminals and 128 printers throughout the hospital. In addition to the UHIS terminals, the critical care management system which is called Patient Data Management System, (PDMS), is available at over 90 ICU beds and in the operating rooms.

Applied Clinical Informatics, 2017

Background: Planning and controlling surgical operations hugely impacts upon productivity, patient safety, and surgeons' careers. Established, specialized software for this task is being increasingly replaced by "Operating Room (OR)-modules" appended to enterprise-wide resource planning (ERP) systems. As a result, usability problems are re-emerging and require developers' attention. Objective: Systematic evaluation of the functionality and social repercussions of a global, marketleading IT business control system (SAP R3, Germany), adapted for real-time OR process steering. Methods: Field study involving document analyses, interviews, and a 73-item survey addressed to 77 qualified (> 1-year system experience) senior planning executives (end users; "planners") working in surgical departments of university hospitals. Results: Planners reported that 57% of electronic operation requests contained contradictory information. Key screens contained clinically irrelevant areas (36 +/-29%). Compared to the legacy system, users reported either no improvements or worse performance, in regard to coordination of OR stakeholders, intra-day program changes, and safety. Planners concluded that the ERP-planning module was "non-intuitive" (66%), increased planning work (56%, p=0.002), and did not impact upon either organizational mishap spectrum or frequency. Interviews evidenced intra-institutional power shifts due to increased system complexity. Planners resented e.g. a trend towards increased personal culpability for mishap. Conclusions: Highly complex enterprise system extensions may not be directly suited to specific process steering tasks in a high risk/low error-environment like the OR. In view of surgeons' high primary task load, the repeated call for simpler IT is an imperative for ERP extensions. System design should consider a) that current OR IT suffers from an input limitation regarding planning-relevant real-time data, and b) that there are social processes that strongly affect planning and particularly ERP use beyond algorithms. Real improvement of clinical IT tools requires their independent evaluation according to standards developed for pharmaceutical subjects.

1998

This paper tries to describe a coherent vision of a possible next generation of HIS that rethinks how and what for computing is used in hospitals. Current systems, organized mainly around the `database` and the `communication` paradigm help the data processing to a great extent. At the same time they cannot be accepted as 'automated' systems, as handling of information is done mostly by end-users, i e. by human actors. Emerging methods enabling automated information handling are the following: integrated handling of different media, seamless communication among different systems, alternative input-output devices, tools for pro-active information handling These technologies should be grouped to two main branches: technical advances in data handling and theoretical advances in knowledge handling. The advances in knowledge handling are really important: tools based on that can take over routine information handling tasks from human end users. To discuss automation in HIS it is useful to understand the process of information handling in general within the hospital. A suggested multidimensional information space, where information objects are gathered mainly along two axes, the 'patient axis' and the 'management' axis might be of help. Combinations of selected dimensions resulted in a space of an estimated 2294082 possible information handling situation types in an earlier publication. Automation of information handling tasks can be derived from this model. The authors suggest to automate certain tasks done usually by active actors of the information handling situation space. Software agents working 'on their own' are known entities in HIS systems. Two components are needed for automation: -an organized data base where itscontent can be 'understood' and interpreted by an algorithm, with other words a knowledge base -an algorithm, that covers a certain routine information handling task. Data bases of HIS should be re-thought in a way that enables automated processing to a greater extent. The development of data base technologies clearly point to this direction. If most of the data bases of a HIS will be like that, new generation of applications might be launched to use them. E.g. a software agent called 'patient assistant' could collect data from different sources and build a coherent and updated patient file. The results of a knowledge based, agent operated HIS should be the following: -significantly less direct human involvement -significantly less paper to be produced -enhanced speed of data flow in general -enhanced reliability by widespread watchdog functions

International Joint Conference on Biomedical Engineering Systems and Technologies, 2012

The aim of this paper is to present some ideas about new directions in hospital information systems' design. They are based on results obtained in the context of joint research with Medical University Sofia, requirements from other hospitals and discussions with industrial providers of such systems. We target investigations, design, organisation and future expansion of a hospital information system, new concepts and methods for continuous acquisition of patient's vital data, transmission, collection and binding of that data for diagnostic and disease tracking purposes, investigations on relevance of life quality and healthcare based on the e-Health technologies and medication and drug tracking. Some of these new investigations are oriented to build data mining background.

The aim of this paper is to present some ideas about current research in hospital information systems’ design and some new unanswered problems. The presented research is based on join work with Medical University Sofia, on requirements from other hospitals and discussions with industrial providers of such systems. We target investigations, design, organisation and improvement of hospital information systems as well as enhanced personal health records structure, tracking of life long medications, treatments, changes in the body and general health status. Additional research is oriented to preventive diagnostic and investigations on relevance of life quality and healthcare based on the eHealth/mHealth technologies.

International Journal of Medical Informatics, 2005

Today, the economic and regulatory environment, involving activitybased 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.

International Journal of Engineering and Technology

Hospital Information System is the most fragile component of the health care system in the countries in development process. The modernization of the health care system does not integrate a rigid reflection on the installation of these tools into the hospital, which remain foreign with the strategies of these countries. This article aims at studying the case of a hospital Information system by schematizing the distribution of its components as well as its flow of information in the form of two complementary cartographies, a functional cartography and an information flow cartography, so this study's main objective is to reveal the axes of improvement of this system, by studying it, while focusing themselves on the transfer of information in the hospital institution which is the object of our study, to demonstrate this objective we have developed rich and flexible scenarios in the form of flowchart, that can also incorporate descriptions of users and their current and potential use of the information system. The formalization of the cartographies, in our case, enters in an improvement approach of the information system. Keyword-Hospital Information System1, components2, functional cartography3, information flow artography4, Information System improvement5. I. INTRODUCTION The introduction of any change poses a certain number of problems and of resistance at various levels. In the field of the information systems in health the problematic of introduction, although being common to all the countries, seem to have a peculiarity in the African context [8]. Indeed, African hospitals are differentiated from several angles relating to the cultural, political, organizational and structural context of hospital institutions. The management of these aspects constitutes obviously, an additional challenge to raise for the implementation and management of computerized information systems [3]. The Hospital Information system is inserted in the organization "hospital" in perpetual evolution; it is able, according to rules and preset procedures, of acquiring data, evaluating it, processing it by computer or organizational tools, to distribute information containing a strong added value to all the internal or external partners of the establishment, collaborating in a common work directed towards a specific goal, namely the assumption of responsibility of a patient and the re-establishment of this one [4]. To reinforce this state of mind, it appeared important to us to describe the information system to measure the insufficiencies, to point the factors must reinforce to build in the second time a factual base of knowledge able to help the decision makers, clinicians and managers [10]. In this work, we will start with a case study of a Moroccan hospital, which is a university hospital center, the purpose of this study is to define the existing HIS, to know its characteristics, and to measure its level of maturity, to chart and schematize the existing system and to propose improvements, schematically, per the returns on the questionnaires and the remarks made during our study. Lastly, the main aims of this study are, of one, to study the case of a Moroccan hospital institution of close, by implying the users in the study of the existing HIS, of two, try to propose improvements allowing to evolve the system per the organization evolutions and to the user needs. II. METHODOLOGY The organization which is the object of our study is a Moroccan hospital, and in order to study its IS, we used two questionnaires, the first, aimed at manager and responsible of IT department, was completed with the aim of defining the characteristics of the system; the second, aimed at the pilots of the HIS components, was in the form of a System Components Information Sheet (Modules). Our main objective is to study the state of the existing system, to have a sight on the level of maturity of this last, like arising the problems and difficulties pronounced during the use of the system, to propose improvements making it possible to make evolve the system according to the needs of its users and beneficiaries [7].

International journal of bio-medical computing, 1991

Expectations for hospital information systems (HIS) have yet to be realized. Requirements have been defined by the International Medical Informatics Association, health care futurists, and others. With a volatile marketplace and evolving technologies, computerization has been a non-trivial task. However, recent advances in architecture and communication standards promise to make networking possible. In addition, the development of professional workstations and of computer-based patient records linked to new tools and applications can transform health care. For HIS to realize these expectations, however, technology assessment and outcome analysis must play critical roles.