Suchen und Finden
Health Information Systems - Architectures and Strategies
von: Alfred Winter, Reinhold Haux, Elske Ammenwerth, Birgit Brigl, Nils Hellrung, Franziska Jahn
Springer-Verlag, 2011
ISBN: 9781849964418 , 340 Seiten
2. Auflage
Format: PDF
Kopierschutz: DRM
Preis: 90,94 EUR
Health Information Systems: Architectures and Strategies
2
Foreword from the 1st Edition in 2004
6
Series Preface
8
Preface for the 2nd Edition
9
Acknowledgements for the 2nd Edition
11
Acknowledgements for the 1st Edition
12
Annotation to the Figures
13
Contents
14
List of Figures
21
Figure Credits
31
List of Tables
33
About the Authors
35
1: Introduction
38
2: Health Institutions and Information Processing
40
2.1Introduction
40
2.2 Significance of Information Processing in Health care
40
2.2.1 Information Processing as Quality Factor
40
2.2.2Information Processing as Cost Factor
41
2.2.3Information as Productivity Factor
43
2.2.4Holistic View of the Patient
43
2.2.5Hospital Information System as Memory and Nervous System
44
2.3 Progress in Information and Communication Technology
45
2.3.1Impact on the Quality of Health Care
45
2.3.2Impact on Economics
47
2.3.3Changing Health care
48
2.4 Importance of Systematic Information Management
49
2.4.1Affected People and Areas
49
2.4.2Amount of Information Processing
50
2.4.3Sharing the Same Data
51
2.4.4Integrated Information Processing to Satisfy Information Needs
52
2.4.5Raising the Quality of Patient Care and Reducing Costs
53
2.4.6Basis of Systematic Information Processing
53
2.5 Examples
54
2.5.1Knowledge Access to Improve Patient Care
54
2.5.2Nonsystematic Information Processing in Clinical Registers
55
2.5.3The WHO eHealth Resolution15
56
“The Fifty-Eighth World Health Assembly …
57
2.5.4Estimated Impact of eHealth to Improve Quality and Efficiency of Patient Care
58
2.6 Exercises
59
2.6.1Amount of Information Processing in Typical Hospitals
59
2.6.2Information Processing in Different Areas
59
2.6.3Good Information Processing Practice
60
2.7 Summary
60
3: Information System Basics
61
3.1 Introduction
61
3.2 Data, Information, and Knowledge
61
3.3 Information Systems and Their Components
62
3.3.1Systems and Subsystems
62
3.3.2Information Systems
62
3.3.3Components of Information Systems
63
3.3.4Architecture and Infrastructure of Information Systems
65
3.4 Information Management
66
3.5 Exercises
66
3.5.1On the Term Information System
66
3.5.2On Enterprise Functions
67
3.5.3On Application Components
67
3.5.4On Architectures and Infrastructures
67
3.5.5On Information Management
67
3.6 Summary
67
4: Health Information Systems
69
4.1 Introduction
69
4.2 Hospital Information Systems
69
4.3 Transinstitutional Health Information Systems
72
4.4 Electronic Health Records as a Part of Health Information Systems
74
4.5 Challenges for Health Information Systems
74
4.6 Example
76
4.6.1 Architecture of a Hospital Information System
76
4.7 Exercises
77
4.7.1 Hospital Information System as a System
77
4.7.2 Buying a Hospital Information System
77
4.7.3 Transinstitutional Health Information Systems
77
4.8 Summary
78
5: Modeling Health Information Systems
79
5.1 Introduction
79
5.2 On Models and Metamodels
79
5.2.1Definitions
79
5.2.2Types of Models
81
5.2.2.1Functional Models
81
5.2.2.2Technical Models
82
5.2.2.3Organizational Models
82
5.2.2.4Data Models
84
5.2.2.5Business Process Models
85
5.2.2.6Information System Models
87
5.3 A Metamodel for Modeling Health Information Systems on Three Layers: 3LGM²
87
5.3.1UML Class Diagrams for the Description of 3LGM²
88
5.3.23LGM²-B
91
5.3.2.1Domain Layer
91
5.3.2.2Logical Tool Layer
94
5.3.2.3Physical Tool Layer
96
5.3.2.4Interlayer Relationships
98
5.3.33LGM²-M
102
5.3.43LGM²-S
103
5.4 On Reference Models
104
5.5 A Reference Model for the Domain Layer of Hospital Information Systems
106
5.6 Exercises
107
5.6.1Typical Implementation of Hospital Functions
107
5.6.23LGM² as a Metamodel
107
5.6.3Modeling with 3LGM²
108
5.6.3.1HIS Components
108
5.6.3.2Create the Model
108
5.6.3.3Interlayer Relationships
108
5.6.3.4New Enterprise Function
108
5.7 Summary
109
6: Architecture of Hospital Information Systems
110
6.1 Introduction
110
6.2 Domain Layer: Data to Be Processed in Hospitals
110
6.2.1 Entity Types Related to Patient Care
111
6.2.2 Entity Types About Resources
112
6.2.3 Entity Types Related to Administration
113
6.2.4 Entity Types Related to Management
113
6.3 Domain Layer: Hospital Functions
114
6.3.1 Patient Care
114
6.3.1.1 Patient Admission
114
Appointment Scheduling
116
Patient Identification and Checking for Recurrent
116
Administrative Admission
116
Medical Admission
118
Nursing Admission
118
Visitor and Information Service
118
6.3.1.2 Decision Making, Planning, and Organization of Patient Treatment
118
Decision Making and Patient Information
120
Medical and Nursing Care Planning
120
6.3.1.3 Order Entry
121
Preparation of an Order
121
Appointment Scheduling
123
6.3.1.4 Execution of Diagnostic, Therapeutic and Nursing Procedures
123
Execution of Diagnostic and Therapeutic Procedures
124
Execution of Nursing Procedures
125
6.3.1.5 Coding of Diagnoses and Procedures
125
6.3.1.6 Patient Discharge and Transfer to Other Institutions
126
Administrative Discharge and Billing
127
Medical Discharge and Medical Report Writing
127
Nursing Discharge and Nursing Report Writing
128
6.3.2 Supply and Disposal Management, Scheduling, and Resource Allocation
128
6.3.2.1 Supply and Disposal Management
128
Catering
128
Material and Medication Management
128
Laundry Management
128
Management of Medical Devices
130
6.3.2.2 Scheduling and Resource Allocation
130
6.3.2.3 Human Resources Management
130
6.3.3 Hospital Administration
131
6.3.3.1 Patient Administration
132
6.3.3.2 Archiving of Patient Information
132
Opening of a Patient Record
133
Administration and Allocation of Patient Records
133
Long-Term Archiving
134
6.3.3.3 Quality Management
134
Internal Quality Management
134
Performance of Legal Notification Requirements
135
6.3.3.4 Cost Accounting
135
6.3.3.5 Controlling
135
6.3.3.6 Financial Accounting
136
6.3.3.7 Facility Management
136
6.3.3.8 Information Management3
136
Strategic Information Management
136
Tactical Information Management
139
Operational Information Management
139
6.3.4 Hospital Management
139
6.3.5 Research and Education
139
6.3.5.1 Research Management
141
6.3.5.2 Execution of Clinical Trials and Experiments
141
6.3.5.3 Knowledge Retrieval and Literature Management
141
6.3.5.4 Publishing and Presentation
141
6.3.5.5 Education
141
6.3.6 Clinical Documentation: A Hospital Function?
141
6.3.7 Domain Layer: Exercises
142
6.3.7.1 Differences in Hospital Functions
142
6.3.7.2 Different Health Care Professional Groups and Hospital Functions
142
6.3.7.3 Support of Hospital Functions
142
6.3.7.4 The Patient Entity Type
143
6.3.8 Domain Layer: Summary
143
6.4 Logical Tool Layer: Application Components
145
6.4.1 Patient Administration System
146
6.4.2 Medical Documentation System
148
6.4.3 Nursing Management and Documentation System
150
6.4.4 Outpatient Management System
151
6.4.5 Provider or Physician Order Entry System (POE)
153
6.4.6 Patient Data Management System (PDMS)
155
6.4.7 Operation Management System
157
6.4.8 Radiology Information System
159
6.4.9 Picture Archiving and Communication System (PACS)
160
6.4.10 Laboratory Information System
162
6.4.11 Enterprise Resource Planning System
163
6.4.12 Data Warehouse System
164
6.4.13 Document Archiving System
166
6.4.14 Other Computer-Based Application Components
168
6.4.15 Clinical Information System and Electronic Patient Record System as Comprehensive Application Components
169
6.4.16 Typical Non-Computer-Based Application Components
170
6.4.16.1 The Paper-Based Patient Chart System
170
6.4.16.2 The Paper-Based Patient Record System
172
6.5 Logical Tool Layer: Integration of Application Components
172
6.5.1 Taxonomy of Architectures at the Logical Tool Layer
173
6.5.1.1 Number of Databases: Central Versus Distributed
173
DB1 Style
174
DBn Style
174
Mixed DB1/DBn Style
175
6.5.1.2 Number of Application Components: Monolithic Versus Modular
175
6.5.1.3 Number of Software Products and Vendors: All-in-One Versus Best-of-Breed
176
6.5.1.4 Communication Pattern: Spaghetti Versus Star
177
6.5.2 Integrity
179
6.5.2.1 Object Identity
179
6.5.2.2 Referential Integrity
180
6.5.2.3 Consistency
180
6.5.3 Types of Integration
181
6.5.3.1 Data Integration
181
6.5.3.2 Semantic Integration
181
6.5.3.3 Access Integration
182
6.5.3.4 Presentation integration
182
6.5.3.5 Contextual Integration
183
6.5.3.6 Functional integration
183
6.5.3.7 Process Integration
183
6.5.4 Standards
184
6.5.4.1 Health Level 7 (HL7) Version 2
184
6.5.4.2 Health Level 7 (HL7) Version 3
186
6.5.4.3 Digital Imaging and Communications in Medicine (DICOM)
187
6.5.4.4 ISO/IEEE 11073
188
6.5.4.5 Standard for Contextual Integration
188
6.5.4.6 Integrating the Healthcare Enterprise (IHE)
188
6.5.4.7 Electronic Data Interchange for Administration, Commerce, and Transport (EDIFACT)
189
6.5.4.8 Clinical Document Architecture (CDA)
189
6.5.5 Integration Technologies
190
6.5.5.1 Federated Database System
190
6.5.5.2 Transaction Management: 2-phase commit protocol and master application components
190
6.5.5.3 Middleware
191
Message Exchange by Communication Servers
192
Remote Function Calls
194
Service-Oriented Architectures (SOAs) and Portals
195
6.5.6 Logical Tool Layer: Example
196
6.5.6.1 Typical Realizations: Centralized, Monolithic and All-in-One HIS
196
6.5.7 Logical Tool Layer: Exercises
198
6.5.7.1 Data Distribution Style at the Logical Tool Layer
198
6.5.7.2 HIS Infrastructures
198
6.5.7.3 A Paperless Hospital
201
6.5.7.4 Introducing a Departmental Computer-Based Application Component
201
6.5.7.5 Loose and Close Coupling
202
6.5.7.6 Integrating Nursing Documentation
202
6.5.8 Logical Tool Layer: Summary
202
6.6 Physical Tool Layer: Physical Data-Processing Systems
203
6.6.1 Servers and communication networks
204
6.6.2 Clients
204
6.6.3 Storage
205
6.6.4 Typical Non-computer-Based Physical Data-Processing Systems
205
6.6.5 Infrastructure
206
6.7 Physical Tool Layer: Integration of Physical Data-Processing Systems
207
6.7.1 Taxonomy of Architectures at the Physical Tool Layer
207
6.7.1.1 Distribution of Computing Power: Mainframes vs. Client-Server
208
6.7.2 Physical Integration
209
6.7.3 Computing Centers
210
6.7.4 Physical Tool Layer: Example
211
6.7.4.1 The Amount of Data to Be Processed at a Hospital’s Computing Center
211
6.7.5 Physical Tool Layer: Exercises
212
6.7.5.1 HIS Infrastructure
212
6.7.6 Physical Tool Layer: Summary
212
6.8 Summarizing Example
213
6.8.1 Health Information Systems Supporting Clinical Business Processes
213
Patient Treatment at a Physician’s General Practice
213
Sec154_6
213
Arrival at ward
213
Nursing Admission
213
Medical Admission
214
Medical Care Planning and Order Entry
214
Execution of Diagnostic, Therapeutic, and Nursing Procedures
214
Review of Findings
215
Decision Making
215
Sec162_6
215
Transfer to Another Department
215
Discharge from Hospital and Aftercare
216
6.9 Summarizing Exercises
216
6.9.1 Hospital Functions and Processes
216
6.9.2 Application Components and Hospital Functions
216
6.9.3 Multiprofessional Treatment Teams
217
6.9.4 Information Needs of Different Health Care Professionals
217
6.9.5 HIS Architectures
217
6.9.6 Communication Server
217
6.9.7 Anatomy and Physiology of Information Processing
217
6.10 Summary
218
7: Specific Aspects for Architectures of Transinstitutional Health Information Systems
219
7.1 Introduction
219
7.2 Domain Layer
220
7.2.1 Specific Aspects for Hospital Functions
220
7.2.1.1 Patient Admission
220
7.2.1.2 Decision Making, Planning, and Organization of Patient Treatment
221
7.2.1.3 Execution of Diagnostic and Therapeutic Procedures
221
7.2.2 Additional Enterprise Functions
222
7.3 Logical Tool Layer
222
7.3.1 Integration of Application Components
222
7.3.2Strategies for Electronic Health Record Systems
224
7.3.2.1The Provider-Centric Strategy
225
7.3.2.2The Patient-Centric Strategy
225
7.3.2.3The Regional- or National-Centric Strategy
226
7.3.2.4The Strategy of Independent Health Banks
226
7.4 Physical Tool Layer
226
7.5 Examples
227
7.5.1“Gesundheitsnetz Tirol (GNT)”: The Tyrolean Health Care Network
227
7.5.1.1Background and Overall Functionality
227
7.5.1.2System Architecture and Workflows
227
7.5.1.3 Important Lessons Learned
229
7.5.2 Veterans Health Information Systems and Technology Architecture (VISTA)7
230
7.5.3 The Hypergenes Biomedical Information Infrastructure9, 10
230
7.5.4 The National Health Information System in Korea11, 12
231
7.6Exercises
232
7.6.1Challenges of Transinstitutional Health Information Systems
232
7.6.2Strategies for Transinstitutional Electronic Health Records
232
7.6.3 The Term “Electronic Health Record”
233
7.6.4 Transinstitutional Information Systems in other Sectors
233
7.7 Summary
233
8: Quality of Health Information Systems
234
8.1 Introduction
234
8.2 Quality of Structures
235
8.2.1 Quality of Data
235
8.2.2 Quality of Computer-Based Application Components and Their Integration
236
8.2.3 Quality of Physical Data Processing Systems
238
8.2.4 Quality of the Overall HIS Architecture
239
8.2.5 Exercises
239
8.2.5.1 Quality Criteria in 3LGM² Models
239
8.2.5.2 Quality of Computer-Based Application Components
240
8.2.5.3 Usability of Software Products
240
8.2.5.4 Quality of HIS Architectures
240
8.2.6 Summary
240
8.3 Quality of Processes
241
8.3.1 Single Recording, Multiple Usability of Data
241
8.3.2 No Transcription of Data
241
8.3.3 Leanness of Information Processing Tools
241
8.3.4 Efficiency of Information Logistics
243
8.3.5 Patient-Centered Information Processing
243
8.3.6 Exercises
244
8.3.6.1 Quality of Processes in an Intensive Care Unit
244
8.3.6.2 Transcription of Data
244
8.3.6.3 Leanness of Information Processing Tools
244
8.3.6.4 Quality of Processes
244
8.3.7 Summary
245
8.4 Quality of Outcome
245
8.4.1 Fulfillment of Hospital’s Goals
246
8.4.2 Fulfillment of the Expectations of Different Stakeholders
246
8.4.2.1 Patients and Relatives
247
8.4.2.2 Health Care Professionals
247
8.4.2.3 Administrative Staff
247
8.4.2.4 Hospital Management
248
8.4.3 Fulfillment of Information Management Laws
248
8.4.4 Exercises
249
8.4.4.1 Expectation of Patients and Relatives
249
8.4.4.2 National Laws for Information Processing
249
8.4.5 Summary
249
8.5 Balance as a Challenge for Information Management
249
8.5.1 Balance of Homogeneity and Heterogeneity
250
8.5.2 Balance of Computer-Based and Non-Computer-Based Tools
250
8.5.3 Balance of Data Security and Working Processes
251
8.5.4 Balance of Functional Leanness and Functional Redundancy
252
8.5.5 Balance of Documentation Quality and Documentation Efforts
252
8.5.6 Exercises
253
8.5.6.1 Best-of-Breed Versus All-in-One
253
8.5.7 Summary
253
8.6 Evaluation of Health Information Systems Quality
254
8.6.1 Typical Evaluation Phases
254
8.6.1.1 Study Exploration
255
8.6.1.2 First Study Design
256
8.6.1.3 Operationalization of Methods and Detailed Study Plan
256
8.6.1.4 Execution of Study
257
8.6.1.5 Report and Publication of Study
257
8.6.2 Typical Evaluation Methods
257
8.6.2.1 Quantitative Evaluation Methods
257
Time Measurements
257
Event Counting
258
Quantitative Questionnaires
258
8.6.2.2 Qualitative Evaluation Methods
258
Qualitative Interviews
259
Qualitative Observations
259
Qualitative Content Analysis
259
8.6.2.3 Special Evaluation Studies
259
8.6.3 Exercises
260
8.6.3.1 Selection of Evaluation Criteria
260
8.6.3.2 Planning of an Evaluation Study
260
8.6.3.3 The Baby CareLink Study
261
8.6.4 Summary
261
8.7 Summarizing Examples
261
8.7.1 The Baldrige Health Care Information Management Criteria
261
8.7.2 Information Management Standards of the Joint Commission
262
8.7.3 The Baby CareLink Study18
263
8.7.4 In-Depth Approach: The Functional Redundancy Rate
263
8.8 Summarizing Exercises
268
8.8.1 Evaluation Criteria
268
8.8.2 Joint Commission Information Management Standards
268
8.9 Summary
268
9: Strategic Information Management in Hospitals
270
9.1 Introduction
270
9.2 Strategic, Tactical and Operational Information Management
271
9.2.1Information Management
271
9.2.2Information Management in Hospitals
274
9.2.3Strategic Information Management
275
9.2.4Tactical Information Management
276
9.2.5Operational Information Management
277
9.2.6Relationship Between IT Service Management and Information Management
279
9.2.7Example
281
9.2.7.1Typical Projects of Tactical Information Management
281
9.2.8Exercises
281
9.2.8.1Influences on HIS Operation
281
9.2.8.2Typical Projects of Tactical Information Management
281
9.2.8.3Diagnostics and Therapy of HIS
281
9.2.9Summary
282
9.3 Organizational Structures of Information Management
282
9.3.1Chief Information Officer
282
9.3.2Information Management Department
284
9.3.3Example
284
9.3.3.1Organizational Structures for Information Management
284
9.3.4Exercises
285
9.3.4.1Information Systems Managers as Architects
285
9.3.4.2Organizational Structures for Information Management in a Hospital
286
9.3.4.3Centralization of Organizational Structures
286
9.3.4.4Organizational Structures for Information Management at PMC
286
9.3.5Summary
286
9.4 Strategic Planning
287
9.4.1Tasks
287
9.4.1.1Aligning Business Plans and Information Management Plans
287
9.4.1.2Long-Term HIS Planning
288
9.4.1.3Short-Term HIS Planning
288
9.4.2Methods
289
9.4.2.1Strategic Alignment
289
9.4.2.2Portfolio Management
289
9.4.3The Strategic Information Management Plan
290
9.4.3.1Purpose of Strategic Information Management Plans
290
9.4.3.2Structure of Strategic Information Management Plans
292
Strategic Goals of the Hospital and of Information Management
292
Description of the Current State of the Hospital Information System
293
Analysis and Assessment of the Current State of the Hospital Information System
293
Description of the Planned State of the Hospital Information System
293
Migration Path from the Current to the Planned State
293
9.4.4Example
294
9.4.4.1Structure of a Strategic Information Management Plan
294
9.4.5Exercises
294
9.4.5.1Life Cycle of a Strategic Information Management Plan
294
9.4.5.2Deviation from a Strategic Information Management Plan
294
9.4.5.3Strategic Information Management and Strategic Hospital Management
294
9.4.5.4Establishing a Strategic Information Management Plan
296
9.4.6Summary
296
9.5 Strategic Monitoring
296
Root
296
9.5.1Tasks
297
9.5.1.1Permanent Monitoring Activities
297
9.5.1.2Ad Hoc Monitoring Activities
298
9.5.1.3Certification of HIS
299
9.5.2Methods
300
9.5.2.1HIS Benchmarking
300
9.5.2.2HIS Certification
300
9.5.3Examples
301
9.5.3.1A HIS Benchmarking Report
301
9.5.3.2COBIT
301
Plan and Organize
303
Acquire and Implement
303
Deliver and Support
303
Monitor and Evaluate
303
9.5.3.3CCHIT Functional Quality Criteria
304
9.5.4Exercises
305
9.5.4.1An Information Processing Monitoring Report
305
9.5.4.2COBIT
305
9.5.4.3Most Relevant Key Performance Indicators
305
9.5.4.4Organizing User Feedback
305
9.5.5Summary
305
9.6 Strategic Directing
306
Sec75_9
306
9.6.1Tasks
306
9.6.2Methods
306
9.6.3Example
307
9.6.3.1Project Management Boards at PMC
307
9.6.4Exercise
307
9.6.4.1A Project Management Board at PMC
307
9.6.5Summary
307
9.7Last But Not Least: Education!
308
9.8 Summarizing Examples
308
9.8.1Deficiencies in Information Management
308
9.8.2Computer Network Failures14
309
9.8.3Information Management Responsibilities15
310
9.8.4Safely Implementing Health Information and Converging Technologies
311
9.8.5Increased Mortality After Implementation of a Computerized Physician Order Entry System17
312
9.9 Summarizing Exercises
312
9.9.1Management of Other Information Systems
312
9.9.2Beginning and End of Information Management
312
9.9.3Cultivating Hospital Information Systems
313
9.9.4Hospital Information System Failure
313
9.9.5Increased Mortality
313
9.9.6Relevance of Examples
313
9.9.7Problems of Operational Information Management
313
9.10 Summary
314
10: Strategic Information Management in Health Care Networks
316
10.1 Introduction
316
10.2 Description of Health Care Networks
317
10.3 Organizational Structures of Information Management in Health Care Networks
317
10.3.1Centrality of Information Management in Health Care Networks
317
10.3.2Intensity of Information Management in Health Care Networks
319
10.4 Types of Health Care Networks
319
10.5 Example
320
10.5.1Regional Health Information Organizations
320
10.6Exercise
321
10.6.1The Plötzberg Health Care Network
321
10.7 Summary
321
11: Final Remarks
323
Thesaurus
325
Recommended Further Readings
358
Index
361
Alle Preise verstehen sich inklusive der gesetzlichen MwSt.