Alfred Winter

Strategic information management plans: the basis for systematic information management in hospitals

Information management in hospitals is a complex task. In order to reduce complexity, we distinguish strategic, tactical, and operational information management. This is essential, because each of these information management levels views hospital information systems from different perspectives, and therefore uses other methods and tools. Since all these management activities deal only in part with computers, but mainly with human beings and their social behavior, we define a hospital information system as a sociotechnical subsystem of a hospital. Without proper strategic planning it would be a matter of chance, if a hospital information system would fulfil the information strategies goals. In order to support strategic planning and to reduce efforts for creating strategic plans, we propose a practicable structure.

Strategic Information Management in Hospitals

Until now we have discussed how health information systems look like and how their quality can be described and measured. We will now examine how high quality health information systems can be achieved and how high quality can be maintained, especially in hospitals. High quality HIS can only by achieved and HIS failures can only be prevented if the HIS are systematically planned, monitored and directed. We summarize this triad by the term ‘information management’.

Kopplungsstrategien für Anwendungssysteme im Krankenhaus

The realization of specific coupling strategies and integration techniques is discussed exem-plarily for a university hospital, the Universitätsklinikum Leipzig (UKL) in Germany. The integration of the central patient management system serving the administrative department with the clinical workplace systems serving hospital wards is presented. We analyse the integration with respect to the underlying theoretical conceptions and discuss information management issues for deployment and maintenance of the overall IT infrastructure. This paper presents the pros and cons of synchronous and asynchronous patient data replication, the practical experience with the deployment of a communication server, and the experience with using an RFC interface, a proprietary interface to the enterprise resource planning system SAP R/3. Both, organizational and technical issues are addressed in this context.

Assessing the Prognoses on Health Care in the Information Society 2013 - Thirteen Years After

Health care and information technology in health care is advancing at tremendous speed. We analysed whether the prognoses by Haux et al. - first presented in 2000 and published in 2002 [1] - have been fulfilled in 2013 and which might be the reasons for match or mismatch. Twenty international experts in biomedical and health informatics met in May 2013 in a workshop to discuss match or mismatch of each of the 71 prognoses. After this meeting a web-based survey among workshop participants took place. Thirty-three prognoses were assessed matching; they reflect e.g. that there is good progress in storing patient data electronically in health care institutions. Twenty-three prognoses were assessed mismatching; they reflect e.g. that telemedicine and home monitoring as well as electronic exchange of patient data between institutions is not established as widespread as expected. Fifteen prognoses were assessed neither matching nor mismatching. ICT tools have considerably influenced health care in the last decade, but in many cases not as far as it was expected by Haux et al. in 2002. In most cases this is not a matter of the availability of technical solutions but of organizational and ethical issues. We need innovative and modern information system architectures which support multiple use of data for patient care as well as for research and reporting and which are able to integrate data from home monitoring into a patient centered health record. Since innovative technology is available the efficient and wide-spread use in health care has to be enabled by systematic information management.

Manifest – Kundeninduzierte Orchestrierung komplexer Dienstleistungen

ZusammenfassungIn unseren Volkswirtschaften gewinnt der Dienstleistungssektor eine immer größere Bedeutung. Parallel dazu verstärkt die nahezu ubiquitäre Verfügbarkeit von Informationen den Selbstbestimmungswunsch der Bürger. Als Kunden z. B. im Bereich der Ausbildung, der Finanzwirtschaft und der Mobilität sowie als Patienten im Gesundheitswesen wollen sie Dienstleistungen, auch wenn sie komplexer Natur sind, eigenverantwortlich auswählen und zusammenstellen. Es ist an der Zeit, dass Informationstechnologie (IT) stärker zur Unterstützung solcher kundeninduzierten Orchestrierung komplexer Dienstleistungen genutzt wird. Dabei handelt es sich um eine weitreichende Entwicklung, da Menschen in unterschiedlichen Bedürfnisbereichen bzw. Lebenswelten Beziehungen zu zahlreichen Anbietern besitzen. Zur Realisierung eines solchen Paradigmenwechsels besteht ein Forschungsbedarf zum Einsatz der IT in Disziplinen, die noch zu oft getrennt agieren. Diese Aktivitäten müssen zusammengeführt und sowohl die Forschung als auch die Ausbildung transdisziplinär gestaltet werden. Dabei sind die Disziplinen Informatik, Medizinische Informatik und Wirtschaftsinformatik in besonderer Weise gefordert.

The Integrated Data Repository Toolkit (IDRT): accelerating translational research infrastructures

Description The Open Source software i2b2 [1] provides a translational research platform for storing biomedical data and querying these data with a user-friendly interface for researchers (Figure 1). Despite its powerful features, it is lacking user-friendly tools for installation and configuration, the import of source data and the creation of a comprehensive navigational structure (i2b2 ontology). To close these gaps, the Integrated Data Repository Toolkit (IDRT), consisting of three software tools, has been created. The i2b2 Wizard provides a shell GUI for the installation and configuration of i2b2 instances, projects and users. The i2b2 Import Tool offers a GUI for browsing i2b2 projects and importing data in various standard data formats into i2b2 (e.g., textual (CSV), relational (SQL) or structured data (CDISC ODM/XML)), as well as a dedicated extractor for biomaterial data. During import, i2b2 ontologies are automatically created from metadata included in the source data. The i2b2 Ontology Editor (IOE), being part of the i2b2 Import Tool, can be used for enhancing these i2b2 ontologies. Besides standard functions like rearranging, adding, deleting and renaming folders and items, the IOE is capable of augmenting i2b2 ontologies with more advanced i2b2 functions. By utilizing the two windows of the IOE (one showing the unaltered source i2b2 ontology and the other the manually created target i2b2 ontology), mappings can be achieved by simple drag-and-drop operations. For example, start and end dates can be added to items by dragging a date item onto a fact item. Medical terminologies can easily be imported with the IDRT (e. g. ICD-10, LOINC) and can also be mapped via the same drag-and-drop operations to data elements (expandable beyond the supplied terminologies via a regular expression editor in the IOE). The IDRT tools support the more advanced i2b2 functionalities for “fact nesting”, called “modifiers”. Since the i2b2 web browser query application (i2b2 Web Client) does not support simple access and visualization of modifiers, an IDRT plugin was created that is able to display, combine and export related facts. Additional documentation for enhanced i2b2 usage is provided on the IDRT website [2].

Quality of Health Information Systems

The International Organization for Standardization (ISO) defines quality in general as the ability to meet all the expectations of the purchaser of goods or services, or in other words, as the degree to which a set of inherent characteristics fulfills requirements, where “requirements” means need or expectation. Three major approaches to quality assessment are typically distinguished: Quality of structures, quality of processes, and quality of outcome. In the context of health care, the concept of quality of structures applies to the human, physical, and financial resources that are needed to provide medical care (e.g., educational level of staff, availability of medical equipment). Quality of processes describes the quality of activities carried out by care providers (e.g., adherence to professional standards, appropriateness of care). Finally, quality of outcome describes the effects of patient care, that is, the changes in the health status of the patient (e.g., mortality, morbidity, costs). While quality of structures influences quality of processes, quality of processes in turn influences quality of outcome.

Comparing a Japanese and a German Hospital Information System

OBJECTIVES To examine the architectural differences and similarities of a Japanese and German hospital information system (HIS) in a case study. This cross-cultural comparison, which focuses on structural quality characteristics, offers the chance to get new insights into different HIS architectures, which possibly cannot be obtained by inner-country comparisons. METHODS A reference model for the domain layer of hospital information systems containing the typical enterprise functions of a hospital provides the basis of comparison for the two different hospital information systems. 3LGM(2) models, which describe the two HISs and which are based on that reference model, are used to assess several structural quality criteria. Four of these criteria are introduced in detail. RESULTS The two examined HISs are different in terms of the four structural quality criteria examined. Whereas the centralized architecture of the hospital information system at Chiba University Hospital causes only few functional redundancies and leads to a low implementation of communication standards, the hospital information system at the University Hospital of Leipzig, having a decentralized architecture, exhibits more functional redundancies and a higher use of communication standards. CONCLUSIONS Using a model-based comparison, it was possible to detect remarkable differences between the observed hospital information systems of completely different cultural areas. However, the usability of 3LGM(2) models for comparisons has to be improved in order to apply key figures and to assess or benchmark the structural quality of health information systems architectures more thoroughly.

Towards More Integrated Implementation of Healthcare Information Systems: Using the 3LGM2 for Modeling the IHE-Scheduled Workflow Integration Profile

In todays healthcare enterprises, data from many sources are needed to make optimal healthcare decisions. Therefore, the integrating the healthcare enterprise (IHE) concept emerged to solve the interoperability problems by collaborative professional organizations representing both buyers and vendors. The goal of this work is to model and analyze the IHE-scheduled workflow integration profile in order to facilitate the adoption of the IHE concepts. This is achieved by creating the 3-layer model of this integration profile utilizing the 3LGM2 tool. The created model has been able to provide support for structured and comprehensive analysis of the scheduled workflow integration profile in all its aspects: processes, information, applications and organization.

The 3LGM2-Tool to Support Information Management in Health Care

In industrialized as well as in developing countries the driving force for healthcare has recently been the trend towards a better coordination of care. The focus has been changed from isolated procedures in a single healthcare institution (e.g. a hospital or a general practice) to the patient-oriented care process spreading over institutional boundaries. This should lead to a shift towards better integrated and shared care. Health care professionals in different departments of a hospital but moreover in a region - and in many cases even worldwide - have to cooperate in order to achieve health for the patient. [1] Cooperation needs an adequate system for communicating and processing of information, i.e., an information system, which is that socio-technical subsystem of a (S et of) health care institution(s), which presents information at the right time, in the right place to the right people [2, 3]. Hospital Information Systems (HIS) as well as regional Health Information Systems (rHIS) (consisting of different institutional information systems) are constructed like a (complex of) building(s) out of different and probably heterogeneous bricks and components. Thus cooperation depends especially on the availability of adequate communication links between the institutional information systems and their components. Besides technical problems of communication links there are a lot of complex problems of connecting heterogeneous software components of different vendors and with different database schemata to be solved. Especially the proper application of communication standards like HL7 and DICOM [4-6] needs proper planning and supervision as part of a systematic information management. Like an architect the information manager needs a blueprint or model for the information systems architecture respectively the enterprise architecture [7-9]. In [10] we proposed the 3LGM2 as a meta model for modeling Information Systems (IS). 3LGM2 has been designed to describe IS by concepts on three layers. The domain layer consists of enterprise functions and entity types, the logical tool layer focuses on application components and the physical tool layer describes physical data processing components. In contrast to other approaches a lot of inter-layer-relationships exist. 3LGM2 is defined using the Unified Modeling Language (UML). The meta model has been supplemented by the 3LGM2 tool [12]. Using 3LGM2 as the ontological basis this tool enables information managers to graphically design even complex IS. It assists information managers similarly to Computer Aided Design tools (CAD) supporting architects. The tool provides means for analyzing a HIS model and thus for assessing the HIS quality. The talk will focus on the 3LGM2 tool and its most important features. It will be shown, how a model can be created by graphical user interaction as well as by importing data from other sources. It will be illustrated how the tools analyzing features support information managers doing their job. Examples will be taken from 3LGM2 models of the information system of the Leipzig University Hospital and the regional health information system of Saxony, a federal state of Germany.