Birgit Brigl

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’.

Assessing the integration of information system components

This paper presents formal approaches for assessing the integration of information system components. They were developed to support decisions in the strategic management of information systems. The fulfillment of integration requirements, the dependency of information system components on each other, and the heterogeneity of the integration infrastructure are the major assessment criteria.The meta-model 3LGM2A is the (semi-)formal base for methods introduced here. The fulfillment of integration requirements is checked by matching sets of application components that have specific requirements (requirements domains) with sets of application components that exchange data or call operations related to the requirements (communication domains). Requirements categories support the handling of the numerous specific requirements.For assessing the complexity of an information system or its subsystems the figures degree of informational dependence, degree of functional dependence, and degree of heterogeneity are defined.

The LBI-method for automated indexing of diagnoses by using SNOMED. Part 2. Evaluation

We present a simple, formal, lexicon-based method for automated indexing of diagnoses based on the Systematized Nomenclature of Medicine (SNOMED), called LBI-method. Part 1 gave an introduction to the LBI-method and presented its realisation as application system SALBIDH. Part 2 presents the design and the results of an evaluation study to judge the quality of the LBI-method. In this evaluation study the quality of automated indexing as well as the quality of the retrieval of patient data by using automated indexed diagnoses was examined. The results show that the retrieval based on SNOMED indices is at least as good as the retrieval based on ICD classes despite a lot of indexing errors. From this we gather that our system is not yet good enough for immediate routine use but that an appropriate indexing quality and, as a result, a higher retrieval quality can be achieved after few improvements of the LBI-method, especially after revision of the lexicons.

The LBI-method for automated indexing of diagnoses by using SNOMED. Part 1. Design and realization

We present a simple, formal, lexicon-based method for automated indexing of diagnoses based on the Systematized Nomenclature of Medicine (SNOMED II), called the LBI-method. Part 1 gives an introduction to the LBI-method and presents its realization as application system SALBIDH. The underlying model states that a diagnosis is represented by a set of indices of any nomenclature. The LBI-method is defined as a composition of functions, which in turn define the 3 steps of the LBI-method: preprocessing, morphological analysis, and semantic analysis. Part 2 will focus on the design and the results of an evaluation study to judge the quality of the LBI-method. In this evaluation study the quality of automated indexing was examined as well as the quality of the retrieval of patient data by using automated indexed diagnoses.

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.

Health Institutions and Information Processing

Health information systems strongly influence quality and efficiency of health care, and technical progress offers advanced opportunities to support health care. In this chapter, we will discuss the interrelation between health information systems on one side and health care on the other side.

Modeling Health Information Systems

Modeling HIS is an important precondition for their management: What we cannot describe, we usually cannot manage adequately. After defining the concepts necessary for dealing with this chapter, we will present some types of information system models describing different aspects of HIS. We will then focus on the so-called “three-layer graph-based metamodel” (3LGM²), which has been developed for describing, evaluating and planning health information systems. 3LGM² models and their application for information management will play an important role throughout this book. Finally, we introduce reference models and a specific reference model that facilitates modeling information systems in hospitals.

Information System Basics

Every domain usually has its own terminology, which often differs from the ordinary understanding of concepts and terms. This chapter presents the terminology for information systems and their management, as used in this book. It is, therefore, essential to read this chapter carefully. All relevant concepts can also be found in the Thesaurus at the end of the book.

Specific Aspects for Architectures of Transinstitutional Health Information Systems

Although this book focuses on hospital information systems, it is important to understand that institutional information systems, in general, and hospital information systems, in particular, are parts of larger, cross-linked systems.

Architecture of Hospital Information Systems

After having introduced health information systems in general we will at first turn our attention to hospital information systems (HIS). According to our previous definition of health information systems a HIS is the socio-technical subsystem of a hospital which comprises all information processing as well as the associated human or technical actors in their respective information processing roles. We now take a closer look at what HIS look like. We will do that rather synthetically. This means that we will first look at all the detailed components a HIS consists of and afterwards we will explain step by step how these components can be synthesized, that is, assembled in order to achieve what users nowadays experience as the HIS.