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PubMed2006

Success and failure factors in the regional health information system design process--results from a constructive evaluation study.

OBJECTIVES: To identify success and failure factors in the design process of a regional health information system. METHODS: A constructive evaluation study including interviews, observations, usability study and document analysis. RESULTS: Modelling was found to be a key element for the successful implementation of a health information system. The developed service chain model helped to define use cases and to implement seamless service chains. User participation in the design process was a success factor resulting in good user acceptance and signs of positive impacts on work practices. Evaluation study also helped system developers to guide the system's further development. An important failure factor identified was the lack of semantic interoperability of the system components. CONCLUSIONS: The results emphasize the socio-technical nature of health information systems. The starting point for development should be thorough insight into the health care work practices where the information systems are to be used. Successful system design should start from modelling of work processes, data and information flows and definition of concepts and their relations. Health informatics as a scientific discipline provides theories and models for the design and development process.

Attitude to Computers↗
PubMed2002

Towards the creation of a health information system for cancer in KwaZulu-Natal, South Africa.

The paper aims to evaluate the potential of Geographical Information Systems (GIS) in the creation of a health information system (HIS) for cancer. A case study describes the spatial distribution of reported cancer in KwaZulu-Natal, South Africa and correlates this with levels of development. The study illustrates the problems of data shortage in a developing country. The mapping of reported cancer reveals a concentration of cancer in the developed metropolitan districts, where the hospitals are located. The study therefore provides a 'geography of accessibility to treatment centres' due to the under-reporting of the disease. Despite incomplete data and under-reporting of the disease, the study illustrates the potential of GIS to add value to a HIS for cancer.

Demography↗
PubMed2005

[Some common errors in health information system report (DR Congo)].

The development of operational health information systems in sub-Saharan African countries still poses some difficult challenges. In fact, the analysis of the 1996 annual report from the "Health for All Project" in Kinshasa contains a certain number of ambiguities. They are situated at the levels of indicators for coverage which exceed 100% and of incidence rates equal to 0%, whereas they're were certain cases of poor choices for the denominator. This article discusses the ensuing difficulties of interpretation and suggests presenting the coverage of the programme for the target population separately from that of the population outside the health zone, as well as proposing to give the constant K the value of 1000 or 10000 if needed in order to attain the true incidence rate, which otherwise would remain equal to zero. The correct denominator is proposed where it is indicated.

Data Collection↗
PubMed2005

A systems engineering perspective on the human-centered design of health information systems.

The discipline of systems engineering, over the past five decades, has used a structured systematic approach to managing the "cradle to grave" development of products and processes. While elements of this approach are typically used to guide the development of information systems that instantiate a significant user interface, it appears to be rare for the entire process to be implemented. In fact, a number of authors have put forth development lifecycle models that are subsets of the classical systems engineering method, but fail to include steps such as incremental hazard analysis and post-deployment corrective and preventative actions. In that most health information systems have safety implications, we argue that the design and development of such systems would benefit by implementing this systems engineering approach in full. Particularly with regard to bringing a human-centered perspective to the formulation of system requirements and the configuration of effective user interfaces, this classical systems engineering method provides an excellent framework for incorporating human factors (ergonomics) knowledge and integrating ergonomists in the interdisciplinary development of health information systems.

Artificial Intelligence↗
PubMed1998

Information management in national tuberculosis control programmes and national health information systems.

A good notification system is one of the key elements for the success of national tuberculosis programmes (NTPs). The national health information system (NHIS) in low income countries is often weak and unreliable. When restructuring this system, what circuit should be used to integrate TB data: the NTP or the NHIS? Experience from several countries shows that unlike the NHIS, only the data generated by the NTP are reliable and complete, and arrive rapidly enough to be used for programme management. It is therefore the duty of the NTP to collect this information and transmit it to the NHIS at each level of the health system. These were the conclusions of a seminar held in Cotonou, Benin, organised by the International Union Against Tuberculosis and Lung Disease, which involved the leaders of the NHIS and of NTPs of six West African countries.

Africa↗
PubMed2005

[National public health information system].

Information production and its communication being a key public health activity, developing modern information systems is a precondition for its fulfilling these assignments. A national public health information system (NPHIS) is a set of human resources combined with computing and communication technologies. It enables data linkage and data coverage as well as undertaking information production and dissemination in an effective, standardized and safe way. The Croatian Institute of Public Health LAN/WAN modules are under development. Health Safety System, Health Workers Registry, and Digital Library are among the Institute's developmental priorities. Communication between NPHIS participants would unfold over the Internet by using every relevant data protection method. Web technology-based applications would be run on special servers. Between individual applications, use would be made of the transaction module of communication through an exchange of the HL7 standard-based xml messages. In the conditions of transition, the health system must make an optimal use of the resources, which is not feasible without applying modern information and communication technologies.

Croatia↗
PubMed2005

Health information systems evaluation: a focus on clinical decision supports system.

In a review of selected literature on Health Information Systems (HIS) evaluation, a specific focus on Clinical Decision Support Systems (CDSS) is taken because of their relative popularity. This paper discusses the issues and problems of CDSS evaluation such as methods, adoption and barriers. The limited use and evaluation of CDSS are still debated. Clinical evaluations of CDSS performed in the actual clinical settings may provide better understanding of their adoption, particularly in the diagnostic function. New HIS evaluation frameworks that incorporate technological, human and organisational issues may be useful to complement existing ones.

Decision Support Systems, Clinical↗
PubMed1993

CDC WONDER: a comprehensive on-line public health information system of the Centers for Disease Control and Prevention.

OBJECTIVES: CDC WONDER, a comprehensive on-line public health information system of the Centers for Disease Control and Prevention (CDC), was developed to place timely, action-oriented information in the hands of public health professionals. METHODS: A unified system was developed de novo to be used for and to evolve along with public health. All data are stored and updated on the CDC mainframe. RESULTS: CDC WONDER provides menu-driven access to 24 databases with information on mortality, hospital discharges, cancer incidence, notifiable diseases, acquired immunodeficiency syndrome, the Morbidity and Mortality Weekly Report, etc.; each database has on-line documentation. Results can be tabulated and graphed, and there is full-text searching of textual databases. Non-CDC staff have access via telephone connection. From August 1991 through June 1992, system databases were accessed 10,698 times, and there were 842 users (mean of 97 new users per month). CONCLUSIONS: CDC WONDER has shown that it is possible to build a large, on-line database of scientific data for public health professionals. CDC WONDER provides a common foundation from which to build information-based public health plans and policy and could help strengthen the public health system.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

Expanding the scope of health information systems. Challenges and developments.

OBJECTIVES: To identify current challenges and developments in health information systems. METHODS: Reports on HIS, eHealth and process support were analyzed, core problems and challenges were identified. RESULTS AND CONCLUSION: Health information systems are extending their scope towards regional networks and health IT infrastructures. Integration, interoperability and interaction design are still today's core problems. Additional problems arise through the integration of genetic information into the health care process. There are noticeable trends towards solutions for these problems.

Computational Biology↗
PubMed1999

Criteria for the evaluation of district health information systems.

A comprehensive set of evaluation criteria for District Health Information Systems (DHISs) in South Africa (SA) have been developed. The criteria are organised in the following eight categories: philosophy and objectives, policy and procedures, functionality, facilities and equipment, DHIS management and staffing, user/patient interaction, staff development and education, and evaluation and quality improvement. A handbook of evaluation criteria has been compiled by restating the evaluation criteria to include mechanisms for measuring whether or not criteria have been met.

Evaluation Studies as Topic↗
PubMed1995

From research to policy: what have we learned from designing the Population Health Information System?

This article discusses the lessons learned from the experience of designing and using a population health information system and the policy implications of information generated. A useful system must include measures of the population's health status and socioeconomic risk when analyzing health care use. The strong gradient that can be demonstrated in service use across income groups where these indicators are included challenges policymakers and health care managers to rethink fundamental beliefs about the role of medical care. Given the size of health care expenditures in western economies, the author argues for redirecting some of these resources toward other means of improving the health of populations. Outcomes research should be expanded to assess the efficacy of non-medical and medical interventions. A population-based health information system can help identify opportunities for shifting expenditures toward meliorating the determinants of health, while monitoring the health care system to ensure that adverse effects do not occur.

Canada↗
PubMed2006

Augmentation cystoplasty rates at children's hospitals in the United States: a pediatric health information system database study.

PURPOSE: We identified augmentation cystoplasty rates in children with spina bifida at children's hospitals enrolled in the Pediatric Health Information System database. MATERIALS AND METHODS: The Pediatric Health Information System database tabulates demographic and diagnostic patient data from 35 children's hospital centers in the United States. Between October 1999 and September 2004 we extracted data on 0 to 19-year-old patients with International Classification of Diseases-9 diagnosis codes for spina bifida. The International Classification of Diseases-9 procedure code for augmentation cystoplasty was cross-referenced with these patients to determine the total number of patients with augmentation, total population augmentation rates and individual institution rates of bladder augmentation. RESULTS: Staff at enrolled pediatric medical centers submitted inpatient data accounting for 9,059 beds servicing an aggregate metropolitan population of 82 million individuals. In the 5-year period 12,925 unique spina bifida patient encounters were identified, including 665 patients who underwent augmentation cystoplasty. The mean 5-year institutional number of augmentations performed in children with spina bifida was 20 (range 1 to 121) and the mean annual number of augmentations performed per institution was 4. The overall augmentation rate at 33 hospitals contributing data for the full years 2000 to 2003 was 5.4% (range 0.5% to 16.3%, p <0.0001). The male-to-female ratio of those who underwent augmentation was 1:1.2. Median length of stay in children with augmentation was 7 days (mean 9). The median age of children with augmentation was 10.4 years, that is 11.3 years in boys and 9.8 years in girls. The difference in mean age was statistically significant (p <0.003). At institutions where 10 or more augmentations were performed in 5 years (mean 27) mean patient age at operation was 10.1 years. This was significantly younger than the mean patient age of 12.3 years at hospitals where fewer than 10 augmentations (mean 5) were done in 5 years (p <0.05). CONCLUSIONS: Clinical management for neurogenic bladder conditions has evolved to emphasize nonoperative management. Several studies suggest that aggressive early intervention improves bladder compliance and may protect renal function. However, results from the Pediatric Health Information System database demonstrate no change in augmentation rates during this time and they demonstrate significant interinstitutional variability. To our knowledge this represents the largest series of augmentation cystoplasty in children with spina bifida to date.

Adolescent↗
PubMedDate not supplied

Using a population-based health information system to study child health.

OBJECTIVE: This paper describes the population-based analyses of measures of child health status used throughout this supplement. METHODS: The articles in this supplement examine health-related data for children 0 to 19 years. Most analyses cover the period from April 1, 1994 to March 31, 1999. Administrative and survey data were used to assess child health and well-being. For regional comparisons, data were broken down by subregions of Manitoba, called Regional Health Authorities (RHAs), and neighbourhoods of Winnipeg, called Winnipeg Community Areas (Winnipeg CAs). The premature mortality rate (PMR) was used as a proxy of the overall health of the population. All graphs comparing rates among RHAs and Winnipeg CAs rank these subregions in the same order, from lowest to highest PMR. Income was operationalized by dividing the province's population into urban and rural quintiles based upon household income. Other aspects of methodology are discussed. RESULTS: Results are presented in the articles that follow this one. CONCLUSION: The relationships between key child health indicators and geographic and socioeconomic factors for Manitoba children are discussed in the articles following this one.

Adolescent↗
PubMed2003

Specification levels and collaborative definition for the integration of health information systems.

In this paper, we extend our previous work for defining interoperability for health information systems into proposed documentation levels for specifying integration, and a model for defining various interoperability aspects in collaboration between integrators, health service providers and system providers. We are using these models in defining solutions for a set of different integration needs in PlugIT project in Finland. We propose collaborative definition and clear levels of integration specifications to promote adequacy, consistency and efficiency of integration solutions and software component specifications in health information systems.

Delivery of Health Care↗
PubMed1994

National health information systems in the Pacific islands: in search of a future.

Health information is essential for proper management and deployment of limited resources in the health services of the Pacific Islands. There have been numerous efforts to establish and strengthen sustainable information systems but the common feature of these attempts has been the very limited achievement. Subsequently, the use of information as a management tool has been abandoned in favour of 'gut feeling', hearsay and adhocry. In the last decade health planning and primary health care activities have necessitated the re-emphasis of monitoring and surveillance of health and health service indicators. Therefore a revival of interest in health information systems is taking place. A review of national health information systems in the Pacific showed that routinely collected data remained largely untouched by human thought. The contributing factors to the current inertia are examined with suggestions on how to elevate health information from its current lowly status to its rightful place as an essential tool for management. The special problems of small island states, like limited resources, geographical isolation, natural barriers to technology, and diverse cultural milieu, will be examined in relation to an appropriate health information system for Pacific Island countries in the twenty-first century.

Information Systems↗
PubMed2005

Health information systems: failure, success and improvisation.

BACKGROUND AND PURPOSE: The generalised assumption of health information systems (HIS) success is questioned by a few commentators in the medical informatics field. They point to widespread HIS failure. The purpose of this paper was therefore to develop a better conceptual foundation for, and practical guidance on, health information systems failure (and success). METHODS: Literature and case analysis plus pilot testing of developed model. RESULTS: Defining HIS failure and success is complex, and the current evidence base on HIS success and failure rates was found to be weak. Nonetheless, the best current estimate is that HIS failure is an important problem. The paper therefore derives and explains the "design-reality gap" conceptual model. This is shown to be robust in explaining multiple cases of HIS success and failure, yet provides a contingency that encompasses the differences which exist in different HIS contexts. The design-reality gap model is piloted to demonstrate its value as a tool for risk assessment and mitigation on HIS projects. It also throws into question traditional, structured development methodologies, highlighting the importance of emergent change and improvisation in HIS. CONCLUSIONS: The design-reality gap model can be used to address the problem of HIS failure, both as a post hoc evaluative tool and as a pre hoc risk assessment and mitigation tool. It also validates a set of methods, techniques, roles and competencies needed to support the dynamic improvisations that are found to underpin cases of HIS success.

Information Systems↗