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At least 19 recordsLinked to original sources

From hospital information systems to health information systems. Problems, challenges, perspectives.

OBJECTIVES: Hospital information systems are evolving towards health information systems. This article aims at identifying both proven benefits and critical issues, and at discussing problems and possible solutions. METHODS: Reports on HIS successes and failures were analyzed, and core challenges were identified. These challenges are discussed against state of the art solutions. RESULTS: In spite of demonstrated benefits, there are more severe problems than reports on successes suggest. Among today's core problems are integration, human-computer interaction, socio-technical issues, and support of processes. CONCLUSIONS: Significant efforts of all parties involved in the health care process are needed to improve, implement, and evaluate the concepts described.

Cost-Benefit Analysis↗

A vision for child health information systems: developing child health information systems to meet medical care and public health needs.

In both the medical care and public health arenas, a variety of information systems have been developed to serve providers and program managers. In general, these systems have not been designed to share information with other information systems and provide comprehensive information about a child's health status to the information user. A number of initiatives are underway to develop integrated information systems. In December 2003, All Kids Count hosted an invitational conference "Developing Child Health Information Systems to Meet Medical Care and Public Health Needs." Through a series of plenary presentations and breakout discussion groups, participants developed a series of recommendations about governance, economic issues, information infrastructure, and uses of information from integrated child health information systems (CHIS). Common threads in the recommendations were: (1) development of a national coalition of stakeholders to promote integration of separate child health information systems within the context of ongoing national initiatives such as the National Health Information Infrastructure and the Public Health Information Network, (2) the need to develop the business and policy cases for integrated CHIS, (3) the need to develop agreement on standards for collecting and transferring information, and (4) the need to get the word out about the importance of integrating separate CHIS to improve health and health services.

Child↗

Security for decentralized health information systems.

Health care information systems must reflect at least two basic characteristics of the health care community: the increasing mobility of patients and the personal liability of everyone giving medical treatment. Open distributed information systems bear the potential to reflect these requirements. But the market for open information systems and operating systems hardly provides secure products today. This 'missing link' is approached by the prototype SECURE Talk that provides secure transmission and archiving of files on top of an existing operating system. Its services may be utilized by existing medical applications. SECURE Talk demonstrates secure communication utilizing only standard hardware. Its message is that cryptography (and in particular asymmetric cryptography) is practical for many medical applications even if implemented in software. All mechanisms are software implemented in order to be executable on standard-hardware. One can investigate more or less decentralized forms of public key management and the performance of many different cryptographic mechanisms. That of, e.g. hybrid encryption and decryption (RSA+DES-PCBC) is about 300 kbit/s. That of signing and verifying is approximately the same using RSA with a DES hash function. The internal speed, without disk accesses etc., is about 1.1 Mbit/s. (Apple Quadra 950 (MC 68040, 33 MHz, RAM: 20 MB, 80 ns. Length of RSA modulus is 512 bit).

Computer Communication Networks↗

The Copernican era of healthcare terminology: a re-centering of health information systems.

Health terminology and classifications have been an unseen backwater in healthcare practice and information systems development. Today however, the recognized need for comparable patient data is driving a new discovery about its strategic importance. Consistent patient descriptions and concept-centered data representations are crucial for efficient discovery of optimal treatments, best outcomes, and efficient practice patterns. The fabled linkage of knowledge sources at the time and place of care requires the conceptual intermediary of common terminology. A brief history overviewing the evolution of health classifications will provide the foundation for considering present and evolving health terminology developments. Their roles in health information systems will be characterized. Discussion will focus on the likely influences of the HIPAA legislation nationally and the new ISO Healthcare Informatics Technical Committee internationally, on terminology adaptation and incorporation.

Disease↗

Integrating the lightweight authentication protocol (LAP) with access control mechanisms in wireless health care information systems.

Health information networks are expected to support information exchange that is authentic, accurate, private and available when, where and to whom is needed. With the increase of the shared medical information and resources in healthcare wireless information systems, unauthorized access to the information by illegal users also increases. The security of the transmitted information is a vital issue. In this paper, we report on the development of the Lightweight Authentication Protocol (LAP), which makes a mobile and distributed system more secure and flexible and we implement it in a Health Care Environment where the clinicians use mobile and wireless devices like PDAs. We also provide an indicative example of integrating the LAP with access control mechanisms. Context-based Team Access Control (C-TMAC) model is used in this example, since it provides great flexibility on user-permissions management in collaborative healthcare environments. LAP is indeed capable to support efficiently the advanced authorization procedures of such demanding active security models.

Computer Security↗

Components of occupational health information systems.

Occupational health information systems continue to evolve and mature. Consistent throughout this evolution is the linkage of four data bases: job history, work site exposure, environmental agents, and health and safety. A review of the literature cites common elements within these data bases and characteristics of successful systems. Among the factors of successful systems is the role of key staff members. The medical record practitioner can be a significant contributor in the design of such systems. The profession should explore further the opportunities that exist in the occupational health setting.

Environmental Pollutants↗

To decay is system: the challenges of keeping a health information system alive.

Health information system (HIS) architecture and socio-technical approaches for system deployment have been topics of systematic research for decades. Sustainable operation in gradually changing environments, however, has not yet received sufficient attention. Even HIS that have gone life to the satisfaction of their developers and end-users may degrade gracefully or fail catastrophically if not continuously and thoroughly kept in sync with their environment. Critical environmental changes may owe their origins to the complexity of health care and its delivery. Seemingly minor environmental changes can result in significant failures on the part of the information system and may adversely affect the quality of health care delivered. Such minor degradation or near failure may go unnoticed for a while and then hit unexpectedly. Five origins of decay will be analyzed. Methods of systematic observation and containment of such decaying processes will tentatively be presented. Some origins of system decay exist in the immediate hospital or regional setting of usage. Indicators to identify processes of decay will be suggested and methods to preemptively reduce the risk of decay will be presented. Other origins span national health care systems or beyond. Not all such risks can hence be controlled locally. Software Oversight Committees may be an instrument to monitor those risks that cannot be controlled through routine local management.

Computer Systems↗

Concepts and solutions for future-proof health information systems and health networks.

Based on shared care information systems' requirements for high level interoperability, a generic component architecture has been derived. For implementing, running and maintaining acceptable and useable health information systems components, all views of the ISO Reference Model--Open Distributed Processing have to be considered. Following the Model Driven Architecture (MDA) paradigm, a reference model as well as concept-representing domain models both independent of platforms must be specified, which are combined and harmonised as well as automatically transferred into the platform-specific models using appropriate tools.

Computer Security↗

Integrating child health information systems.

The Health Resources and Services Administration and All Kids Count (a national technical assistance center fostering development of integrated child health information systems) have been working together to foster development of integrated child health information systems. Activities have included: identification of key elements for successful integration of systems; development of principles and core functions for the systems; a survey of state and local integration efforts; and a conference to develop a common vision for child health information systems to meet medical care and public health needs. We provide 1 state (Utah) as an example that is well on the way to development of integrated child health information systems.

Child↗

All Kids Count Connections: a community of practice on integrating child health information systems.

Integrated child health information systems consolidate data about multiple health care services a child receives into information useful to families, private health care providers, public health officials, and others. The challenges to successful integration faced by public health agencies are similar, yet system integration projects have historically struggled in isolation to overcome these barriers. All Kids Count created a community of practice called Connections to bring together 11 state and local public health agencies engaged in child health information system integration projects to learn from each other, capture best practices, and collaboratively address challenges. As demonstrated by All Kids Count Connections, communities of practice can be employed by geographically distributed public health agencies to address complex issues.

Child↗

3LGM(2)-Modelling to Support Management of Health Information Systems.

Both regional health information systems and hospital information systems need systematic information management. Due to their complexity information management needs a thorough description or model of the managed HIS. The three layer graph based meta model (3LGM(2)) and the 3LGM(2) tool provide means for effectively modeling HIS. The 3LGM(2) tool has been used to build a model of the health information system of the German federal state Saxony. The model is not only used to support the further development of the Saxonian health information system but also for supporting strategic information management planning in the medical center of Leipzig University. Acceptance of the method depends strictly on its integration in management structures on the institutional, regional, national or even European level.

Disease Management↗

Oral health information systems--towards measuring progress in oral health promotion and disease prevention.

This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable, chronic disease, and data stored in the WHO Global InfoBase may allow advanced health systems research. Sound knowledge about progress made in prevention of oral and chronic disease and in health promotion may assist countries to implement effective public health programmes to the benefit of the poor and disadvantaged population groups worldwide.

Adolescent↗

Understanding referral from primary care clinics in rural Kenya: using health information systems to prioritize health services.

This study analyses the referral patterns of patients, over time, from primary care to secondary or tertiary level facilities in rural Africa. The data come from a health information system of a non-governmental organization with a decade of experience in health services delivery in Samburu District, Kenya. The differential referral patterns from two communities are examined in some detail to shed more light on the meaning of a 'referral rate' in this context. First, referral rates over time for two clinics are calculated and compared. These quantitative data, obtained from monthly reports from 1989 to 1997, are interpreted in the light of qualitative data obtained from interviews with community health workers, nurses and members of the communities. The main differences in referral between these ostensibly similar communities are for malaria, trauma and anaemia. Social, environmental and specific health services factors are used to explain these differences. We demonstrate that basic information from health information systems, which tell us little on their own because referral in this context is a rare event, can be combined with local knowledge from the community to provide evidence for health managers to set priorities for public health and clinical interventions.

Health Care Rationing↗