Developments in Healthcare Information Systems and Technologies: Models and Methods

Developments in Healthcare Information Systems and Technologies: Models and Methods

Joseph Tan (McMaster University, Canada)
Release Date: July, 2010|Copyright: © 2011 |Pages: 398
DOI: 10.4018/978-1-61692-002-9
ISBN13: 9781616920029|ISBN10: 1616920025|EISBN13: 9781616920036|ISBN13 Softcover: 9781616923716
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Description & Coverage

The need for continual development and transformation of healthcare information systems is evident, though progress in this arena is often met with a significant number of challenges.

Developments in Healthcare Information Systems and Technologies: Models and Methods presents the latest research in healthcare information systems design, development, and deployment, benefiting researchers, practitioners, and students. Contributions investigate topics such as clinical education, electronic medical records, clinical decision support systems, and IT adoption in healthcare.


The many academic areas covered in this publication include, but are not limited to:

  • Electronic Medical Records
  • Health IT futures
  • Health service management
  • Modeling of healthcare systems
  • Open source software and e-health
  • Patient online discussions
  • Patient-doctor profiling
  • Process thinking in healthcare
  • Public health programs
  • Ubiquitous healthcare systems
Table of Contents
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Editor Biographies
Joseph K. H. Tan, PhD, is the Wayne C. Fox Professor of E-Business Innovation & E-Health, McMaster University, Hamilton, Ontario, Canada. Previously, Dr. Tan had served as Professor and Head, Information System and Manufacturing (ISM) Department, Wayne State University, and as Acting Chair of the Masters in Health Administration (MHA) Program, Department of Healthcare & Epidemiology, Faculty of Medicine, the University of British Columbia. Currently, as the Editor-in-Chief, the International Journal of Healthcare Information Systems & Informatics (IJHISI), Professor Tan sits on various journal advisory and editorial boards as well as on numerous organizing committees for local, national, and international meetings and conferences. Professor Tan is well published and his research, which has enjoyed significant support in the last 21 years from local, national, and international funding agencies and other sources, has also been widely cited and applied across a number of major disciplines, including health care informatics and clinical decision support, health technology management research, human processing of graphical representations, ergonomics, health administration education, telehealth, mobile health, and e-health promotion programming. His hobbies include writing and editing books, book chapters, and journal articles; working on collaborative grant projects; engaging in philosophical discussions with colleagues and peers; and reading his son’s work.
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This section is an introduction to the full preface, which is included in the book.

For years, misguided health organizational information technology (IT) leadership, and the lack of available expertise and skills in the application of health IT (HIT) models and methods have somehow predisposed administrators of large-scale health maintenance organizations (HMOs) to become generally reluctant to migrate away from legacy health information systems (HISs).  For many health provider organizations, the more recent decline in economic activities over the last few years has also further led to new debates on allocating limited public and private resources so gravely needed to build and sustain large-scale interoperable systems infrastructure in order to achieve such a system migration efficiently and effectively.  Not surprisingly, progress towards adopting new health IT initiatives such as innovative e-technologies for the health care industry in the United States (US) has been slower than most other industries.  Inadvertently, a major gap in the strategic and opportunistic use of emerging health IT models and methods now exists to significantly transform the apparently fragmented nature of US health services delivery system.

Aside from the fear of costly systems failure, many key stakeholders in the US health care system have, admittedly, been resistant to invest in new and contemporary enterprisewide systems due to the lack of a well-focused national health IT vision and strategy.  On the one hand, attempts to successfully diffuse interoperable, integrative HIT applications throughout the US health care system must now depend on the strength of the health IT leadership shouldered by the current Administration.  On the other hand, progress in health IT implementation and diffusion will also depend on how quickly many of these health key stakeholder groups who have been technological laggards for one reason or another can be motivated, challenged, and appropriately enticed to design, develop, and deploy large-scale, complex and interoperable computer-based enterprisewide systems.  Such enterprisewide systems include, but are not limited to, those that are designed to incorporate integrative health data management models, new biomedical informatic methods, web-based semantic search capabilities, and emerging clinical decision support methodologies.  In the context of today’s complex and largely fragmented US health services systems, specific applications of enterprisewide, interoperable systems can range from patient-centric records and information services systems such as electronic medical records (EMRs), electronic health records (EHRs), personal health records (PHRs), payor-based health records (PBHRs) and computer-based physician order entry (CPOE) systems, to health administrative-aided transaction and health information exchange (HIE) systems such as e-prescribing systems (EPS), supply chain management (SCM), customer relationship management (CRM), enterprise resource planning (ERP), and e-payment systems.

Briefly, key reasons why the diffusion of interoperable, integrative HIT models and methods is needed in the US health care services sector entail:

(a) an urgency, as a whole,  to contain escalating health care cost - the growing health care cost has become an increasingly unsustainable burden on US taxpayers over the years;

(b) the growing complexities and uncertainties in the health information processing and exchange environment of large, medium, and even smaller health organizations populating the US health care system - the expansion of stakeholder groups and increased federal, state, and municipal regulatory oversight mechanisms surrounding health services delivery have and will continue to add to the already intricate health information management (HIM) and services delivery system; and

(c) the potential of interoperable, integrative HIT models and methods to aid complex data analysis and semi-structured decision making - such analysis will not only empower care providers, but also enable critical information sharing to occur among referring physicians in consultation with patients, and especially when specialists and a team of caregivers are involved in key administrative and clinical decision making.

With increasing attention paid to the critical role that HIT models and methods can and will play in reforming the US health care system, we are finally seeing a trend in increased projections on health IT spending, which is currently anticipated to exceed 15 billion dollars annually for the US (Lipowicz, 2009). According to the National Coalition on Health Care, in 2008 alone, the US has spent well over 17% of its Gross Domestic Product (GDP) on health care - a percentage that clearly exceeded those spent by many other OCED countries (National Coalition on Health Care, 2009). Sadly, the fact that the US has outspent almost every other country on health care has not translated into better health or even more convenient, accessible, available or affordable health care services delivery for Americans.  In fact, findings abstracted from 2007-2008 data in a study championed by the consumer health advocacy group Families USA has revealed that one out of every three Americans under 65 may still have to live, at one point in time or another, without health insurance coverage (Parisi and Bailey, 2009).

Clearly, many of the issues raised here have now taken central stage in the debate raised by the Obama Administration for championing health care reform in the US.  As well, various solutions have been considered, chief among them, using and adopting interoperable, integrative HIT applications.  Such a strategy is not without merit, as various forms of health technologies have indeed risen over the years to similar challenges; for instance, online claims processing and e-prescribing have been successfully deployed by various HIT vendors to serve as tools to combat rapidly escalating health administrative costs while simultaneously leveraged to reduce wastes, increase efficiencies, eliminate redundancies, and improve the overall quality of clinical care and services.

Raghupathi and Tan (2002, 2008) noted that various strategic applications of HIT models and methods can evidently improve the efficiency and effectiveness of US health care services delivery, adding value to existing, legacy-based HISs, and helping to integrate the islands of health services management systems.  Their arguments not only cited the power of e-technologies to streamline increasingly complex routine HIM processes that may require multi-provider, cross-organizational collaboration, but also the ability of interoperable, integrative HIT capabilities to augment enterprisewide efficiencies and care provider network connectivity.

Accordingly, the key underlying argument for migrating from legacy HISs is that both data and processes linked to diverse functioning information systems must now be shared on an increasingly real-time basis between both on-site and off-site caregivers if we want to improve the quality of patient care.  These interoperable, integrative systems can also streamline complex administrative and clinical workload, easing the communication needs among health care administrators, HIT personnel, health engineers, health informatic researchers, and HIT consultants, all of whom need to work closely together in today’s health services delivery systems if major systems bottlenecks are to be effectively managed over time.  Figure 1 depicts the Model and Evidence Driven Integrated Analysis (MEDIA) paradigm, an integrated model management framework that is applied in this review to provide an integrative conceptualization of the evolving, state-of-the-art developments in HIT models and methods.

Figure 1: The Model and Evidence Integrated Analysis (MEDIA) Paradigm

Against this background, existing HIT models and gathered evidence will not simply aggregate but will be seen as complementing each other alongside the MEDIA integration and analysis process.  Take the case of the influenza propagation - a disease model - and imagine how it can intermingle with a patient care process model, such as that of a primary clinic.  Given the separate evidence about the flu outbreak and patient arrival pattern, running both models in parallel within the MEDIA framework produces either a more realistic health care supply-demand scenario in the context of a real-world community health setting, and/or offers insights into other related and potential issues needed to be addressed when challenged with health hazard preparation such as when an apparent discrepancy is observed to be operative within the overall system.  All such information analysis and its integration can be further quantified and addressed consistently.  Such multi-attribute analytic capability is crucial to the success of any future applications and developments of HIT models and methodologies.

The rest of this review on health IT models and methods is organized as follows.  In Section 2, a high-level systems perspective of HIS information and process flow in the context of applying HIT models and methods is outlined.  Fundamentally, the classical information system input-process-output triad that underlies all systems engineering conceptualization is revisited.  In Section 3, the focus will shift to the complexity-uncertainty challenge encountered in the current US health care sector.  Following this, in Section 4, the emerging engineering approaches in health services applications at two levels are highlighted.  These levels include: (1) the general health engineering level; and (2) the more focused health services modeling level.  In Section 5, the MEDIA paradigm, including its three key facets are briefly overviewed: (a) domain ontology modeling and management that lays the foundation for model representation and infrastructural connectivity; (b) hybrid probabilistic modeling that computationally integrates systems and subsystems models; and (c) adaptive knowledge fusion to generate quality assurance that support active information collection and continuing operations management.  Essentially, the MEDIA approach is based on a linked series of health engineering concepts, which deviates fundamentally from the traditional health care best practices in which quality is heavily dependent upon the hands-on skills of expert clinical practitioners as well as the deployment of progressively specialized medical instrumentation.  The application of the MEDIA paradigm is also illustrated in a case study on risk management.  Finally, in Section 6, we conclude this review by speculating on future research directions and practical implications in the field of health IT models and methods.

Dr. Joseph Tan, Wayne State University, USA; Dr. Xiangyang Li, University of Michigan - Dearborn, USA; Dr. Yung-wen Liu, University of Michigan, USA