Abstract
Health-care information systems (HCIS) intervene in medical reasoning and function. In a continuously changing environment health-care professionals find themselves overwhelmed with fast pacing advances both in information technology (IT) and in medical practice. Use of evidence-based medicine (EBM) is flourishing and the coupling between HCIS and EBM opens new frontiers for both. Yet the problems that relate to HCIS development and implementation remain the same. The problems of today have been problems of yesterday and are likely to stay, or evolve, in the future. The chapter takes the reader to a journey around the factors that are involved in HCIS development and implementation. Discussion is mostly non-technical and focuses on organization and individual readiness to adopt HCIS technology in the workplace. Discussion formalizes to a concrete framework, which is accompanied by a formal statistical methodology on how to apply the framework in practice. The proposed framework integrates existing formal models related to technology readiness and acceptance, EBM, organization climate and computer knowledge and skills.
TopIntroduction
Health-care information systems (or HCIS for short) represent system federations, which encompass heterogeneous (and often distributed) components aiming toward the support of clinical functions. HCIS are part of Hospital Information Systems (or HIS for short); the latter capture non-clinical, yet critical, functions that support resource management and logistics. Health-care professionals are the [main] users of HCIS; here the term professional refers to both medical and nursing personnel. HCIS field has expanded, diversified and often lead to the creation of new fields, such as nursing informatics, which is now accepted as a separate field (ANIA, 2008; HIMSS, 2008) while a variety of resources about HCIS can be accessed via numerous public websites –for instance (Pohly, 2008).
This chapter takes a step back from technology or specialized HCIS components and focuses on what lies behind the scene. It focuses on people, specifically to health-care professionals and overviews and discusses the concepts, which are the prerequisites to successful HCIS implementation. Presentation takes the form of a journey from early research and key principles to evolving measures of human behavior in relation to the introduction of new technology in the workplace. The journey is taken with the vehicle of EBM – Evidence Based Medicine. EBM marks a major shift in the practice of medicine, alludes to “the wise use of the best evidence available” (Sehon and Stanley, 2003), and involves both the individual as well as the community – Jenicek and Stanchenko (2003) elaborate on the processes involved in the diffusion of EBM to evidence-based public health.
HCIS design and implementation implies existence of a formal architecture, which embraces elements and associations between elements. Based on the work by Mason and Mitroff (1973) the architectural model of a HCIS encompasses at least one person of a certain worldview value structure who is confronted with a clinical problem within a clinical context for which he /she needs supportive evidence to arrive at a decision and that evidence is made available to her through some mode of presentation which, in turn, is implemented via a computing system developed and installed by a team of HCIS specialists. (Emphasis is placed on the key variables and follows authors’ practice) – see Figure 1. Architectural ingredients are associated to each other and associations are briefly marked along the links.
Figure 1. HCIS architecture. Main components are capitalized. Associations between components are in parenthesis of the arrows. Suggested associations are indicative, essentially all components may associate with each other.
The definition, although generic for information systems and more than 35 years old, captures the essential elements of any modern HCIS and can be used to steer modeling of system components and associative relationships between components. Architecture couples clinical context, clinical decision-making style and technology with a range of psychometric parameters, which encapsulate perception about, intention to, and usefulness of HCIS in everyday clinical practice.
EBM occupies the midst of all associations and it is purposefully embodied in the architecture. It is acknowledged that EBM and HCIS interact since the former needs HCIS to access evidence resources and the latter must be re-engineered to serve EBM (Georgiou, 2001). Atkins and Louw (2000) take the argument a step further calling for the necessity of a framework toward evidence-based information systems while in the guide for evidence-based organizational implementation proposed by Kresse et al (2007) information systems hold a prominent position.
Key Terms in this Chapter
Clinical Problem Solving: The term denotes the processes via which clinical decisions are made in order to improve patient health. The processes include diagnosis (specification of disease by linking symptoms with causes of disease), therapy planning (actions targeted to alleviate the causes of disease), monitoring (actions that are targeted to steer patient status on a healthy course) and prevention (actions that are targeted to support maintenance of healthy status).
EBM (Evidence Based Medicine): EBM emphasizes that delivery of health-care service and patient management should be based on the optimal use of available evidence about the patient and/or disease. In practice EBM implies the use of formal protocols, which facilitate, or direct, the health-care professional to gather, and often exhaustively, the evidence that is necessary given the clinical task at hand.
Technology Readiness Index (TRI): The model can be viewed as a variation of TAM, which focuses on information technology. It measures enthusiasm of personnel to accept information technology in their workplace.
HCIS (Health-Care Information Systems): These are information based system federations or architectures, which support delivery of health-care services. Service support may be diverse and encompass clinical decision making, management of resources, management of patients (booking or scheduling), epidemiological inquiries, etc.
Organizational Implementation: The term is use to indicate the systematic effort, which must be organized, planned, and directed in order to put a HCIS in practice. There are two conditions that must be satisfied before a system is taken to the workplace, namely: acceptability and acceptance. Acceptability may be seen as a necessary condition meaning that the system is appropriate in all technical respects while acceptance implies that the system
Time Management: It is attitudinal concept, which supports the perception of an individual (or team) with respect to time and to time in context of short or long range planning.
Technology Acceptance Model (TAM): The model was introduced in order to help researchers and practitioners to study the process of implementation of new technology in the workplace. It works by assessing attitude of personnel with respect to new technology over perceived ease of use and usefulness.