HEALTHCARE IS INTEROPERABILITY

Challenges and Solutions

Vasiliki Mantzana

, Konstantinos Koumaditis

and Marinos Themistocleous

1,2

University of Piraeus, Department of Digital Systems, 150 Androutsou Street, Piraeus, 18534, Greece

University of Coimbra, CISUC, Coimbra, Portugal

Keywords: Healthcare information systems, Healthcare organisations, Challenges, Solutions.

Abstract: Healthcare systems seek to provide services of high quality and profound safety through Healthcare

Information Systems (HIS). Despite the potential benefits of HIS and the significant efforts that have been

made, it has been reported that healthcare systems have a low success rate. It has been reported that the lack

of interoperability still affects the services provided to patients and citizens. In this paper we (a) propose a

novel healthcare processes and services classification, (b) present the HIS challenges and (c) suggest a

solution based on Service Oriented Architecture (SOA), which can increase the interoperability among

systems and hence the quality of provided healthcare services.

1 INTRODUCTION

Improving patients’ safety implies a complex

system-wide effort, which involves all stakeholders

and includes a broad range of actions, such as

paying attention to medication errors, which are the

cause of almost half of all preventable adverse

events and optimizing the use of new technologies.

Nowadays, the development of Healthcare

Information Systems (HIS) that will result in

enhanced services and will save and improve human

lives is the main priority for the healthcare sector

worldwide. In support of this, the economic stimulus

bill signed by the USA Congress included about $19

billion promotes the use of healthcare information

technology, including Electronic Prescribing

(ePrescribing), which can help prevent medication

errors from sloppy hand writing and harmful drug

interactions.

Information Technology (IT) applications such

as Internet-based telemedicine, personal health

records, asynchronous healthcare communication

systems, and picture archiving communication

systems have been applied in healthcare to improve

the capabilities of physicians and clinical staff and

provided increased services to patients, caregivers,

and citizens in general. It appears that HIS play an

increasingly crucial role in the healthcare sector

advancement, by providing an infrastructure to

integrate people, processes and technologies.

In this paper, the authors analyse and propose a

novel classification of healthcare processes and

services, present the HIS challenges and finally

suggest a solution based on Service Oriented

Architecture.

2 HEALTHCARE INFORMATION

SYSTEMS

HIS have been defined as computerized systems

designed to facilitate the management and operation

of all technical (biomedical) and administrative data

for the entire healthcare system, for a number of its

functional units, for a single healthcare institution, or

even for an institutional department or unit

(Rodrigues et al., 1999). HIS are a key enabler, as

they have the potential to improve healthcare

services, by providing rapid and widespread access

to information at the point of care. A plethora of IS,

ranging from order entry and administrative HIS to

laboratory and operation theatre HIS, have been

implemented in the healthcare sector. In shedding

some light on the underlined services that exist in

healthcare organizations, we reviewed the normative

on HIS classification. Based on the processes that

HIS support, Mantzana (Mantzana, 2006)

categorized them into: (a) clinical, (b) non-clinical,

559

Mantzana V., Koumaditis K. and Themistocleous M..

HEALTHCARE IS INTEROPERABILITY - Challenges and Solutions.

DOI: 10.5220/0003164505590562

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2011), pages 559-562

ISBN: 978-989-8425-34-8

 2011 SCITEPRESS (Science and Technology Publications, Lda.)

adopt this classification and extend it, by proposing

that the patient record category should be added, as

it refers to medical records that can be maintained by

the citizen or the health professional. This category

can be further broken down into services (a)

Electronic Patient Records Systems (EPR), which

are detailed records of encounters between patients

and their healthcare providers and (b) Electronic

Personal Health Records (ePHR) that are citizen

self-maintained health and healthcare records

(Gaunt, 2009). For each service category, we

identify and describe related Information Systems,

as this is illustrated in Table 1.

Table 1: Healthcare processes and services.

roc Service Ref

Clinical

Provides electronic charting and

documentation to flow sheets, forms,

notes, work lists, care plans, etc.

(Manjoney,

2004)

Telemedicine

Delivery of healthcare services and

information exchange across

distance.

(Wootton,

2006)

Pharmaceutical

Pharmacy

Keep records about drugs’ ordering,

stocking and distribution

(Anderson P.,

2009)

ePrescribing

Support medicines orders,

administration, use and supply.

(NHS CFH,

2009)

Laboratory

Manage laboratory information, flag

abnormal values or provide possible

explanations for those abnormalities.

(Pantanowitz,

2007)

Non- Clinical

Support

HRM services manage information

about personnel and management

(Kabene, 2006)

CPOE services allow physicians to

enter and send orders.

(Metzger,

2010)

e-Learning increases the

opportunities to learning and

research.

(Land Lesley

Pek Wee,

2007)

Administrative

CRM services are built upon the HIS

as to integrate information generated

from medical acts to sustain the

relationship between hospitals and

customer.

(Hung, 2010)

Financial and accounting

Financial and accounting transactions

with patients, employees etc

(Mantzana,

2006)

Patient

Recor

Electronic Patient Records (EPR)

Detailed healthcare records

(Gaunt, 2009)

Electronic Personal Health

Records

Citizen self-maintained records.

(Gaunt, 2009)

The countless amount of hours and money spent

on HIS and services advancement aim at the

healthcare sector modernization and the

enhancement of services provided to citizens and

patients. However, these efforts have resulted in HIS

that have evolved in a haphazard and fragmented

way, and include data in crude formats without any

attempt to synthesize or analyze them, as required by

proper day-to-day management (Mantzana, 2006).

The need to provide an interoperable environment

has become imperative, as the non-integrated nature

of the healthcare systems is strongly associated

among others with the medical errors that occur. For

instance: (a) hard copy films are constantly

lost/unavailable and (b) information needed for

diagnosing is often missing (Cowan, 2004). Thus, as

the information needed is not available on time,

errors usually occur in prescribing, administering

and dispensing drugs services to patients.

3 HIS CHALLENGES

Despite the potential benefits of HIS, it has been

reported that healthcare systems have a low success

rate. In UK, hundreds of millions of pounds and

countless hours of peoples’ time have been spent on

Information Systems implementations. However, the

quality of the healthcare systems suffers as a result

of medical errors, clinical employees’ resistance to

change and fragmented care (Leape et al., 1995).

Medical errors are the failure of a planned action to

be completed as intended (error of execution) or the

use of a wrong plan (including failure to use a plan)

to achieve an aim (error of planning). Several types

of medical errors, such as failure to the

administration of treatment, error to employ

indicated tests, and avoidable delays in treatment

have been reported. The Institute of Medicine (IOM)

of USA determined medical errors as a problem of

big magnitude reporting that the number of

Americans that die each year from medical mistakes

to resume to 98,000 approximately (Kohn et al.,

2000).

Although the aforementioned findings date back

a decade the problem is not eliminated. The medical

error rate used to calculate the IOM’s national

estimate has also been supported by most recent

studies in Canada, Australia, and other developed

countries. Based on the current state of knowledge

of medical harm, it has been estimated that 5% of

hospital admissions experience some type of adverse

error, 30% of which cause consequential harm

(Wachter, 2008). This implies that more than half-a-

HEALTHINF 2011 - International Conference on Health Informatics

560

million people in the U.S. were affected by

preventable medical errors last year. The countless

amount of hours and money spent on HIS and

services advancement aim at the healthcare sector

modernization and the enhancement of services

provided to citizens and patients. However, these

efforts have resulted in HIS that have evolved in a

haphazard and fragmented way, and include data in

crude formats without any attempt to synthesize or

analyze them, as required by proper day-to-day

management (Mantzana, 2006). The need to provide

an interoperable environment has become

imperative, as the non-integrated nature of the

healthcare systems is strongly associated among

others with the medical errors that occur. For

instance: (a) hard copy films are constantly

lost/unavailable and (b) information needed for

diagnosing is often missing (Cowan, 2004). Thus, as

the information needed is not available on time,

errors usually occur in prescribing, administering

and dispensing drugs services to patients.

4 HIS SOLUTION

Interoperability is becoming a central issue in the

healthcare agenda and researchers and vendors are

focusing on ways to address it. According to IEEE,

interoperability is the ability of two or more systems

that is used to exchange information and to use this

information that has been exchanged (IEEE, 1990).

In the field of healthcare interoperability means that

the ability to communicate and exchange data

accurately, effectively, securely and consistently

with different information technology systems,

software applications, and networks in various

settings and exchange data such that clinical or

operational purpose and meaning of the data are

preserved and unaltered (Patricia and Noam, 2007).

Healthcare interoperability is linked with a variety of

both technical and organizational issues such as the

diversity of applications and systems across

departments and the different attitudes and

perceptions between stakeholders. Moreover, even

thought healthcare organizations invest in

integration technologies, in many cases perform

point-to-point integration between solutions adding

to the lack of interoperability (Jay, 2009). The

different aspects of interoperability are addressed by

various initiatives. The aim of these initiatives is not

only to support data/information exchange, but also

to include meaning in them (Lopez, 2009). These

peculiarities of HIS make SOA an adequate

candidate to solve the problem. Despite the

significant benefits that SOA has provided to other

sectors, healthcare systems remain laggards, thus,

leaving scope for timeliness and novel research.

SOA provides a framework for an infrastructure

to facilitate the interactions and communications

between services (Papazoglou M. , 2007a). SOAs

are more of a paradigm, or a style of design that

concludes to architecture. In other words, SOA is a

way of thinking about building software than a

software development technique (Boersma, 2005).

Figure 1: Proposed solution for healthcare systems interoperability.

HEALTHCARE IS INTEROPERABILITY - Challenges and Solutions

561

As SOA is being adopted by the healthcare

industry, the collections of processes that each

consists of specific services will be available for use,

such as pharmaceuticals, labs and patients as seen in

Figure 1. In SOA services aid integration of

applications that were not written with the intent to

be easily integrated, as is the case in most HIS

environments. In more detail, service-based

applications are developed as independent sets of

interacting services offering well-defined interfaces

to their potential users (Papazoglou M. ). This is

achieved by employing loosely coupled distributed

applications between transacting partners and it does

not involve fixed agreements before the use of an

offered service is permitted. Thus, adding to the

flexibility that is required in an interoperable HIS

environment. Since the location of a system

providing services is transparent, these acquired

services may be hosted outside the organization,

thus increasing the integration between systems.

5 CONCLUSIONS

Despite the amount of hours and money spent on IS

implementations and the technological advancement,

healthcare systems still face several challenges.

Problems, with great magnitude such as medical

errors to less substantial as redundant processing and

data are still a part of everyday processing.

Eliminate medical errors and enhancing the quality

of services provided to users in a cost effective way

is a challenge that IT developers are facing. The

answer can be true interoperability through SOA.

SOA can provide true interoperability and enhance

the quality of healthcare services provided, as it

allows system capabilities to be selected and

packaged as services that are better focused and

available across the entire organization.

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