Clinical Information Systems: A Component-Based Approach PDF
Preview Clinical Information Systems: A Component-Based Approach
Health Informatics (formerly Computers in Health Care) Kathryn J. Hannah Marion J. Ball Series Editors Springer New York Berlin Heidelberg Hong Kong London Milan Paris Tokyo Rudi Van de Velde Patrice Degoulet Clinical Information Systems A Component-Based Approach With 125 Illustrations RudiVandeVelde,Ph.D. PatriceDegoulet,M.D.,Ph.D. ProfessorattheFacultyofMedicine ProfessorattheBroussaisHoˆtel-Dieu FreeUniversityofBrussels FacultyofMedicine and UniversityPierreandMarieCurie DepartmentofMedicalInformatics 15,ruedel’EcoledeMe´decine AZ-VUB,UniversityHospitalBrussels 75006Paris,France 101,LaarbeekAvenue and 1090Brussels,Belgium DepartmentofMedicalInformatics [email protected] HEGP,GeorgesPompidouUniversityHospital 20,rueLeblanc 75015Paris,France [email protected] SeriesEditors: KathrynJ.Hannah,Ph.D.,R.N. MarionJ.Ball,Ed.D. AdjunctProfessor,Departmentof VicePresident,ClinicalSolutions CommunityHealthScience Healthlink,Inc. FacultyofMedicine 2HamillRoad TheUniversityofCalgary Quadrangle359West Calgary,AlbertaT2N4N1,Canada Baltimore,MD21210 and AdjunctProfessor TheJohnsHopkinsUniversity SchoolofNursing Baltimore,MD21205,USA Coverillustration:Coverart©GaryNichols/Images.com. LibraryofCongressCataloging-in-PublicationData Velde,RudiVande. Clinicalinformationsystems:acomponent-basedapproach/RudiVandeVelde, PatriceDegoulet. p.;cm.—(Healthinformatics) Includesbibliographicalreferencesandindex. ISBN0-387-95538-0(alk.paper) 1.Medicine—Dataprocessing. 2.Hospitalcare—Dataprocessing. 3.Information storageandretrievalsystems—Medicine. 4.Medicalrecords—Dataprocessing. I.Degoulet,Patrice. II.Title. III.Series. [DNLM: 1.HospitalInformationSystems. 2.CommunityNetworks. 3.Decision SupportSystems,Clinical. 4.MedicalRecordsSystems,Computerized. WX26.5V435c2002] R858.V4452002 610′.285—dc21 2002026668 ISBN0-387-95538-0 Printedonacid-freepaper. ©2003Springer-VerlagNewYork,Inc. Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten permissionofthepublisher(Springer-VerlagNewYork,Inc.,175FifthAvenue,NewYork,NY10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similarordissimilarmethodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,evenifthey arenotidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyare subjecttoproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoing topress,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityforany errors or omissions that may be made. The publisher makes no warranty, express or implied, with respecttothematerialcontainedherein. PrintedintheUnitedStatesofAmerica. 9 8 7 6 5 4 3 2 1 SPIN10885436 Typesetting:PagescreatedbytheauthorsusingAdobeFrameMaker. www.springer-ny.com Springer-Verlag NewYork Berlin Heidelberg AmemberofBertelsmannSpringerScience+BusinessMediaGmbH To the memory of Jean-Raoul Scherrer Series Preface Thisseries isdirected tohealthcare professionalswho areleading thetrans- formation of health care by using information and knowledge. Launched in 1988 as Computers in Health Care, the series offers a broad range of titles: some addressed to specific professions such as nursing, medicine, and health administration; others to special areas of practice such as trauma and radiology. Still other books in the series focus on interdisciplinary issues, such as the computer-based patient record, electronic health records, and networked healthcare systems. Renamed Health Informatics in 1998 to reflect the rapid evolution in the discipline now known as health informatics, the series will continue to add titles that contribute to the evolution of the field. In the series, eminent experts, serving as editors or authors, offer their accounts of innovations in health informatics. Increasingly, these accounts go beyond hardware and softwaretoaddresstheroleofinformationininfluencingthetransformation of healthcare delivery systems around the world. The series also increas- ingly focuses on“peopleware” and the organizational,behavioral, and soci- etal changes that accompany the diffusion of information technology in health services environments. These changes will shape health services in this new millennium. By making full and creative use of the technology to tame data and to trans- form information, health informatics will foster the development of the knowledge age in health care. As coeditors, we pledge to support our pro- fessional colleagues and the series readers as they share advances in the emerging and exciting field of health informatics. Kathryn J. Hannah Marion J. Ball Preface The reasonable man adapts himself to the world, the unreasonable man adapts the world to him. All progress depends on the unreason- able man. —George Bernard Shaw A hospital information system (HIS) may be defined as a computer system designed to ease the management of all the hospital’s medical and administra- tive information, and to improve the quality of health care. The first HISs were developed in the mid-1960s in the United States and in a few European countries. HISs have followed the general evolutionary trends in computing systems: the development of large central computers, the appearance of microcomputers that replaced passive terminals, the development of mini- computers tied together into distributed systems, and more recently the devel- opment of wide-area networks and Internet-based applications. HIS boundaries have been extended to multisite environments and more recently to the community under the broader concept of community health informa- tion systems (CHISs) or networks (CHINs). Although several dozen products are on the market, few of them actually cover all the requirements of healthcare institutions and provide the adequate integration into the larger healthcare networks. The diversity of the tasks to be performed, the players involved, the existing organizations, and the techni- cal possibilities explain this situation. This book focuses on clinical information systems (CISs), considered as the subsystem of CHISs that are devoted to the direct management of the patient. It represents to CHISs what clinical informatics is to medical or health informatics. The subtitle A Component-Based Approach stresses the idea that an integrated and comprehensive CIS can be built up from a basic set of interdependent components. This approach, which finds its background in modern software engineering, should help in building up more flexible and adaptable systems in a domain where technology is changing very rapidly. This book is designed for all healthcare professionals involved in the design, development, evolution, or distribution of open CISs. Decision mak- ers have to face important alternatives that need to consider functionalities, ix x Preface evolutivity, and costs. HIS architects will concentrate on the optimal defini- tion of and collaboration between components. The book does not require any specialized mathematical or statistical knowledge. The first chapter shows the evolution of CISs from a functional, a techni- cal, and an architectural perspective. Chapters 2 and 3 consider CISs as a col- lection of collaborative business objects. An architecture around six basic components is presented. Chapters 4 to 9 describe each basic component in detail. Chapter 10 describes the specific aspects of the integration of PACS and CIS. In Chapters 11 to 14, four case studies relate experiences in the development and/or deployment of component-based CISs: the AZ-VUB in Brussels, the Pompidou University Hospital in Paris, the Cantonal University Hospital in Geneva, and the Vanderbilt University Hospital in Nashville. The principal technical terms used in clinical informatics and software engineer- ing and their definitions may be found in the glossary. A number of people have provided comments and criticism, and we would particularly like to thank Françoise Aimé, Elisabeth Delbecke, Marion Lavril-Robey, and Lise Marin. When we were preparing this textbook, Mar- ion J. Ball and Kathryn J. Hannah nicely encouraged us. We are indebted to them for their warm and constant support. Anne Tomasino greatly helped us with the Shakespearean language. Rudi Van de Velde Patrice Degoulet Contents Series Preface vii Preface ix 1 Introduction: The Evolution of Health Information Systems 1 Functional Perspective ............................................................................. 1 Hospital Information Systems ............................................................. 1 Community Health Information Systems ............................................ 2 Clinical Information Systems .............................................................. 3 Technology Perspective ........................................................................... 4 Object-Oriented and Component-Based Computing ........................... 4 Middleware .......................................................................................... 5 Mobile Communications ..................................................................... 7 Architectural Perspective ......................................................................... 7 Mainframe Architectures ..................................................................... 7 Departmental Systems ......................................................................... 8 Distributed Systems and the Client/Server Era ................................... 8 Network-Centric Architectures and Web Services .............................. 10 Toward Component-Based Clinical Information Systems ....................... 11 Summary and Conclusions ....................................................................... 12 References ................................................................................................ 14 2 Frameworks: A Collection of Business Objects 15 A New Vision ........................................................................................... 15 Software Components .............................................................................. 16 Software Objects ...................................................................................... 18 Business Rules .......................................................................................... 19 Architectural Requirements ...................................................................... 20 ArchitecturalDesign ................................................................................ 21 Architecture Layers ............................................................................. 21 Dynamics of the Architecture .............................................................. 24 Enterprise Infostructure Model ................................................................ 24 Patient Component .............................................................................. 25 Activity Component ............................................................................ 26 xi xii Contents Resource Management Component ..................................................... 26 Health Record Component .................................................................. 27 Authorization Component ................................................................... 28 Knowledge Management Component ................................................. 28 Application Domain ................................................................................. 30 Technical Infrastructure ........................................................................... 32 Summary and Conclusions ....................................................................... 33 References ................................................................................................ 34 3 Frameworks: A Collaboration of Objects 37 Dimensions in Communications .............................................................. 38 Infrastructure Level ............................................................................. 38 Applicative Level ................................................................................ 38 Communication Standards ....................................................................... 39 Communication at the Syntax Level ................................................... 40 Communication at the Semantic Level ................................................ 44 Communication at the Pragmatic Level .............................................. 45 Collaboration Between Objects ................................................................ 45 Collaboration via the WWW ............................................................... 45 Request Brokers ................................................................................... 46 Downloadable Components ................................................................. 48 OMG CORBAmed Approach ............................................................. 48 CCOW ................................................................................................. 49 Scenarios in Distributed Environments .................................................... 50 Summary and Conclusions ....................................................................... 51 References ................................................................................................ 52 4 The Patient Component 55 Conceptual Specifications ........................................................................ 55 Functional Specifications ......................................................................... 56 Patient Retrieval .................................................................................. 56 Patient Identification and Registration ................................................ 57 Patient Admission and Discharge ........................................................ 58 Patient Tracking and Transfer Functions ............................................. 59 Patient Health Data Cards ........................................................................ 59 Rationale for Using Health Data Cards ............................................... 59 Card Technologies ............................................................................... 60 Examples of Health Data Card Applications ....................................... 61 Summary and Conclusions ....................................................................... 63 References ................................................................................................ 63 5 The Activity Component 65 Conceptual Specifications ........................................................................ 66 Contents xiii Activities and Tasks ............................................................................. 66 Classification of Healthcare Tasks ...................................................... 67 The Life Cycle of an Activity .............................................................. 69 Provider Order Entry Systems .................................................................. 72 Benefits ................................................................................................ 72 Requirements ....................................................................................... 73 POE and Computer-Based Decision Support ........................................... 76 Critiquing Systems .............................................................................. 77 Consulting Systems ............................................................................. 77 Reminder Systems ............................................................................... 77 Event Engine ........................................................................................ 78 Rules .................................................................................................... 81 Computer-Based Guidelines ................................................................ 82 Framework for Automating Medical Processes: The Workflow Engine . 83 Summary and Conclusions ....................................................................... 85 References ................................................................................................ 86 6 The Health Record Component 89 Scope of Health Records .......................................................................... 89 Strategies in Evolving Toward Electronic Health Records ...................... 90 From Healthcare Provider to Patient-Centered Electronic Records .... 90 Barriers to the Development of Electronic Health Records ................ 91 Requirements for the Implementation of EHR Systems ..................... 92 Conceptual Specifications ........................................................................ 93 Time and Events .................................................................................. 94 Classes of Clinical Data: The User Point of View .............................. 96 Health Records Structures ................................................................... 100 Health Record Component Architecture ............................................. 107 Health Record Management ..................................................................... 111 User Interface Component ................................................................... 111 Strategies of Clinical Data Entry at the Point of Care ......................... 112 Presentation for Reading and Interpretation ........................................ 116 Summary and Conclusions ....................................................................... 117 References ................................................................................................ 118 7 The Knowledge Component 123 Conceptual Specifications ........................................................................ 124 Types of Knowledge ............................................................................ 124 Knowledge Representation Formalisms .............................................. 125 Inferences and Problem-Solving Techniques ...................................... 130 Ontologies and Terminology Servers ....................................................... 133 Architectural Frameworks ........................................................................ 135 Clinical Decision Support Systems .......................................................... 136 Historical Background ......................................................................... 136
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