Electronic immunization data collection systems: application of an evaluation framework

BACKGROUND: Evaluating the features and performance of health information systems can serve to strengthen the systems themselves as well as to guide other organizations in the process of designing and implementing surveillance tools. We adapted an evaluation framework in order to assess electronic immunization data collection systems, and applied it in two Ontario public health units. METHODS: The Centers for Disease Control and Prevention’s Guidelines for Evaluating Public Health Surveillance Systems are broad in nature and serve as an organizational tool to guide the development of comprehensive evaluation materials. Based on these Guidelines, and informed by other evaluation resources and input from stakeholders in the public health community, we applied an evaluation framework to two examples of immunization data collection and examined several system attributes: simplicity, flexibility, data quality, timeliness, and acceptability. Data collection approaches included key informant interviews, logic and completeness assessments, client surveys, and on-site observations. RESULTS: Both evaluated systems allow high-quality immunization data to be collected, analyzed, and applied in a rapid fashion. However, neither system is currently able to link to other providers’ immunization data or provincial data sources, limiting the comprehensiveness of coverage assessments. We recommended that both organizations explore possibilities for external data linkage and collaborate with other jurisdictions to promote a provincial immunization repository or data sharing platform. CONCLUSIONS: Electronic systems such as the ones described in this paper allow immunization data to be collected, analyzed, and applied in a rapid fashion, and represent the infostructure required to establish a population-based immunization registry, critical for comprehensively assessing vaccine coverage

A service oriented architecture to implement clinical guidelines for evidence-based medical practice

Health information technology (HIT) has been identified as the fundamental driver to streamline the healthcare delivery processes to improve care quality and reduce operational costs. Of the many facets of HIT is Clinical Decision Support (CDS) which provides the physician with patient-specific inferences, intelligently filtered and organized, at appropriate times. This research has been conducted to develop an agile solution to Clinical Decision Support at the point of care in a healthcare setting as a potential solution to the challenges of interoperability and the complexity of possible solutions. The capabilities of Business Process Management (BPM) and Workflow Management systems are leveraged to support a Service Oriented Architecture development approach for ensuring evidence based medical practice. The aim of this study is to present an architecture solution that is based on SOA principles and embeds clinical guidelines within a healthcare setting. Since the solution is designed to implement real life healthcare scenarios, it essentially supports evidence-based clinical guidelines that are liable to change over a period of time. The thesis is divided into four parts. The first part consists of an Introduction to the study and a background to existing approaches for development and integration of Clinical Decision Support Systems. The second part focuses on the development of a Clinical Decision Support Framework based on Service Oriented Architecture. The CDS Framework is composed of standards based open source technologies including JBoss SwitchYard (enterprise service bus), rule-based CDS enabled by JBoss Drools, process modelling using Business Process Modelling and Notation. To ensure interoperability among various components, healthcare standards by HL7 and OMG are implemented. The third part provides implementation of this CDS Framework in healthcare scenarios. Two scenarios are concerned with the medical practice for diagnosis and early intervention (Chronic Obstructive Pulmonary Disease and Lung Cancer), one case study for Genetic data enablement of CDS systems (New born screening for Cystic Fibrosis) and the last case study is about using BPM techniques for managing healthcare organizational perspectives including human interaction with automated clinical workflows. The last part concludes the research with contributions in design and architecture of CDS systems. This thesis has primarily adopted the Design Science Research Methodology for Information Systems. Additionally, Business Process Management Life Cycle, Agile Business Rules Development methodology and Pattern-Based Cycle for E-Workflow Design for individual case studies are used. Using evidence-based clinical guidelines published by UK’s National Institute of Health and Care Excellence, the integration of latest research in clinical practice has been employed in the automated workflows. The case studies implemented using the CDS Framework are evaluated against implementation requirements, conformance to SOA principles and response time using load testing strategy. For a healthcare organization to achieve its strategic goals in administrative and clinical practice, this research has provided a standards based integration solution in the field of clinical decision support. A SOA based CDS can serve as a potential solution to complexities in IT interventions as the core data and business logic functions are loosely coupled from the presentation. Additionally, the results of this this research can serve as an exemplar for other industrial domains requiring rapid response to evolving business processes

An Integrative Review of the Literature on Technology Transformation in Healthcare

Healthcare transformation through technology is a core objective of health reform. It is important for decision makers to understand the likelihood that reform policies will in fact transform. This study evaluates evidence of technology transformation in healthcare through an integrative review of the healthcare and business literature, guided by the theory of punctuated equilibrium (TPE). TPE describes the process of transformation within organizations, markets, and groups. The theory explains transformation as a pattern of long periods of incremental change (equilibrium) punctuated by short periods of dramatic change (revolution). An underlying deep structure defines the environment of the organization, market, or group. Radical change in the deep structure of the environment is necessary for transformational change. This integrative review covered the period January 2004 through April 2012. The inclusion criteria required that the article or study address both the implementation of health information technology in the United States and describe one of the three components of TPE. Five hundred twenty articles focusing on transformational change were identified through structured database searches of MedLine/PubMed, Business Source Complete, Social Science Research Network, and others. The articles were reviewed, and coded using the three elements of TPE. A directed content analysis of the coded data produced 10 themes describing the three TPE elements: variations in the environment, market complexity, regulation, flawed risk and reward, theories of technology acceptance, barriers, ethical considerations, competition and sustainability, environmental elements of revolution, and internal elements of revolution. The results describe a healthcare market exhibiting strong equilibrium and substantial resistance to change from HIT. Minimal descriptions of the revolutionary element of TPE were evident. The deep structure of healthcare indicates that the historical provider and hospital-centered market prevails. Conditions that might encourage alteration of this deep structure were: empowering and engaging patients; updating care delivery models; and reducing market uncertainty. The revolutionary changes seen in other complex markets from banking to travel to manufacturing relied heavily on the power of the consumer to alter deep structure. Although the concept of patient centeredness was present in the literature there was little clarity regarding the patient as an agent of structural change. To our knowledge this is the first application of TPE to investigate technology transformation in healthcare. Others have demonstrated TPE as a viable model for explaining transformational change in other markets. The study is limited by the study timeframe and the absence of newer literature reflecting the impact of recent policy changes. Despite this limitation the findings suggest that TPE presents a potentially valuable framework to guide evaluation of the progress of policies that encourage transformation from technology. Some propose that altering the complex deep structure of healthcare may require a complete destruction of existing processes before new processes, innovations, and technologies can emerge. The Affordable Care Act (2010) and the meaningful use provisions of the HITECH Act (2009) are moving healthcare toward new patient centered models of care. Uncertainty around the future of reform policies from possible repeal or amendment likely contributes to resistance to transformational change. This may perpetuate the historical rational and incremental pattern of HIT advancement. Patients as consumers have the potential to influence change given the appropriate tools. The importance of consumers to the transformation process suggests that policies fostering technologies that integrate patients into new care delivery models are likely paramount to realizing technological transformation