An ontology-based approach for data integration in regionally interoperable healthcare systems

In order to best utilize the limited resource of medical resources, and to reduce the cost and improve the quality of medical treatment, we propose to build an interoperable regional healthcare systems among several levels of medical treatment organizations. In this paper, our approaches are as follows:(1) the ontology based approach is introduced as the methodology and technological solution for information integration; (2) the integration framework of data sharing among different organizations are proposed(3)the virtual database to realize data integration of hospital information system is established. Our methods realize the effective management and integration of the medical workflow and the mass information in the interoperable regional healthcare system. Furthermore, this research provides the interoperable regional healthcare system with characteristic of modularization, expansibility and the stability of the system is enhanced by hierarchy structure

Considerations regarding the Performance Improvement of the Hospital Healthcare Services from Romania by the Implementation of an Integrated Management System

The continuous quality improvement is an obligatory condition for the achievement and maintaining of the performance in healthcare services. Introducing the concepts of quality improvement in medical practice represents a distinctive component of the hospital reform in Romania. Healthcare quality is a more important principle in sanitary field, because the level of patients ‘knowledge is increasing concomitantly with the technological and therapeutic progresses. The continuous quality improvement is an obligatory condition for the achievement and maintaining the performance in healthcare organization, especially in hospital. The integration of many management systems (quality management, environmental management, security and occupational health management, information security management) and the development of an integrated management model applicable to Romanian hospitals, which have as principal goal to improve the performance of health services, represent a challenge for the Romanian health system. An integrated management system is a logical and systematic managerial approach, which permits taking-up optimum strategic and operational decisions. These decisions take into consideration all the essential aspects which lead to an efficient functionality of health organization, in terms of quality, environment, security and occupational health, and information security.healthcare, hospital, quality, integrated management system

A process analysis of the Namibian Health System: An exploratory case study

AbstractBackground: The Namibian health system is fragmented and data are collected from disparate systems that are not interoperable. Interoperability in this case refers to the ability of health information systems (HISs) to communicate and exchange health-related data at various healthcare levels. The multiplicity of HISs has resulted in limited access to integrated data across the entire health system, leading to duplication of data and under-reporting from primary healthcare facilities, yielding unreliable institution-based data within the health system.Methods: A qualitative approach was employed using a two-phase design. In phase one, a business process re-engineering (BPR) approach was applied to conduct a process analysis of the Namibian health system. A process model is developed to illustrate health inter-level data flows. In phase two, the process model was validated by experts, and semi-structured interviews were conducted as part of a Delphi study to elicit the opinions of experts on challenges and bottlenecks in the data flow process. Interview results were inductively analyzed using the NVivo software to identify themes and patterns from the data.Findings: The national HIS faces pertinent challenges concerning fragmented systems, originating from vertical programmes and donor-funded systems that do not exchange data with the national-level district health information system (DHIS). Findings also highlight that Namibia, among other developing nations, faces similar integration challenges, such as a lack of a trained workforce, different healthcare interoperability standards used by various HISs, an inadequate foundational infrastructure, and an absence of policies, unclear roles and structures that are necessary for driving HIS integration initiatives.Conclusion: There is a need to strengthen collaboration between the national HISs and vertical health systems (VHSs) to address curb the integration challenges. The Ministry of Health (MoH) needs to invest in capacity building projects to train HIS officers on data analysis and use of DHIS 2. In addition, a clear outline of structures and functions needs to be defined to ensure that various MoH units, particularly the IT department, fulfill their primary role of providing IT services, including HIS integration.  [Ethiop. J. Health Dev. 2018;32(4):200-209]Key words: Health information systems, process analysis, business process re-engineering, integration, interoperability, Namibi

Changing Places: The Need to Alter the Start Point for Information Security Design

Information security is a necessary requirement of information sharing within an electronic health system because without it confidentiality, availability, or integrity controls are absent. Research shows that the application of security in this setting is subject to workarounds partly because of resistance to security controls from clinicians who feel that their voice is excluded from the security design process. Heeks\u27 explored the nature of health system design and referred to the distance between system designer and practitioner as the \u27design-reality gap\u27. To reduce this gap, systems designers typically deploy usercentred, participatory approaches to design. They use various forms of consultation and engagement to ensure that the needs of users are responded to within the design and that users understand the design process and constraints. Whilst there is evidence to suggest that the overall electronic health records (EHR) system design has increasingly used elements of a participatory, human-centred design approach, the security elements of design are still technology-focused. This discussion paper characterises the problem, outlines the principles of Heeks\u27 Information, Technology, Processes, Objectives, Skills, Management Systems, Other Resources (ITPOSMO) framework, and then uses this framework to evaluate security dimensions of both the UK and Australian EHR programmes. The resulting proposal for a \u27communities of practice\u27 approach as an alternative start-point to healthcare systems security design, provides a basis for reconceptualising the integration of security practices into EHR systems. In the increasingly distributed and complex environment of healthcare delivery, this new approach can help to address the fundamental challenges experienced in healthcare security practice today

The management and integration of biomedical knowledge: Application in the health-e-child project (position paper)

The Health-e-Child project aims to develop an integrated healthcare platform for European paediatrics. In order to achieve a comprehensive view of children’s health, a complex integration of biomedical data, information, and knowledge is necessary. Ontologies will be used to formally define this domain knowledge and will form the basis for the medical knowledge management system. This paper introduces an innovative methodology for the vertical integration of biomedical knowledge. This approach will be largely clinician-centered and will enable the definition of ontology fragments, connections between them (semantic bridges) and enriched ontology fragments (views). The strategy for the specification and capture of fragments, bridges and views is outlined with preliminary examples demonstrated in the collection of biomedical information from hospital databases, biomedical ontologies, and biomedical public databases

Can the NHS learn about human factors from the Ministry of Defence?

The National Health Service (NHS) in England has ambitious plans to drive innovation in health information technology (HIT) to improve patient safety, quality and cost effectiveness. Acute trusts are complex socio-technical systems that are required to implement a number of large information technology projects in order to meet national targets for digital maturity. This research explored whether the Ministry of Defence (MOD) Human Factors Integration Model for the acquisition process could be applied to a HIT project. A qualitative research study was undertaken in a large English NHS acute trust using the experience of implementing an electronic observation system to explore transferability of the MOD approach to acute healthcare. Data were collected using semi-structured interviews and focus groups and analysed thematically with reference to SEIPS 2.0 (Holden et al, 2013) healthcare systems model and the MOD framework. Key findings included limited awareness of Human Factors in healthcare; information system design/specification to deliver positive outcomes around patient safety and financial savings. Human Factors negative systems issues included alert fatigue, changing mental models, inability to maximise data for patient benefit, system resilience, local and national interoperability issues

The EHR-ARCHE project: Satisfying clinical information needs in a Shared Electronic Health Record System based on IHE XDS and Archetypes

AbstractPurposeWhile contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers’ information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment.MethodsUsing methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study.ResultsWe identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8–14min versus 20min or more).ConclusionsOur results show that for an efficient satisfaction of health care providers’ information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is superior to a conventional metadata-based XDS search

Government Ownership and Adaptation in Scale-Up: Experiences from Community-Based Family Planning Programme in the Democratic Republic of the Congo

A systematic approach to scale-up was applied to expand an integrated  package of family planning and primary healthcare services from the  Democratic Republic of the Congo‘s South Kivu province to health zones in Lomami, Lualaba, and Kasai Central provinces. This approach was based on recommendations from the ExpandNet/WHO guide Beginning with the end in mind. The approach emphasized application of three  recommendations: engaging government stakeholders, ensuring the relevance of the intervention, and tailoring the innovation to the setting. This approach led to successful scale-up of community-based family planning, increasing access to and uptake of contraception and  demonstrating potential for sustainability; 231,566 new acceptors were recruited and 149,826 couple-years of protection were generated. The systematic scale-up approach led to integration of community-based family planning indicators in the national health information system and transferred ownership of the interventions to the government, creating and strengthening government platforms with potential to sustain the interventions.Keywords: DRC, family planning, communities, systematic scale-up, integration, adaptatio

Towards Object-aware Process Support in Healthcare Information Systems

The processes to be supported by healthcare information systems are highly complex, and they produce and consume a large amount of data. Besides, they require a high degree of flexibility. Despite their widespread adoption in industry, however, traditional process management systems (PrMS) have not been broadly used in healthcare environments so far. One major reason for this is the missing integration of processes with business data; i.e., business objects (e.g., medical orders or reports) are usually outside the control of a PrMS. By contrast, our PHILharmonicFlows framework offers an object-aware process management approach, which tightly integrates business objects and processes. In this paper, we use this framework to support a breast cancer diagnosis scenario. We discuss the lessons learned from this case study as well as requirements from the healthcare domain that can be effectively met by an object-aware process management system

The importance of accessible information in promoting the inclusion of people with an intellectual disability

People with an intellectual disability experience high levels of social exclusion and a range of health inequalities. Increased inclusion and participation in healthcare decision making have been identified as key to promoting inclusion in health and social care. However, achieving these objectives requires increased recognition of the communication and health literacy needs of individuals with an intellectual disability and consideration of the appropriateness of the information currently provided. In this article, we report the results of a pre-COVID-19 qualitative study exploring the provision and use of accessible information to support the healthcare inclusion of individuals with an intellectual disability. A total of 35 clinicians participated in focus group discussions, and 10 people with intellectual disabilities and 10 carers were interviewed regarding their experiences of using accessible health-related information. Qualitative data analysis using a framework approach highlighted the crucial role of communication partners when using accessible information, deficits in current National Health Service (NHS: UK’s publicly funded health care system) information provision in the UK, and possible broader relevance of accessible resources. The implications of these findings for the provision of accessible information in a post-COVID-19 environment are explored, and recommendations are made for the increased integration and theory-driven research to inform the provision, content, and use of health-related information, especially the provision of online information, in the future