Application of fuzzy simulation for evaluating enterprise application integration in healthcare organisations

Healthcare organisations have focused on the latest technological innovations to overcome their organisational and clinical problems. The information systems were not developed in a cordinated way but evolved as autonomous and hetrogeneous systems. Thus, the integration of these systems represents one of the most urgent priorities of healthcare organisations that allow the whole organisation to meet the increasing clinical, organisational and managerial needs. Recently, technological developments have emerged in the area of integration technology such as Enterprise Application Integration (EAI). This provides significant benefits to organisations to overcome the integration problem. This work therefore evaluates the adoption of EAI in healthcare organisations. In doing so, Fuzzy Cognitive Mapping (FCM) simulation is used to demonstrate the causal inter-relationships between the EAI adoption factors. FCM simulation provides insights into better understanding about interdependencies of the factors that influence EAI adoption in healthcare organisations

Identifying common problems in the acquisition and deployment of large-scale software projects in the US and UK healthcare systems

Public and private organizations are investing increasing amounts into the development of healthcare information technology. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardised procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the problems that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail on electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of Healthcare Information Systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems

Can information technology improve my ambulatory practice?

eHealth is the use of information and communication technologies for health. mHealth is the use of mobile technology in health. As with all information technology (IT), advances in development are rapidly taking place. The application of such technology to individual ambulatory anaesthesia practice should improve the delivery of quality patient care to the patient. Improved multilevel communication and information exchange should not be to the detriment of patient confidentiality. There are various opportunities throughout the perioperative ambulatory care process for the individual anaesthesiologist to participate in eHealth. The most important contributions may manifest with improved preoperative communication, intraoperative  recordkeeping and postoperative tracking of outcomes data. However, it is crucial that development in the health IT field is coordinated to ensure interoperability.Keywords: eHealth, mHealth, health information technology, ambulatory anaesthesi

Information Systems and Healthcare XX: Toward Seamless Healthcare with Software Agents

Healthcare processes are frequently fragmented and often badly supported with IT. Inter- and intra-organizational communication and media frictions complicate the continuous provision of information according to the principle of information logistics. Based on extensive literature review, we present the vision of seamless healthcare with horizontally and vertically integrated healthcare processes enabled by seamless IT support. Its implementation requires the establishment of a communication infrastructure and the deployment of adequate standards in healthcare. There are already comprehensive approaches for dealing with integrating heterogeneous information systems. However, they lack a common communication infrastructure and do not support proactivity and flexibility which are dominant characteristics in healthcare. We propose a software agent-based approach for realizing the vision of seamless healthcare. We present a corresponding implementation for integrating heterogeneous information systems in the context of the German Health Telematics Infrastructure. Based on the concept and the implementation, we show that the modular approach is capable of supporting a wide range of different applications. We furthermore outline which facets of an agent-based solution could be implemented in an operative real-world environment. In closing we derive implications for IT decision makers in healthcare and show directions for future approaches for reducing information logistics related deficits in healthcare

eHealth key issues in portuguese public hospitals

Hospital managers, health and IT Professionals have their work increasingly supported and dependent on information systems and technologies. To be more effective and efficient in the way health care is delivered, considerable improvements in health information systems and technologies still have to be made at the local and national levels. This is a study that seeks for a deeper understanding of the Portuguese hospitals main stakeholder’s concerns regarding their interaction with Information Technology, so opportunities for improvement can be later identified. Seven public hospitals have been selected to participate in this study. In each hospital, managers, IT and health professional were interviewed leading to the discussion of some global and shared perceptions that resulted in a list of eHealth key issues in public Portuguese hospitals.The authors would like to thank the Central Administration for Health Services (ACSS) of the Portuguese Health Ministry for sponsoring this study

Machine Learning Approaches to Determine Feature Importance for Predicting Infant Autopsy Outcome

Introduction: Sudden unexpected death in infancy (SUDI) represents the commonest presentation of postneonatal death. We explored whether machine learning could be used to derive data driven insights for prediction of infant autopsy outcome. Methods: A paediatric autopsy database containing >7,000 cases, with >300 variables, was analysed by examination stage and autopsy outcome classified as ‘explained (medical cause of death identified)’ or ‘unexplained’. Decision tree, random forest, and gradient boosting models were iteratively trained and evaluated. Results: Data from 3,100 infant and young child (<2 years) autopsies were included. Naïve decision tree using external examination data had performance of 68% for predicting an explained death. Core data items were identified using model feature importance. The most effective model was XG Boost, with overall predictive performance of 80%, demonstrating age at death, and cardiovascular and respiratory histological findings as the most important variables associated with determining medical cause of death. Conclusion: This study demonstrates feasibility of using machine-learning to evaluate component importance of complex medical procedures (paediatric autopsy) and highlights value of collecting routine clinical data according to defined standards. This approach can be applied to a range of clinical and operational healthcare scenario

Transforming Public Servants’ Health Care Organization in Greece through the Implementation of an Electronic Referral Project

AbstractObjectiveThe Greek Public Servants’ Health Care Organization aiming to organize, monitor, and enhance the health care services provided to 1,500,000 public servants decided to respond to the national alert of the economic crisis through the reduction of costs caused by diagnostic tests (€300,000,000 claims for 2008), to improve working conditions of contracted physicians and laboratories, and to enhance services provided to insured members. In September 2010, the Greek Public Servants’ Health Care Organization initiated a pilot project that electronically records the prescription process of the diagnostic tests, which is Web-based, is open source, and was provided for free to the contracted physicians and diagnostic centers.MethodsIn this article, we present some interesting findings resulting from the implementation of the pilot electronic referral project by examining a 9-month period.ResultsFifty-eight percent of the physicians had the necessary equipment for the operation of the system, more than 3600 physicians used it, 17,495 public servants had been served through the system, and 178,456 paraclinical examinations had been prescribed with a cost of €1,394,980. In addition, the analysis revealed that the implementation of an electronic referral system could provide significant benefits, such as a faster referral process, valid and coherent information, minimization of the risk of misinterpreting the electronic referral due to illegibility of handwriting, and improvement in quality of services.ConclusionsThe Greek electronic referral system was one of the first attempts toward creating the basis of a society of transparency and cost control. The lessons learnt from this article should not be ignored in the process of redesigning and improving the electronic referral system for Greece

Pragmatic oriented data interoperability for smart healthcare information systems

Smart healthcare is a complex domain for systems integration due to human and technical factors and heterogeneous data sources involved. As a part of smart city, it is such a complex area where clinical functions require smartness of multi-systems collaborations for effective communications among departments, and radiology is one of the areas highly relies on intelligent information integration and communication. Therefore, it faces many challenges regarding integration and its interoperability such as information collision, heterogeneous data sources, policy obstacles, and procedure mismanagement. The purpose of this study is to conduct an analysis of data, semantic, and pragmatic interoperability of systems integration in radiology department, and to develop a pragmatic interoperability framework for guiding the integration. We select an on-going project at a local hospital for undertaking our case study. The project is to achieve data sharing and interoperability among Radiology Information Systems (RIS), Electronic Patient Record (EPR), and Picture Archiving and Communication Systems (PACS). Qualitative data collection and analysis methods are used. The data sources consisted of documentation including publications and internal working papers, one year of non-participant observations and 37 interviews with radiologists, clinicians, directors of IT services, referring clinicians, radiographers, receptionists and secretary. We identified four primary phases of data analysis process for the case study: requirements and barriers identification, integration approach, interoperability measurements, and knowledge foundations. Each phase is discussed and supported by qualitative data. Through the analysis we also develop a pragmatic interoperability framework that summaries the empirical findings and proposes recommendations for guiding the integration in the radiology context