History of monolithic and modular health information systems

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History of monolithic and modular health
information systems

• A.Hasman

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(No Transcript)
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Central approach to system development

• Central systems
• First design a blueprint of a total hospital
  information system
• Then develop the system and install the system in
  the various departments (after prioritization,
  patient registration funtion first)
• Central computer system with backup
• Star configuration of terminals
• Uniform user interface and operation
• If development is a failure big financial loss

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Central approach

• Central database
• Several system parts (functions) communicate with
  each other via this central database
• Automatic standardization of terminology
• Long development times
• Because of that problems with changing hardware,
  operating systems and programming languages
• Users do not always have a good insight in the
  total functionality of the system
• Not much competition
• Varying quality of the various functions

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Central system

• Many terminals (or PCs currently)
• Backup hardware
• Separation of functions communication,
  applications and database management
• Central datastorage

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Modular approach

• Independent departmental/support systems
• Each system has its own database
• Relatively short development times
• Relatively cheap to develop
• Competition keeps quality high
• Systems need data exchange standardization of
  data (HL7). If not then entry of redundant data
  in systems
• Each system has its own user interface
• Sometimes several terminals needed to access the
  different systems
• If development is a failure this is only a
  partial failure

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Data exchange
Laboratory system
Pharmacy system
Department B
Terminal 1
Terminal 2
Terminal 2
Terminal 1
Department A
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Current architecture

• From IT to ICT (LANs and WANs)
• Client-server architecture
• PCs and PDAs as terminals
• One or more database servers
• Modular and central approaches converge
• Via the network the different systems are
  accessible
• Graphical user interface
• Uniform operation

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Distributed systems
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Types of information systems

• Transaction processing systems
• Capture of transaction data
• Programmed decision systems
• Take automatic decisions on the basis of stored
  data (e.g. stock management and automatic
  ordering
• Management information systems
• Report generation, answers to what is
  questions to locate problems or challenges
• Decision support systems
• Support decisions answers to what if
  questions for semi-structured problems
• Expert systems
• Provide solutions for structured problems

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Important!

• Standardization of functionality
• Standardization of data so that they can be
  exchanged
• Open systems
• Security

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The Classic Mode of Development
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Enter the Knowledge Environment
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Enter Clinical Models
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Knowledge-enabled Methodology