Chapter 8 Gain a basic understanding of the core technologies behind health care information systems: System software Data management Networks and data communications Information processing distribution schemes Internet, intranets, and extranets Clinical and managerial decision support Discuss emerging trends in information technology (such as mobility, Web services, Internet, wireless). Identify some of the major issues in the adoption of information technologies in health care organizations. Discuss why it is important for a health care organization to adopt an overall information systems architecture. Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser Why IT/IS: Error Rates • World-class competitiveness in Manufacturing < 230 errors per million opportunities • Financial services < 5 errors per million • Healthcare: 6000 –300,000 errors per million –Healthcare errors are likely under reported • malpractice threats • practitioner confidentiality concerns Error rates in healthcare are orders of magnitude higher than in other industries Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser Core Technologies System Software Data management and access Networks and data communications Information processing distribution schemes Internet, intranets, and extranets Clinical and managerial decision support Trends in user interactions with systems System Architecture A series of programs that carry out basic computing functions Manage user interface, files and memory Operates peripherals Allows development of applications without have to include basic computer instructions Operating Sytems (Personal Systems) Proprietary Windows Mac OS Open source Linux Production Systems MVS UNIX Interface Engine—a software program designed to simplify the creation of management of interfaces between applications systems (Altis, 2004) Relational Databases Relational Database Management System (RDMS) Applications have three layers Interface Data manipulation Tables Object-oriented Database Object-oriented database management system (OODBMS) Object-Relational Database management system (ORDBMS) Data dictionaries—document data definitions Clinical data repositories—large databases that include data from a variety of sources Data Warehouse and Data Mart Non-relational structure to facilitate “drill down” retrieval Data mining—discovering patterns in data Network Communication protocols Network Types and Configurations Network Media and Bandwidths Network Communication Devices Needed for communication among networked computers an devices Open Standards Interconnection (OSI) Seven Layers Conceptual model, not a set of actual specifications Internet Model—Transmission Control Protocol/Internet Protocol (TCP/IP) Layered model Represents a set of actual protocol specifications at each layer Other protocols Ethernet—Local Area Networks Asynchronous Transfer Mode (ATM)—fast transmission speeds Bluetooth—wireless devices IEEE 802.11 (Wi-Fi)—popular for wireless computers Local Area Network (LAN) vs. Wide Area Network (WAN) LAN—devices are under the control of one organization in the same geographic area WAN—an network that extends beyond a LAN Topology Physical or Logical Example of Ethernet is a Physical “Star” and Logical “Bus” Common Types Twisted pair wire (Category 5 most common) Coaxial cable (older) Fiber optic cable Microwave Spread spectrum Communications across WAN require a service carrier POTS Leased line Integrated services digital network (ISDN) Purchased T-1 (or other) line Bandwidth = Capacity of the transmission med1a Greater capacity = greater speed Rates expressed as bits per second (bps) Hub—device in which data from the network come together Bridge—connects neworks at the data link layer; networks with the same protocols Router—operates at the network layer; help determine the destination of data Gateway—connects networks with different protocols; operates at or above the transport level Switch—may be a gateway or a router; all switches rout data to their destinations Terminal to Host—dumb terminal interacts with host computer File Server—application and database are on one computer; user’s computer gets data files from file server Client/server—multiple servers with specialized functions; client runs application & server has data Every computer or device has a unique Internet Protocol (IP) address Use changed dramatically with the introduction of Hypertext Transfer Protocol (http) and the World Wide Web (www) WWW Uniform Resource Locator (URL) Example-- http://www.josseybass.com Web Browser Plug-ins Mark up languages HTML XML Other Protocols E-mail (smtp, pop3, imap) File Transfer (ftp) Internet telephoning (VoIP) Intranets Secure computer network that uses Internet technologies, but is internal to an organization Extranets Similar to intranets, but includes business partners or the organization Web 2.0 is a range of Web-based communities, services, and technologies, including social-networking sites, wikis, blogs, and messaging capabilities. The “2.0”reflects the view that this collection represents the second generation of Web technologies and capabilities. Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser Decision Support Systems (DSS) Artificial Intelligence Three steps of Decision Making Intelligence Design Choice Problems are Structured Unstructured semistructured Transaction based systems use for structured problems DSS is needed for semi and unstructured problems Stand alone generally has three components Data Management Module—database, data warehouse, clinical data repository Model Management Module—user selects model to be applied to problem Dialog Module—the user interface (Oz, 2004) A branch of computer science that is devoted to emulating the human mind Example: Google Multiple types Expert systems Natural language processing Neural networks Fuzzy logic Input Devices Output Devices External Storage Devices Mobile Personal Computing Devices Standard—mouse & keyboard Other Trackball or trackpad Touch screens Source data input devices, such as bar coding Document Imaging Speech Recognition Computer Monitor Printer Speech Sequential Magnetic tape Direct Access Magnetic disks Floppy disks Zip drives RAID CDs & DVDs Optical tape Flash memory Personal Digital Assistants (PDAs) Pocket PCs Laptop computer Tablet computer Cellular phone combinations The coming together of an information system is guided by the IS architecture Consists of concepts, strategies, and principles Platforms are specific vendors and technologies Infrastructure generally refers to networks and network applications Characteristics and Capabilities Architecture ensures organizationally defined characteristics and capabilities Application Integration Best of Breed Monolithic Visual integration It is important for health care organizations to have thoughtful architecture discussions System Software Data Management and Access Networks and Data Communications Network Communication protocols Network Types & Configurations Network Media & Bandwidth Network Communication Devices Distribution Schemes Internet Intranets & Extranets Decision Support Decision Support System Artificial Intelligence User Interactions Input Devices Output Devices External Storage Devices Mobile Personal Computing Information System Architecture