简介
Health Information Systems: Architectures and Strategies is a definitive introductory resource that tackles the pivotal role of information systems in health care. Illustrating the importance of information systems in delivering high-quality health care at the lowest possible cost, this book provides the essential resources needed by the health informatics / medical informatics specialist to understand and successfully manage the complex nature of hospital and transinstitutional health information systems. The book refines concepts described in the Editors鈥?previous book Strategic Information Management in Hospitals and considers both the progress in the field and also the lessons learned. Perception of information systems in health care has changed. There is no longer a focus only on single institutions like hospitals, but health care institutions within health care networks come to the fore. In producing this new book, the Editors have broadened the focus from hospital information systems and their strategic management to strategic management of transinstitutional health information systems. Alfred Winter, PhD, is Professor of Medical Informatics at the Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany Reinhold Haux, PhD, is Professor of Medical Informatics and Director at the Peter L. Reichertz Institute for Medical Informatics at University of Braunschweig 鈥?Institute of Technology and Hannover Medical School, Germany Elske Ammenwerth, PhD, is Professor of Medical Informatics at UMIT - University for Health Sciences, Medical Informatics and Technology , Hall i.T., Austria Birgit Brigl, PhD, is at the IT full service provider of the German Federal Ministry of Finance, Frankfurt/Main, Germany Nils Hellrung, PhD, is research associate at the Peter L. Reichertz Institute for Medical Informatics at University of Braunschweig 鈥?Institute of Technology and Hannover Medical School, Germany Franziska Jahn, MSc, is research associate at the Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany
目录
Foreword from the 1st Edition in 2004 6
Series Preface 8
Preface for the 2nd Edition 9
Acknowledgements for the 2nd Edition 11
Acknowledgements for the 1st Edition 12
Annotation to the Figures 13
Contents 14
List of Figures 21
Figure Credits 31
List of Tables 33
About the Authors 35
1: Introduction 38
2: Health Institutions and Information Processing 40
2.1Introduction 40
2.2\u2002Significance of Information Processing in Health care 40
2.2.1\u2002Information Processing as Quality Factor 40
2.2.2Information Processing as Cost Factor 41
2.2.3Information as Productivity Factor 43
2.2.4Holistic View of the Patient 43
2.2.5Hospital Information System as Memory and Nervous System 44
2.3\u2002Progress in Information and Communication Technology 45
2.3.1Impact on the Quality of Health Care 45
2.3.2Impact on Economics 47
2.3.3Changing Health care 48
2.4\u2002Importance of Systematic Information Management 49
2.4.1Affected People and Areas 49
2.4.2Amount of Information Processing 50
2.4.3Sharing the Same Data 51
2.4.4Integrated Information Processing to Satisfy Information Needs 52
2.4.5Raising the Quality of Patient Care and Reducing Costs 53
2.4.6Basis of Systematic Information Processing 53
2.5\u2002Examples 54
2.5.1Knowledge Access to Improve Patient Care 54
2.5.2Nonsystematic Information Processing in Clinical Registers 55
2.5.3The WHO eHealth Resolution15 56
\u201cThe Fifty-Eighth World Health Assembly \u2026 57
2.5.4Estimated Impact of eHealth to Improve Quality and Efficiency of Patient Care 58
2.6\u2002Exercises 59
2.6.1Amount of Information Processing in Typical Hospitals 59
2.6.2Information Processing in Different Areas 59
2.6.3Good Information Processing Practice 60
2.7\u2002Summary 60
3: Information System Basics 61
3.1\u2002Introduction 61
3.2\u2002Data, Information, and Knowledge 61
3.3\u2002Information Systems and Their Components 62
3.3.1Systems and Subsystems 62
3.3.2Information Systems 62
3.3.3Components of Information Systems 63
3.3.4Architecture and Infrastructure of Information Systems 65
3.4\u2002Information Management 66
3.5\u2002Exercises 66
3.5.1On the Term Information System 66
3.5.2On Enterprise Functions 67
3.5.3On Application Components 67
3.5.4On Architectures and Infrastructures 67
3.5.5On Information Management 67
3.6\u2002Summary 67
4: Health Information Systems 69
4.1\u2002Introduction 69
4.2\u2002Hospital Information Systems 69
4.3\u2002Transinstitutional Health Information Systems 72
4.4\u2002Electronic Health Records as a Part of Health Information Systems 74
4.5\u2002Challenges for Health Information Systems 74
4.6\u2002Example 76
4.6.1\u2002Architecture of a Hospital Information System 76
4.7\u2002Exercises 77
4.7.1\u2002Hospital Information System as a System 77
4.7.2\u2002Buying a Hospital Information System 77
4.7.3\u2002Transinstitutional Health Information Systems 77
4.8\u2002Summary 78
5: Modeling Health Information Systems 79
5.1\u2002Introduction 79
5.2\u2002On Models and Metamodels 79
5.2.1Definitions 79
5.2.2Types of Models 81
5.2.2.1Functional Models 81
5.2.2.2Technical Models 82
5.2.2.3Organizational Models 82
5.2.2.4Data Models 84
5.2.2.5Business Process Models 85
5.2.2.6Information System Models 87
5.3\u2002A Metamodel for Modeling Health Information Systems on Three Layers: 3LGM虏 87
5.3.1UML Class Diagrams for the Description of 3LGM虏 88
5.3.23LGM虏-B 91
5.3.2.1Domain Layer 91
5.3.2.2Logical Tool Layer 94
5.3.2.3Physical Tool Layer 96
5.3.2.4Interlayer Relationships 98
5.3.33LGM虏-M 102
5.3.43LGM虏-S 103
5.4\u2002On Reference Models 104
5.5\u2002A Reference Model for the Domain Layer of Hospital Information Systems 106
5.6\u2002Exercises 107
5.6.1Typical Implementation of Hospital Functions 107
5.6.23LGM虏 as a Metamodel 107
5.6.3Modeling with 3LGM虏 108
5.6.3.1HIS Components 108
5.6.3.2Create the Model 108
5.6.3.3Interlayer Relationships 108
5.6.3.4New Enterprise Function 108
5.7\u2002Summary 109
6: Architecture of Hospital Information Systems 110
6.1\u2002Introduction 110
6.2\u2002Domain Layer: Data to Be Processed in Hospitals 110
6.2.1\u2002Entity Types Related to Patient Care 111
6.2.2\u2002Entity Types About Resources 112
6.2.3\u2002Entity Types Related to Administration 113
6.2.4\u2002Entity Types Related to Management 113
6.3\u2002Domain Layer: Hospital Functions 114
6.3.1\u2002Patient Care 114
6.3.1.1 Patient Admission 114
Appointment Scheduling 116
Patient Identification and Checking for Recurrent 116
Administrative Admission 116
Medical Admission 118
Nursing Admission 118
Visitor and Information Service 118
6.3.1.2\u2002Decision Making, Planning, and Organization of Patient Treatment 118
Decision Making and Patient Information 120
Medical and Nursing Care Planning 120
6.3.1.3\u2002Order Entry 121
Preparation of an Order 121
Appointment Scheduling 123
6.3.1.4\u2002Execution of Diagnostic, Therapeutic and Nursing Procedures 123
Execution of Diagnostic and Therapeutic Procedures 124
Execution of Nursing Procedures 125
6.3.1.5\u2002Coding of Diagnoses and Procedures 125
6.3.1.6\u2002Patient Discharge and Transfer to Other Institutions 126
Administrative Discharge and Billing 127
Medical Discharge and Medical Report Writing 127
Nursing Discharge and Nursing Report Writing 128
6.3.2\u2002Supply and Disposal Management, Scheduling, and Resource Allocation 128
6.3.2.1\u2002Supply and Disposal Management 128
Catering 128
Material and Medication Management 128
Laundry Management 128
Management of Medical Devices 130
6.3.2.2\u2002Scheduling and Resource Allocation 130
6.3.2.3\u2002Human Resources Management 130
6.3.3\u2002Hospital Administration 131
6.3.3.1\u2002Patient Administration 132
6.3.3.2\u2002Archiving of Patient Information 132
Opening of a Patient Record 133
Administration and Allocation of Patient Records 133
Long-Term Archiving 134
6.3.3.3\u2002Quality Management 134
Internal Quality Management 134
Performance of Legal Notification Requirements 135
6.3.3.4\u2002Cost Accounting 135
6.3.3.5\u2002Controlling 135
6.3.3.6\u2002Financial Accounting 136
6.3.3.7\u2002Facility Management 136
6.3.3.8\u2002Information Management3 136
Strategic Information Management 136
Tactical Information Management 139
Operational Information Management 139
6.3.4\u2002Hospital Management 139
6.3.5\u2002Research and Education 139
6.3.5.1\u2002Research Management 141
6.3.5.2\u2002Execution of Clinical Trials and Experiments 141
6.3.5.3\u2002Knowledge Retrieval and Literature Management 141
6.3.5.4\u2002Publishing and Presentation 141
6.3.5.5\u2002Education 141
6.3.6\u2002Clinical Documentation: A Hospital Function? 141
6.3.7\u2002Domain Layer: Exercises 142
6.3.7.1 Differences in Hospital Functions 142
6.3.7.2\u2002Different Health Care Professional Groups and Hospital Functions 142
6.3.7.3\u2002Support of Hospital Functions 142
6.3.7.4\u2002The Patient Entity Type 143
6.3.8\u2002Domain Layer: Summary 143
6.4 Logical Tool Layer: Application Components 145
6.4.1\u2002Patient Administration System 146
6.4.2\u2002Medical Documentation System 148
6.4.3\u2002Nursing Management and Documentation System 150
6.4.4\u2002Outpatient Management System 151
6.4.5\u2002Provider or Physician Order Entry System (POE) 153
6.4.6\u2002Patient Data Management System (PDMS) 155
6.4.7\u2002Operation Management System 157
6.4.8\u2002Radiology Information System 159
6.4.9\u2002Picture Archiving and Communication System (PACS) 160
6.4.10\u2002Laboratory Information System 162
6.4.11\u2002Enterprise Resource Planning System 163
6.4.12\u2002Data Warehouse System 164
6.4.13\u2002Document Archiving System 166
6.4.14\u2002Other Computer-Based Application Components 168
6.4.15\u2002Clinical Information System and Electronic Patient Record System as Comprehensive Application Components 169
6.4.16\u2002Typical Non-Computer-Based Application Components 170
6.4.16.1\u2002The Paper-Based Patient Chart System 170
6.4.16.2\u2002The Paper-Based Patient Record System 172
6.5\u2002Logical Tool Layer: Integration of Application Components 172
6.5.1\u2002Taxonomy of Architectures at the Logical Tool Layer 173
6.5.1.1\u2002Number of Databases: Central Versus Distributed 173
DB1 Style 174
DBn Style 174
Mixed DB1/DBn Style 175
6.5.1.2\u2002Number of Application Components: Monolithic Versus Modular 175
6.5.1.3\u2002Number of Software Products and Vendors: All-in-One Versus Best-of-Breed 176
6.5.1.4\u2002Communication Pattern: Spaghetti Versus Star 177
6.5.2\u2002Integrity 179
6.5.2.1\u2002Object Identity 179
6.5.2.2\u2002Referential Integrity 180
6.5.2.3\u2002Consistency 180
6.5.3\u2002Types of Integration 181
6.5.3.1\u2002Data Integration 181
6.5.3.2\u2002Semantic Integration 181
6.5.3.3\u2002Access Integration 182
6.5.3.4\u2002Presentation integration 182
6.5.3.5\u2002Contextual Integration 183
6.5.3.6\u2002Functional integration 183
6.5.3.7\u2002Process Integration 183
6.5.4\u2002Standards 184
6.5.4.1\u2002Health Level 7 (HL7) Version 2 184
6.5.4.2\u2002Health Level 7 (HL7) Version 3 186
6.5.4.3\u2002Digital Imaging and Communications in Medicine (DICOM) 187
6.5.4.4\u2002ISO/IEEE 11073 188
6.5.4.5\u2002Standard for Contextual Integration 188
6.5.4.6\u2002Integrating the Healthcare Enterprise (IHE) 188
6.5.4.7\u2002Electronic Data Interchange for Administration, Commerce, and Transport (EDIFACT) 189
6.5.4.8\u2002Clinical Document Architecture (CDA) 189
6.5.5\u2002Integration Technologies 190
6.5.5.1\u2002Federated Database System 190
6.5.5.2\u2002Transaction Management: 2-phase commit protocol and master application components 190
6.5.5.3\u2002Middleware 191
Message Exchange by Communication Servers 192
Remote Function Calls 194
Service-Oriented Architectures (SOAs) and Portals 195
6.5.6\u2002Logical Tool Layer: Example 196
6.5.6.1 Typical Realizations: Centralized, Monolithic and All-in-One HIS 196
6.5.7\u2002Logical Tool Layer: Exercises 198
6.5.7.1 Data Distribution Style at the Logical Tool Layer 198
6.5.7.2\u2002HIS Infrastructures 198
6.5.7.3\u2002A Paperless Hospital 201
6.5.7.4\u2002Introducing a Departmental Computer-Based Application Component 201
6.5.7.5\u2002Loose and Close Coupling 202
6.5.7.6\u2002Integrating Nursing Documentation 202
6.5.8\u2002Logical Tool Layer: Summary 202
6.6\u2002Physical Tool Layer: Physical Data-Processing Systems 203
6.6.1\u2002Servers and communication networks 204
6.6.2\u2002Clients 204
6.6.3\u2002Storage 205
6.6.4\u2002Typical Non-computer-Based Physical Data-Processing Systems 205
6.6.5\u2002Infrastructure 206
6.7\u2002Physical Tool Layer: Integration of Physical Data-Processing Systems 207
6.7.1\u2002Taxonomy of Architectures at the Physical Tool Layer 207
6.7.1.1\u2002Distribution of Computing Power: Mainframes vs. Client-Server 208
6.7.2\u2002Physical Integration 209
6.7.3\u2002Computing Centers 210
6.7.4\u2002Physical Tool Layer: Example 211
6.7.4.1 The Amount of Data to Be Processed at a Hospital\u2019s Computing Center 211
6.7.5\u2002Physical Tool Layer: Exercises 212
6.7.5.1 HIS Infrastructure 212
6.7.6\u2002Physical Tool Layer: Summary 212
6.8\u2002Summarizing Example 213
6.8.1 Health Information Systems Supporting Clinical Business Processes 213
Patient Treatment at a Physician\u2019s General Practice 213
Sec154_6 213
Arrival at ward 213
Nursing Admission 213
Medical Admission 214
Medical Care Planning and Order Entry 214
Execution of Diagnostic, Therapeutic, and Nursing Procedures 214
Review of Findings 215
Decision Making 215
Sec162_6 215
Transfer to Another Department 215
Discharge from Hospital and Aftercare 216
6.9\u2002Summarizing Exercises 216
6.9.1 Hospital Functions and Processes 216
6.9.2\u2002Application Components and Hospital Functions 216
6.9.3\u2002Multiprofessional Treatment Teams 217
6.9.4\u2002Information Needs of Different Health Care Professionals 217
6.9.5\u2002HIS Architectures 217
6.9.6\u2002Communication Server 217
6.9.7\u2002Anatomy and Physiology of Information Processing 217
6.10\u2002Summary 218
7: Specific Aspects for Architectures of Transinstitutional Health Information Systems 219
7.1\u2002Introduction 219
7.2\u2002Domain Layer 220
7.2.1\u2002Specific Aspects for Hospital Functions 220
7.2.1.1\u2002Patient Admission 220
7.2.1.2\u2002Decision Making, Planning, and Organization of Patient Treatment 221
7.2.1.3\u2002Execution of Diagnostic and Therapeutic Procedures 221
7.2.2\u2002Additional Enterprise Functions 222
7.3\u2002Logical Tool Layer 222
7.3.1\u2002Integration of Application Components 222
7.3.2Strategies for Electronic Health Record Systems 224
7.3.2.1The Provider-Centric Strategy 225
7.3.2.2The Patient-Centric Strategy 225
7.3.2.3The Regional- or National-Centric Strategy 226
7.3.2.4The Strategy of Independent Health Banks 226
7.4\u2002Physical Tool Layer 226
7.5\u2002Examples 227
7.5.1\u201cGesundheitsnetz Tirol (GNT)\u201d: The Tyrolean Health Care Network 227
7.5.1.1Background and Overall Functionality 227
7.5.1.2System Architecture and Workflows 227
7.5.1.3\u2002Important Lessons Learned 229
7.5.2\u2002Veterans Health Information Systems and Technology Architecture (VISTA)7 230
7.5.3\u2002The Hypergenes Biomedical Information Infrastructure 230
7.5.4\u2002The National Health Information System in Korea 231
7.6Exercises 232
7.6.1Challenges of Transinstitutional Health Information Systems 232
7.6.2Strategies for Transinstitutional Electronic Health Records 232
7.6.3\u2002The Term \u201cElectronic Health Record\u201d 233
7.6.4\u2002Transinstitutional Information Systems in other Sectors 233
7.7\u2002Summary 233
8: Quality of Health Information Systems 234
8.1\u2002Introduction 234
8.2\u2002Quality of Structures 235
8.2.1\u2002Quality of Data 235
8.2.2\u2002Quality of Computer-Based Application Components and Their Integration 236
8.2.3\u2002Quality of Physical Data Processing Systems 238
8.2.4\u2002Quality of the Overall HIS Architecture 239
8.2.5\u2002Exercises 239
8.2.5.1\u2002Quality Criteria in 3LGM虏 Models 239
8.2.5.2\u2002Quality of Computer-Based Application Components 240
8.2.5.3\u2002Usability of Software Products 240
8.2.5.4\u2002Quality of HIS Architectures 240
8.2.6\u2002Summary 240
8.3\u2002Quality of Processes 241
8.3.1\u2002Single Recording, Multiple Usability of Data 241
8.3.2\u2002No Transcription of Data 241
8.3.3\u2002Leanness of Information Processing Tools 241
8.3.4\u2002Efficiency of Information Logistics 243
8.3.5\u2002Patient-Centered Information Processing 243
8.3.6\u2002Exercises 244
8.3.6.1 Quality of Processes in an Intensive Care Unit 244
8.3.6.2\u2002Transcription of Data 244
8.3.6.3\u2002Leanness of Information Processing Tools 244
8.3.6.4\u2002Quality of Processes 244
8.3.7\u2002Summary 245
8.4\u2002Quality of Outcome 245
8.4.1\u2002Fulfillment of Hospital\u2019s Goals 246
8.4.2\u2002Fulfillment of the Expectations of Different Stakeholders 246
8.4.2.1\u2002Patients and Relatives 247
8.4.2.2\u2002Health Care Professionals 247
8.4.2.3\u2002Administrative Staff 247
8.4.2.4\u2002Hospital Management 248
8.4.3\u2002Fulfillment of Information Management Laws 248
8.4.4\u2002Exercises 249
8.4.4.1 Expectation of Patients and Relatives 249
8.4.4.2\u2002National Laws for Information Processing 249
8.4.5\u2002Summary 249
8.5\u2002Balance as a Challenge for Information Management 249
8.5.1\u2002Balance of Homogeneity and Heterogeneity 250
8.5.2\u2002Balance of Computer-Based and Non-Computer-Based Tools 250
8.5.3\u2002Balance of Data Security and Working Processes 251
8.5.4\u2002Balance of Functional Leanness and Functional Redundancy 252
8.5.5\u2002Balance of Documentation Quality and Documentation Efforts 252
8.5.6\u2002Exercises 253
8.5.6.1 Best-of-Breed Versus All-in-One 253
8.5.7\u2002Summary 253
8.6\u2002Evaluation of Health Information Systems Quality 254
8.6.1\u2002Typical Evaluation Phases 254
8.6.1.1\u2002Study Exploration 255
8.6.1.2\u2002First Study Design 256
8.6.1.3\u2002Operationalization of Methods and Detailed Study Plan 256
8.6.1.4\u2002Execution of Study 257
8.6.1.5\u2002Report and Publication of Study 257
8.6.2\u2002Typical Evaluation Methods 257
8.6.2.1 Quantitative Evaluation Methods 257
Time Measurements 257
Event Counting 258
Quantitative Questionnaires 258
8.6.2.2\u2002Qualitative Evaluation Methods 258
Qualitative Interviews 259
Qualitative Observations 259
Qualitative Content Analysis 259
8.6.2.3\u2002Special Evaluation Studies 259
8.6.3\u2002Exercises 260
8.6.3.1 Selection of Evaluation Criteria 260
8.6.3.2\u2002Planning of an Evaluation Study 260
8.6.3.3\u2002The Baby CareLink Study 261
8.6.4\u2002 Summary 261
8.7\u2002Summarizing Examples 261
8.7.1\u2002The Baldrige Health Care Information Management Criteria 261
8.7.2\u2002Information Management Standards of the Joint Commission 262
8.7.3\u2002The Baby CareLink Study18 263
8.7.4\u2002In-Depth Approach: The Functional Redundancy Rate 263
8.8\u2002Summarizing Exercises 268
8.8.1 Evaluation Criteria 268
8.8.2\u2002Joint Commission Information Management Standards 268
8.9\u2002Summary 268
9: Strategic Information Management in Hospitals 270
9.1\u2002Introduction 270
9.2\u2002Strategic, Tactical and Operational Information Management 271
9.2.1Information Management 271
9.2.2Information Management in Hospitals 274
9.2.3Strategic Information Management 275
9.2.4Tactical Information Management 276
9.2.5Operational Information Management 277
9.2.6Relationship Between IT Service Management and Information Management 279
9.2.7Example 281
9.2.7.1Typical Projects of Tactical Information Management 281
9.2.8Exercises 281
9.2.8.1Influences on HIS Operation 281
9.2.8.2Typical Projects of Tactical Information Management 281
9.2.8.3Diagnostics and Therapy of HIS 281
9.2.9Summary 282
9.3\u2002Organizational Structures of Information Management 282
9.3.1Chief Information Officer 282
9.3.2Information Management Department 284
9.3.3Example 284
9.3.3.1Organizational Structures for Information Management 284
9.3.4Exercises 285
9.3.4.1Information Systems Managers as Architects 285
9.3.4.2Organizational Structures for Information Management in a Hospital 286
9.3.4.3Centralization of Organizational Structures 286
9.3.4.4Organizational Structures for Information Management at PMC 286
9.3.5Summary 286
9.4\u2002Strategic Planning 287
9.4.1Tasks 287
9.4.1.1Aligning Business Plans and Information Management Plans 287
9.4.1.2Long-Term HIS Planning 288
9.4.1.3Short-Term HIS Planning 288
9.4.2Methods 289
9.4.2.1Strategic Alignment 289
9.4.2.2Portfolio Management 289
9.4.3The Strategic Information Management Plan 290
9.4.3.1Purpose of Strategic Information Management Plans 290
9.4.3.2Structure of Strategic Information Management Plans 292
Strategic Goals of the Hospital and of Information Management 292
Description of the Current State of the Hospital Information System 293
Analysis and Assessment of the Current State of the Hospital Information System 293
Description of the Planned State of the Hospital Information System 293
Migration Path from the Current to the Planned State 293
9.4.4Example 294
9.4.4.1Structure of a Strategic Information Management Plan 294
9.4.5Exercises 294
9.4.5.1Life Cycle of a Strategic Information Management Plan 294
9.4.5.2Deviation from a Strategic Information Management Plan 294
9.4.5.3Strategic Information Management and Strategic Hospital Management 294
9.4.5.4Establishing a Strategic Information Management Plan 296
9.4.6Summary 296
9.5\u2002Strategic Monitoring 296
Root 296
9.5.1Tasks 297
9.5.1.1Permanent Monitoring Activities 297
9.5.1.2Ad Hoc Monitoring Activities 298
9.5.1.3Certification of HIS 299
9.5.2Methods 300
9.5.2.1HIS Benchmarking 300
9.5.2.2HIS Certification 300
9.5.3Examples 301
9.5.3.1A HIS Benchmarking Report 301
9.5.3.2COBIT 301
Plan and Organize 303
Acquire and Implement 303
Deliver and Support 303
Monitor and Evaluate 303
9.5.3.3CCHIT Functional Quality Criteria 304
9.5.4Exercises 305
9.5.4.1An Information Processing Monitoring Report 305
9.5.4.2COBIT 305
9.5.4.3Most Relevant Key Performance Indicators 305
9.5.4.4Organizing User Feedback 305
9.5.5Summary 305
9.6\u2002Strategic Directing 306
9.6.1Tasks 306
9.6.2Methods 306
9.6.3Example 307
9.6.3.1Project Management Boards at PMC 307
9.6.4Exercise 307
9.6.4.1A Project Management Board at PMC 307
9.6.5Summary 307
9.7Last But Not Least: Education! 308
9.8\u2002Summarizing Examples 308
9.8.1Deficiencies in Information Management 308
9.8.2Computer Network Failures 309
9.8.3Information Management Responsibilities 310
9.8.4Safely Implementing Health Information and Converging Technologies 311
9.8.5Increased Mortality After Implementation of a Computerized Physician Order Entry System 312
9.9\u2002Summarizing Exercises 312
9.9.1Management of Other Information Systems 312
9.9.2Beginning and End of Information Management 312
9.9.3Cultivating Hospital Information Systems 313
9.9.4Hospital Information System Failure 313
9.9.5Increased Mortality 313
9.9.6Relevance of Examples 313
9.9.7Problems of Operational Information Management 313
9.10\u2002Summary 314
10: Strategic Information Management in Health Care Networks 316
10.1\u2002Introduction 316
10.2\u2002Description of Health Care Networks 317
10.3\u2002Organizational Structures of Information Management in Health Care Networks 317
10.3.1Centrality of Information Management in Health Care Networks 317
10.3.2Intensity of Information Management in Health Care Networks 319
10.4\u2002Types of Health Care Networks 319
10.5\u2002Example 320
10.5.1Regional Health Information Organizations 320
10.6Exercise 321
10.6.1The Pl枚tzberg Health Care Network 321
10.7\u2002Summary 321
11: Final Remarks 323
Thesaurus 325
Recommended Further Readings 358
Index 361
Series Preface 8
Preface for the 2nd Edition 9
Acknowledgements for the 2nd Edition 11
Acknowledgements for the 1st Edition 12
Annotation to the Figures 13
Contents 14
List of Figures 21
Figure Credits 31
List of Tables 33
About the Authors 35
1: Introduction 38
2: Health Institutions and Information Processing 40
2.1Introduction 40
2.2\u2002Significance of Information Processing in Health care 40
2.2.1\u2002Information Processing as Quality Factor 40
2.2.2Information Processing as Cost Factor 41
2.2.3Information as Productivity Factor 43
2.2.4Holistic View of the Patient 43
2.2.5Hospital Information System as Memory and Nervous System 44
2.3\u2002Progress in Information and Communication Technology 45
2.3.1Impact on the Quality of Health Care 45
2.3.2Impact on Economics 47
2.3.3Changing Health care 48
2.4\u2002Importance of Systematic Information Management 49
2.4.1Affected People and Areas 49
2.4.2Amount of Information Processing 50
2.4.3Sharing the Same Data 51
2.4.4Integrated Information Processing to Satisfy Information Needs 52
2.4.5Raising the Quality of Patient Care and Reducing Costs 53
2.4.6Basis of Systematic Information Processing 53
2.5\u2002Examples 54
2.5.1Knowledge Access to Improve Patient Care 54
2.5.2Nonsystematic Information Processing in Clinical Registers 55
2.5.3The WHO eHealth Resolution15 56
\u201cThe Fifty-Eighth World Health Assembly \u2026 57
2.5.4Estimated Impact of eHealth to Improve Quality and Efficiency of Patient Care 58
2.6\u2002Exercises 59
2.6.1Amount of Information Processing in Typical Hospitals 59
2.6.2Information Processing in Different Areas 59
2.6.3Good Information Processing Practice 60
2.7\u2002Summary 60
3: Information System Basics 61
3.1\u2002Introduction 61
3.2\u2002Data, Information, and Knowledge 61
3.3\u2002Information Systems and Their Components 62
3.3.1Systems and Subsystems 62
3.3.2Information Systems 62
3.3.3Components of Information Systems 63
3.3.4Architecture and Infrastructure of Information Systems 65
3.4\u2002Information Management 66
3.5\u2002Exercises 66
3.5.1On the Term Information System 66
3.5.2On Enterprise Functions 67
3.5.3On Application Components 67
3.5.4On Architectures and Infrastructures 67
3.5.5On Information Management 67
3.6\u2002Summary 67
4: Health Information Systems 69
4.1\u2002Introduction 69
4.2\u2002Hospital Information Systems 69
4.3\u2002Transinstitutional Health Information Systems 72
4.4\u2002Electronic Health Records as a Part of Health Information Systems 74
4.5\u2002Challenges for Health Information Systems 74
4.6\u2002Example 76
4.6.1\u2002Architecture of a Hospital Information System 76
4.7\u2002Exercises 77
4.7.1\u2002Hospital Information System as a System 77
4.7.2\u2002Buying a Hospital Information System 77
4.7.3\u2002Transinstitutional Health Information Systems 77
4.8\u2002Summary 78
5: Modeling Health Information Systems 79
5.1\u2002Introduction 79
5.2\u2002On Models and Metamodels 79
5.2.1Definitions 79
5.2.2Types of Models 81
5.2.2.1Functional Models 81
5.2.2.2Technical Models 82
5.2.2.3Organizational Models 82
5.2.2.4Data Models 84
5.2.2.5Business Process Models 85
5.2.2.6Information System Models 87
5.3\u2002A Metamodel for Modeling Health Information Systems on Three Layers: 3LGM虏 87
5.3.1UML Class Diagrams for the Description of 3LGM虏 88
5.3.23LGM虏-B 91
5.3.2.1Domain Layer 91
5.3.2.2Logical Tool Layer 94
5.3.2.3Physical Tool Layer 96
5.3.2.4Interlayer Relationships 98
5.3.33LGM虏-M 102
5.3.43LGM虏-S 103
5.4\u2002On Reference Models 104
5.5\u2002A Reference Model for the Domain Layer of Hospital Information Systems 106
5.6\u2002Exercises 107
5.6.1Typical Implementation of Hospital Functions 107
5.6.23LGM虏 as a Metamodel 107
5.6.3Modeling with 3LGM虏 108
5.6.3.1HIS Components 108
5.6.3.2Create the Model 108
5.6.3.3Interlayer Relationships 108
5.6.3.4New Enterprise Function 108
5.7\u2002Summary 109
6: Architecture of Hospital Information Systems 110
6.1\u2002Introduction 110
6.2\u2002Domain Layer: Data to Be Processed in Hospitals 110
6.2.1\u2002Entity Types Related to Patient Care 111
6.2.2\u2002Entity Types About Resources 112
6.2.3\u2002Entity Types Related to Administration 113
6.2.4\u2002Entity Types Related to Management 113
6.3\u2002Domain Layer: Hospital Functions 114
6.3.1\u2002Patient Care 114
6.3.1.1 Patient Admission 114
Appointment Scheduling 116
Patient Identification and Checking for Recurrent 116
Administrative Admission 116
Medical Admission 118
Nursing Admission 118
Visitor and Information Service 118
6.3.1.2\u2002Decision Making, Planning, and Organization of Patient Treatment 118
Decision Making and Patient Information 120
Medical and Nursing Care Planning 120
6.3.1.3\u2002Order Entry 121
Preparation of an Order 121
Appointment Scheduling 123
6.3.1.4\u2002Execution of Diagnostic, Therapeutic and Nursing Procedures 123
Execution of Diagnostic and Therapeutic Procedures 124
Execution of Nursing Procedures 125
6.3.1.5\u2002Coding of Diagnoses and Procedures 125
6.3.1.6\u2002Patient Discharge and Transfer to Other Institutions 126
Administrative Discharge and Billing 127
Medical Discharge and Medical Report Writing 127
Nursing Discharge and Nursing Report Writing 128
6.3.2\u2002Supply and Disposal Management, Scheduling, and Resource Allocation 128
6.3.2.1\u2002Supply and Disposal Management 128
Catering 128
Material and Medication Management 128
Laundry Management 128
Management of Medical Devices 130
6.3.2.2\u2002Scheduling and Resource Allocation 130
6.3.2.3\u2002Human Resources Management 130
6.3.3\u2002Hospital Administration 131
6.3.3.1\u2002Patient Administration 132
6.3.3.2\u2002Archiving of Patient Information 132
Opening of a Patient Record 133
Administration and Allocation of Patient Records 133
Long-Term Archiving 134
6.3.3.3\u2002Quality Management 134
Internal Quality Management 134
Performance of Legal Notification Requirements 135
6.3.3.4\u2002Cost Accounting 135
6.3.3.5\u2002Controlling 135
6.3.3.6\u2002Financial Accounting 136
6.3.3.7\u2002Facility Management 136
6.3.3.8\u2002Information Management3 136
Strategic Information Management 136
Tactical Information Management 139
Operational Information Management 139
6.3.4\u2002Hospital Management 139
6.3.5\u2002Research and Education 139
6.3.5.1\u2002Research Management 141
6.3.5.2\u2002Execution of Clinical Trials and Experiments 141
6.3.5.3\u2002Knowledge Retrieval and Literature Management 141
6.3.5.4\u2002Publishing and Presentation 141
6.3.5.5\u2002Education 141
6.3.6\u2002Clinical Documentation: A Hospital Function? 141
6.3.7\u2002Domain Layer: Exercises 142
6.3.7.1 Differences in Hospital Functions 142
6.3.7.2\u2002Different Health Care Professional Groups and Hospital Functions 142
6.3.7.3\u2002Support of Hospital Functions 142
6.3.7.4\u2002The Patient Entity Type 143
6.3.8\u2002Domain Layer: Summary 143
6.4 Logical Tool Layer: Application Components 145
6.4.1\u2002Patient Administration System 146
6.4.2\u2002Medical Documentation System 148
6.4.3\u2002Nursing Management and Documentation System 150
6.4.4\u2002Outpatient Management System 151
6.4.5\u2002Provider or Physician Order Entry System (POE) 153
6.4.6\u2002Patient Data Management System (PDMS) 155
6.4.7\u2002Operation Management System 157
6.4.8\u2002Radiology Information System 159
6.4.9\u2002Picture Archiving and Communication System (PACS) 160
6.4.10\u2002Laboratory Information System 162
6.4.11\u2002Enterprise Resource Planning System 163
6.4.12\u2002Data Warehouse System 164
6.4.13\u2002Document Archiving System 166
6.4.14\u2002Other Computer-Based Application Components 168
6.4.15\u2002Clinical Information System and Electronic Patient Record System as Comprehensive Application Components 169
6.4.16\u2002Typical Non-Computer-Based Application Components 170
6.4.16.1\u2002The Paper-Based Patient Chart System 170
6.4.16.2\u2002The Paper-Based Patient Record System 172
6.5\u2002Logical Tool Layer: Integration of Application Components 172
6.5.1\u2002Taxonomy of Architectures at the Logical Tool Layer 173
6.5.1.1\u2002Number of Databases: Central Versus Distributed 173
DB1 Style 174
DBn Style 174
Mixed DB1/DBn Style 175
6.5.1.2\u2002Number of Application Components: Monolithic Versus Modular 175
6.5.1.3\u2002Number of Software Products and Vendors: All-in-One Versus Best-of-Breed 176
6.5.1.4\u2002Communication Pattern: Spaghetti Versus Star 177
6.5.2\u2002Integrity 179
6.5.2.1\u2002Object Identity 179
6.5.2.2\u2002Referential Integrity 180
6.5.2.3\u2002Consistency 180
6.5.3\u2002Types of Integration 181
6.5.3.1\u2002Data Integration 181
6.5.3.2\u2002Semantic Integration 181
6.5.3.3\u2002Access Integration 182
6.5.3.4\u2002Presentation integration 182
6.5.3.5\u2002Contextual Integration 183
6.5.3.6\u2002Functional integration 183
6.5.3.7\u2002Process Integration 183
6.5.4\u2002Standards 184
6.5.4.1\u2002Health Level 7 (HL7) Version 2 184
6.5.4.2\u2002Health Level 7 (HL7) Version 3 186
6.5.4.3\u2002Digital Imaging and Communications in Medicine (DICOM) 187
6.5.4.4\u2002ISO/IEEE 11073 188
6.5.4.5\u2002Standard for Contextual Integration 188
6.5.4.6\u2002Integrating the Healthcare Enterprise (IHE) 188
6.5.4.7\u2002Electronic Data Interchange for Administration, Commerce, and Transport (EDIFACT) 189
6.5.4.8\u2002Clinical Document Architecture (CDA) 189
6.5.5\u2002Integration Technologies 190
6.5.5.1\u2002Federated Database System 190
6.5.5.2\u2002Transaction Management: 2-phase commit protocol and master application components 190
6.5.5.3\u2002Middleware 191
Message Exchange by Communication Servers 192
Remote Function Calls 194
Service-Oriented Architectures (SOAs) and Portals 195
6.5.6\u2002Logical Tool Layer: Example 196
6.5.6.1 Typical Realizations: Centralized, Monolithic and All-in-One HIS 196
6.5.7\u2002Logical Tool Layer: Exercises 198
6.5.7.1 Data Distribution Style at the Logical Tool Layer 198
6.5.7.2\u2002HIS Infrastructures 198
6.5.7.3\u2002A Paperless Hospital 201
6.5.7.4\u2002Introducing a Departmental Computer-Based Application Component 201
6.5.7.5\u2002Loose and Close Coupling 202
6.5.7.6\u2002Integrating Nursing Documentation 202
6.5.8\u2002Logical Tool Layer: Summary 202
6.6\u2002Physical Tool Layer: Physical Data-Processing Systems 203
6.6.1\u2002Servers and communication networks 204
6.6.2\u2002Clients 204
6.6.3\u2002Storage 205
6.6.4\u2002Typical Non-computer-Based Physical Data-Processing Systems 205
6.6.5\u2002Infrastructure 206
6.7\u2002Physical Tool Layer: Integration of Physical Data-Processing Systems 207
6.7.1\u2002Taxonomy of Architectures at the Physical Tool Layer 207
6.7.1.1\u2002Distribution of Computing Power: Mainframes vs. Client-Server 208
6.7.2\u2002Physical Integration 209
6.7.3\u2002Computing Centers 210
6.7.4\u2002Physical Tool Layer: Example 211
6.7.4.1 The Amount of Data to Be Processed at a Hospital\u2019s Computing Center 211
6.7.5\u2002Physical Tool Layer: Exercises 212
6.7.5.1 HIS Infrastructure 212
6.7.6\u2002Physical Tool Layer: Summary 212
6.8\u2002Summarizing Example 213
6.8.1 Health Information Systems Supporting Clinical Business Processes 213
Patient Treatment at a Physician\u2019s General Practice 213
Sec154_6 213
Arrival at ward 213
Nursing Admission 213
Medical Admission 214
Medical Care Planning and Order Entry 214
Execution of Diagnostic, Therapeutic, and Nursing Procedures 214
Review of Findings 215
Decision Making 215
Sec162_6 215
Transfer to Another Department 215
Discharge from Hospital and Aftercare 216
6.9\u2002Summarizing Exercises 216
6.9.1 Hospital Functions and Processes 216
6.9.2\u2002Application Components and Hospital Functions 216
6.9.3\u2002Multiprofessional Treatment Teams 217
6.9.4\u2002Information Needs of Different Health Care Professionals 217
6.9.5\u2002HIS Architectures 217
6.9.6\u2002Communication Server 217
6.9.7\u2002Anatomy and Physiology of Information Processing 217
6.10\u2002Summary 218
7: Specific Aspects for Architectures of Transinstitutional Health Information Systems 219
7.1\u2002Introduction 219
7.2\u2002Domain Layer 220
7.2.1\u2002Specific Aspects for Hospital Functions 220
7.2.1.1\u2002Patient Admission 220
7.2.1.2\u2002Decision Making, Planning, and Organization of Patient Treatment 221
7.2.1.3\u2002Execution of Diagnostic and Therapeutic Procedures 221
7.2.2\u2002Additional Enterprise Functions 222
7.3\u2002Logical Tool Layer 222
7.3.1\u2002Integration of Application Components 222
7.3.2Strategies for Electronic Health Record Systems 224
7.3.2.1The Provider-Centric Strategy 225
7.3.2.2The Patient-Centric Strategy 225
7.3.2.3The Regional- or National-Centric Strategy 226
7.3.2.4The Strategy of Independent Health Banks 226
7.4\u2002Physical Tool Layer 226
7.5\u2002Examples 227
7.5.1\u201cGesundheitsnetz Tirol (GNT)\u201d: The Tyrolean Health Care Network 227
7.5.1.1Background and Overall Functionality 227
7.5.1.2System Architecture and Workflows 227
7.5.1.3\u2002Important Lessons Learned 229
7.5.2\u2002Veterans Health Information Systems and Technology Architecture (VISTA)7 230
7.5.3\u2002The Hypergenes Biomedical Information Infrastructure 230
7.5.4\u2002The National Health Information System in Korea 231
7.6Exercises 232
7.6.1Challenges of Transinstitutional Health Information Systems 232
7.6.2Strategies for Transinstitutional Electronic Health Records 232
7.6.3\u2002The Term \u201cElectronic Health Record\u201d 233
7.6.4\u2002Transinstitutional Information Systems in other Sectors 233
7.7\u2002Summary 233
8: Quality of Health Information Systems 234
8.1\u2002Introduction 234
8.2\u2002Quality of Structures 235
8.2.1\u2002Quality of Data 235
8.2.2\u2002Quality of Computer-Based Application Components and Their Integration 236
8.2.3\u2002Quality of Physical Data Processing Systems 238
8.2.4\u2002Quality of the Overall HIS Architecture 239
8.2.5\u2002Exercises 239
8.2.5.1\u2002Quality Criteria in 3LGM虏 Models 239
8.2.5.2\u2002Quality of Computer-Based Application Components 240
8.2.5.3\u2002Usability of Software Products 240
8.2.5.4\u2002Quality of HIS Architectures 240
8.2.6\u2002Summary 240
8.3\u2002Quality of Processes 241
8.3.1\u2002Single Recording, Multiple Usability of Data 241
8.3.2\u2002No Transcription of Data 241
8.3.3\u2002Leanness of Information Processing Tools 241
8.3.4\u2002Efficiency of Information Logistics 243
8.3.5\u2002Patient-Centered Information Processing 243
8.3.6\u2002Exercises 244
8.3.6.1 Quality of Processes in an Intensive Care Unit 244
8.3.6.2\u2002Transcription of Data 244
8.3.6.3\u2002Leanness of Information Processing Tools 244
8.3.6.4\u2002Quality of Processes 244
8.3.7\u2002Summary 245
8.4\u2002Quality of Outcome 245
8.4.1\u2002Fulfillment of Hospital\u2019s Goals 246
8.4.2\u2002Fulfillment of the Expectations of Different Stakeholders 246
8.4.2.1\u2002Patients and Relatives 247
8.4.2.2\u2002Health Care Professionals 247
8.4.2.3\u2002Administrative Staff 247
8.4.2.4\u2002Hospital Management 248
8.4.3\u2002Fulfillment of Information Management Laws 248
8.4.4\u2002Exercises 249
8.4.4.1 Expectation of Patients and Relatives 249
8.4.4.2\u2002National Laws for Information Processing 249
8.4.5\u2002Summary 249
8.5\u2002Balance as a Challenge for Information Management 249
8.5.1\u2002Balance of Homogeneity and Heterogeneity 250
8.5.2\u2002Balance of Computer-Based and Non-Computer-Based Tools 250
8.5.3\u2002Balance of Data Security and Working Processes 251
8.5.4\u2002Balance of Functional Leanness and Functional Redundancy 252
8.5.5\u2002Balance of Documentation Quality and Documentation Efforts 252
8.5.6\u2002Exercises 253
8.5.6.1 Best-of-Breed Versus All-in-One 253
8.5.7\u2002Summary 253
8.6\u2002Evaluation of Health Information Systems Quality 254
8.6.1\u2002Typical Evaluation Phases 254
8.6.1.1\u2002Study Exploration 255
8.6.1.2\u2002First Study Design 256
8.6.1.3\u2002Operationalization of Methods and Detailed Study Plan 256
8.6.1.4\u2002Execution of Study 257
8.6.1.5\u2002Report and Publication of Study 257
8.6.2\u2002Typical Evaluation Methods 257
8.6.2.1 Quantitative Evaluation Methods 257
Time Measurements 257
Event Counting 258
Quantitative Questionnaires 258
8.6.2.2\u2002Qualitative Evaluation Methods 258
Qualitative Interviews 259
Qualitative Observations 259
Qualitative Content Analysis 259
8.6.2.3\u2002Special Evaluation Studies 259
8.6.3\u2002Exercises 260
8.6.3.1 Selection of Evaluation Criteria 260
8.6.3.2\u2002Planning of an Evaluation Study 260
8.6.3.3\u2002The Baby CareLink Study 261
8.6.4\u2002 Summary 261
8.7\u2002Summarizing Examples 261
8.7.1\u2002The Baldrige Health Care Information Management Criteria 261
8.7.2\u2002Information Management Standards of the Joint Commission 262
8.7.3\u2002The Baby CareLink Study18 263
8.7.4\u2002In-Depth Approach: The Functional Redundancy Rate 263
8.8\u2002Summarizing Exercises 268
8.8.1 Evaluation Criteria 268
8.8.2\u2002Joint Commission Information Management Standards 268
8.9\u2002Summary 268
9: Strategic Information Management in Hospitals 270
9.1\u2002Introduction 270
9.2\u2002Strategic, Tactical and Operational Information Management 271
9.2.1Information Management 271
9.2.2Information Management in Hospitals 274
9.2.3Strategic Information Management 275
9.2.4Tactical Information Management 276
9.2.5Operational Information Management 277
9.2.6Relationship Between IT Service Management and Information Management 279
9.2.7Example 281
9.2.7.1Typical Projects of Tactical Information Management 281
9.2.8Exercises 281
9.2.8.1Influences on HIS Operation 281
9.2.8.2Typical Projects of Tactical Information Management 281
9.2.8.3Diagnostics and Therapy of HIS 281
9.2.9Summary 282
9.3\u2002Organizational Structures of Information Management 282
9.3.1Chief Information Officer 282
9.3.2Information Management Department 284
9.3.3Example 284
9.3.3.1Organizational Structures for Information Management 284
9.3.4Exercises 285
9.3.4.1Information Systems Managers as Architects 285
9.3.4.2Organizational Structures for Information Management in a Hospital 286
9.3.4.3Centralization of Organizational Structures 286
9.3.4.4Organizational Structures for Information Management at PMC 286
9.3.5Summary 286
9.4\u2002Strategic Planning 287
9.4.1Tasks 287
9.4.1.1Aligning Business Plans and Information Management Plans 287
9.4.1.2Long-Term HIS Planning 288
9.4.1.3Short-Term HIS Planning 288
9.4.2Methods 289
9.4.2.1Strategic Alignment 289
9.4.2.2Portfolio Management 289
9.4.3The Strategic Information Management Plan 290
9.4.3.1Purpose of Strategic Information Management Plans 290
9.4.3.2Structure of Strategic Information Management Plans 292
Strategic Goals of the Hospital and of Information Management 292
Description of the Current State of the Hospital Information System 293
Analysis and Assessment of the Current State of the Hospital Information System 293
Description of the Planned State of the Hospital Information System 293
Migration Path from the Current to the Planned State 293
9.4.4Example 294
9.4.4.1Structure of a Strategic Information Management Plan 294
9.4.5Exercises 294
9.4.5.1Life Cycle of a Strategic Information Management Plan 294
9.4.5.2Deviation from a Strategic Information Management Plan 294
9.4.5.3Strategic Information Management and Strategic Hospital Management 294
9.4.5.4Establishing a Strategic Information Management Plan 296
9.4.6Summary 296
9.5\u2002Strategic Monitoring 296
Root 296
9.5.1Tasks 297
9.5.1.1Permanent Monitoring Activities 297
9.5.1.2Ad Hoc Monitoring Activities 298
9.5.1.3Certification of HIS 299
9.5.2Methods 300
9.5.2.1HIS Benchmarking 300
9.5.2.2HIS Certification 300
9.5.3Examples 301
9.5.3.1A HIS Benchmarking Report 301
9.5.3.2COBIT 301
Plan and Organize 303
Acquire and Implement 303
Deliver and Support 303
Monitor and Evaluate 303
9.5.3.3CCHIT Functional Quality Criteria 304
9.5.4Exercises 305
9.5.4.1An Information Processing Monitoring Report 305
9.5.4.2COBIT 305
9.5.4.3Most Relevant Key Performance Indicators 305
9.5.4.4Organizing User Feedback 305
9.5.5Summary 305
9.6\u2002Strategic Directing 306
9.6.1Tasks 306
9.6.2Methods 306
9.6.3Example 307
9.6.3.1Project Management Boards at PMC 307
9.6.4Exercise 307
9.6.4.1A Project Management Board at PMC 307
9.6.5Summary 307
9.7Last But Not Least: Education! 308
9.8\u2002Summarizing Examples 308
9.8.1Deficiencies in Information Management 308
9.8.2Computer Network Failures 309
9.8.3Information Management Responsibilities 310
9.8.4Safely Implementing Health Information and Converging Technologies 311
9.8.5Increased Mortality After Implementation of a Computerized Physician Order Entry System 312
9.9\u2002Summarizing Exercises 312
9.9.1Management of Other Information Systems 312
9.9.2Beginning and End of Information Management 312
9.9.3Cultivating Hospital Information Systems 313
9.9.4Hospital Information System Failure 313
9.9.5Increased Mortality 313
9.9.6Relevance of Examples 313
9.9.7Problems of Operational Information Management 313
9.10\u2002Summary 314
10: Strategic Information Management in Health Care Networks 316
10.1\u2002Introduction 316
10.2\u2002Description of Health Care Networks 317
10.3\u2002Organizational Structures of Information Management in Health Care Networks 317
10.3.1Centrality of Information Management in Health Care Networks 317
10.3.2Intensity of Information Management in Health Care Networks 319
10.4\u2002Types of Health Care Networks 319
10.5\u2002Example 320
10.5.1Regional Health Information Organizations 320
10.6Exercise 321
10.6.1The Pl枚tzberg Health Care Network 321
10.7\u2002Summary 321
11: Final Remarks 323
Thesaurus 325
Recommended Further Readings 358
Index 361
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