American Health Information Management Association

Health IT and EHRs: Principles and Practice, Sixth Edition

Chapter 2: Information Systems Theory and

Development Life Cycle

Information System

A set of components that work together to achieve a common purpose

General Systems Theory

Systems theory is an interdisciplinary field of study that analyzes and describes how any group of objects work together to produce a result.

For example,

A car is a system of body parts, electrical and electronic elements, interior features, power train and chassis, and other components that, once fueled, results in a device that can transport humans and materials without exposure to weather elements

At a minimum, any system, including information systems, have:

Boundaries

Inputs

Processes

Outputs

Goal directedness

Goals

Examples of Systems

Mechanical systems – developed by humans but can operate without human intervention

Air conditioning systems (process) heat and cool (output) the air (input) to make humans comfortable (goal)

Human systems – organized relationships among people

Healthcare system brings together healthcare workers (input) to treat (process) patients (input) so their disease (input) is cured (output/goal)

Man–machine systems – operations that assist humans in the performance of their work

Filing system identifies the sequence in which paperwork (input) is to be arranged (process) for ease (goal) of later retrieval (output)

Closed versus Open Systems

Closed systems are those where all parts operate together without external influences. There is no feedback mechanism to enable adjustment to an environment

Open systems are affected by the environment, responding in ways that enable them to adapt to changes

Interoperability

Interoperability is the ability to exchange data among information systems.

While an EHR is a system of systems, the systems are generally limited to those supplied by a single vendor or use customized software to make connections with other systems

EHR systems are not as interoperable as desired with systems external to an organization, largely due to the proprietary nature of vendor software

However, open-source software, or software that is not proprietary to a given vendor does not necessarily produce interoperability. This is because the software can be used in a proprietary way that does not support interoperability.

Information Theory

Data Flow

Data Sources

Data Uses

Data Quality

Knowledge Creation

Best Practices

Information Theory (continued)

Data Flow

Data flows from a source via a transmitter that channels the data to a receiver in order to reach a destination

Data Sources

Data that generate information come from many sources

Data Uses

Data are used in many ways: as secondary data sources, for generating information, creating knowledge, and yielding wisdom

Data Quality

For information systems to be useful, the source data must be accurate

Knowledge Generation

Integrating data with the experience of the user (as an additional data source) is a relatively new function of information technology

Best Practices

As wisdom is generated with repeated creation of knowledge, it becomes a best practice

Data Flow

Data Uses

Vital Signs

Patient: Mary Smith

Data-Information-Knowledge Continuum

DATA

Basic facts and observations

INFORMATION

Data that have been organized & processed

KNOWLEDGE

Experience added to information

Temperature is 101.2 F

This is higher than yesterday

Higher temperature suggests infection

WISDOM

Repeated collection of data informed by experience

Best practice is to administer antibiotic

Data Quality

For data to contribute to meaningful information, it must be:

Accurate

Complete

Timely

Precise

Current

Granular

Relevant

Defined

Accessible

Consistent

Information Systems Theory

Explains how information, and ultimately knowledge and wisdom, are generated by data processed in predictable ways to contribute value. Information systems:

Use devices to capture data in multiple formats that are converted to a machine-processable state

Apply instructions (also converted into a machine-processable state) to index, store, calculate, compare, and perform other functions on the data

Use devices to display the original data at another time or place and present results of calculations, comparisons, and other functions to users in various formats

(Reason)

Role of Technology in Healthcare

No matter how well an information system, such as an EHR or other health IT is designed, it is still just a tool.

It can be designed to learn and predict, but it is incapable of heuristic thought, or having gut instincts.

Personal vigilance in the form of professional judgment must be applied to use these tools properly.

Characteristics of Information Systems

Hardware and software provide the equipment and computing instructions, but:

People – are the key reason for information systems to exist, but they often are the most difficult element of the system to manage.

Policy – refers to directives or principles upon which people perform their work; policies are needed to ensure information systems success.

Process – the manner in which a task is performed. Process change is one of the most significant factors in success or failure of EHRs.

People, Policy, and Process

Relationships between component parts (objects) and their properties (attributes)

Disparate parts must work together to process information and with all people who are stakeholders for a successful HER.

Unity of purpose causes the parts to have integrity.

Policies set the boundaries for adoption and realization of EHR benefits.

Feedback mechanisms provide information about environmental factors that interact with the successful functioning of the system.

Cybernetics

Theory of control in which systems accept input, process it, and produce output relative to sensors that monitor against standards and hence control processing and inputs to ensure the best possible results

Systems Development Life Cycle

Ensures a project is developed correctly and within time and budget constraints

Two perspectives:

Traditional SDLC has a specific beginning and ending point

Modern SDLC includes a feedback mechanism, especially important for complex projects, such as health IT, that require change over time

Traditional SDLC Methodology

Traditional SDLC Step 1: Feasibility

The existing (manual) system is evaluated and deficiencies are identified.

The result is the determination as to whether it makes sense to proceed with the project.

Traditional SDLC Step 2: Analysis

New (automated) system requirements are defined.

Deficiencies in the existing system are addressed with specific proposals for improvement.

Traditional SDLC Step 3: Design

The proposed system is designed.

Plans are laid out concerning:

Physical construction

Hardware

Operating systems

Programming

Communications

Security issues

Traditional SDLC Step 4: Implement

The new system is developed.

The new components and programs are obtained and installed.

Users of the system are trained in its use, and all aspects of performance are tested.

If necessary, adjustments are made at this stage.

Traditional SDLC Step 5: Test

The system is put into use.

The new system can be phased in, according to application or location, and the old system gradually replaced.

It may be more cost-effective to shut down the old system and implement the new system all at once.

Traditional SDLC Step 6: Maintain

When the new system is up and running for a while, it should be exhaustively evaluated.

Maintenance must be kept up rigorously at all times.

Users of the system and support documentation should be kept up-to-date concerning the latest modifications and procedures.

Modern SDLC

May be used for traditional projects such as information system vendor selection,

But also for workflow and process improvement, strategic planning, and many other types of projects

Especially useful for complex information systems, such as health IT

Modern SDLC

Identification of Need

Sets goals and defines expected benefits

Anticipates organizational changes

Identifies budgeting, scheduling, staffing, communications

Initiates change management

Aids cost-benefit analysis and assessment of financial feasibility

Specification of Requirements

Provides overview and engages all stakeholders

Delineates staff roles and responsibilities

Aids in performing process mapping to specify functional requirements

Identifies technical requirements

Plans project and risk management methodologies, including deliverables, controls, conversion, bridge technologies

Documents all aspects of planning

Aids staff development

Acquisition

Market research to understand what is available

Request for proposal

Due diligence for vendor of choice

Contract negotiation

Approval to acquire product

Financing

Implementation

Install, customize, and turn over to users for adoption

Issues management

Change control

Turnover strategy

Plan and carry out training

Plan and carry out testing

Install hardware and software, including communications and network components

Implement security controls

System build (including data modeling, table and file creation, template building, report development)

Data conversion

Go-live

Acceptance

Maintenance

Ongoing support to keep system current and accurate, including:

Software maintenance; such as patches, routine modifications, major upgrades, emergency changes, and renewal of subscriptions

Hardware upgrades and maintenance

Hardware and software inventories and license agreement maintenance

User preference changes

Disposal of out-of-date system components

Monitoring of Results

Provides the feedback mechanism to assess:

Whether intended goals and benefits of project are being met

What changes need to be made to either the components of the project or the goals and expected benefits

Monitoring involves:

Performance measurement

Benefits realization:

Return on investment

Provider and patient satisfaction

Outcomes assessment

Celebration

Course correction

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