History of monolithic and modular health information systems A.Hasman

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

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

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

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

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

Current architecture From IT to ICT (LANs and WANs) Client-server architecture PC’s 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

Distributed systems

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

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

The Classic Mode of Development

Enter: the Knowledge Environment

Enter: Clinical Models

Knowledge-enabled Methodology