1. Engineering Medical Information Systems
Architecture, Data and Usability & Security
Jason Washo
SE516
University of Scranton

2. Authors Jens H. Weber-Jahnke Department of Computer Science
University of Victoria, Canada
Morgan Price
Department of Family Practice
University of British Columbia, Canada

3. Why Medical & IT?
Information technology professional in health insurance
Fortune 500 health care and insurance clients
Specialization in electronic medical records (article’s focus)
Hopes with incorporating experience and research into a graduate thesis
Always be a need for health care and life insurance
Medical school coming into area

4. Introduction
Sustainable health care systems highly depend on interoperable and effectively managed medical information systems (MISs)
The United States of America could save $81 billion annually by implementing or improving medical information systems
Not just the money, but the quality of care increases as well
Article targets software engineers with basic knowledge in the medical information technology field
The authors introduce the reader to essential methods and concepts for developing and maintaining these types of systems

5. Topics of Focus Architecture & Infrastructure
Health Data and Information / Clinical Knowledge
Usability
Privacy & Security

6. Architecture & Infrastructure
Taxonomy of MISs:
Clinical Point-Of-Care (POS)
Public Health Information Systems
Primary Care Systems (PCS)
Organizations w/ Function Standards/Models:
Health Level Seven (HL7)
HL7 Messaging Standards
HL7 Reference Information Model (RIM)
Clinical Document Architecture (CDA)
HL7 Development Framework
American Medical Informatics Association (AMIA)
OpenEHR
Health Level Seven (HL7), is an all-volunteer, not-for-profit organization involved in development of international healthcare standards. “HL7” is also used to refer to some of the specific standards created by the organization (i.e. HL7 v2.x, v3.0, HL7 RIM etc.). HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing and retrieval of electronic health information. The standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world.
openEHR is an international not-for-profit foundation, working towards making the interoperable, life-long electronic health record a reality and improving health care in the information society. It does this by developing open specifications, open-source software and knowledge resources engaging in clinical implementation projects; participating in international standards development; and supporting health informatics education

7. Architecture & Infrastructure
When engineering an MIS, two key aspects are considered during design:
Architecture (principles of design and construction)
Macroscopic Perspective
Health authorities
State, country, or international jurisdictions
Microscopic Perspective
Provisioning and maintaining single systems
Utilizing tools and key components of single systems
Infrastructure (collections of communication components )
Interoperability
Accommodation of evolving networks

8. Health Data & Information
Health Data Structures
Repository Design
Messaging
Health Data Coding Systems
LOINC (Logical Observation Identifiers Names and Codes )
SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms)
Health Data Representation
The combination of the database and messaging in order to provide data in way that:
High-quality decisions are made
Knowledge is transferred properly
LOINC (Logical Observation Identifiers Names and Codes) was developed to provide a definitive standard for identifying clinical information in electronic reports. The LOINC database provides a set of universal names and ID codes for identifying laboratory and clinical test results in the context of existing HL7, ASTM E1238, and CEN TC251 observation report messages.
SNOMED CT (Systematized Nomenclature of Medicine--Clinical Terms) is a comprehensive clinical terminology, originally created by the College of American Pathologists (CAP) and, as of April 2007, owned, maintained, and distributed by the International Health Terminology Standards Development Organization (IHTSDO), a non-for-profit association in Denmark.
The demand for timely, accurate personal health data is continuously growing. The increasing volume of generated health data from different sources creates new needs for a national, or international, future intergraded personal electronic health record (EHR).

9. Usability
Usability and ergonomics aspects needs consideration when designing the interaction portion MIS
The article mentions some frameworks and models concerning usability:
Human Computer Interaction (HCI) Frameworks
Enabling computers and humans to work together
Computer Supported Collaborative Work (CSCW) Model
Enabling humans to work cooperatively with use of computer
Both negative and positive sides to usability need consideration as well
Computer Supported Cooperative Work (CSCW) is a design-oriented academic field bringing together social psychologists, sociologists, and computer scientists, among others. Despite the variety of disciplines, CSCW is an identifiable research field focused on understanding characteristics of interdependent group work with the objective of designing adequate computer-based technology to support such cooperative work.

10. Privacy & Security
Since health information is highly confidential, the privacy and security of data in the MIS is another design consideration
Legislations and standards
Health Insurance Portability and Accountability Act (HIPAA)
Enforcement and design of security with usability

11. Conclusion Emerging area of the information technology industry
Many challenges still exist