Realize a trustworthy health informationsystem

1. Realize a trustworthy health informationsystem Christoph Isele, Berlin, GermanyDagstuhl Seminar on Model-Based Design of Trustworthy Health Information Systems 12.2.2009

2. Why should I trust the information on a computer screen? • like the scholar in Goethe's Faust: • What we possess in black and white,We can in peace and comfort bear away. • or more analytic: • I trust the manufacturer / product • I trust the people running the system • I trust the colleagues who entered the reported information

3. Device My patientrecord affiliated hospital Hospital Information System Expert workplace legend of healthcare IT:no double entry of data

4. Realizing a HIS • Healthcare institution: design, build, run the information system • Software Vendor: design, build software products and devices • Responsibility (information management) • Data Privacy

6. where is the challenge ? • application in a HIS as “Colleague” • alert derived from (external) parameters • traceability of suggestions • interoperability with different stakeholders • different granularity of items • few control / feedback

7. Notice one • Most healthcare professionals are like craftsmen, they like tools or products that enhance their capacities. • Only few know what they need and this knowledge increases every week, so they never find the end. • The manufacturer designs a product and it growth on the customer feedback

8. Notice two • Standards, catalogues and master data are fine, but where do I find the right one? • User management has more user than HR has employees • Only a few percent of the drugs in the national list are used; some other are used too

9. Notice three • Most hospitals in “the developed countries” are in competition with other healthcare provider. • Goals, main focus and guidelines change from institution to institution • Every institution likes to tailor their tools (if they have at least some money)

10. Who is in charge for the health information system managed enterprise domain managed enterprise domain hospital information system negotiable collaboration domain LIS functionsvendoroperating department functions vendorservices participating care provider functions vendortailoring hospital operating hospital clinical information system well known application domain

11. Dedicated applications in manageable domains

12. Dedicated applications • Most part of information systems in healthcare are applications for experts • Input for the design are the requirements and the knowledge of experts(for standard applications a set of experts) • Sometimes it is difficult at the border to find the right level for the interface • Use the whole UML tool set, design at attribute level

13. Medical Device • Special form of an application for experts • Medical device directive (MDD): “the reversal of the burden of proof”the manufacturer has to calculate and minimize the risk of potential harm, he has to instruct how the device must be used. • Institution must have a responsible person that assures only trained people are working and they respect the instructions

14. Medical Device • Medical Device • strong focus on intended use • defined input • defined procedures, result • defined risk management • defined and trained user (expert) • defined environment (should be)

15. Hospital Information System • Focus on information retrieval and exchange • Requirement: broad and quick access • Different sources for information: data input by users, input of documents via communication network • 2nd scene: managing production

16. Health Information System • The institution • Establishes business processes / policies • Derives business rules / privileges • Identity management • Central managed: user identity, roles • Deal with delegation, shared user, guests • Privileges • In case of emergency breaking the privileges • “my patient”

17. Hospital information system • Data privacy • Role, function based privileges • Logging of access, change, transport, delete • Logging change / history of access rights • Logging of noticeable events • Data privacy for patients and employees

18. Hospital Information System Expert workplace Workplace for experts: IT as “colleague” or as “mentor” Device

19. Requirement for DS, WF • To guarantee that the assisting expert function get the necessary information • Customizing, tailoring and monitoring through systems engineer in the hospital • Standardization and interoperability established for documents, to do for data (complex structure, semantic) • Monitoring “data feed is alive”

20. Collaboration with documents • Business object “document” • consumer is a user • common analogy to the real world • basic model, known methods, basic concepts e.g. digital signature • basic categories in standards available • defined workflow • no real start for further automatic data processing

21. Collaboration • Business objects for data exchange • consumer is an application (algorithm) and acts only on this data • information is a consistent set of parameters(value, unit, timestamp, method, “author”) • today: bilateral cross checked interfaces • tomorrow: semantic, ontology

22. Device My patientrecord affiliated hospital Hospital Information System Expert workplace Expanding healthcare IT

23. health records for professionals • stipulation for the basic business process(revenue allocation, sponsored by marketing budged ?) • provider for a technical infrastructure (SLAs, professional services, HPC) • stipulation about joint treatment gives the foundation for information sharing (following data privacy in Germany)

24. Conclusion • In the end is the institution responsible for the health information system they use • And there will be an “architect” of the health institution, who builds the HIS • The “scientific community” should provide models and the vendors should provide the according parameters, so that architects can plan the HIS.

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