Traditional IT development approaches such as systems development life-cycle (SDLC) methods and functional team IT organization were outdated long before the advent of the digital economy. In response to the drawbacks of the traditional IT development approaches, various alternative systems development methods such as rapid application development (RAD) and object-oriented systems development were introduced in 1990s. Due to its relative popularity, there are a large number of evaluation studies on clinical decision support systems (CDSS). Kaplan (Kaplan, 2001) reviewed studies focusing on the evaluation of CDSS, with the main emphasis upon changes in clinical performance and systems that could improve patient
care. Kaplan’s study includes many evaluations of CDSSs using designs based on laboratory experiments or Randomized Controlled Clinical Trials (RCTs).
Delpierre et al. (Delpierre et al., 2004) reviewed studies of computer-based patient record systems (CBPRS). The objective of their review was to carry out a systematic survey of studies analyzing the impact of CBPRS on medical practice, quality of care, and user and patient satisfaction. Tan with Sheps (Tan & Sheps, 1998) use the term health decision support systems (HDSS) and, more specifically, clinical decision support systems and expert systems (CDSS/ES) to characterize many HIS applications. A group health decision support system (gHDSS) combines analytic modeling, network communications, and decision technology to support group decision-making processes such as group strategic thinking, problem formulation, and generation of goal-seeking solutions. This technology has the potential to increase the efficiency, effectiveness, and productivity of group interactions through asynchronous board meetings, on-line forums, or special group meetings in which board members and executives can network and share information with one another without being completely constrained by separation in time and geographical distance. Intelligent decision support systems (IDSS) are basically DSS that have an intelligent component,
which either replaces or enhances the model subsystem. In past years, some proposals for intelligent and agent-based decision support systems (e.g. Kebair & Serin, 2006; Liu et al., 2006; Sokolova, 2009) have been described. New approaches of researching IDSS appear following the rapid progress of agent systems and network technology
A strategy to reduce medication error is to implement Electronic Prescribing Decision Support Systems (EPDS) (Ayres et al., 2006). In a clinical business context, EPDS should be a core function of a point of care clinical system but software vendors tend to develop it as either a standalone system or an additional module to a point-of-care clinical system. Starting with the requirements for semantic interoperability derived from paradigm changes for health systems and their supporting health information systems, the need of an architectural approach for analyzing, designing, implementing, and maintaining advanced, sustainable, semantically interoperable HIS has been shown. The weakest aspect in the evaluated architectural approaches for HIS development was the lack of a formal architecture development methodology covering the complete architecture lifecycle, and a clearly defined development process describing tasks, work products, roles, workflows, etc. The Rational Unified Process (RUP) (Kruchten, 2003) was found to be the most comprehensive source of methods and processes for system development, including architecture development. This development process constitutes the better approach to complete the HIS-DF, providing details on how to deliver a sound architecture description. HIS-DF tasks, responsible persons, products, guidance, phases, and workflows are described specializing (tailoring) the RUP process. RUP facilitates the flexibility, scalability and reusability of the methodology by describing method components and providing guidance and tooling for creating reusable Method Content (RUP Plug-ins) and documenting the methodology through exportableWeb pages and XMI files.
Semantic interoperability is a basic challenge to be met for new generations of distributed, communicating and cooperating health information systems enabling shared care and e-health. Analysis, design, implementation and maintenance of such systems and intrinsic architectures have to follow a unified development methodology. The Generic Component Model (GCM) (Lopez & Blobel, 2009) is used as a framework for modeling any system to evaluate and harmonize state of the art architecture development approaches and standards for health information systems as well as to derive a coherent architecture development framework for sustainable, semantically interoperable HIS and their components. The proposed methodology is based on the Rational Unified Process (RUP), taking advantage of its flexibility to be configured for integrating other architectural approaches such as Service-Oriented Architecture (SOA), Model-Driven Architecture (MDA), ISO 10746, and HL7 Development Framework (HDF).
Health Information Systems: Concepts, Methodologies, Tools and Applications
Joel J. P. C. Rodrigues Instituto de Telecomunicações, Portugal & University of Beira Interior,
Covilhã, Portugal
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