Chapter 2

1. Chapter 2 Information Systems Theory and Life Cycle

2. General Systems Theory • A system is a set of elements that work together to achieve a common goal • A formal systems methodology ensures a more valid and reliable information system • At a minimum, an information system has: • Boundaries • Inputs • Processes • Outputs • Goal directedness • Goals

3. 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)

4. General Systems Theory • Systems can be characterized as being either deterministic or probabilistic • Deterministic system • Parts function according to a predictable relationship • Example: When an alarm clock is set, it will chime at the time specified • Probabilistic system • All relationships among the parts cannot be defined in advance • Example: Humans will eat, sleep, grow, and age, but no one can determine precisely how tall one will be or when one will die

5. General Systems Theory • Systems may also be classified as being closed or open • Closed • All parts operate together without external influences • Open • Parts of the system are impacted by or interact with the environment

6. Interoperability • Interoperability is the ability to exchange data among information systems • “Because EHRs are essentially a system of systems, they depend on being able to connect with many systems” • EHRs, therefore, should be open systems where they conform to open, or readily available, standards • However, “open systems” has come to mean that anyone may have access to the underlying software and frequently for free (“freeware”)

7. Information Theory Information Source Destination Example: Observation about a patient Channel Example: Sign of disease Transmitter Receiver Example: Medical record Example: Documentation, or report Example: Clinician, or monitoring device

8. Information Theory • Data Flow • Basic information theory describes the flow of data from an information source to its ultimate destination. • Data Sources • Input requires an information source. • In the case of health information, the source is generally an observation about a patient or a response to a question asked of the patient. • Data Uses • Information theory recognizes not only the flow of data, but also how data are used, how they may be converted to information, and how experience may be applied to the information to support the creation of knowledge.

9. Patient: Mary Smith Vital Signs Data-Information-Knowledge Continuum This patient has an infection. I will order an antibiotic KNOWLEDGE Experience added to information INFORMATION Data that have been organized & processed This is higher than yesterday DATA Basic facts and observations Temperature is 101.2 F

10. Data Quality • For data to contribute to meaningful information, it must be: • Accurate • Complete • Timely • Precise • Current • Granular • Relevant • Defined • Accessible • Consistent • For data to be processed into information by a computer, it must be structured data

11. 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 • Use devices to present the results of calculations, comparisons, and other functions to users in various formats

12. (Reason) Role of Technology in Healthcare • No matter how well an EHR 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 the tool properly

13. 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

14. 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 EHR • 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

15. 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

16. Systems Development Life Cycle • Purpose of systems and information systems theory is to appreciate the steps necessary to develop, or at least plan for implementing an EHR • Two perspectives: • Traditional SDLC from developer’s (e.g., vendor or self-developer) view • SDLC for project management where a system is acquired

17. Traditional SDLC Methodology Six steps: 1. Feasibility 2. Analysis 3. Design 4. Implement 5. Test 6. Maintain

18. 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

19. SDLC Step 2: Analysis • New (automated) system requirements are defined • Deficiencies in the existing system are addressed with specific proposals for improvement

20. SDLC Step 3: Design • The proposed system is designed • Plans are laid out concerning: • Physical construction • Hardware • Operating systems • Programming • Communications • Security issues

21. 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

22. 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

23. 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

24. SDLC for EHR Project Management Pharmacy System CPOE Spiral Model Initiation EMAR Initiation Initiation Planning Planning Planning Acquisition Acquisition Acquisition Implementation Implementation Implementation Operations Operations Operations Disposition Disposition Disposition

25. Initiation • Addresses feasibility (cost) and analysis (benefits) • Sets goals and defines expected benefits • Anticipates organizational changes • Identifies budgeting, scheduling, staffing, communications • Initiates change management

26. Planning • Provides overview and engages all stakeholders • Delineates staff roles and responsibilities • Process mapping to specify functional requirements • Identifies technical requirements • Plans project and risk management methodologies, including deliverables, controls, conversion, bridge technologies • Staff development • Documentation

27. Acquisition • Market research to understand what is available • Request for proposal • Due diligence for vendor of choice • Contract negotiation • Approval to acquire product • Financing

28. 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

29. Operations • Ongoing support to keep system current and accurate • Performance measurement • Benefits realization • Maintenance • Upgrades and patches • User preference changes

30. Disposition • Orderly transition from vendor to organization • May also include • Equipment obsolescence • Upgrading hardware and software • Ceasing to use, or rely as heavily upon, bridge, or interim, components • Example: Amount of bulk scanning may decrease considerable as more data are entered directly by users • Example: A standalone e-prescribing system adopted prior to EHR will no longer be used when full EHR incorporates e-prescribing

31. Conclusion • EHR is a system of systems, each having inputs, processes, outputs, boundaries, and goals to which the integration of systems is directed • A systematic approach to developing or acquiring an EHR is essential to ensure that all elements, including hardware, software, people, policies, and processes are in place and working successfully together to achieve the best possible results