Chapter 8
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Gain a basic understanding of the core technologies
behind health care information systems:
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System software
Data management
Networks and data communications
Information processing distribution schemes
Internet, intranets, and extranets
Clinical and managerial decision support
Discuss emerging trends in information technology
(such as mobility, Web services, Internet, wireless).
Identify some of the major issues in the adoption of
information technologies in health care organizations.
Discuss why it is important for a health care
organization to adopt an overall information systems
architecture.
Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
Why IT/IS: Error Rates
• World-class competitiveness in
Manufacturing < 230 errors per million
opportunities
• Financial services < 5 errors per million
• Healthcare: 6000 –300,000 errors per million
–Healthcare errors are likely under reported
• malpractice threats
• practitioner confidentiality concerns
Error rates in healthcare are orders of
magnitude higher than in other industries
Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
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Core Technologies
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System Software
Data management and access
Networks and data communications
Information processing distribution schemes
Internet, intranets, and extranets
Clinical and managerial decision support
Trends in user interactions with systems
System Architecture
 A series of programs that carry out
basic computing functions
 Manage user interface, files and memory
 Operates peripherals
 Allows development of applications without
have to include basic computer instructions
 Operating Sytems (Personal
Systems)
 Proprietary
 Windows
 Mac OS
 Open source
 Linux
 Production Systems
 MVS
 UNIX
Interface Engine—a software program designed
to simplify the creation of management of
interfaces between applications systems (Altis, 2004)
 Relational Databases
 Relational Database Management System
(RDMS)
 Applications have three layers
 Interface
 Data manipulation
 Tables
 Object-oriented Database
 Object-oriented database management
system (OODBMS)
 Object-Relational Database management
system (ORDBMS)
 Data dictionaries—document data
definitions
 Clinical data repositories—large
databases that include data from a
variety of sources
 Data Warehouse and Data Mart
 Non-relational structure to facilitate “drill
down” retrieval
 Data mining—discovering patterns
in data
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Network Communication protocols
Network Types and Configurations
Network Media and Bandwidths
Network Communication Devices
Needed for communication among networked
computers an devices
 Open Standards Interconnection (OSI)
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 Seven Layers
 Conceptual model, not a set of actual specifications
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Internet Model—Transmission Control
Protocol/Internet Protocol (TCP/IP)
 Layered model
 Represents a set of actual protocol specifications at each
layer
 Other protocols
 Ethernet—Local Area Networks
 Asynchronous Transfer Mode (ATM)—fast
transmission speeds
 Bluetooth—wireless devices
 IEEE 802.11 (Wi-Fi)—popular for wireless
computers
 Local Area Network (LAN) vs. Wide
Area Network (WAN)
 LAN—devices are under the control of one
organization in the same geographic area
 WAN—an network that extends beyond a
LAN
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Topology
 Physical or Logical
 Example of Ethernet is a Physical “Star” and Logical
“Bus”
 Common Types
 Twisted pair wire (Category 5 most common)
 Coaxial cable (older)
 Fiber optic cable
 Microwave
 Spread spectrum
 Communications across WAN
require a service carrier
 POTS
 Leased line
 Integrated services digital network (ISDN)
 Purchased T-1 (or other) line
 Bandwidth = Capacity of the
transmission med1a
 Greater capacity = greater speed
 Rates expressed as bits per second
(bps)
 Hub—device in which data from the
network come together
 Bridge—connects neworks at the
data link layer; networks with the
same protocols
 Router—operates at the network
layer; help determine the
destination of data
 Gateway—connects networks with
different protocols; operates at or
above the transport level
 Switch—may be a gateway or a
router; all switches rout data to their
destinations
 Terminal to Host—dumb terminal
interacts with host computer
 File Server—application and
database are on one computer;
user’s computer gets data files from
file server
 Client/server—multiple servers with
specialized functions; client runs
application & server has data
 Every computer or device has a
unique Internet Protocol (IP)
address
 Use changed dramatically with the
introduction of Hypertext Transfer
Protocol (http) and the World Wide
Web (www)
 WWW
 Uniform Resource Locator (URL)
Example-- http://www.josseybass.com
 Web Browser
 Plug-ins
 Mark up languages
 HTML
 XML
 Other Protocols
 E-mail (smtp, pop3, imap)
 File Transfer (ftp)
 Internet telephoning (VoIP)
 Intranets
 Secure computer network that uses Internet
technologies, but is internal to an
organization
 Extranets
 Similar to intranets, but includes business
partners or the organization
 Web 2.0 is a range of Web-based
communities, services, and technologies,
including social-networking sites, wikis,
blogs, and messaging capabilities.
 The “2.0”reflects the view that this
collection represents the second
generation of Web technologies and
capabilities.
Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition
Wager ~ Lee ~ Glaser
 Decision Support Systems (DSS)
 Artificial Intelligence
 Three steps of Decision Making
 Intelligence
 Design
 Choice
 Problems are
 Structured
 Unstructured
 semistructured
 Transaction based systems use for
structured problems
 DSS is needed for semi and unstructured problems
 Stand alone generally has three
components
 Data Management Module—database, data
warehouse, clinical data repository
 Model Management Module—user selects
model to be applied to problem
 Dialog Module—the user interface
(Oz, 2004)
 A branch of computer science that is
devoted to emulating the human
mind
 Example: Google
 Multiple types
 Expert systems
 Natural language processing
 Neural networks
 Fuzzy logic
 Input Devices
 Output Devices
 External Storage Devices
 Mobile Personal Computing
Devices
 Standard—mouse & keyboard
 Other
 Trackball or trackpad
 Touch screens
 Source data input devices, such as bar coding
 Document Imaging
 Speech Recognition
 Computer Monitor
 Printer
 Speech
 Sequential
 Magnetic tape
 Direct Access
 Magnetic disks
 Floppy disks
 Zip drives
 RAID
 CDs & DVDs
 Optical tape
 Flash memory
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Personal Digital Assistants (PDAs)
Pocket PCs
Laptop computer
Tablet computer
Cellular phone combinations
 The coming together of an
information system is guided by the
IS architecture
 Consists of concepts, strategies, and
principles
 Platforms are specific vendors and
technologies
 Infrastructure generally refers to
networks and network applications
 Characteristics and Capabilities
 Architecture ensures organizationally defined
characteristics and capabilities
 Application Integration
 Best of Breed
 Monolithic
 Visual integration
It is important for health care organizations to
have thoughtful architecture discussions
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System Software
Data Management and Access
Networks and
Data Communications
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Network Communication protocols
Network Types & Configurations
Network Media & Bandwidth
Network Communication Devices
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Distribution Schemes
Internet
Intranets & Extranets
Decision Support
 Decision Support System
 Artificial Intelligence
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User Interactions
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Input Devices
Output Devices
External Storage Devices
Mobile Personal Computing
Information System Architecture
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Information Architecture and Technologies that Support