![Introduction:
Healthcare Information Systems are defined as “Computerized
systems designed to facilitate the management and operation of
all technical (biomedical) and administrative data for the entire
healthcare system, for a number of its functional units, for a
single healthcare institution, or even for an institutional
department or unit” [9]. The employment of computers in the
healthcare sector can be traced back to the 1960s. During the
early 1970s, the first attempts to adopt HIS were made [10].
However, in the past, HIS initiatives were limited to the
automation of business processes related to (a) administration
and (b) healthcare tools and techniques related to various
medical procedures as: diagnostic, therapeutic and surgical.
During the 80s, innovative patterns in database designs and
applications related to HIS, concluded to developments in
planning and administration of the healthcare data. In parallel,
HIS also introduced low cost financial systems for hospitals
under 200 beds in size [11]. It should be noted that the early
computerized systems were limited in big hospitals and
government projects (military).
As the IT industry flourish the HIS technology was populated
with various network applications. The ‘net period with the
internet, intranet and extranet affected the communication of
data in hospitals especially in the 1990's. In the middle of the
same decade the interface engine emerged as a product to
support the integration of applications, as best-of-breed
applications became harder to manage [12]. New experience and
knowledge in applications such as Internet-based telemedicine,
personal health records, asynchronous healthcare
communication systems, m-health and picture archiving
communication systems (PACS) have been applied in the
healthcare sector [13]. The growth of the aforementioned
applications has lead to the development of healthcare services
that have been characterized as complex, redundant and](https://image.slidesharecdn.com/introductionhealthcareinformationsystemsaredefinedascomp-221018173725-49f64c59/85/IntroductionHealthcare-Information-Systems-are-defined-as-Comp-docx-1-320.jpg)
![transcriptive [14].
In shedding some light on the underlined services that exist in
healthcare organizations, we reviewed the normative on HIS
classification. Based on the services that HIS support,
Mantzana [7] categorized them into: (a) clinical, (b) non-
clinical, (c) pharmaceutical and (d) laboratory. The authors
adopt this classification and extend it, by proposing that the
patient record category should be added, as it refers to medical
records that can be maintained by the citizen or the health
professional. This category can be further broken down into (a)
Electronic Patient Records Systems (EPR), which are detailed
records of encounters between patients and their healthcare
providers and (b) Electronic Personal Health Records (ePHR)
that are citizen self-maintained health and healthcare records
Extensive and serious quality problems exist in health care
delivery processes, resulting in tremendous harms and losses to
stakeholders. An increasing concern for improving health care
quality has been expressed from both public and private
sectors [1]. Along with the initiate of health care industry
transformation, information technologies have been regarded as
promising tools in facilitating health care system restructuring
process [2], [3]. Hospitals are the major places where patients
receive health care services. In the United States, in particular,
public laws have been put into force aiming at promoting and
impelling health care institutions, especially for hospitals, to
adopt and implement such technologies [4].
In the past decades, there is a proliferating amount of studies
and investigations examining the impacts of different kinds of
HITs on health care quality. A number of literature reviews
were also performed in this field. However, the attempts that
have been made to synthesize the empirical evidence regarding
the impacts of HITs on care quality in hospital-related settings,
such as hospital intensive care units (ICUs), hospital emergency
departments (EDs), and medical offices, are rare. Therefore, a
systematic review of literature aiming at better understanding](https://image.slidesharecdn.com/introductionhealthcareinformationsystemsaredefinedascomp-221018173725-49f64c59/85/IntroductionHealthcare-Information-Systems-are-defined-as-Comp-docx-2-320.jpg)
![the current relationships between the use of HITs and health
care quality is needed.
For the purpose of the present review study, we define Health
Information Technologies (HITs) as technologies or systems
used to manage and share patients' health care information,
promote care quality, and enhance patient safety [5]. HITs can
be used by patients themselves for disease self-care [6]. In this
study, HITs that are substantially designed to be used in
hospital-related settings are our major concerns. Consistent
with [7], we deliberately included HITs that are widely used.
For example, electronic medical record (EMR), computerized
physician order entry (CPOE), and electronic medication
administration record (eMAR).
Health care quality was examined in four major areas: (1) health
care timeliness (i.e., the ability to provide timely health care),
including indicators such as inpatient length of stay, outpatient
waiting time; (2) health care effectiveness (i.e., the ability to
provide beneficial outcomes to patients), including indicators
such as patient health status after treatment, patient recovery
rate, and readmission rate; (3) personnel (e.g., care providers
and patients) adherence to health care; and (4) personnel
perception about the care quality, such as physicians'
satisfaction with the technology-augmented health care
processes.
The Information Technology in Healthcare track at HICSS
serves as a forum at which healthcare, computer science, and
information systems professionals can come together to discuss
issues related to the application of information technology in
healthcare. While the medical, technical, and managerial
perspectives each contributes to particular aspects of the health
care problems, the complexity of today's problems requires
more than one perspective. As a unique opportunity for cross-
disciplinary interaction, we hope this track will give our
conference participants and the readers of these proceedings’
new insights into the problems they face.](https://image.slidesharecdn.com/introductionhealthcareinformationsystemsaredefinedascomp-221018173725-49f64c59/85/IntroductionHealthcare-Information-Systems-are-defined-as-Comp-docx-3-320.jpg)
![HIS Interoperability And Service Oriented Architecture
Interoperability is becoming a central issue in the healthcare
agenda and researchers and vendors are focusing on ways to
address it [28]. Interoperability has been defined as the
capability to share and process information across systems,
regardless of their implementation structure (language and
platform) [29]. Healthcare interoperability is linked with a
variety of both technical and organizational issues such as the
diversity of applications and systems across departments and
the different attitudes and perceptions between
stakeholders [30]. Moreover, even thought healthcare
organizations invest in integration technologies, in many cases
perform point-to-point integration between solutions adding to
the lack of interoperability [31].
The different aspects of interoperability (Electronic Health
Records, messages, security, terminology and languages, data
types, information models, architectures, archetypes, standards,
etc.) are addressed by various initiatives. The aim of these
initiatives is not only to support data/information exchange, but
also to include meaning in them [32]. These peculiarities of HIS
make Service Oriented Architecture an adequate candidate to
solve the problem. Despite the significant benefits that SOA has
provided to other sectors [33], healthcare systems remain
laggards, thus, leaving scope for timeliness and novel research.
Service Oriented Architecture provides a framework for an
infrastructure to facilitate the interactions and communications
between services [33]. SOAs are more of a paradigm [34], or a
style of design [35] that concludes to an architecture. In other
words, SOA is a way of thinking about building software than a
software development technique [36]. From a technical
perspective SOA is an architectural paradigm for building
reusable Information Technology (IT) infrastructures. A service
infrastructure enables discovery, composition and invocation of
services thus applications are built using functionality from
available services. Furthermore, SOA is a way of providing](https://image.slidesharecdn.com/introductionhealthcareinformationsystemsaredefinedascomp-221018173725-49f64c59/85/IntroductionHealthcare-Information-Systems-are-defined-as-Comp-docx-4-320.jpg)
![availability of legacy functionality to remote clients,
implementing new business process models by utilizing existing
or third-party software assets thus minimizing the IT costs and
increasing innovation through IT investments [34]. From a
business perspective SOA can address issues raised from
different stakeholder groups as they interact between them.
Thus, SOA is becoming the de-facto approach to bridging the
gap between business models and software infrastructure and
flexibly supporting changing business needs [34].
As SOA is being adopted by the healthcare industry, collections
of services as well as specific services will be available for use,
so the main HIS system will incorporate among other the
different departments and external Web Services (WS) of the
pharmaceuticals, labs and patients [37], as seen in Figure 1. In
SOAs services aid integration of applications that were not
written with the intent to be easily integrated, as the is the case
in most HIS environments. In more detail, service-based
applications are developed as independent sets of interacting
services offering well-defined interfaces to their potential
users [33]. This is achieved by employing loosely coupled
distributed applications between transacting partners and it does
not involve fixed agreements before the use of an offered
service is permitted. Thus, adding to the flexibility that is
required in an interoperable HIS environment. Since the
location of a system providing services is transparent, these
acquired services may be hosted outside the organization, thus
increasing the integration between systems.
Figure 1. SOA and healthcare services
View All
SOA ability to provide services that are developed using
existing system capabilities decreases the amount of redundant
data and thus reduces IT costs. With SOA, system processing is
organized and represented as a set of services, which are made
available through a standard interface to the entire system [38].](https://image.slidesharecdn.com/introductionhealthcareinformationsystemsaredefinedascomp-221018173725-49f64c59/85/IntroductionHealthcare-Information-Systems-are-defined-as-Comp-docx-5-320.jpg)
IntroductionHealthcare Information Systems are defined as Comp.docx
- 1. Introduction: Healthcare Information Systems are defined as “Computerized systems designed to facilitate the management and operation of all technical (biomedical) and administrative data for the entire healthcare system, for a number of its functional units, for a single healthcare institution, or even for an institutional department or unit” [9]. The employment of computers in the healthcare sector can be traced back to the 1960s. During the early 1970s, the first attempts to adopt HIS were made [10]. However, in the past, HIS initiatives were limited to the automation of business processes related to (a) administration and (b) healthcare tools and techniques related to various medical procedures as: diagnostic, therapeutic and surgical. During the 80s, innovative patterns in database designs and applications related to HIS, concluded to developments in planning and administration of the healthcare data. In parallel, HIS also introduced low cost financial systems for hospitals under 200 beds in size [11]. It should be noted that the early computerized systems were limited in big hospitals and government projects (military). As the IT industry flourish the HIS technology was populated with various network applications. The ‘net period with the internet, intranet and extranet affected the communication of data in hospitals especially in the 1990's. In the middle of the same decade the interface engine emerged as a product to support the integration of applications, as best-of-breed applications became harder to manage [12]. New experience and knowledge in applications such as Internet-based telemedicine, personal health records, asynchronous healthcare communication systems, m-health and picture archiving communication systems (PACS) have been applied in the healthcare sector [13]. The growth of the aforementioned applications has lead to the development of healthcare services that have been characterized as complex, redundant and
- 2. transcriptive [14]. In shedding some light on the underlined services that exist in healthcare organizations, we reviewed the normative on HIS classification. Based on the services that HIS support, Mantzana [7] categorized them into: (a) clinical, (b) non- clinical, (c) pharmaceutical and (d) laboratory. The authors adopt this classification and extend it, by proposing that the patient record category should be added, as it refers to medical records that can be maintained by the citizen or the health professional. This category can be further broken down into (a) Electronic Patient Records Systems (EPR), which are detailed records of encounters between patients and their healthcare providers and (b) Electronic Personal Health Records (ePHR) that are citizen self-maintained health and healthcare records Extensive and serious quality problems exist in health care delivery processes, resulting in tremendous harms and losses to stakeholders. An increasing concern for improving health care quality has been expressed from both public and private sectors [1]. Along with the initiate of health care industry transformation, information technologies have been regarded as promising tools in facilitating health care system restructuring process [2], [3]. Hospitals are the major places where patients receive health care services. In the United States, in particular, public laws have been put into force aiming at promoting and impelling health care institutions, especially for hospitals, to adopt and implement such technologies [4]. In the past decades, there is a proliferating amount of studies and investigations examining the impacts of different kinds of HITs on health care quality. A number of literature reviews were also performed in this field. However, the attempts that have been made to synthesize the empirical evidence regarding the impacts of HITs on care quality in hospital-related settings, such as hospital intensive care units (ICUs), hospital emergency departments (EDs), and medical offices, are rare. Therefore, a systematic review of literature aiming at better understanding
- 3. the current relationships between the use of HITs and health care quality is needed. For the purpose of the present review study, we define Health Information Technologies (HITs) as technologies or systems used to manage and share patients' health care information, promote care quality, and enhance patient safety [5]. HITs can be used by patients themselves for disease self-care [6]. In this study, HITs that are substantially designed to be used in hospital-related settings are our major concerns. Consistent with [7], we deliberately included HITs that are widely used. For example, electronic medical record (EMR), computerized physician order entry (CPOE), and electronic medication administration record (eMAR). Health care quality was examined in four major areas: (1) health care timeliness (i.e., the ability to provide timely health care), including indicators such as inpatient length of stay, outpatient waiting time; (2) health care effectiveness (i.e., the ability to provide beneficial outcomes to patients), including indicators such as patient health status after treatment, patient recovery rate, and readmission rate; (3) personnel (e.g., care providers and patients) adherence to health care; and (4) personnel perception about the care quality, such as physicians' satisfaction with the technology-augmented health care processes. The Information Technology in Healthcare track at HICSS serves as a forum at which healthcare, computer science, and information systems professionals can come together to discuss issues related to the application of information technology in healthcare. While the medical, technical, and managerial perspectives each contributes to particular aspects of the health care problems, the complexity of today's problems requires more than one perspective. As a unique opportunity for cross- disciplinary interaction, we hope this track will give our conference participants and the readers of these proceedings’ new insights into the problems they face.
- 4. HIS Interoperability And Service Oriented Architecture Interoperability is becoming a central issue in the healthcare agenda and researchers and vendors are focusing on ways to address it [28]. Interoperability has been defined as the capability to share and process information across systems, regardless of their implementation structure (language and platform) [29]. Healthcare interoperability is linked with a variety of both technical and organizational issues such as the diversity of applications and systems across departments and the different attitudes and perceptions between stakeholders [30]. Moreover, even thought healthcare organizations invest in integration technologies, in many cases perform point-to-point integration between solutions adding to the lack of interoperability [31]. The different aspects of interoperability (Electronic Health Records, messages, security, terminology and languages, data types, information models, architectures, archetypes, standards, etc.) are addressed by various initiatives. The aim of these initiatives is not only to support data/information exchange, but also to include meaning in them [32]. These peculiarities of HIS make Service Oriented Architecture an adequate candidate to solve the problem. Despite the significant benefits that SOA has provided to other sectors [33], healthcare systems remain laggards, thus, leaving scope for timeliness and novel research. Service Oriented Architecture provides a framework for an infrastructure to facilitate the interactions and communications between services [33]. SOAs are more of a paradigm [34], or a style of design [35] that concludes to an architecture. In other words, SOA is a way of thinking about building software than a software development technique [36]. From a technical perspective SOA is an architectural paradigm for building reusable Information Technology (IT) infrastructures. A service infrastructure enables discovery, composition and invocation of services thus applications are built using functionality from available services. Furthermore, SOA is a way of providing
- 5. availability of legacy functionality to remote clients, implementing new business process models by utilizing existing or third-party software assets thus minimizing the IT costs and increasing innovation through IT investments [34]. From a business perspective SOA can address issues raised from different stakeholder groups as they interact between them. Thus, SOA is becoming the de-facto approach to bridging the gap between business models and software infrastructure and flexibly supporting changing business needs [34]. As SOA is being adopted by the healthcare industry, collections of services as well as specific services will be available for use, so the main HIS system will incorporate among other the different departments and external Web Services (WS) of the pharmaceuticals, labs and patients [37], as seen in Figure 1. In SOAs services aid integration of applications that were not written with the intent to be easily integrated, as the is the case in most HIS environments. In more detail, service-based applications are developed as independent sets of interacting services offering well-defined interfaces to their potential users [33]. This is achieved by employing loosely coupled distributed applications between transacting partners and it does not involve fixed agreements before the use of an offered service is permitted. Thus, adding to the flexibility that is required in an interoperable HIS environment. Since the location of a system providing services is transparent, these acquired services may be hosted outside the organization, thus increasing the integration between systems. Figure 1. SOA and healthcare services View All SOA ability to provide services that are developed using existing system capabilities decreases the amount of redundant data and thus reduces IT costs. With SOA, system processing is organized and represented as a set of services, which are made available through a standard interface to the entire system [38].
- 6. All departments can use the interface and be aware of valuable data or unwanted processing redundancies. A workflow consists of specific applications. The applications can be analyzed in different services and each service communicates with the systems to which it is related. In more detail, HIS users gain an economy of resources as they no longer need to switch among systems to fulfill a workflow. Also, data is logically synchronized across processes and supporting systems proving reusability and flexibility of services. As a result, the level of interoperability among the healthcare organization's processes and people is increased as orchestrated services are aligned with user workflows. Thus, organizations can focus their efforts from maintaining a complex data interface strategy to creating SOA applications that support interoperability and enhances the quality of healthcare services.