Community Health Information Network Research Articles

Lessons learned from three interorganizational health care information systems

The airline, financial, retail, consumer goods and cotton industries are not alone in their increased use of interorganizational information systems (IOSs). Health care organizations are investing and participating in a growing number of IOSs, such as community health information networks (CHINs) and integrated delivery systems (IDS). This paper examines the experiences of three CHIN systems located in the US — Midwest. Multiple data sources, including executive interviews, memoranda, internal documentation and system demonstrations, provided data for this research. The history of each case provides a better understanding of systems implementation and the underlying determinants that emerged as having significant impact. Not only do these findings provide guidelines and learning tools for practitioners, but they also hold implications to the field and its current position on bipolar streams in the literature. Lastly, our findings suggest that large health care infrastructures will continue to be confronted by the presence of the World Wide Web and electronic commerce.

How a community health information network is really used

How a community health information network is really used

Rationale and Design Considerations for a Semantic Mediator in Health Information Systems

Rapid development of community health information networks raises the issue of semantic interoperability between distributed and heterogeneous systems. Indeed, operational health information systems originate from heterogeneous teams of independent developers and have to cooperate in order to exchange data and services. A good cooperation is based on a good understanding of the messages exchanged between the systems. The main issue of semantic interoperability is to ensure that the exchange is not only possible but also meaningful. The main objective of this paper is to analyze semantic interoperability from a software engineering point of view. It describes the principles for the design of a semantic mediator (SM) in the framework of a distributed object manager (DOM). The mediator is itself a component that should allow the exchange of messages independently of languages and platforms. The functional architecture of such a SM is detailed. These principles have been partly applied in the context of the HELIOS object-oriented software engineering environment. The resulting service components are presented with their current state of achievement.

Adoption of security and confidentiality features in an operational community health information network: the Comox Valley experience—case example

Since 1993, a budding community health information network (CHIN) has been in operation in the Comox Valley in Canada. A general hospital and three multi-doctor clinics are linked electronically. The clinics operate without paper charts using a comprehensive clinic information system. The link is provided by RSALink, a commercial message exchange service, based on Health Link, a system developed at the University of Victoria (McDaniel et al., Can. Med. Inform. 1 (1994) 40–41; McDaniel, Dissertation, University of Victoria, Canada, 1994). Health Link is a highly adaptable message exchange service with rich functionality. Despite this, the system is used exclusively to receive laboratory results transmitted by the hospital's laboratory system (RSAStat 1 Rose Systems Applications, RSA, Victoria. 1 ). The results are deposited in the patient data base of a commercial clinic information system (CliniCare 2 CliniCare Corporation. 2 ). This case is instructive because the users' selection of services available through Health Link allows us to observe the preferences in this informational sophisticated environment. Laboratory data transmission is appreciated as highly beneficial. The reliability, security and ample privacy protection and authentication features of Health Link, in contrast, are used in a black box mode and are not consciously exploited. This is consistent with our experience of the use of other systems which have operated for a substantial time, essentially without serious protection features. Our experience suggests that security and confidentiality features are exploited only to the extent that they do not require additional effort or conscientious intervention. This puts the system provider in the difficult position of either offering interactive systems that nobody will use, or providing automated features that nobody is aware of and that are therefore not used to full advantage—if at all.

Chemung Valley Health Network: The Development of a Community Health Information Network

Chemung Valley Health Network: The Development of a Community Health Information Network

Community Health Information Networks and Intranets: Emerging Health Care Communication Models

Community health information networks (CHINs) are a hot topic in health care computing. With the goal of enabling efficient and improved patient care, a CHIN is created by the electronic integration of geographically dispersed health care-related information resources and repositories. Although few fully implemented CHINs are currently in place, the CHIN phenomenon promises to impact profoundly the health care industry. This article provides an overview of CHINs, focusing on technical and organizational aspects, the emerging use of as a means of achieving many of the goals of a CHIN, and the relevance of CHINs and intranets to to laboratorians.

Achieving Effective Medical Information Security: Understanding the Culture

Cet article decrit, du point de vue d'un clinicien generaliste, une solution pour l'implementation de dossiers concernant les patients en toute securite, ainsi que les strategies mises en place pour cette implementation. Cet article souligne donc l'importance de la securite pour la confidentialite de ces dossiers, mais aussi la difficulte de mettre en place un systeme de protection de l'information sur

Strategic constraints in health informatics: are expectations realistic?

In response to demands to enhance the efficiency and accountability of health systems, a range of different information technologies are being promoted. These technologies include integrated hospital systems, community health information networks and data repositories. However, the record of such technologies inside and outside the health industry suggest that such technologies cannot necessarily be relied on. The reason identified is that information systems are inherently logical and rational systems, and often come into conflict with the less rational social systems of organizations. Health information is identified in terms of three basic dimensions of information; that associated with managers; with professionals; and, with patients. The information of these dimensions are focused on very different objectives, have different structures and functions and are controlled by very different social processes. The information is also very complex and diverse within the dimensions. In the clinical encounter the clinician draws on specialist expertise, satisfies administrative requirements, and provides a clinical record. Thus, these dimensions converge at that point. However, collecting information is costly, and an efficient service demands economy in data collection. However, the technologies being promoted demand 'complete' data acquisition based on consistent and stable data definitions and data structures. The article argues that there is, thus, a conflict between the requirements of these technologies, and the realities of providing efficient services within a changing organizational, professional and social environment.

Protecting patient privacy and data quality in a community health information network.

The healthcare industry is under mounting pressure to cut costs without reducing the quality and quantity of healthcare services. One method to streamline operations is to implement community health information networks (CHINs). This article describes ways in which CHINs can offer subscribers improved efficiency, decreased costs, and improved patient care. It also addresses the fact that membership in a CHIN, if not controlled, greatly increases legal risks. Details on how many of these risks can be minimized or avoided are provided.

Swords and plowshares: Information technology for collaborative advantage

Competitors who view information technology exclusively as a strategic weapon for competitive advantage risk missing a valuable opportunity: the use of information technology in conjunction with competitors for collaborative advantage. Collaborative advantage is defined as the benefit gained by a group of participants as the result of their cooperation rather than their competition. The development of a community health information network by seven competing hospitals in Dayton, Ohio illustrates how information technology can provide such an advantage. It also provides lessons for information systems and other managers who might consider such a use of information technology for their organization. Finally, it suggests further research on the subject.

Two Steps Forward. One Step Back.

Participants at a community health information network in Glens Falls, N.Y., have come face-to-face with obstacles that could have meant the end to this rural health network that the New York Department of Health and the John A. Hartford Foundation helped launch more than two years ago. Instead, John Laliberte, Glens Falls Hospital's director of information systems, and the rest of the IS team are recovering from some setbacks and preparing to increase the CHIN's capabilities.

Will the Internet Supplant Community Health Networks?

As issues of security, accountability and access are resolved, the Internet will act as the central infrastructure for a global as well as a community health information network. It will help nurses extend their services to the community and to educate specific patient populations.

Community Health Information Networks: Creating the Health Care Data Highway

Community Health Information Networks: Creating the Health Care Data Highway

Community Health Information Networks

Community Health Information Networks

Laying the Foundation for Community Health Information Network Development

Duncan's article provides an insightful and comprehensive discussion of the nature, characteristics, and value of CHINs. CHINs would appear to provide great value to community efforts to improve the health status of their members. If the value is there, then why have so few CHIN efforts moved beyond the planning stages? According to Drazen and Staisor (1995), several factors interfere with CHIN development in a community: * The value has been difficult to quantify and has large externalities. The value often accrues more to the community than to the participating organizations. * Faced with the large capital requirements to establish a CHIN and unquantified benefits that have large externalities, organizations have been hesitant to redirect scarce capital and human resources to CHIN development. * Health care organizations are feeling competitive pressures that make it difficult for them to collaborate and to fund initiatives that benefit all rather than the organization differentially. * Organizations have difficulty resolving CHIN issues such as allocation of costs, data ownership, and governance structure. * Communities often lack a strong entity that can force collaboration and resolution of issues--for example, a strong, organized business coalition. CHIN DEVELOPMENT IN BOSTON Boston is such a community. The transformation of a community's culture and infrastructure to one that enables CHIN development can be a lengthy process. What can a community do in the interim to foster CHIN development and reduce the magnitude of the eventual task? One possibility is the pursuit of a strategy similar to the one currently underway in Boston--the creation of the Affiliated Health Information Networks of New England. The Affiliated Networks is sponsored by the Massachusetts Health Data Consortium (MHDC). MHDC is a not-for-profit organization dedicated to serving the needs of the community for health data collection and analysis. The Affiliated Networks Planning Committee is composed of the chief information officers (CIOs) of 21 managed care and provider organizations in the state. These organizations include academic medical centers, community hospitals, community health centers, HMOs, and insurance companies. The Planning Committee reports to a Governance Committee overseen by MHDC. The Governance Committee is composed of three provider and three payer representatives. The Planning Committee's charter is to initiate activities designed to: facilitate an effort to improve the state's healthcare information infrastructure by fostering the growth of a variety of health information in Massachusetts, building on systems already in place, while encouraging collaboration and standardization among those networks (MHDC 1994). To fulfill the charter, these activities should: * Address meaningful challenges faced by the participating organizations as they create their own health information * Leverage the power of numbers of organizations --that is, pursue initiatives where the collective pursuit of a challenge enhances the value of the solution or the ability to effect a solution * Address areas that the participating organizations do not view as a potential basis for competitive advantage * Not require the implementation of a specific technology or service. CHIN FOUNDATION INITIATIVES The Affiliated Networks have identified five joint initiatives: durable clinical data set, clinical data interchange standards, standardized provider dictionary, patient confidentiality, and electronic eligibility determination. Each initiative has a review board composed of members nominated by the participating organizations. DURABLE CLINICAL DATASET For any patient, there are a small number of clinical data elements that have long-term clinical utility--for example, allergies, chronic problems, and a precis of prior surgeries. …

Evolving Community Health Information Networks

A community health information network (CHIN) provides technology-based information services to help maintain optimal health for all the residents of a community. Defining features of a CHIN are that its services are available to all stakeholders and that competitors collaborate to share information. The initial impetus for a CHIN is usually to facilitate paying for health care or to share clinical records. Complex legal, organizational, funding, and control issues confront CHIN initiators, and reliable models do not exist today. During development, issues of program focus and technology selection arise, followed by concerns about information privacy and the CHIN's role in quality of care. Once basic capabilities are implemented, a mature CHIN can offer extensive cost-recovering health-related services to providers, related agencies, and consumers. Developments are underway that eventually will allow a CHIN to support a fully integrated longitudinal health record. A national network of mature CHINs would offer health care professionals further collaborative possibilities that could change the shape of future health care.