Old dog, New tricks

Old Dog

 

I’m an old dog. But one which just learned new tricks. Pauline already had her FB account before HI201, I didn’t. Now I do, along with twitter, a Slideshare account and a WordPress blog thanks to Prof. Iris. Of the four, I am most fond of my blog site.

WordPress gave me the opportunity to put my thoughts into words and have these words be read. The blogs, with each week’s driving question enabled me to focus my learning. It’s an eye opener for me. The power of social media is something which I have yet to fully utilize. If I put more effort, I could probably reach out to have more people read whatever it is that I have to say. As is, I fear the comment of a mentor of mine – Always have substance in what you say, do not suffer from “a diarrhea of words but a constipation of ideas.” With this in mind, I set out to write my blogs.

It was uplifting to have some interaction from several people because of what I’ve written or presented. In my blog, “Building the foundation for sustainability” Eva said, “Clear, concise and direct to the point. Easy to understand.” In my Slideshare presentation, “Challenges of implementing EHR in a private hospital” Grace said, “Nice presentation, could relate even as end user.” In my blog, “Gear up for change”, Wendi said, “There is hope for health informatics in our country” because of the statistics that I presented. In my blog, “What’s in it for me?” Prof. Iris said, “Yup, that question needs answering.” After reading my blog about a health game app, Sid said it was a nice idea and that he’s “thinking of mashing experienced game developers with health professionals.” I received several likes for my posts from classmates JayC, Wendi, Lyndon, Pauline and Arjhei as well as Prof. Iris and Prof. Eloy. But I also got some from people who were not classmates, namely Raymonde Uy, Philip Sales and Tony Evangelista. In the Basecamp discussion with Prof. Mike, I asked, “Has there been any well documented research that demonstrates that EHR implementation improves clinical results in patient care?” I ended up answering my own question thru a journal review and got a thumbs up from Prof. Mike because of the effort.

On my part, I commented that I liked how Burr is able to put his experiences as a nurse in an IT department into the discussion of the various topics. This is the gist of how graduate studies should be – the sharing of one’s experiences for everyone to learn from. This is what separates us from college students, a wealth of experience and practical knowledge that we could share to put realities into theoretical discussions. I also commented on a post of Wendi about how I agreed with her regarding design-reality gaps and a diagram of hers which gave me an “aha” moment, her simplified diagram of health informatics, eHealth and global health. In a blog post, Pauline and I had a discussion about not being into games. Her blog mentioned about the ills of video game playing on eyesight, but I can see video games helping out athletes. I pose this question, “Is there any medical condition in which video games could be used by your patients to develop focusing ability, hand eye coordination and peripheral vision or does it always lead to eye strain?”

Here’s a shot of my Slideshare stats to document my interaction in this area. Most of the views I received were from my discussion on interoperability of disparate information systems. I did some research and made a diagram as to the methods that could be applied for different systems to talk to each other.

 

Stats

 

As I’ve mentioned earlier, I espouse the idea of the KISS principle – keep it simple stupid. In one of my blogs I quoted Einstein, “If you can’t explain it simply, you don’t understand it well enough.” We were asked to use mind maps early on and I continued to use mind maps even when I was not required to do so. My mind maps were my personal thoughts, not ones which I found on textbooks. They enabled me to put it all out there and at the same time gather all my thoughts so that I could explain them simply. What I found after several posts was that if you asked me to put all my mind maps in one big sheet I could connect all the dots with some alterations. I could sum up everything I learned in this one semester in one big mind map!

It has been a fruitful semester for me. If I could make a suggestion to Prof. Iris, why not make a compilation of the most thought-provoking blogs of MSHI students past and present? If I have a fault, it would be that I did not have the time to read all of my classmates posts due to time constraints. Given more time, I would. Not being social media savvy and partly because I’m OC, I was even averse to posting comments without first figuring out where the edit button was.

During the semester, Peter and I came upon a word which got me thinking, “metacognition.” Its definition is “a higher-order thinking that enables understanding, analysis, and control of one’s cognitive processes, especially when engaged in learning.” I’d like to achieve that status. I do recall some posts of Franco and Prof. Iris about learning which I found interesting. Graduate studies is about self-directed learning. In some ways, I found it to be “learning for learning’s sake” yet learning with a goal in mind. In my Slideshare, I posted, “Never ending student of life’s lessons.” We are all students and will remain to be.

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Health Games

Instead of hunger games, let’s play health games. To start things off, I am not a game player so I am not familiar with the  games which are available in the market nor the ways games are played. But I listened to Sid Cardenas talk about his health game app, Gobbles and this is where I would like to go with this blog.

Driving question: “Can games improve health?”

There are lots of game applications in development as therapies in mental health, rehabilitation medicine and chronic disease monitoring as well as physical fitness. In the previous Mobile Health Congress, Zynga and FourSquare were recognized as the most popular gamification platforms. These games utilized points or badges to reward individuals as they accomplish certain milestones or surpass the achievements of fellow game players. The idea was to get yourself from point A to point B in terms of physical fitness or a health condition and get rewarded, part of that reward was the health benefits you derived by utilizing the game platform.

During his webinar, Sid talked of the gamification of health and game-based learning. According to gamification.org, gamification is “the concept of applying game mechanics and game design techniques to engage and motivate people to achieve their goals. ” According to Sebastian Deterding,  it means applying elements and design concepts from games to other contexts that are not themselves games. Game-based learning utilizes the elements of competition, player engagement and immediate rewards to answer the learning objective.

Our assignment is to evaluate a health related game app for the topic of gamification of health. I’d like to take a different path and describe a game idea taking up from Sid’s game-based learning app. Aside from Gobbles, Sid developed a game, Pharmageddon which involved battling pathogens with the right drugs. In a similar vein, my game concept is Kid Doc, a simulation interactive application which stimulates health learning for kids. My game idea and evaluation comes from a kiddie TV show seen in Disney Junior, Doc McStuffins, which is about a 6-yr-old girl aspiring to be a doctor. She communicates with and heals stuffed animals and toys with playmates Lambie, Stuffy and Chilly. Many TV shows end up as games, this one did as a web-based online game with mixed reviews because of its limitations.

 

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Kids have always been playing doctor for the longest time. Parents and children see doctors as good role models. I’d like to go a step further and look into the concept of an educational game which incorporates doctor role simulation, imaginative play, problem solving, building up on general health knowledge while strengthening values such as caring for others , helping out one another and rising up from failure.

Think of a game which mashes Dr. Doogie Hawser from the TV series, Lara Croft of Tomb Raider fame and  Dora the Explorer and that’s the concept. My game app, Kid Doc could be set up to be adaptable to cater to all skill levels using selectable difficulty levels. The game should be set up to be intellectually demanding yet appropriate to the user’s age level.

The image model of the game is that of small girl however, this could be set up differently with game settings. The player would be randomly assigned a health scenario and a problem which must be solved. She could be battling viruses, bacteria, parasites, worms etc. Background scenes could be anatomical regions such as the respiratory system and pneumonia, tonsils and tonsillitis as well causative factors of disease such as food intake and diarrhea. We could cover topics such as basic personal hygiene and first aid measures. Her animal friends could be partners in her adventures or they could be the victims of pathogens. The game opens up children to be familiar with objects or procedures kids usually see in doctor’s clinics and hospitals to make them less apprehensive when they encounter them – a stethoscope, an otoscope, an ENT light, a neuro-hammer, tongue depressors, thermometers, syringes and x-rays. These same objects could be the same weapons they use to battle the pathogens. The scenarios are endless, a wrong drug or therapy could slow them down or end the game. The end of the game could feature a list of booboos or don’t dos to pick up on for the next game. Learning objectives can be established for each disease situation.

The digital age has opened up new worlds, it is up to us to find uses  for emerging technologies in healthcare. Game playing and health therapy is one of them. According to Saatchi & Saatchi Wellness, a healthcare brand market developer, “gamification in health care isn’t the future – it’s now.”

 

Reference:

  1. McCallum S. Gamification and serious games for personalized health. Studies in health technology and informatics 2012;177:85-96. Accessed thru: http://www.miro.ing.unitn.it/download/Didactics/Misure2/2012%20pHealth%20-%20Gamification.pdf
  2. Gamberini, Luciano, et al. “A game a day keeps the doctor away: A short review of computer games in mental healthcare.” Journal of CyberTherapy and Rehabilitation 1.2 (2008): 127-145. Accessed thru: http://htlab.psy.unipd.it/uploads/Pdf/Publications/Papers/Cyber_rehab08.pdf
  3. Deterding S. From Game Design Elements to Gamefulness: Defining Gamification. Accessed thru: http://gamification-research.org/2012/04/defining-gamification/#sthash.ngjtJfjz.dpuf
  4. What is Game-Based Learning? Carleton.edu webpage. Accessed thru: http://serc.carleton.edu/introgeo/games/whatis.html
  5. Cardenas I. Game-based Learning:  Theory and Learning. Webinar. Master of Science Health Informatics program, University of the Philippines Manila.

What’s your numb3r?

Whats your number?  Click on this link to find out:  http://www.populationaction.org/Articles/Whats_Your_Number/Summary.php

 

Number.001

No, that was not my health app. I’m just starting off this blog with that link to pique your interest and reinforce the concept that numbers are objective, insightful and can be great motivators. Just enter data the app requires, the app calculates and displays the results. The next step of action is up to you.

Driving Question:
“How can mobile applications be useful in primary care?”

My quick and easy answer to the driving question is improved patient engagement and improved access to care. What you need is in your hand, available with a swipe of the screen, the touch of a button.

Mobile devices are here to stay, mobile applications are there to be developed. Dr. Sandejas already introduced to us the prospect of developing our own app. Ideas have already been germinating in my mind for a website I have in the works, an app seems to be a good first step. Not really a good thing to broadcast one’s plans but this is what the blog requires so I call first dibs to this idea since that class is a year away and suggestions would be most welcome. My app falls more into the category of personal health rather than the community based primary health care scenario of the required reading material.

My inspiration for Numb3rs,  my health app is a scale with displays all sorts of numbers.

index2

I’d like to develop this scale into an app for a handheld device which displays all the numbers this particular scale generates. At present, there are obvious limitations for the transition from scale to handheld device. The scale utilizes bioelectrical impedance analysis by measuring mild electrical charges our body gives off from one point to the next. Utilizing the touch screen of a mobile gadget instead of the hand grips of the scale presents a technological challenge.

However, we can already generate the data just by doing a few exercises, making a few measurements and answering a few questions. Without going into details, the app requires:

  • birthdate
  • gender
  • height
  • weight
  • cardiac rate
  • blood pressure
  • hip and waist measurement
  • results of outlined exercises

For greater accuracy, we could input measurements of wrist, forearm, bicep, neck and thigh. At the end, I would be able to give: Body Mass Index (BMI) following Asian standards, Basic Metabolic Rate (BMR), Body Fat Analysis and Body Age. Displayed results would be calculated results as well as the ideal which the user must strive for. With these, I would incorporate into the app the Cardiac Risk Assessment  which I discussed in a previous blog to evaluate the risk of cardiac events . The user now has objective numbers which evaluates his present health condition within the parameters assessed.

Undergo a lifestyle change which includes diet and exercise then crunch the numbers to evaluate your progress. It’s the 7-11 concept – a quick, easy, one-stop online calculator!

 

Reference:

1. Kaplan WA. Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries? Globalization and Health 2006;2:9 Accessed thru: http://www.biomedcentral.com/content/pdf/1744-8603-2-9.pdf

Telehealth and the Human Factor

“Telemedicine is about human interaction and the content. It is not about the technology. Telemedicine only succeeds when barriers are addressed and overcome.” – Dr. Michael Sullivan

 

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The World Health Organization (WHO)  defines telemedicine as “the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interest of advancing the health of individuals and their communities.” (WHO, Telemedicine, Opportunities and Developments in Member States, 2010)

The driving question asks:
“How can telehealth support healthcare delivery in the Philippines?”

A study by Trevor et al revealed that in many low- and middle-income countries, information communication technology (ICT) is being increasingly employed for different purposes in various health-related areas. Of ICT-enabled health programs, 42 percent use it to extend geographic access to healthcare, 38 percent to improve data management and 31 percent to facilitate communication between patients and physicians outside the physician’s office.  With our 7,000 plus islands geographically described as an archipelago and centers of specialized medicine concentrated in metropolitan areas, there exists an inequality in the provision of healthcare from those living in urban areas to those in the remote and rural regions of the country. In this regard, telehealth can definitely play a supportive role to the traditional practice of medicine.

The Arizona Telemedicine Program’s telehealth experts outlined a strategy for creating sustainable telemedicine programs in developing countries.  It can easily summed be up as initiate-build-operate-transfer:  Phase 1 starts off by conducting meetings with high level public officials including that of the health sector, Phase 2 is the identification of a national telemedicine champion, Phase 3 is to build out and launch the network of rural telemedicine clinics and Phase 4 is the critical disengagement process as well as assessment of the program. Country partners that they have started this on are Panama, Balkan countries, Mexico and China. The areas of medicine covered were telepediatrics, teleobstetrics, telepulmonology, teledermatology, and tele-emergency medicine.

According to WHO,  obstacles to telemedicine adoption are: problems connected to protection of personal data, different priorities, perceived lack of demand in developing countries, availability and maintenance of necessary infrastructures such as electric net instability, availability and quality of internet connectivity, bandwidth, obsolete computers, computer viruses and availability of technical personnel.

We were tasked to revise two portions of Telehealth Act of 2012. I did go through the bill but what concerns me more would be its implementation.  With proper planning and resources, the barriers stated above can be overcome even in our setting.

My concerns arise from the experiences that Dr. Marcelo himself noted. One apprehension is that of sustainability. The Telehealth Bill allocates a budget for the telehealth program. However, I am not sure if it would be sufficient. Local government must be involved from inception when the centers for telemedicine are identified. Another area for concern for me is that any top down decision makes implementation difficult. I am skeptical that the  initiate-build-operate-transfer strategy the Arizona Telemedicine Program proposes or the Telehealth Act itself would take root without any sense of ownership from the people who it wishes to serve as well as health workers tasked to carry out the program. There may be deficiences in the technology aspect, it is the human factor which fills in the gaps and ensures success. In a previous topic and slide presentation, I discussed that innovative programs were better built from the ground up. There must be involvement of the community and local government with the program design and the technology solution must align with an indigenous need not an imposed one.

 

References:
1. Telehealth Act of 2012. Accessed thru: http://www.congress.gov.ph/download/basic_15/HB06336.pdf
2. Marcelo. Telehealth in the Philippines. Accessed thru: http://bit.ly/telehealthinthephilippines
3. Arizona Telemedicine Program’s International Telehealth Experts Outline Strategy for Creating Sustainable Telemedicine programs in Developing Countries. Accessed thru: http://www.uahealth.com/news/arizona-telemedicine-program-s-international-telehealth-experts-outline-strategy-creating
4. Byers. WHO: Telehealth Use Developing in Low and Middle income Countries. Accessed thru: http://www.clinical-innovation.com/topics/health-information-exchange/who-telehealth-use-developing-low-and-middle-income-countries
5. Polillo. Internet and Sustainable Telemedicine for Developing Countries: An Introduction. Accessed thru: http://www.slideshare.net/rpolillo/internet-and
6. Sullivan. Developing a National Telemedicine Network. Accessed thru: http://www.slideshare.net/HINZ/developing-a-national-telemedicine-network

Privacy, Dignity, Respect

“Privacy is not only a means to an end. It is an independent good that individuals use to maintain control over their personal lives. In the case of health care, though, privacy is very much a means to improving medical outcomes. People who know they can trust the health care system are more likely to seek full treatment. In this way, privacy has concrete benefits for each individual, and for society as a whole.” – Privacilla.com

Patient privacy is commonly defined as the right of patients to determine when, how and to what extent their health information is shared with others. It involves maintaining confidentiality and sharing identifying data, only with healthcare providers and related professionals who need it in order to care for the patient. This identifying data is known as protected health information (PHI).

Privacilla,  a web- based project which aims to bring forward the concept of “privacy” as a public policy issue expounds on my sentiments best. According to them, doctors make the best decisions about treatment if they have access to all relevant information in their patients’ medical histories. However, some illnesses may have some stigma attached to them. Because of this, patients may avoid treatment if they are not confident that whatever they say, whatever examinations that will be done as well as its results will remain private. This being so, patients who seek consult may withhold important information out of concern for their privacy. This may prevent patients from receiving full and appropriate treatment.

The driving question asks us, “What policies are in place to protect the Filipino patient’s privacy and confidentiality of health information?”

 

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Our big medical centers who have been evaluated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have policies and systems in place. JCAHO is an independent, not-for-profit organization, which accredits and certifies health care organizations and programs in the United States as well as in other countries. JCAHO accreditation is recognized as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. Once JCAHO surveyors evaluate an organization, they expect its staff to know the organization’s mission, the organization’s policies for protecting confidentiality, what efforts each department is making to improve patient privacy and confidentiality, and how each area’s function relates to all of these.

Even our PhilHealth covers patient privacy in several portions of their Benchmark Manual for hospital accreditation. I was able to obtain hospital policies which included the following: a policy on records keeping and management, a policy regarding access to medical records, a policy on borrowing of medical records by physicians and representatives, a policy on medical records confidentiality, as well as a policy on confidentiality of records used for quality improvement. With these policies, hospital staff know who can have access to patient information, the security measures needed for handling patient health information, the limits of quality improvement measures regarding use of patient data as well as the proper procedures for destroying patient health information.

In most hospitals, these policies are in place. However, implementation is another thing altogether. The reading material provided for this assignment provides a stark picture of the reality in Philippine hospitals. The Cebu case was a sad reflection of how far hospital personnel stray from their mission of health care. Even a president of the country is not spared from the prying and intruding eyes of media caused by an unnecessary disclosure of her past medical treatments . The rise of social media offers a challenge to the issue of patient privacy.

From all these, we, as healthcare professionals should remember:

  • Carefully handle patients’ health information to protect their privacy
  • Decide what personal health information can be shared with others
  • Decide how that information can be shared, and with whom it may be shared
  • Not have information about patients discussed in areas where others could overhear
  • Not post personal information nor medical treatments of patients online
  • Carefully handle patients’ health information to protect their privacy
  • Keep the information in patients’ individual records as accurate as possible
  • Recognize that privacy also refers to the right to have physical privacy (eg. curtains closed)

Patient confidentiality and privacy are important aspects of the healthcare industry. Our patients trust us. It is only right that we maintain their trust by maintaining their right to privacy. More than patient privacy though, we should recognize our patients as persons who deserve to get the treatment they need in an environment which fosters dignity and respect.

Reference:
1. The importance of medical privacy. Article. Privacilla webpage. Accessed thru: http://privacilla.org/business/medical/medicalimportance.html
2. Joint Commission on Accreditation of Healthcare Organizations. JCAHO website. Accessed thru: http://www.jointcommission.org/
3. Antonio, Marcelo. Health Information Privacy in the Philippines. Accessed thru: http://aehin.hingx.org/Share/Details/2044

Clinical Decision Support Systems and CHITS

CHITS recently celebrated its 10th year. From its inception as a “Child Health Injury Tracking System” to its present iteration as a “Community Health Information System,” CHITS continues to evolve.

I have to confess that I do not know all the programs that CHITS is in to. My classmates are better equipped to handle this topic.  I am limited to what I could find thru the web and the discussions that came from Dr. Marcelo’s lectures.

The driving question is:

“How can Clinical Decision Support Systems (CDSS) improve the quality of healthcare?”

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An electronic health record system achieves its full potential when clinical decision support systems are used with it. I came across this paper, “Development and Validation of a Clinical and Computerized System for Management of Hypertension at a Primary Health Care System”.  I’m sharing screenshots for this clinical decision support system which has been tested for use in India.

 

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From class discussions, I gathered that CHITS’ function has been as an electronic patient registry and tool for data reports generation.  It would be a worthwhile goal to develop CHITS as a holistic platform which can address public health and primary healthcare concerns, an integrated whole instead of separate disease program platforms. The development of clinical decision support systems could be a step in the right direction in CHITS evolution.

This clinical decision support system which I just presented also provides an algorithm which guided health workers deployed in rural India as to what anti-hypertensive to give. Obviously, the value of the system in our setting  is not in replacing doctors and actual medical consultations.  But I do see this as a risk evaluation system which can be incorporated into CHITS’ present function of patient registry.  Health workers can identify high risk patients, ask them to seek consult with physicians and dispense diet and activity recommendations.  A similar program has been initiated to meet with the millennium development goal of decreasing maternal risk factors by identifying high risk mothers and addressing the risks factors. Hypertension and cardiovascular diseases remain to be among the top causes of mortality and morbidity in the country according to the Department of Health. The dissemination of information regarding hypertension and its risks easily falls within CHITS’ present capabilities and is a welcome addition to its arsenal towards achieving its goal of improving community health and wellness.

References:

1. Anchala Di Angelantonio Prabhakaran Franco. “Development and Validation of a Clinical and Computerized System for Management of Hypertension at a Primary Health Care System.”  Accessed thru: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0079638

2. Leading Causes of Mortality and Morbidity in the Philippines.  DOH webpage. Accessed thru: http://www.doh.gov.ph/kp/statistics/morbidity.html and http://www.doh.gov.ph/node/198.html

Seven Approaches for Interoperability

“Standards are enablers. Interoperable systems are what support the business and clinical requirements in a typical eHealth agenda.”
– Dennis Giokas, Emerging Technology Group

Dr. Mike Muin asked us to choose a healthcare scenario to discuss and I chose this one:

Dr. Santos (Internal Medicine) uses an EMR called ClinicSys. He uses it for   SOAP notes, clinical abstracts, referral letters and admitting notes. He is a consultant at Reyes General Hospital (RGH). RGH has a Hospital Information System (HIS) called HospitalSys. Dr. Santos wants to send a patient for admission (with admitting orders) to RGH. Dr. Santos wants to get notice that patient has been admitted.

For my answers and slideshow presentation, here’s the link to Slideshare:

 

 

This was a scenario which I could relate to even if our hospital does not have a hospital information system in place. I chose to look at this assignment as a problem solving exercise. I tried to deconstruct the problem, seen from the perspective of a hospital administrator faced with an issue, looking for solutions.

Interoperability can be defined as “the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.”

There are two parts to that definition – the exchange of data and the use of that data that has been exchanged. Interoperability issues can arise from any part of this equation. Dennis Giokas, Chief Information Officer and Head of Emerging Technologies Group said, “Data has to move between two or more systems – the exchange of information. The receiving system and users must be able to process and use the data. To “use” the data we need to ensure that it’s delivered in a way that can be easily understood by the receiving system and users so it can be applied. That’s where semantic interoperability enters the picture.”

In my previous blogs, I discussed the issues with regard to people, processes, technology and financial resources. Looking at it from another perspective, these factors can be seen in the Ishikawa Fishbone diagram for root cause analysis.  Modifying this a bit to fit the context of the discussion since Dr. Muin said there were no financial constraints, I came up with this diagram (Figure 1):

Fishbone.001

Figure 1. Ishikawa Fishbone Diagram for Interoperability Issues between 2 Disparate Information Systems

 

From this diagram, I came up with the following project goals:
– Evaluate cause and effect factors by reviewing Fishbone diagram
– Create an IT support group for medical staff
– Form a technical working group which includes medical staff, hospital   management, IT support group to discuss ways to integrate disparate doctors’ systems and hospital system
– Determine standards needed such as data content standard, data exchange standard
– Identify and prevent data level conflicts
– Re-train hospital staff regarding data collection and coding

From my research, approaches that can be used for interoperability issues are those represented in this diagram (Figure 2). Information in IS1 is represented by vertical lines, while the information in IS2 is shown as horizontal lines representing a disparate system.

 

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Figure 2. Approaches for Interoperability between Disparate Information Systems

The discussion for each approach can be seen in my Slideshare presentation or thru my citation of references.
My options for this problem are:
– Check if an upgrade for both Information Systems would resolve the problem
– Upgrade the Hospital Information System, find out which Clinic Systems are interoperable then inform doctors of these systems, have them switch
– Replace present Hospital Information System with another having a strategic intent of interoperability with other systems
– Use Database translation approach if only the ClinicSys of Dr. Santos is to be considered
– Use Standardization approach if several other doctors have their own disparate information systems
– Consider a Web-based platform information system for everyone to use

Dubbed as “the holy grail” of health IT, the issue is so complex because there are multiple levels of integration and many possible applications. HL7 and SNOMED CT seem to be the direction that we are headed to.

Barriers cited for interoperability are:
– Barrier #1: Lack of a master reference information model
– Barrier #2: Limited collection of codified clinical data
– Barrier #3: Limited use of controlled medical vocabularies
– Barrier #4: Technical challenges to providing data comparability
– Barrier #5   Lack of a messaging standard which supports semantic interoperability

Kerry Stratton, the managing director of IT system company InterSystems however said, “Some of the biggest barriers to interoperability could be human rather than technical.” We, as students of health informatics and future leaders of the industry are placed in the forefront to find solutions for health information system interoperability.

References:
1. Interoperability of Information Systems. What-when-how.com webpage. Accessed thru: http://what-when-how.com/information-science-and-technology/interoperability-of-information-systems/
2. Semantic Interoperability: The Holy Grail of Medical Informatics. E-mds webpage. Accessed thru: http://www.e-mds.com/news/semantic-interoperability-holy-grail-medical-informatics
3. The Holy Grail of IT integration. Hospitalmanagement.net webpage. Accessed thru: http://www.hospitalmanagement.net/features/feature46351/