Introduction

One of the cardinal requirements for continuity in healthcare delivery is the stable and smooth exchange of health information across various levels and contexts in the healthcare field. A health information system, or HIS, is a broad framework of information systems that consolidates multiple health functions into a unified platform; this consolidation is what is commonly referred to as integration. When implemented in a specific facility such as US Navy Military Hospital, a health information system evolves into a hospital information system. By using the same concept underpinning a health information system, a hospital information system combines much independent information system to facilitate core processes such as the registration, referral, checking in, and release of patients. It also supports the execution of numerous medical, administrative, and financial tasks.

Architectural Schema of the Health Information Systems

According to Dwivedi (2016), HIS can be integrated using a compact, open architecture; this architecture is in turn supported by a middleware that is not only detached from individual applications but can also aggregate common healthcare data and distribute it to a wide range of multivendor programs via different channels of deployment. Based on the integration goals of US Navy Military Hospital, all elements – organizational, administrative, and clinical – in its healthcare layout should be hinged on the architecture. As a consequence, the architecture should be able to hold all critical information and enterprise workflows by framing them based on relevant paradigms and standards.

Fig 1: Diagrammatic depiction of middleware-oriented architecture

Fig 2: Schematic representation of HIS architecture

HowEach Health Information System is integrated into the Overall Infrastructure

There are four integration methods that US Navy Military Hospital can employ to incorporate its entire HISinto its general infrastructure: application-based, middleware-based, coordinate-based, and message-based integration. In this case, middleware-based integration seems to be the most suitable to the hospital’s organizational structure. Bouchemal (2018) argues that this approach comprises of a family of services, conventional techniques, and interfaces that support the whole system. It offers the foundation for the exchange of operational data and services.

By using middleware, services are implemented through multiple technologies such as Java, DCOM, Web Services, and CORBA (Bouchemal, 2018). The pressure to duplicate techniques and data in many information systems; instead, it allows them to function by anchoring other forms of integration – specifically application and message. Collective middleware elements enable integration and interlinking of HIS.

Dwivedi (2016) states that in general, healthcare organizations need to share common information and service platforms that should be accessible to end-user programs through common interfaces; middleware-based integration satisfies this need. It is worth noting that this approach could necessitate amendments in legacy infrastructure, including integration into the general architecture. According to Sicilia (2013), the PICNIC family of services, the Object Management Group (OMG) suite of technologies, such as TQS and PIDS, and other innovations like DIMS (data integration middleware services), CORBAmed, HANSA (healthcare advanced network system architecture), and HISA (health information system architecture), provide a number of solutions to the problem of integration.

According to Sicilia (2013), the middleware layer functions as the core feature of the system, providing an infrastructure to which all programs are and can be linked. The distributive healthcare environment (DHE) embodies the middleware layer. The middleware layer allows health information to be input, stored, altered, and extracted for sharing or use via a group of common services which are accessible to the applications via common and dependable APIs. Sicilia (2013) adds that at the same time, the middleware layer’s services support health information management via stable and technology-reliant interfaces throughout the organization. The conceptual basis of all HISs is provided, explicitly, by HISA.  HISA model is efficiently symbolized by Synex, a service that paves the way for its development and implementation (Dwivedi, 2016).

Bouchemal (2018) contends that as a middleware component, Synex offers a straightforward integration route that enables data sharing between legacy as well as new HIS. By resolving the distribution and diversity aspects of HIS, Synex assures remote and real-time access to health information functions and medical data. The overarching role of Synex is to provide optimal flexibility and mobility of middleware and programs.

According to Dwivedi (2016), HANSA, a product of the EU Health Telematics Fourth Framework programme, is another epitome of HISA structure. It is designed to determine shared migration mechanisms and concepts, and to show that current legacy data layouts can be superimposed on a standard, open middleware supporting healthcare-related functionalities. Last but not least, EAI (enterprise application integration), a relatively recent middleware technique, uses various technologies to present an integration infrastructure that unifies HISs across the healthcare organization (Dwivedi, 2016). While its mechanisms are identical to the three tiers of HISA, it replaces HISA’s middleware tier with a message-based communication framework.

Conclusion

In short, the design and implementation of different HISs is only the first step toward an effective and seamless provision of healthcare services. The second and most crucial step is integration. Having many HISs does not guarantee efficient healthcare delivery. The modern health facility needs more than variety; it requires every HIS to communicate with each other and with the organization. Successful integration means that US Navy Military Hospital – or any other hospital for that matter – can focus its energies on the overall quality of patient-centered functions rather than exclusive processes with limited impacts concerning optimizing service provision. Today, information systems supporting healthcare organizations are structurally and operationally similar to a tightly-linked data network; their integration, therefore, is pursued as a matter of urgency instead of as an afterthought.

References

Bouchemal, N. (2018). Intelligent systems for healthcare management and delivery. New York,NY: IGI Global.

Dwivedi, A. (2016). Reshaping medical practice and care with health information systems.NewYork, NY: IGI Global.

Sicilia, M.A. (2013). Interoperability in healthcare information systems: Standards,management, and technology. New York, NY: IGI Global.

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