scope:

Preface

Why This Book?

During the years I have worked in healthcare information technology (IT), either with vendors of electronic health records (EHRs) or the hospitals implementing this technology, I have been asked many times by colleagues to recommend a practical book on the subject. The clinicians-physicians, nurses, pharmacists- are looking for a book to introduce them to the modeling techniques and engineering tools the IT department or their vendor uses, while the information technologists are interested in an introductory text on the clinical domain, something that can be assimilated without going to medical school. Realizing these two highly educated groups of professionals rarely speak the same language, they need a communication tool.

Systems analysis in general and structured systems analysis specifically offer a rigorous methodology and can create such communication tools in the form of models, diagrams, and other succinct, systematic artifacts. Systems analysis has been successfully applied in thousands of IT projects in other industries, but somehow it just never caught on in the healthcare IT domain. One can find books and articles on the vendor selection process, best practices for user training, and the psychological, sociological, and financial aspects of informatics in medicine as well as the cultural and organizational change management that accompanies the implementation of IT in clinical environments. However, to my best knowledge, very little if any has been published in the domain of healthcare informatics systems analysis.

Even when an organization does have the systems analysis related to EHRs it has developed or implemented, this reference is considered an intellectual property to be guarded accordingly, as a secret possession. Unfortunately, a software blueprint kept in a vault cannot be improved, lessons learned by others cannot be applied to or derived from it, and the professionals involved in the development or implementation of EHRs may find themselves "reinventing the wheel" solving problems others have already solved or worse-making the same mistakes others did before them.

Finding no better (published) alternative, I decided to write this book with two goals in mind:

1. Introduce the clinicians to a methodology and tools set so they can better communicate with the IT specialists developing or implementing EHRs

2. Clarify the complexity of the medications domain, a major part of an EHR- the prescription, dispensation, computerized physician order entry, and administration of drugs-for IT professionals to better communicate with their clinical colleagues

In addition, the last chapter on interoperability presents to both clinicians and informatics professionals the standards and vocabularies, rules, and regulations governing the EHR as recommended by U.S. authorities in the recently published American Recovery and Reinvestment Act (ARRA). According to ARRA, meaningful use of certified EHR systems in the United States will entitle clinicians to substantial funds from the U.S. government over the next couple of years. Thus, the need for a structured, systematic analysis of EHRs has aligned with a major, current development in the U.S. healthcare IT industry: the publication of government- backed standards for the industry to adopt to be considered a meaningful user of this technology.

What Is in This Book?

The first chapter is a short primer on structured systems analysis intended to introduce beginners to the tools used in the book: conceptual and logical data models, entity relationship diagrams, context and data flow diagrams.

The second chapter initiates the analysis of the medications domain from two perspectives: workflows and data structures. Workflows are decomposed into processes, activities, and tasks, while data structures are partitioned in the conceptual, entity-relationship, and logical data models.

The analysis continues in a more detailed fashion in Chapters 3 through 6, which respectively discuss the process to prescribe, order, dispense, and administer drugs. The next three chapters illustrate how the system is expected to interact optimally with users: Chapter 7 is on the user interface; Chapter 8, "Clinical Decision Support," involves what the system can and should do with the information it possesses; and the output expected is discussed in Chapter 9, "Report."

The final chapter presents the standards, vocabularies, rules, and regulations, which if adopted and implemented correctly will enable various disparate EHR systems to play together in the proverbial healthcare IT sandbox.

What Is Not in This Book?

Throughout this book, we examine together the EHR medications domain using structured systems analysis methodology and tools. The system described is a vendor-, platform-, and computer language-independent generic EHR. The reader will not find any vendor or hospital, technology or specific database, application or product mentioned by name. At least initially, system analysis is blind to these issues.

The goal of the book is not to provide the complete, correct, and consistent technical specs for such an ideal, hypothetical system to be built. The book presents the tools and methods to enable and facilitate the communications between clinicians and IT so they in turn can interpret, develop, and implement such clinical-technical specifications. Thus, do not expect to find actual software code, hardware specs, testing scripts, or physical data model minutiae in the book.

In the same spirit, the pharmacological examples used are for IT demonstrative and illustrative purposes only; the examples are not intended for actual clinical or medical use.

Is This Book for You?

The book should be accessible to both clinicians and IT professionals: No initial knowledge of medicine or computer sciences is assumed or required.

Clinicians: Physicians, nurses, pharmacists, C-level administrators, and other healthcare professionals contemplating or in the midst of the implementation of EHR technology will benefit from the succinct diagrammatic representations of the medications domain: workflows and data elements.

IT: Software engineers, architects, data and process modelers, product and project managers, database administrators, analysts, testers, and consultants will find the book useful in clarifying the terms and verbiage used by the clinicians in their work, while reviewing modeling techniques used by other industries for more than four decades.

Whether in the process of requirements elicitation, analysis, design, code, test, configuration, implementation, or maintenance of EHRS, both clinicians and IT professionals can benefit from better techniques to facilitate the abstraction of complex ideas into a set of easily understood models and diagrams. It is hoped both groups should find a common ground, clear and easy-to-use methodology and tools to make their collaboration on the medications informatics domain more productive.

Each chapter ends with a set of questions that should help the reader review the material covered; answers are found in the back of the book. Students and teachers of healthcare informatics will find the book is both methodical and didactic for their academic purposes; thus, it could be used as a textbook for a course on the subject.

When applied correctly, systems analysis can accelerate development, decrease costs, and increase the quality of a software product and eventually user satisfaction. I believe systems analysis can be applied to healthcare informatics with the same successful results demonstrated in other industries.