Innovation in health information systems

Citation

Stockdale, R. and Day, K. (2009), "Innovation in health information systems", Journal of Systems and Information Technology, Vol. 11 No. 3. https://doi.org/10.1108/jsit.2009.36511caa.001

Innovation in health information systems

Article Type: Guest editorial From: Journal of Systems and Information Technology, Volume 11, Issue 3.

In many ways information technology and systems are synonymous with the concept of innovation. This is especially true in healthcare, where providers of care continue to explore innovations regarding the electronic health record (EHR), decision support systems, computerized physician order entry systems and other innovative products to support them. Information technology innovations can be defined as the development of new communication and digital technologies and their associated applications (Lyytinen and Rose, 2003). However, it doesn't end there. Implementations of these innovations influence organizations, people's work activities and processes, and the tools they use. Innovations also broaden our thinking and stimulate considerations of “what if” and “how about” scenarios, with people taking advantage of change brought about by these implementations to better serve their needs.

A good innovation should be extended to broader audiences and diverse interpretations. Söderström et al. use the opportunity provided by an EHR implementation to propose regional and national standardization of healthcare processes and simplify a patient's journey through disparate and disconnected health services. Heart et al. make the point that this need to nationalize the EHR could be compounded by the political and structural framework of a country. Efforts at creating a national EHR must be tailored to the country in which it is expect to work. Cockcroft extends our understanding of evaluation of implementations to include insights gained from the perspectives represented by the media.

On a more granular level, health information systems are not enough in and of themselves. The use and effect of newer forms of health innovation by different user groups are explored by Jokela et al. in their study of a mobile health information system. Other forms of technology, such as the radio frequency identification (RFID) technology implementation described by Bahri are rapidly becoming another part of the work environment in healthcare. On a par with the development of social networking skills using the Internet and other forms of technology readily available to everyone, Lahtiranta proposes the idea of reconstructing the EHR to include input and use of health information management by people using healthcare services.

In the spirit of Kuhn's (1996) description of scientific revolution, it appears that our paradigm about health information system innovations is being challenged by the demand to extend the EHR geographically, politically and to introduce the “patient” as a competent and engaged user. Valente and Rogers (1995) draw a parallel between innovation diffusion and Kuhn's paradigm shift explanation, exploring the role of innovation diffusion as a precursor to a new paradigm. The authors in this special issue call for an extension of the innovations we've already adopted, raising the bar for innovative development and opening up new ways of using information systems in healthcare.

A media analysis approach to evaluating national health information infrastructure development

Sophie Cockcroft presents the idea that academic and project-level evaluations of health information systems innovations are not enough. The media have a unique perspective on such an innovation, and provide a public forum for its evaluation. In this paper she reviews the concept of “integrated health records” from the perspective of the media in three different countries (Australia, the UK, and Canada) and compares them. It appears from Cockcroft's research, that the media provide a very different emphasis on health information innovations: politics, government decisions about funding, and the public's concerns about the use of public money, and issues concerning privacy and security strongly influence the funding, implementation, and use of integrated health records. The perspective gleaned from the media about health information system innovations could provide a new angle on the development of a national integrated health record to support future implementation success.

Current challenges of personal health information management

Janne Lahtiranta highlights the demand for people in all walks of life to access, use, create, and store their own health information as a result of the growing emphasis on self-care. The author presents the idea that people are already managing their personal information electronically, regardless of the platform (mobile phone, computer or the internet). The EHR, based in healthcare services and managed on behalf of people, is no longer enough. This innovation is being extended to individuals using healthcare services and should be available for them to use on their own behalf. The author recommends the development of “citizen pathways” that integrate a person's health journey with the actions, context, processes, and facilities used by healthcare providers.

Bottom-up or top-down? A comparative analysis of electronic health record diffusion in Ireland and Israel

Tsipi Heart, Philip O'Reilly, David Sammon, and John O'Donoghue contrast and compare efforts at national implementation of an EHR in Ireland and Israel. They outline the imperative to extend innovations in health information systems, such as the EHR, beyond the boundaries of the initial implementation, e.g. a hospital. In agreement with other authors in this edition, they draw to our attention the need to develop a supporting infrastructure that is more than the innovation – political, legal, and organizational changes are needed to ensure the nationalization of the EHR. Countries, like Israel, where there is a high degree of computerization and integration of primary and secondary care appear to be more ready for national EHRs than others with a decentralized, localized and fragmented healthcare systems, and a lower emphasis on computerization.

Managing the implementation of an innovative technology in a hospital: a case study

This paper by Shamshul Bahri provides a description of the implementation of RFID technology in a hospital, highlighting the differences between this kind of technology implementation in healthcare and the implementation of something like an electronic health information system. Bahri argues that although RFID technology appears to be invisible and ubiquitous, it is still an information system and should be treated as such.

The juxtaposition of the classic change cycle developed by Lewin (1951) and the system development cycle is used to float the idea that although RFID is different in nature to what healthcare people are used to calling an information system, its implementation in a hospital setting should be completed in the same way that of any other healthcare information system.

A comparison study of using a mobile medical information system

Jorma Jokela, Shengnan Han, Ville Harkke, Markku Kallio, Leena Lindgren, and Maaret Castrèn have conducted a comparative study to investigate the use of a mobile medical information system by two user groups: one civilian medical students and the other military. The study addresses the use and effects of a government-developed system in Finland to gain insights in behavioural characteristics of users. The mobile system allows for the retrieval of knowledge and provides access to information as and when required by the medical practitioner. Despite some differences in use, the authors concluded that diverse environments were not critical to the use of such innovative mobile health systems, but that system characteristics were a more important influence on use and effects. This research supports the growing literature on the advantages of mobile systems in healthcare by emphasizing the importance of the system's use to both groups in the study.

Standards for sharing information security and processes in healthcare

Eva Söderström, Rose-Mharie Åhlfeldt, and Nomie Eriksson use a case study of a patient requiring surgery to present an argument for standardized processes to reduce risks of medical error, delays in care, and breaches of information security, with a focus on the latter. The extension of innovation in health information systems is paramount if a health system is to reap any benefits from such innovations. They argue that it is not enough to develop an innovation if it is not used within and across boundaries of different healthcare services, and if processes are not adjusted and standardized accordingly.

Acknowledgements

We would like to thank Craig Standing for giving us the opportunity to put together this special edition about innovation in health information systems. We would also like to thank those who submitted papers, and the authors of the selected papers. A special thank you to the many reviewers who gave their time to provide constructive feedback and useful guidance to the authors.

Rosemary Stockdale and Karen DayGuest Editors