INFO 731Prudence W. Dalrymple, PhD

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In this lecture, we will define a system, and describe different types of systemsidentify stakeholders and examine how their views of systems differ from one anothersee how the role of the systems analyst as a problem-solver is similar to that of the informaticianlook at the system development process andacknoweldge that views of systems differ according to various roles

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An understanding of systems and how they work is fundamental to understanding healthcare informaticsFrom a systems perspective, almost anything is a systemFailure to appreciate the inter-relatedness of various components of health care has led to inefficiencies, errors, waste and lack of progress

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A system is a group of interrelated components that function together to achieve a desired result.An information system (IS) is an arrangement of people, data, processes, and information technology that interact to collect, process, store, and provide as output the information needed to support an organization.Information technology is a contemporary term that describes the combination of computer technology (hardware and software) with telecommunications technology (data, image, and voice networks).

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• During the planning phase, an organization’s total information system needs are identified, analyzed, prioritized, and arranged.

• During the analysis phase, requirements are gathered from users, studied and organized. Any redundancies are eliminated and a solution recommended

• During the design phase, the description of the recommended solution is converted into logical and then physical system specifications.

• During the implementation phase, the information system is coded, tested, installed, and supported in the organization.

• During the maintenance phase, the system is systematically repaired and improved.

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Functions:InputProcessingOutputStorageControl

Components:PeopleProceduresDataSoftwareHardware

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A transaction processing system (TPS) is an information system that captures and processes data about operational transactions. In business, this might be sales; in healthcare, this is usually administrative data related to patient care

A management information system (MIS) is an information system that provides for management-oriented reporting based on transaction processing and operations of the organization.

A decision support system (DSS) is an information system that either helps to identify decision making opportunities or provides information to help make decisions. In healthcare, this is usually targeted to support clinical decisions

An executive information system (EISs) is tailored to the unique information needs of executives.

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An expert system is an information system that captures the expertise of workers and then simulates that expertise to the benefit of non-experts. This is exemplified in certain decision support systems.A communications and collaboration system is an information system that enables more effective communications between the various aspects of healthcare to enhance their ability to collaborate. For example between physicians and nurses, pharmacists and clinicians, inpatient and outpatient systems.An office automation system is an information system that supports the wide range of office activities that provide for improved workflow between workers.

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A stakeholder is any person who has an interest in an existing or proposed information system. Stakeholders can be technical or non-technical workers. They may also include both internal and external workers.

Information workers are those workers whose jobs involve the creation, collection, processing, distribution, and use of information.

A Systems Analyst is an information worker who is a facilitator or a coach, who bridges the communication gap between the non-technical and technical stakeholders. This is also a responsibility of an informatician or informaticist.

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All information systems have multiple stakeholders whose job satisfaction, productivity, accuracy, and motivation are affected by the information system.Some of these stakeholders are chief executives, boards, clinicians, patients, vendors/suppliers, government agencies and the public

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System designer – a technical specialist who translates system users’ business requirements and constraints into technical solution. She or he designs the computer databases, inputs, outputs, screens, networks, and software that will meet the system users’ requirements.

System builders – a technical specialist who constructs information systems and components based on the design specifications generated by the system designers.

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Informaticians perform many of the functions customarily handled by systems analysts. They are expected to bring domain knowledge as well as systems knowledge to their positions. Thus, they study the problems and needs of an organization to determine how people, data, processes, and information technology can improve the organization’s ability to achieve its goals. They generally do not program.

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"Problems" that need solving may be:Problems, either real or anticipated, that require corrective actionOpportunities to improve a situation despite the absence of complaints Directives to change a situation regardless of whether anyone has complained about the current situation

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Working knowledge of information technology

Familiarity with healthcare environment

General problem-solving skills

Good interpersonal communication skills

Good interpersonal relations skills

Flexibility and adaptability

Character and ethics

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Quality Improvement & Patient Safety

Security and Privacy

Need for Data Exchange & Interoperability

Continued Technology Development in Healthcare

Economic Pressures

National Reform Movements

Consumerism

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Understanding clinical workflow is an essential part of information system design and deployment. Understanding the “before” state helps identify key components as well ads unnecessary steps, and how parts of a system are related. During design and implementation, awareness of the system’s impact on workflow can help prevent costly and dangerous work-arounds. Workflow analysis is similar to business process redesign (BPR) because it is the study, analysis, and redesign of fundamental business processes to improve quality and efficiency.

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Networks and the Internet

Mobile and Wireless Technologies

Object Technologies

Collaborative Technologies

Enterprise Applications

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System development process – a set of activities, methods, best practices, deliverables, and automated tools that stakeholders use to develop and maintain information systems and software.

It is cyclical, aiming at continuous testing and evaluation

It requires continual feedback to optimize results

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A general approach to problem-solving 1. Identify the problem.2. Analyze and understand the problem.3. Identify solution requirements or expectations.4. Identify alternative solutions and choose the “best” course

of action.5. Design the chosen solution.6. Implement the chosen solution.7. Evaluate the results. If the problem is not solved, return to

step 1 or 2 as appropriate.

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Simplified System Development Process

General Problem-Solving Steps

System initiation 1. Identify the problem.

System analysis 2. Analyze and understand the problem.3. Identify solution requirements or

expectations.

System design 4. Identify alternative solutions and choose the “best” course of action.

5. Design the chosen solution.

System implementation 6. Implement the chosen solution.7. Evaluate the results. If the problem is not

solved, return to step 1 or 2 as appropriate.20

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System initiation – the initial planning for a project to define initial scope, goals, schedule, and budget.

System analysis – the study of a problem to recommend improvements and specify the requirements and priorities for the solution.

System design – the specification or construction of a technical, computer-based solution for the requirements identified in a system analysis.

System implementation – the construction, installation, testing, and delivery of a system into production.

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Project management – the activity of defining, planning, directing, monitoring, and controlling a project to develop an acceptable system within the allotted time and budget.

Process management – the ongoing activity that defines, improves, and coordinates the use of an organization’s chosen methodology (the “process”) and standards for all system development projects.

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Clinical information systems support patient care functions that extend out to the clinical staff

Nursing, pharmacy, lab, radiology

Administrative information systems support internal business operations of an organization, as well as reach out to suppliers (of materials, equipment, supplies, and services).

Human resourcesFinancial management & billingInventory control

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Information systems architecture - a unifying framework into which various stakeholders with different perspectives can organize and view the fundamental building blocks of information systems.

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Knowledge — consists of raw data that is processed to create useful information. Process — the activities (including management) that carry out the mission of the organizaiton. Communication — how the system interfaces with its users and other information systems.

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Database technologies that support accumulation and use of data, information and knowledgeSoftware technologies that automate and support information processes and servicesInterface technologies that support communication and collaboration

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System owners’ viewInterested not in raw data but in information that enables process efficiencies and procductivity, improves patient saftey and enhances the organization.Delivers values while controlling costsDefines scope and vision for project.

System users’ viewData is something recorded on forms, stored in file cabinets, recorded in books and spreadsheets, or stored on computer.Focus on procedures as they pertain to data.Specify data requirements – system users know the detail about clinical procedures and policies

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System designers’ viewTranslate the systems users’ data requirements into database design.Data structures, database schemas, fields, indexes, and constraints of particular database management system (DBMS).

System builders’ viewMust represent data in database languageDBMS or other data technologies

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System owners’ viewConcerned with high-level processes and functions; not concerned with process details.Functions are groups of related processes that support the organization, such as nursing, housekeeping, supplies, pharmacy, radiology, billingA cross-functional information system is a system that supports relevant business processes from several functions without regard to departmental boundaries.

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System users’ viewConcerned with processes or “work” that must be performed to provide the appropriate responses to business events. Process requirements – a user’s expectation of the processing requirements (activities, data flow, work flow) for a process and its information systems.Policy – a set of rules that govern a process.Procedure – a step-by-step set of instructions and logic for accomplishing a process.Work flow – the flow of transactions through processes to ensure appropriate checks and approvals are implemented.

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System designers’ viewConcerned with which processes to automate and how to automate themConstrained by limitations of application development technologies being usedSoftware specifications – the technical design of processes to be automated or supported by computer programs to be written by system builders.

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System builders’ viewConcerned with programming logic that implements automated processes.

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System owners’ viewWho (which units, employees, patients, medical staff and external partners) must interact with the system?Where are they located?What other information systems will the system have to interface with?

System users’ viewConcerned with the information system’s inputs and outputs.Interactions with the system

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System designers’ viewConcerned with the technical design of both the user and the system-to-system communication interfaces.Interface specifications – technical designs that document how system users are to interact with a system and how a system interacts with other systems.User dialogue – a specification of how the user moves from window to window or page to page, interacting with the application programs to perform useful work.

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System builders’ viewConcerned with the construction, installation, testing and implementation of user and system-to-system interface solutions.

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