Laying the Foundation - for integrating health care IT

Health Management Technology, Oct, 2001 by Robert Seliger

Characterizing and conceptualizing an integrated healthcare information system is a critical step in building one.

Architecting and implementing a truly integrated healthcare information system is not easy. It's not so much that any one part of a healthcare information system is difficult to architect and implement. Rather, it's the combination of all the parts that becomes untenable.

We are plagued by a lack of compatibility among information systems, which makes integration efforts unsuccessful or, at best, highly painful for most provider organizations. Too often, we try to somehow piece together the various components of a complex information system without having created in our minds, from the outset, a solid conceptual model of the various components needed and how these components should interrelate to achieve desired outcomes.

We must first characterize and conceptualize the information system so we can abstract away the complexity, leaving behind a system we can truly understand and intuitively analyze.

An Everyday Analogy

Take the home stereo system for example. Most of us can purchase a home stereo system, install it, then use it regularly. We can also expand an existing stereo system without difficulty by purchasing add-on components. In the era of the "couch potato," we can even buy a single remote control that enables us to control all the equipment at the push of a button. Let's dissect why.

Looking at the stereo system from the outside in, we inherently understand a number of key components reflected in its operation and use. For example, we know that "volume" means how loud the sound is, and that any stereo system provides a way to boost or decrease sound. When purchasing a stereo receiver as a system component, we expect it to have a volume control. No matter what the volume control looks like or how it is operated, for any receiver from any manufacturer, the volume control provides the same function.

We also know that for the control that enables us to provide power to the component, the label "on" means on and "off" means off. We know that within our system, the speaker is where the sound comes from; the radio is what we use to receive broadcasts, and the compact disc player is what we use to play CDs. We know that if any component in the system has a power cord connected to it, we must plug it into an electrical outlet.

All these things we seem to inherently know about stereo systems are decidedly not profound. Yet, they enable us to buy, install and use very sophisticated electronic components comprised of microprocessors, amplifiers, servo mechanisms and lasers with little or no understanding of how the components were designed and created; independent of whether they were produced by the same or different manufacturer; and with minimal concern about whether last year's model of receiver will operate with this year's model of speaker. Why is this?

Common Reference Model

We carry in our heads, gained from life experience, a model for stereo systems that we can apply to any specific system we see. The designers and manufacturers of components that comprise stereo systems, and the salespersons who sell them, share the basic model with us. This reference model enables us to map the specific stereo systems we see to a general model we already understand.

Reference models for complex systems--from healthcare information systems to home stereo systems--categorize our concepts into the four primary perspectives:

The information model perspective deals with terminology and concepts. For example, the term "volume" means the same thing to the designer, salesperson and consumer.

The system management perspective deals with the basic controls that enable us to perform fundamental operations on the system, such as turning the power on and off.

The enterprise connectivity perspective concerns the ways in which the stereo system connects to things in the home--what might be thought of as the "enterprise" within which the system resides, such as the electrical outlet for power, and an antenna or cable outlet for radio reception.

The user experience perspective pertains to the overall experience of using the system for its intended purposes, such as playing a CD or listening to the radio.

Now, imagine a receiver that labeled its volume control "decibel attenuator." Would users be confused about what this control actually did? Or suppose a receiver did not have a power cord, but rather required that an electrical feed be run directly into it. A user would need to assess the added cost and complexity of installing such a system. What if there was no way to turn the system on or off? Or what if the user had to enter obscure computer instructions to listen to a CD or the radio? Would any of us purchase such a system and if we did, could we use it?

Each of us can formulate these questions and evaluate whether to purchase this system because each of us mapped this system to our already-formed reference model of a stereo. Even a person who didn't fully understand the rationale for the capabilities of such a system would immediately recognize its peculiarities. Why? Because when a system either satisfies or violates our reference model, we are able to reason about the system from the outside without needing to know anything about what's inside.