Information and Communication Technologies (ICTs) have made significant impact on healthcare industry in the globe. Its adoption and use, has transformed the way healthcare services are delivered and monitored. Influenced by this transformation, MOHCDGE have formulated an eHealth Strategy 2013-2018 to manage these massive shifts from traditional HMIS to electronic means. The strategy highlights the important aspect to consider when automating health facilities. One of the key areas targeted for transformation is the use of ICT to make health facilities more effective and efficient.
However, health information Systems (HIS) in developing countries have been characterized as fragmented, with a number of subsystem operating independently. The fragmentation nature of health systems has been with other factors due existing of multiple initiative to computerize healthcare systems, each initiative serving its own data need goals. Therefore, integration is in essence an initiative to rectify fragmentation. Integration of health care information systems have been ongoing efforts to strengthening quality of care by ensuring proper management of healthcare resources through information-based management system. Due to fragmentation nature of HIS, various efforts have been employed to ensure coherent and standardized HMIS.
With respect to Health Information Systems, integration refers to the act of bringing data and systems together from disparate subsystems to be viewed as one in a certain perspective. As per Park, (2004) integration combine together the data and process of sub-systems into one system, and dealing with aggregation of subsystems cooperating so that the system is able to deliver the overarching functionality and ensure that sub-systems function together as a whole system. In HIS, integration further looking on the processes and routine to capture, process and analyses wide range of data, for both patient and aggregate across different health programs to be used by policy maker and healthcare providers for planning, resource allocation and decision-making purposes. HIS Integration does not only imply computer systems, some integration is paper based reporting system to electronic systems.
This paper reviews some integration approach used in health information systems, drawing literature experiences form developing countries.
Table of Contents
1. Introduction
2. Integration vs Interoperability
3. Horizontal, Vertical and Star Integration
4. Information Systems Interoperability Methods
4.1 Mapping-Based Interoperability Methods
4.2 Intermediary-Based Interoperability Methods
4.3 Query-oriented Interoperability Methods
5. HIS Integration Technologies
5.1 Message-Oriented Integration
5.2 Application-Oriented Integration
5.3 Middleware-Oriented Integration
5.4 Coordinated-Oriented Integration
6. Web API
7. Integration Architecture
8. Interoperability Framework
8.1 Semantic Interoperability Framework
8.2 Model Driven Interoperability Framework
8.3 Knowledge Level Interoperability Framework
9. Proposed Framework
Research Objectives and Topics
The primary objective of this work is to review existing integration approaches for Health Information Systems (HIS) and propose an extended framework that addresses operational challenges to facilitate better data quality and workflow management, particularly in developing countries.
- Analysis of HIS fragmentation and the necessity for integration.
- Evaluation of integration types (Horizontal, Vertical, Star) and interoperability methods.
- Review of technical integration solutions including Message, Application, and Middleware-oriented approaches.
- Development of an extended 4-T framework based on knowledge-level interoperability.
- Conceptualization of operational boundaries in EMR-DHIS2 integration.
Excerpt from the Book
Horizontal, Vertical and Star Integration
According to Toohey at el., (2012) there are three basic Health Information systems Integration Approaches: Horizontal integration, Vertical integration and Star integration as illustrated on figure 2 and 3. Horizontal integration approach deals with integrating system functionality which are within the same level or between different systems supporting different functional areas of a business (Wangler, 2000). A shown in Figure 2., a typical example in health systems is integrating different modules of the hospital management system, such as integrating registration module to billing, then billing to laboratory, and laboratory to diagnosis and treatment. The aim of horizontal integration is to automated transaction operations of the organization.
On other hand, Vertical integration is about joining two systems of different levels following the line of command (Monteiro, 2003; Sahay, 2012; Smith, Madon, Anifalaje, Lazarro-Malecela, & Michael, 2008). Vertical integration is between systems on different control and managerial levels of an organization. As indicted on Figure 2.2, the typical example in health systems is integrating the hospital systems with the district health information system or integrating district system to national data system. The aim of vertical integration is to make data availability for managing services offered at lower level.
Summary of Chapters
1. Introduction: Discusses the impact of ICT on healthcare and the fragmentation of existing health information systems in developing countries.
2. Integration vs Interoperability: Clarifies the conceptual distinctions between integration as a process of joining systems and interoperability as the technical ability to exchange data.
3. Horizontal, Vertical and Star Integration: Describes three fundamental architectural approaches to integrating health information systems based on organizational levels and functional connectivity.
4. Information Systems Interoperability Methods: Examines technical strategies for achieving semantic interoperability, specifically Mapping, Intermediary, and Query-oriented methods.
5. HIS Integration Technologies: Details specific technical solutions for integration, including Message, Application, Middleware, and Coordinated-oriented approaches.
6. Web API: Explains the role of APIs and transport protocols (SOAP vs REST) in modern health system integration.
7. Integration Architecture: Compares mediator-based (centralized) and peer-to-peer (decentralized) architectures for data integration.
8. Interoperability Framework: Reviews existing frameworks for HIS integration, covering semantic, model-driven, and knowledge-level approaches.
9. Proposed Framework: Introduces an extended 4-T framework that incorporates an operational boundary level to better conceptualize HIS integration needs.
Keywords
Health Information Systems, Integration, Interoperability, Developing Countries, DHIS2, EMR, Horizontal Integration, Vertical Integration, Semantic Interoperability, Middleware, API, Knowledge Level Framework, Data Quality, Healthcare Technology, Operational Boundary
Frequently Asked Questions
What is the primary focus of this research?
The research focuses on reviewing various approaches and architectures for integrating Health Information Systems (HIS) to overcome fragmentation, specifically within the context of developing nations.
What are the main thematic fields covered?
The work covers system interoperability, integration architectures, messaging standards, technical frameworks (such as semantic and model-driven approaches), and knowledge management across organizational boundaries.
What is the central research question?
The study explores how to effectively integrate disparate health information systems to improve data quality, decision-making, and resource management through both technical and operational strategies.
Which scientific methods are utilized?
The research employs a comprehensive literature review of integration approaches, evaluates existing frameworks, and proposes an extended, theoretically grounded model (the 4-T framework).
What is addressed in the main body of the work?
The body analyzes integration definitions, architectural types, interoperability methods, specific integration technologies like APIs and middleware, and discusses conceptual frameworks for system alignment.
Which keywords characterize this research?
Key terms include Health Information Systems, Integration, Interoperability, EMR, DHIS2, Middleware, and the proposed 4-T operational framework.
Why is the 'Operational Boundary' significant in the proposed framework?
It is significant because the author argues that successful integration depends not just on technical aspects, but on addressing organizational reporting practices and workflows.
How does the proposed 4-T framework improve upon previous models?
It extends Carlile’s 3-T framework by adding an 'Operational' level, which allows for the conceptualization of integration challenges beyond simple technical data exchange.
How does the paper differentiate between SOAP and REST APIs?
The paper highlights that while SOAP is standardized for service-oriented messaging, REST APIs are often preferred for their flexibility and ease of implementation in modern health systems like DHIS2.
- Arbeit zitieren
- Bigten Kikoba (Autor:in), 2018, Health Information System Integration Approaches, München, GRIN Verlag, https://www.grin.com/document/437199
