Modular Questions for Vendor Systems John Jones Module 4 DQ In order to ensure their healthcare facility is compliant with the 2014 deadline for the electronic health record (EHR), the informatics professional has many choices available to him or her. The two main methods of incorporating EHR, also called EMR, are “ best of breed” and integrated systems. A good example of best of breed is if the current system the HCF is using is working very well, new EMR software could upgrade the current OS very easily. In contrast, starting completely over with all new software constitutes the integrated system (Kleaveland, 2007). Although both best of breed and integrated system are very different and have their own particular nuances, the two systems each have both advantages and disadvantages.
Doctor John Fontanetta (2010) is an emergency room physician who makes a convincing case for best of breed. Although speaking for the ER staff, he points out that the clinic or hospital has normally spent many years developing the system to suit their particular specialty and/or purpose. Why throw that away for an entirely new system that may or may not be up to date and suited to the facility? Another compelling argument concerns the fast-spreading H1N1 influenza virus. Doctor Fontanetta reports one hospital and its best of breed vendor had treatment and hospitalization plans operational in less
than a day! However, Jay Simmons, an informatics professional, opts for the integrated system (2011), stating that not only are operating costs are lowered but the system is more efficient, in that PMS and EHR are working together. Yet even he admits that a clinic might regret ridding itself of the existing PMS.
Kleaveland, B. (2007). “ The Tech Doctor: Best-of-Breed or
Integrated Systems?” Retrieved from:
http://www. physicianspractice. com/articles/tech-doctor-best-breed-or-integrated-systems.
Fontanetta, J. MD (2010). “ Best-of-breed versus single vendor approach
for the ED”, Retrieved from:
http://www. healthcareitnews. com/news/best-breed-versus-single-vendor-approach-ed? page= 1.
Simmons, J. (2011). “ Risks of Interfacing Different Systems with EHR”,
Module 4 DQ 2
Sabooniha (2012) accurately describes the different loose knit information systems in a healthcare facility (pharmacy, financial, care, etc.) as a group of islands. They know who each other is but none of them is connected. The resulting chaos can result in a number of disadvantages for the facility, including increased costs and redundancy among systems. The most important resulting problem is the loss of data reliability. Therefore, he states that integration of all these systems is imperative for the business to be more competitive. The factors one must consider, according to Sabooniha, are “ Flexibility, Real time, Reliability, Reusability, Performance, Complexity,
Maintainability, Maturity, Portability, Scalability and Heterogeneity” and their brief definitions are below:
1. Flexibility (Can the technologies adapt to fast changes?)
2. Real time (How current is the information?)
3. Reliability (Is the data maintained.)
4. Reusability (Can existing IS components be recycled for newer versions?)
5. Performance (How fast and/or good is this system.)
6. Complexity (How complex is the system; will the facility have to hire a specific programmer?)
7. Maintainability (Is the system changeable without causing problems elsewhere.)
8. Maturity (How long has this system been available?)
9. Portability (Can it be easily put into other systems?)
10. Scalability (Again, if the facility grows, does the system grow with it?)
11. Heterogeneity (What about the older Enterprise systems; are they still useable?)
The Centers for Disease Control (2012) agrees with Sabooniha in stating that the integration of systems will enhance security of the systems and greatly curtail the infamous leaks of patient privacy. In addition, from their perspective, integrated systems will assist the CDC in indentifying and monitoring public health risks.
Sabooniha, N. et al (2012). “ An Evaluation of Hospital Information
Systems Integration Approaches” Retrieved from:
http://www. kevin-lee. co. uk/work/research/sabooniha_rami_2012. pdf.
CDC (2010). “ Updated Guidelines for Evaluating Public Health Surveillance
Systems”, Retrieved from:
http://www. cdc. gov/MMWr/preview/mmwrhtml/rr5013a1. htm.