hoja 9: Datos de la EPA en papel, 1964-
ANEXO 2: Principales cambios metodológicos y otras incidencias en la EPA
Appendix A
Interview University Medical Center St Radboud
In this appendix it is demonstrated that nothing can be found regarding the homemade Information System of University Medical Center St Radboud and therefore an interview has been conducted. Table 31 shows that the used search queries in order to try to find academic literature did not provide any papers. In order to maintain confidentiality the contact person will remain classified and only the questions that are used for the thesis are provided here.
Questionnaire
Organization: University Medical Center St Radboud Date: 10/10/12 Time: 10:00 Contact person: Classified
Question 1: What was the starting point of the UMCN with respect to Information Systems and how did it develop?
The UMCN had developed an Information System itself, called Eclipses, but it was unfeasible to keep the ICT management under control. It became too big and therefore the decision was made to start a procurement to go for the best-of-breed HIS solution.
Question 2: Did UMCN look at the conducted tender of LUMC/UMCU and what aspects were taken into consideration?
The LUMC/UMCU tender used a competitive dialogue procedure to procure their Information System. LUMC/UMCU used this procedure as the HIS/EHR system was not a standard solution at the time. UMCN wanted to procure an Information System as the own developed Eclipses could not compete with the better HIS/EHR systems that were the standard solution. As there was already a standard solution the UMCN could use the open or restricted tender. As there were only six vendors (Chipsoft, iSoft, EPIC, Siemens, McKesson, and Alert) and it is obliged that minimum five vendors are included in the RFP, UMCN did choose for an open tender. The benefits of a restricted tender in terms of
reviewing five instead of six vendors did not outweigh the extra work of creating a RFI.
The EMCR/UMCG tender only asked how UMCN handled the procedure, further no information was exchanged.
Search query Number of
articles
Search query Number of
articles
Information system(s) + UMCN 0 Eclipses + UMCN 0
Information system(s) + Nijmegen 0 Eclipses + Nijmegen 0
Information system(s) + St. Radboud 0 Eclipses + St. Radboud 0 Information system(s) + Eclipses 0
Appendix B
Activity diagram research method HIS
Appendix C
Results Publish or Perish EMR + HIS
Search query Total
number of articles Contemporary h-index Relevant articles Number of different definitions "definition of emr" 32 7 3 3
"definition of electronic medical record" OR "definition of electronic medical records"
11 4 3 3
"ehr is defined" 71 6 1 1
"electronic health record is defined" OR "electronic health records are defined"
16 5 1 1
"emr is defined" 85 11 1 1
"electronic medical record is defined" OR "electronic medical records are defined"
7 3 2 2
Second phase: citation chase 38 0 1 1
260 26 12 12
Table 32 – Results Publish or Perish EMR search queries
Search query Total
number of articles Contemporary h-index Relevant articles Number of different definitions "definition of hospital information systems" OR
"definition of hospital information system"
12 6 5 4
"hospital information system is defined" OR "hospital information systems are defined"
3 1 1 1
Second phase: citation chase 2 1 1
17 7 7 6
Appendix D
Rephrased definition regarding EHR (figure 9)
# Source Original definition (EHR is/are … ) Rephrased definition
1 (Jha et al., 2006) key components like electronic documentation of vendors’ notes, electronic viewing of laboratory and radiology results, and electronic prescribing
an EHR has key components like several clinical
functions
2 (Häyrinen et al., 2008) a repository of patient data in digital form, stored and exchanged securely, and accessible by multiple authorized users
an EHR is a repository of patient data in digital
form, stored and exchanged securely, and
accessible by multiple authorized users 3 (Iakovidis, 1998) digitally stored health care information about an
individual’s lifetime with the purpose of supporting continuity of care education and research, and ensuring confidentiality at all times
an EHR is health care information about an
individual's lifetime stored digitally ensuring confidentiality at all times with the purpose of supporting continuity of care education and research
4 (Simon et al., 2007) an integrated clinical information system that tracks patient health data and may include such functions as visit notes, prescriptions, lab orders, etc.
an EHR is a clinical information system that tracks
health data of a patient including clinical functions
5 (Katehakis et al., 2007) a repository of information regarding the health status of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorized users
an EHR is a repository of information regarding the health status of a subject of care in computer
processable form, stored and transmitted securely, and accessible by multiple authorized users
6 (Hoffman & Podgurski, 2009) a repository of electronically maintained information about an individual‘s lifetime health status and health care
an EHR is a repository of the health status and
health care information of an individual's lifetime maintained electronically
7 (Terry, 2008) an electronic record of health-related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff
an EHR is an electronic record of health-related
information on an individual that is created,
gathered, managed, and consulted by authorized
# Source Original definition (EHR is/are … ) Rephrased definition 8 (DesRoches et al., 2010) adoption of twenty-four clinical functions across all
major clinical units in the hospital
an EHR is an EHR if it has adopted twenty-four
clinical functions across all major clinical units in
the hospital 9 (Garde & Knaup, 2006) a repository of information regarding the health status
of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorized users
an EHR is a repository of information regarding the health status of a subject of care in computer
processable form, stored and transmitted securely, and accessible by multiple authorized users
10 (Zhang & Liu, 2010) a subset of EMR record maintained by each CDO and is created and owned by the patient. An EHR typically has patient input and access that spans episodes of care across multiple CDOs within a community, region, or state
an EHR is a subset of EMR record which is created and owned by the patient and has patient input and access that spans episodes of care across
multiple CDOs
11 (Garde et al., 2007) a repository of information regarding the health status of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorized users
a repository of information regarding the health
status of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorized users
12 (Garets & Davis, 2006) A subset of each care delivery organization s EMR, presently assumed to be summaries like ASTM s Continuity of Care Record (CCR) or HL7 s Continuity of Care Document (CCD), is owned by the patient and has patient input and access that spans episodes of care across multiple CDOs within a community, region, or state
an EHR is a subset of each CDO's EMR which is
owned by the patient and has patient input and
access that spans episodes of care across multiple
CDOs
13 (Knaup et al., 2007) a repository of information regarding the health status of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorized users
an EHR is a repository of information regarding the health status of a subject of care in computer
processable form, stored and transmitted securely, and accessible by multiple authorized users
# Source Original definition (EHR is/are … ) Rephrased definition 14 (Alhaqbani & Fidge, 2007) digitally stored healthcare information about an
individual’s lifetime with the purpose of supporting continuity of care, education and research, and ensuring confidentiality at all times
an EHR is health care information about an
individual's lifetime stored digitally ensuring confidentiality at all times with the purpose of supporting continuity of care education and research
15 (Hinman & Ross, 2010) an electronic record of the range of services received by a single patient within his or her lifetime from various vendors and across a series of institutions AND/OR health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization
an EHR is an electronic record containing health-
related information of a patient lifetime created,
managed, and consulted by authorized health care
clinicians and staff
Appendix E
Rephrased definition regarding EMR (figure 22)
# Source Original definition (EMR is/are … ) Rephrased definition
1 (Mehrotra, Epstein, & Rosenthal, 2006) a computerized database containing a medical record for each patient
an emr is a medical record for each patient that is
computer-based
2 (Park, Shin, Choi, Ahn, & Hwang, 2005) a computer application with which health care personnel enter all of the medical records related to the patient care. It is a
comprehensive system that includes all the patient’s health care records, such as
admission and progress notes, operation notes, anesthesia notes, discharge summaries, and nurses’ records
an emr is a medical record for each patient that is
computer-based and entered by health care personnel
3 (Zhang & Liu, 2010) the legal record of what happened to the patient during their encounter at a Care Delivery Organization (CDO) across inpatient and outpatient environments and is owned by the CDO
an emr is a legal record of what happened to the
patient, owned by CDO, during their encounter at
a single Care Delivery Organization (CDO) across
inpatient and outpatient environments
4 (R. C. Wu & Straus, 2006) the computerization of health record content and associated processes usually referring to an electronic medical health record in a physician office setting or a computerized system of files
an emr is a medical record containing health
record content in an electronic manner at a single Care Delivery Organization (CDO)
5 (Wells & others, 2009) computer-based clinical data of an individual that are location specific and kept by a single physician office or practice, community health center or possibly ambulatory clinic
an emr is clinical data of an individual that is
computer-based at a single Care Delivery Organization (CDO)
# Source Original definition (EMR is/are … ) Rephrased definition
6 (Sonoda, 2011) 1. Level 1
Electronic patient information that is handled within a department
2. Level 2
Electronic patient information that is handled across multiple departments
3. Level 3
Patient information that is (mostly) handled within a single medical institution
4. Level 4
Patient information that is handled across multiple medical institutions
5. Level 5
Healthcare-related information that is handled in addition to medical-care information
an emr is patient information that is handled within a single Care Delivery Organization (CDO)
(JAHIS states that level 3 is the most acquired level)
7 (Garets & Davis, 2006) An application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized vendor order entry, pharmacy, and clinical documentation applications. This environment supports the patient s electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their
encounter at the CDO and is owned by CDO.
an emr is an application environment which supports the medical record of a patient in an
electronic manner, is owned by CDO and used in a single Care Delivery Organization (CDO) across inpatient and outpatient environments
# Source Original definition (EMR is/are … ) Rephrased definition 8 (Hinman & Ross, 2010) an electronic record of health-related
information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization
an emr is an electronic record of health-related
information on an individual that can be created,
gathered, managed, and consulted by authorized clinicians and staff within a single Care Delivery
Organization (CDO)
9 (Lenhart, Honess, Covington, & Johnson, 2000) an interoffice electronic software and hardware system that captures the essential components of a patient’s medical encounter with the vendor, including subjective,
objective, assessment, and plan
an emr is a system that captures the essential components of a medical encounter by a patient in an electronic manner with the vendor
10 (Boonstra & Broekhuis, 2010) a computerized medical information systems that collect, store and display patient
information
an emr is patient information that is computer-
based
11 (Tsai & Bond, 2008) a medical records located on a shared computer network that are both read and written electronically on a relational database through a graphic user interface.
an emr is a medical record that is read and written in an electronic manner located on a shared
computer network
12 (Tange, Hasman, de Vries Robbé, & Schouten, 1997)
a repository for patient information within one health-care enterprise (e.g. within one
hospital, author’s note) that is supported by direct computer input and integrated with other information sources
an emr is a repository for patient information within a single Care Delivery Organization (CDO)
Appendix F
Reference Concept Map regarding EMR
Figure 22 – RCM regarding the definition of an EMR
Table 36 – Google hits regarding the definition of
Appendix G
Rephrased definition regarding HIS (figure 23)
# Source Original definition (EMR is/are … ) Rephrased definition
1 (Kuhn & Giuse, 2001) The hospital information system is that socio- technical subsystem of a hospital which allows constructing and managing communication and interoperation by presenting information at the right time, in the right place to the right people.
A HIS is a socio-technical subsystem which allows
constructing and interoperation the
communication and interoperation by presenting information at the right time, in the right place to the right people
2 (AF Winter et al., 2001) A hospital information system is that socio- technical subsystem of a hospital, which comprises all information processing actions as well as the associated human or technical actors in their respective information processing role.
A HIS is a socio-technical subsystem which
comprises all information processing actions as
well as the associated human or technical actors in their respective information processing role
3 (A. Winter et al., 2011) A hospital information system is the socio- technical subsystem of a hospital, which comprises all information processing as well as the associated human or technical actors in their respective information processing roles.
A HIS is a socio-technical subsystem which
comprises all information processing as well as
the associated human or technical actors in their respective information processing role
4 (A. Winter et al., 2010) A hospital information system is the socio- technical subsystem of a hospital, which comprises all information processing as well as the associated human or technical actors in their respective information processing roles.
A HIS is a socio-technical subsystem which
comprises all information processing as well as
the associated human or technical actors in their respective information processing role
5 (Anwar & Shamim, 2011) HIS is an N-tier application suit built for a single location or multi location environment.
Important features of an effective and
functional HIS should include easy, friendly and ready to use, well integrated, customization property and possible tracking and alert facility. Least but not last automation back up is necessary so that no data loss should occur.
A HIS is a N-tier application which should include
easy, friendly and ready to use, well integrated, customization property and possible tracking and alert facility and has an automated back up
# Source Original definition (EMR is/are … ) Rephrased definition
6 (Kaiser, 2003) A hospital information system is defined as a
subsystem of a hospital which comprises all information processing as well as the
associated human or technical actors in their respective information processing roles
A HIS is a subsystem which comprises all
information processing as well as the associated human or technical actors in their respective information processing role
7 (A. Winter, Brigl, & Wendt, 2003) The hospital information system is that socio- technical subsystem of a hospital which allows constructing and managing communication and interoperation by presenting information at the right time, in the right place to the right people.
A HIS is a socio-technical subsystem which allows
constructing and interoperation the
communication and interoperation by presenting information at the right time, in the right place to the right people
Appendix H
Reference Concept Map regarding HIS
Figure 23 – RCM regarding the definition of an HIS
Table 38 – Google hits regarding the definition
Appendix I
Score of considered (sub) topics tender A
Table 39 – Score considered (sub) topics in tender A
Topic Name topic Points that can be
scored per topic
Percentage of total score
1.1 Algemene functionele eisen 5,50 7,33%
1.2 Functionele eisen perceel 1 30,25 40,33%
1.3 Functionele eisen perceel 2 8,25 11,00%
1.4 Technische eisen 5,50 7,33%
1.5 Integratie 5,50 7,33%
2.1 Eisen dienstverlening service 6,00 8,00%
2.2 Eisen dienstverlening implementatie 10,00 13,33%
2.3 Contractvoorwaarden project 4,00 5,33%
Subtopic Name subtopic Points that can be
scored per subtopic
Percentage of total score
1.1.1 Wet en regelgeving 1,10 1,47%
1.1.2 Gebruiksvriendelijkheid 2,75 3,67%
1.1.3 Beschikbaarheid en performance 1,10 1,47%
1.1.4 Beveiliging van informatie 0,55 0,73%
1.2.1 Klinische dossiervoering 3,88 5,17% 1.2.2 Zorgpaden en zorgplannen 0,39 0,52% 1.2.3 Ordercommunicatie 3,88 5,17% 1.2.4 Decision Support 0,39 0,52% 1.2.5 Communicatie / Correspondentie 0,39 0,52% 1.2.6 Medicatie 3,88 5,17%
1.2.7 Medische bibliotheek / knowledge base 3,88 5,17%
1.2.8 Registratie van prestatie-indicatoren 0,39 0,52%
1.2.9 Spoedeisende hulp 0,39 0,52%
1.2.10 Portalen 3,88 5,17%
1.2.11 Patiënt monitoring en datacollectie (PDMS) 3,88 5,17%
1.2.12 Rapportages 0,39 0,52%
1.2.13 Administratie Medisch wetenschappelijk onderzoek 3,88 5,17%
1.2.14 Administratie en monitoring onderwijs 0,39 0,52%
1.2.15 Functionaliteiten organisatorische werkeenheden / ketens 0,39 0,52%
1.3.1 Afspraken planning 3,44 4,58% 1.3.2 Opnameplanning en -registratie 3,44 4,58% 1.3.3 Beddenplanning 0,34 0,46% 1.3.4 Patiëntenlogistiek 0,34 0,46% 1.3.5 Wachtlijstbeheer 0,34 0,46% 1.3.6 Anesthesie, OK en IC 0,34 0,46% 1.4.1 Applicatie 1,10 1,47% 1.4.2 Platform 0,55 0,73%
1.4.3 Data opslag / Database 0,83 1,10%
1.4.4 Beveiliging 0,83 1,10%
1.4.5 Beheer 0,83 1,10%
1.4.6 Monitoring en reporting 0,83 1,10%
1.4.7 Open vragen - techniek 0,55 0,73%
1.5.1 Eisen Service Oriented Architecture 3,30 4,40%
1.5.2 Open vragen – integratie 2,20 2,93%
2.1.1 Eisen met betrekking tot de leverancier 1,20 1,60%
2.1.2 Commerciële en juridische eisen 2,10 2,80%
2.1.3 Serviceondersteuning en –contract (service level agreement) 2,10 2,80%
2.1.4 Innovatie 0,60 0,80%
2.2.1 Implementatie en bedrijfsgerede oplevering 3,00 4,00%
2.2.2 Plan van aanpak voor de implementatie en bedrijfsgerede oplevering 4,00 5,33%
2.2.3 Documentatie en templates 1,00 1,33%
2.2.4 Opleiding en instructie 1,00 1,33%
2.2.5 Conversie 1,00 1,33%
Appendix J
Score of considered (sub) topics tender B
Table 40 – Score considered (sub) topics in tender B
Topic Name topic Points that can be
scored per topic
Percentage of total score
1-2 Zeer belangrijke wensen 400 54,05%
2-1 Implementatieplan 200 27,03%
2-2 Best practices 50 6,76%
2-3 Risico’s 20 2,70%
2-4 Onderhoud en Beheer 30 4,05%
3-1 Presentatie Implementatieplan 40 5,41%
Subtopic Name subtopic Points that can be
scored per subtopic
Percentage of total score
1-2-1 Functionele rijkheid wanneer beschikbaar 80 10,81%
1-2-2 Integraliteit (presenteren, gebruik van gegevens) 20 2,70%
1-2-3 Dossier – gebruiksgemak 28 3,78%
1-2-4 Dossier – delen van gegevens 20 2,70%
1-2-5 Dossier – onderzoek 40 5,41%
1-2-6 Dossier – onderwijs 20 2,70%
1-2-7 Zorgprocessen – toegankelijkheid en overzicht 16 2,16%
1-2-8 Zorgprocessen – ondersteuning van het zorgproces 16 2,16%
1-2-9 Integrale planning – integraliteit deelplanningen 28 3,78%
1-2-10 Integrale planning – planningsvoorkeuren 12 1,62%
1-2-11 Transmurale communicatie – functionaliteit 6 0,81%
1-2-12 Transmurale communicatie – openheid van het syteem 6 0,81%
1-2-13 Stuurinformatie, operationele rapportages 8 1,08%
1-2-14 Zorgadministratie, DBC’s en medische facturatie 20 2,70%
1-2-15 ICT - Beschikbaarheiden betrouwbaarheid 60 8,11%
1-2-16 ICT - Bevoegdheden en veiligheid 20 2,70%
2-1-1 Projectorganisatie en projectmanagement 6 0,81%
2-1-2 Werkwijze, methode en tools 6 0,81%
2-1-3 Fasering 16 2,16%
2-1-4 Tijdsplanning 8 1,08%
2-1-5 Capaciteitsplanning 6 0,81%
2-1-6 Taakverdeling 4 0,54%
2-1-7 Opleiding en training van projectmedewerkers en beheerders 16 2,16%
2-1-8 Opleiding eindgebruikers 12 1,62% 2-1-9 Testen en acceptatie 16 2,16% 2-1-10 Verandermanagement 4 0,54% 2-1-11 Interfaces en integratie 6 0,81% 2-1-12 Pakketaanpassingen en maatwerk 6 0,81% 2-1-13 Conversie en schoning 16 2,16% 2-1-14 Rapportages 6 0,81% 2-1-15 Go-live en nazorg 20 2,70% 2-1-16 Kwaliteitszorg 6 0,81% 2-1-17 Documentatie 6 0,81%
2-1-18 Randvoorwaarden aan de Opdrachtgever 10 1,35%
2-1-19 Samenwerking UMC's 10 1,35%
2-1-20 Plan van aanpak na de beslisimplementatie 20 2,70%
2-2-1 Kwaliteit van de best practices 30 4,05%
2-2-2 Bruikbaarheid van de best practices 10 1,35%
2-2-3 Toekomstvastigheid van de best practices 10 1,35%
2-3 Risico’s 20 2,70%
2-4-1 Inrichting organisatie 15 2,03%
2-4-2 Service Level Agreement 15 2,03%
3-1-1 Competenties projectteam 20 2,70%
Appendix K
Score of considered (sub) topics tender C
Table 41 – Score considered (sub) topics in tender C
Topic Name topic Points that can be
scored per topic
Percentage of total score
Z.1 Compleetheid van Product 140 16,28%
Z.2 Aangeboden functionaliteit 440 51,16%
Y.1 Technische flexibiliteit 50 5,81%
Y.2 Beheersbaarheid 50 5,81%
Y.3 Architectuur 50 5,81%
X.1 Conversie 30 3,49%
X.2 Testen 20 2,33%
X.3 Implementatieplan en nazorg 80 9,30%
Subtopic Name subtopic Points that can be
scored per subtopic
Percentage of total score
Z.1.1 Mate van compleetheid huidig product 80 9,30%