ICT can support all phases of the production of information, starting with the collection of primary data (data entry), but there are two stages on which the computer infrastructure mainly concentrates: data processing and the transmission of information (Wilson, 2000).
According to the existing development of a specific HIS, there are different options or steps
for automation (non-exclusive) in support of each phase of the production of information:
x Development of a manual information (or statistical) system
x Improvement or consolidation of such manual system, to perform effectively
x Development of progressive automation to support some aspects of production (such as data transmission and processing, and reporting) x Increase of degree of automation, up to full
automation
x Automation of information transmission of data and information to other information systems within the NHIS network
x Development of virtual communication
The factors to be considered for final choice depend on the feasibility, needs for and cost- benefits of improving the technology. Often, it is sufficient to improve a manual information system, or to maintain a hybrid (which is a combination of a manual and an automated system), using relatively basic technology. In such a case, consideration should be given to the conditions and capacities of the personnel who will have to handle the applied technology. The volume of managed data is also important. It is worth distinguishing the volume that is really needed to be handled and the unnecessary overload of data that often bear the information systems, especially those of health services.
In small health care centers with little technology and no informatics, it is worth analyzing the cost benefit of computation, especially if good manual information systems are in operation and budgets are limited. The dilemma focuses on what to put under computation, the correct technological level to develop, if improving the manual system is not preferable in the first instance (Wilson, 2000). There are multiple options for the application of equipment, programs and computational connectivity but decisions regarding adoption should include the opinion of all the types of personnel since they all will participate in the information system in some way or another.
Specific hardware and software decisions for deployment and application refer mainly to:
• Computational processors;
• Devices for the storage of information, hard disks;
• Video screens: use of data or graphs environments;
• Multimedia;
• Personal identification devices: readers of cards with magnetic bands, cards with microcircuits or intelligent cards;
• Connectivity equipment: central connection points, directions, and integral parts of communications equipment;
• Other entry/exit devices: printers, fax machines, scanners;
• Programming languages: languages and techniques which cause the equipment and networking technology to function, as well as integrate different applications and databases; • Operating systems programs;
• Program activators: database management, safety systems, interfaces, messaging systems, and intermediate programs;
• Communications programs, programs developed for Internet, HTML, web browsers, and others; • Software: administrative, financial and clinical. In the health sector, hospitals have needs for complex ICT, especially those with big size, multiple production centers and sophisticated specialization. Hospitals can become complex provider centers that require wide range of detailed information.
Sometimes, immediate production (on-line) of information is required, as is the case with intensive care units, and the management of detailed individual data is frequently needed (as in case of medical records). For that reason, national health authorities generally provide high priority to the development of automated hospital information systems, with greater investments in ICT, in order
to support administrative, financing and clinical functions.
Existing information technology in hospitals tends to be quite varied, since they generally have a mixed automated system (combined with manual systems, and with a different degree of computational sophistication. The automation of clinical services is frequently regarded as insufficient or difficult to implement. Starting with isolated specific information systems (such as billing, laboratory, pharmacy), ICT steps for improvement can include the development of an integrated hospital information system based on effective communication of data between all networked units or subsets of a hospital, and also among the clinical services, administrative services, and technical and logistical support services. Furthermore, it is important to consider the rapid obsolescence of ICT, where rapid growth and technological advances together contrast with early aging that characterizes most of existing systems. It is therefore important that users should bve very cautious in order to avoid investing in systems prone to the early obsolescence (PAHO, 1999).
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It is necessary to have personnel who are IT experts for the design and selection, development or application of the technology, for the maintenance of equipment and programs, computer management and output, in accordance with the global management of the National Health Information System. Technological management includes training, monitoring, and evaluation of the operation (often solving problems and operational emergencies with the equipment and programs). In the case of institutions which develop own software programs or applications, an issue which should be resolved in each context is whether external programs should be purchased or a mixed option should be adopted. Each option has advantages and disadvantages, coming from issues such as the intellectual property, possibilities of updating or the capacity to make changes whenever the managers need different reporting, so the program needs to be adapted to satisfy the new requirements of information, in support of health care production processes.
Powerful commercial database management systems (programs of third and fourth
technological generation) are currently available for microcomputers and even personal computers that require technicians to have a different degree of training in programming.
Database management systems can be complemented with programs that permit, in a relatively straightforward way, the capacity to obtain consultation reports and to write reports based on results. This is also a feature of some analysis programs, such as EpiInfo ® and SPSS ®. However, in some less sophisticated centers and for management and public health purposes, it is also possible to use simpler quite friendly equipment and computer programs that can be handled by personnel who are not experts in
informatics. Those programs can have anyway high processing capacity and technological sophistication, accessible at offices at different levels of the health sector and. Such is the case, for example, with many programs run under the Windows Operating System® which are widely used at offices and even at home (such as those of Microsoft Office®), that can be integrated into local or distance networks (via Internet). Microsoft Office®, which is worldwide used, comprises word processors, graphics programs, electronic tables, databases and Internet connection. There are some other available statistical programs, or programs facilitating epidemiological analysis (such as EpiInfo ® or SPSS ®) or geographic information systems (GIS), which are user- friendly.