Appl Clin Inform 2016; 07(04): 1202-1220
DOI: 10.4338/ACI-2016-08-RA-0135
Research Article
Schattauer GmbH

Identification and Characterization of Inter-Organizational Information Flows in the Portuguese National Health Service

Eduardo Pinto
1   INESC TEC, Faculdade de Engenharia, Universidade do Porto
,
António Carvalho Brito
1   INESC TEC, Faculdade de Engenharia, Universidade do Porto
,
Ricardo João Cruz-Correia
2   CINTESIS – Center for Research in Health Technologies and Information Systems, Faculdade de Medicina, Universidade do Porto
› Institutsangaben
Funding The authors would like to thank the Portuguese Ministry of Health and SPMS for the support and FCT for funding this research (SFRH/BD/90838/2012).
Weitere Informationen

Correspondence to:

Eduardo Pinto
INESC TEC
Campus da FEUP
Rua Dr. Roberto Frias
4200 – 465 Porto
Portugal

Publikationsverlauf

received: 03. August 2016

accepted: 05. November 2016

Publikationsdatum:
18. Dezember 2017 (online)

 

Summary

Objectives To understand and build a collective vision of all existing institutions in the Portuguese National Health Service as well as to perceive how and how far the interaction between those multiple institutions is supported by Information Systems (IS).

MethodsUpon identification of the institutions involved in the healthcare process, a set of interviews with experienced people from those institutions was conducted, which produced about five hours of tape. The research was focused exclusively on processes involving two different organizations and any internal processes were altogether excluded from it.

ResultsThe study allowed the identification of about 50 recurrent interaction processes, which were classified into four different varieties in accordance with the nature of the information flow: administrative, clinical, identificational and statistical. In addition, these processes were divided in accordance with the way how that integration is achieved, from completely automated to email or telephone-based.

ConclusionsFunds/Money related processes are technologically more rigid and standardized, whereas auditing and inspection ones are less supported by automatic systems. There emerged an interesting level of sharing and integration in clinical processes, although the integration is mostly made at the interface level. The authors identified 5 particularly relevant and dominant actors (2 classes of individuals and 3 institutions) with which there is a need for coordination and cooperation. The authors consider that, in future works, an effort should be made to provide the various institutions with guidelines/interfaces and prompt such institutions to elaborate upon these.

Citation: Pinto E, Brito AC, Cruz-Correia RJ. Identification and characterization of inter-organizational information flows in the Portuguese National Health Service.


#

 


#

Conflicts of Interest

The authors declare that they have no conflicts of interest in the research.

  • References

  • 1 Bernstein K, Bruun-Rasmussen M, Vingtoft S, Andersen SK, Nøhr C. Modelling and implementing electronic health records in Denmark. Int J Med Inform 2005; 74 (2–4): 213-220.
  • 2 Protti D, Johansen I, Perez-Torres F. Comparing the application of Health Information Technology in primary care in Denmark and Andalucía, Spain. Int J Med Inform 2009; 78 (04) 270-283.
  • 3 Brennan S. The biggest computer programme in the world ever! How’s it going?. J Inf Technol 2007; 22 (03) 202-211.
  • 4 McGinn CA, Gagnon M-P, Shaw N, Sicotte C, Mathieu L, Leduc Y, Grenier S, Duplantie J, Abdeljelil A, Ben Légaré F. Users’ perspectives of key factors to implementing electronic health records in Canada: a Delphi study. BMC Med Inform Decis Mak 2012; 12: 105.
  • 5 Urowitz S, Wiljer D, Apatu E, Eysenbach G, Delenardo C, Harth T, Pai H, Leonard KJ. Is Canada ready for patient accessible electronic health records? A national scan. BMC Med Inform Decis Mak 2008; 08: 33.
  • 6 Rozenblum R, Jang Y, Zimlichman E, Salzberg C, Tamblyn M, Buckeridge D, Forster A, Bates DW, Tamblyn R. A qualitative study of Canada’s experience with the implementation of electronic health information technology. C Can Med Assoc J 2011; 183 (05) 281-288.
  • 7 Grabenbauer L, Fraser R, McClay J, Woelfl N, Thompson CB, Cambell J, Windle J. Adoption of electronic health records: A qualitative study of academic and private physicians and health administrators. Appl Clin Inform 2011; 02 (02) 165-176.
  • 8 Anderson JG. Social, ethical and legal barriers to e-health. Int J Med Inform 2006; 76 (5–6): 480-483.
  • 9 Grabenbauer L, Skinner A, Windle J. Electronic Health Record Adoption – Maybe It’s not about the Money: Physician Super-Users, Electronic Health Records and Patient Care. Appl Clin Inform 2011; 02 (04) 460-471.
  • 10 Eden KB, Totten AM, Kassakian SZ, Gorman PN, McDonagh MS, Devine B, Pappas M, Daeges M, Woods S, Hersh WR. Barriers and facilitators to exchanging health information: A systematic review. Int J Med Inform 2016; 88: 44-51.
  • 11 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005 Suppl Web.
  • 12 Pinho de NF, Beirão G, Patrício L, Fisk RP. Understanding value co-creation in complex services with many actors. J Serv Manag 2014; 25 (04) 470-493.
  • 13 Patrício L, Brito AC, Pinho N, Oliveira M, Pinto E. Designing a sustainable Electronic Health Record: from Service Ecosystem to Information Architecture. 2012 Available from: http://paginas.fe.up.pt/∼ehisa/presentations/LiaPatricio_AntonioBrito_PDS_FEUP.pdf.
  • 14 Pinto E, Brito AC. Architectural Key Dimensions for a Successful Electronic Health Record Implementation. In: ICEIS 2014 – 16th International Conference on Enterprise Information Systems. 2014: 136-143.
  • 15 Pinto E, Brito AC. The Portuguese Health Data Platform: An Alternative Architecture Approach. In: 8th International Conference on e-Health. 2016
  • 16 Deloitte. Saúde em análise – Uma visão para o futuro. 2011
  • 17 Richardson S. Inter-agency Information Sharing in Health and Social Care Services: The Role of Professional Culture. Br J Soc Work 2005; 36 (04) 657-669.
  • 18 Pieters A. Care and cure: Compete or collaborate? Improving inter-organizational designs in healthcare. A case study in Dutch perinatal care. 2013
  • 19 Timpka T, Bång M, Delbanco T, Walker J. Information infrastructure for inter-organizational mental health services: an actor network theory analysis of psychiatric rehabilitation. J Biomed Inform 2007; 40 (04) 429-437.
  • 20 Pouloudi A, Whitley E. Stakeholder identification in inter-organizational systems: gaining insights for drug use management systems. Eur J Inf Syst 1997; 06 (01) 1-14.
  • 21 Unertl KM, Johnson KB, Gadd CS, Lorenzi NM. Bridging Organizational Divides in Health Care: An Ecological View of Health Information Exchange. JMIR Med Informatics 2013; 01 (01) e3.
  • 22 Nardi BA, O’Day V. Information ecologies: Using technologies with heart. First Monday 1999; 04 (05) 1-5.
  • 23 Nazi KM. The personal health record paradox: health care professionals’ perspectives and the information ecology of personal health record systems in organizational and clinical settings. J Med Internet Res 2013; 15: 4.
  • 24 Atalag K, Kingsford D, Paton C, Warren J. Putting Health Record Interoperability Standards to Work. Electron J Heal Informatics 2010; 05 (01) 1-17.
  • 25 Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Vol. 3, Sage Publications Inc; 2008: 379.
  • 26 Harrell Margaret C, Bradley Melissa A. Data Collection Methods Semi-Structured Interviews and Focus Groups. CA: RAND Corporation; 2009: 148.
  • 27 Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis Sage. SAGE; 2006
  • 28 Fedorowicz J, Gogan J, Ray A. The Ecology of Inter-organizational Information Sharing. J Int Inf Manag 2004; 13 (02) 73-86.
  • 29 joão Campos M, Correia M, Antunes L. Leveraging identity management interoperability in ehealth. IEEE Conf Secur Technol ICCST. 2011
  • 30 Stroetmann KA, Artmann J, Stroetmann VN. European countries on their journey towards national eHealth infrastructures. eHealth Strategies. 2011
  • 31 Cresswell KM, Worth A, Sheikh A. Integration of a nationally procured electronic health record system into user work practices. BMC Med Inform Decis Mak 2012; 12 (01) 15.
  • 32 Eichelberg M, Aden T, Riesmeier J, Dogac A, Laleci GB. A survey and analysis of Electronic Healthcare Record standards. ACM Comput Surv 2005; 37 (04) 277-315.
  • 33 Currie G, Suhomlinova O. The Impact of Institutional Forces Upon Knowledge Sharing in the UK NHS: The Triumph of Professional Power and the Inconsistency of Policy. Public Adm 2006; 84 (01) 1-30.
  • 34 Edwards J. Case Study: Denmark’s Achievements With Healthcare Information Exchange. Gart Ind Res Publ. 2006
  • 35 Kazman R, Chen H-M. The metropolis model a new logic for development of crowdsourced systems. Commun ACM. 2009; 52 (07) 76.

Correspondence to:

Eduardo Pinto
INESC TEC
Campus da FEUP
Rua Dr. Roberto Frias
4200 – 465 Porto
Portugal

  • References

  • 1 Bernstein K, Bruun-Rasmussen M, Vingtoft S, Andersen SK, Nøhr C. Modelling and implementing electronic health records in Denmark. Int J Med Inform 2005; 74 (2–4): 213-220.
  • 2 Protti D, Johansen I, Perez-Torres F. Comparing the application of Health Information Technology in primary care in Denmark and Andalucía, Spain. Int J Med Inform 2009; 78 (04) 270-283.
  • 3 Brennan S. The biggest computer programme in the world ever! How’s it going?. J Inf Technol 2007; 22 (03) 202-211.
  • 4 McGinn CA, Gagnon M-P, Shaw N, Sicotte C, Mathieu L, Leduc Y, Grenier S, Duplantie J, Abdeljelil A, Ben Légaré F. Users’ perspectives of key factors to implementing electronic health records in Canada: a Delphi study. BMC Med Inform Decis Mak 2012; 12: 105.
  • 5 Urowitz S, Wiljer D, Apatu E, Eysenbach G, Delenardo C, Harth T, Pai H, Leonard KJ. Is Canada ready for patient accessible electronic health records? A national scan. BMC Med Inform Decis Mak 2008; 08: 33.
  • 6 Rozenblum R, Jang Y, Zimlichman E, Salzberg C, Tamblyn M, Buckeridge D, Forster A, Bates DW, Tamblyn R. A qualitative study of Canada’s experience with the implementation of electronic health information technology. C Can Med Assoc J 2011; 183 (05) 281-288.
  • 7 Grabenbauer L, Fraser R, McClay J, Woelfl N, Thompson CB, Cambell J, Windle J. Adoption of electronic health records: A qualitative study of academic and private physicians and health administrators. Appl Clin Inform 2011; 02 (02) 165-176.
  • 8 Anderson JG. Social, ethical and legal barriers to e-health. Int J Med Inform 2006; 76 (5–6): 480-483.
  • 9 Grabenbauer L, Skinner A, Windle J. Electronic Health Record Adoption – Maybe It’s not about the Money: Physician Super-Users, Electronic Health Records and Patient Care. Appl Clin Inform 2011; 02 (04) 460-471.
  • 10 Eden KB, Totten AM, Kassakian SZ, Gorman PN, McDonagh MS, Devine B, Pappas M, Daeges M, Woods S, Hersh WR. Barriers and facilitators to exchanging health information: A systematic review. Int J Med Inform 2016; 88: 44-51.
  • 11 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005 Suppl Web.
  • 12 Pinho de NF, Beirão G, Patrício L, Fisk RP. Understanding value co-creation in complex services with many actors. J Serv Manag 2014; 25 (04) 470-493.
  • 13 Patrício L, Brito AC, Pinho N, Oliveira M, Pinto E. Designing a sustainable Electronic Health Record: from Service Ecosystem to Information Architecture. 2012 Available from: http://paginas.fe.up.pt/∼ehisa/presentations/LiaPatricio_AntonioBrito_PDS_FEUP.pdf.
  • 14 Pinto E, Brito AC. Architectural Key Dimensions for a Successful Electronic Health Record Implementation. In: ICEIS 2014 – 16th International Conference on Enterprise Information Systems. 2014: 136-143.
  • 15 Pinto E, Brito AC. The Portuguese Health Data Platform: An Alternative Architecture Approach. In: 8th International Conference on e-Health. 2016
  • 16 Deloitte. Saúde em análise – Uma visão para o futuro. 2011
  • 17 Richardson S. Inter-agency Information Sharing in Health and Social Care Services: The Role of Professional Culture. Br J Soc Work 2005; 36 (04) 657-669.
  • 18 Pieters A. Care and cure: Compete or collaborate? Improving inter-organizational designs in healthcare. A case study in Dutch perinatal care. 2013
  • 19 Timpka T, Bång M, Delbanco T, Walker J. Information infrastructure for inter-organizational mental health services: an actor network theory analysis of psychiatric rehabilitation. J Biomed Inform 2007; 40 (04) 429-437.
  • 20 Pouloudi A, Whitley E. Stakeholder identification in inter-organizational systems: gaining insights for drug use management systems. Eur J Inf Syst 1997; 06 (01) 1-14.
  • 21 Unertl KM, Johnson KB, Gadd CS, Lorenzi NM. Bridging Organizational Divides in Health Care: An Ecological View of Health Information Exchange. JMIR Med Informatics 2013; 01 (01) e3.
  • 22 Nardi BA, O’Day V. Information ecologies: Using technologies with heart. First Monday 1999; 04 (05) 1-5.
  • 23 Nazi KM. The personal health record paradox: health care professionals’ perspectives and the information ecology of personal health record systems in organizational and clinical settings. J Med Internet Res 2013; 15: 4.
  • 24 Atalag K, Kingsford D, Paton C, Warren J. Putting Health Record Interoperability Standards to Work. Electron J Heal Informatics 2010; 05 (01) 1-17.
  • 25 Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Vol. 3, Sage Publications Inc; 2008: 379.
  • 26 Harrell Margaret C, Bradley Melissa A. Data Collection Methods Semi-Structured Interviews and Focus Groups. CA: RAND Corporation; 2009: 148.
  • 27 Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis Sage. SAGE; 2006
  • 28 Fedorowicz J, Gogan J, Ray A. The Ecology of Inter-organizational Information Sharing. J Int Inf Manag 2004; 13 (02) 73-86.
  • 29 joão Campos M, Correia M, Antunes L. Leveraging identity management interoperability in ehealth. IEEE Conf Secur Technol ICCST. 2011
  • 30 Stroetmann KA, Artmann J, Stroetmann VN. European countries on their journey towards national eHealth infrastructures. eHealth Strategies. 2011
  • 31 Cresswell KM, Worth A, Sheikh A. Integration of a nationally procured electronic health record system into user work practices. BMC Med Inform Decis Mak 2012; 12 (01) 15.
  • 32 Eichelberg M, Aden T, Riesmeier J, Dogac A, Laleci GB. A survey and analysis of Electronic Healthcare Record standards. ACM Comput Surv 2005; 37 (04) 277-315.
  • 33 Currie G, Suhomlinova O. The Impact of Institutional Forces Upon Knowledge Sharing in the UK NHS: The Triumph of Professional Power and the Inconsistency of Policy. Public Adm 2006; 84 (01) 1-30.
  • 34 Edwards J. Case Study: Denmark’s Achievements With Healthcare Information Exchange. Gart Ind Res Publ. 2006
  • 35 Kazman R, Chen H-M. The metropolis model a new logic for development of crowdsourced systems. Commun ACM. 2009; 52 (07) 76.