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Health IT and EHRs: Principles and Practice, Sixth Edition

Chapter 11: Information Technology

System Architecture

The technical building blocks that support the operation and use of a computer system

Hardware architecture supports

Input/output

Processing

Storage

Input/Output (I/O) Devices

Also known as human-computer interfaces or workstations, because they are the connection between a human and the computing power of the application in the computer

Input/output devices:

Personal computers

Workstations

Desktops

Laptops or notebooks

Tablets

PDAs

Smartphones

Keyboards

Display screens

Navigational devices

Optical character recognition (OCR)

Document scanners

Barcodes

RFID

Voice or speech input

Printers

I/O Considerations

Source of power

Cabled to electrical outlet or battery

Network connectivity

Wired versus wireless connectivity

Portability

Consider size, weight, heat

Computers on wheels

Wireless on wheels (WOW)

Workstations on wheels (WOW)

Screen (real estate)

Size and resolution

Navigational devices

Consider ease of use and loss concerns

Data Storage

Secondary storage devices (drives)

Secondary to primary storage in the computer’s processors

Storage media

Magnetic tape

Magnetic disks

Optical disks

Flash drives/USB drives

Storage configuration: RAID

Storage architecture

Direct-attached storage

Storage area network

Network-attached storage

Hybrid

Content-addressable storage

Storage management – planning and organizing how data are stored

Processing Capability

CPU (processor)

KB, MB, GB, TB, and beyond

MHz, GHz

ALU/registers

ROM

Booting

RAM

Caching

Computer Categories

Supercomputer

Mainframe computer

Personal computer

Mobile devices: notebooks, laptops, tablets, smart phones

Network computers (thin clients)

Communications and Network Architecture

Firewall

Two or more computers communicating makes a network

Client/server architecture:

Service-oriented architecture, including web services architecture

Cloud computing; virtualization

Network Configuration

LAN

WAN

WLAN

VPN

Network Topology

Physical

Logical

Network Components

Network Operating System

Windows, Unix, or other

Network Interface

NIC, LAN Adapters, wireless access card

Transmission Medium

Hardwire cable, infrared light, radio frequencies

Other devices

Hub

Bridge

Router switch

Gateway

Multiplexor

Modems

Network Protocols

Rules of the road

OSI Model:

Seven layers

TCP/IP

FTP

HTTP

Physical Plant

Data center: location that affords special protection (back-up and disaster recovery) for mission-critical equipment

HVAC

UPS

Console monitoring

Caged server racks

Back-up generators

Software that Supports Health IT

Operating System (O/S)

Platform

Application software

Makes applications perform their functions

Source code

Application software (programs) written in a language computers can convert to electrical pulses. Provides instructions for processing.

Developer of software owns it, and generally licenses it to others, but others cannot alter the software.

Note: Configuration of software during implementation is enabled by the source code allowing for customization. Configuration does not alter the underlying source code.

Open-source software is freely distributed to others who may change it, but there may be a fee associated with acquiring it

Free software is software for which no charge is made for its use. It may or may not be open-source software

Usability

Usability refers to factors that make a product easy to use, although ease of use is often subjective and subject to change as users become comfortable with computers and products.

HIMSS identifies Usability Factors (see chapter 7)

NIST defines usability as the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use

Usability frustrations with EHRs led the AMA to identify solutions for making them usable.

Data Quality

Usability must ensure that the data collected, used, and shared are quality data.

Data Retrieval Strategies

Usability and data quality are critical to data retrieval, as they must support clinician thinking:

Scan data rapidly to obtain a quick overview and understanding of a new patient

Retrieve data to refamiliarize themselves with a former patient’s history

Search data for specific facts relative to a current patient

Review a range of data to solve a problem relative to a current patient

Clinical decision support as an external memory tool has been one of the most challenging aspects of data retrieval to design in a usable and accurate manner

System Constraints on CDS

Other Functional Considerations

Screen density

Size of device

Search capability

Navigational support and content positioning

Consistency of design and flexibility

Graphics

Color and icons

Documentation Strategies

Documentation strategies

Free text

Copy and paste

Data reuse

Pick lists or pull-down menus

Defaults

Template-based entry

Macros

NLP

SAFER Systems for Patient Safety

ONC Health IT Safety Program

Safety Assurance Factors for EHR Resilience

Guides for EHRs and other health IT