Executive Summary

Setting Up Healthcare Services Information Systems: A Guide for Requirement Analysis, Application Specification, and Procurement contains practical guidelines and suggestions to be used by healthcare and systems professionals when embarking in the initial stages of planning and developing healthcare services information systems and information technology (IS&T) applications.

Setting up information systems in healthcare involves some key preparative technical tasks: requirements analysis; technical specification of computer-based applications; preparation of Request for Proposals (RFP) for information systems, technology, and services; evaluation and selection of providers; and contracting aspects when acquiring IS&T for healthcare services.

It is expected that the judicious use of the concepts and recommendations detailed in this publication will contribute to improved decisions regarding IS&T design, acquisition, and deployment at all levels of management. The material was prepared considering the specific planning and execution requirements of tasks related to systems design, such as reaching consensus regarding desired functions in computerized applications, and to the complex process of procurement and acquisition of equipment and services. In addition, these guidelines may prove to be of great usefulness to those involved in making policies or to anyone who desires to develop a critical vision of healthcare services information systems and related technology.

Although general principles for requirement analysis and procurement can be applied to any healthcare information project, special consideration was given in this work to the technical knowledge components needed by healthcare professionals involved in IS&T institutional projects. The document describes current developments occurring in the field of information systems and technology, with appropriate emphasis on its implications for healthcare and projection of trends. Highlights of successful ingredients of an IS&T implementation plan are covered, including development of a strategic plan, processes and roles, implementation phases, and application modules.

This publication seeks to balance the readiness for long-term decisions with the practical needs of today’s diverse healthcare institutions in the area of IS&T. To that end, it should be viewed as a general source of information, with references to applicable World Wide Web sources for further details. It is not the purpose of this document to provide highly specific guidelines for individual application systems or users, or the promotion of a specific set of standards.

After a short introductory presentation of the objectives, audience, and description of how this publication was envisioned and written, a Quick Reference chapter facilitates the identification of topics and the navigation throughout the work.

Basic principles of IS&T implementation are discussed from the broad perspective of healthcare services requirements, followed by a comprehensive review of information systems and information technology solutions where project management, market, and commercial aspects are examined. The general and institutional IS&T development framework presented considers healthcare services as productive organizations operating in particular settings with specific functionalities and content requirements that must be defined in each case. In particular, healthcare networks, involving several stakeholders and different levels of clinical and managerial decision-making, must be supported by integrated IS&T solutions. Healthcare-related indicators have been included, representing a range from basic (PAHO Core Data Indicators) to more detailed indicators, involving higher level of information systems development (OECD Healthcare Indicators).

The review of information systems and information technology solutions covers the state of the art and trends. It includes the area of health services automation, features of health services information networks, issues regarding the structuring of the information chain, computer-based patient records, and information project management and implementation aspects of interest to health and systems professionals involved in information systems project development. Components involved in developing, deploying, and operating IS&T are detailed. These components are inter-related in a dynamic process, through project management, project operation, and project development teams. For the purposes of this document, discussions are focused in three basic components: planning, preparation, and procurement. Legal, confidentiality, and security aspects of health information systems and databases are addressed, and references on those important areas are reproduced, including a set of recommendations of functional requirements for healthcare documentation.

Procurement and contracting of IS&T services and products are described. Those topics encompass pertinent details related to the technological and market aspects of systems acquisition, including essential aspects of technology and services outsourcing, preparation of Request for Proposals (RFP), evaluation of proposals and providers, and the negotiation and contracting of services, products, and technological resources.

The core contribution of the document is the description of healthcare services applications functional specifications (Part D). This highly technical chapter lists the basic functionalities that each application area should consider. It includes a systematic categorization of functions in different formats, with the objective of assisting decision makers in the preparation of RFP, in evaluating existing products, and as a departure point for the discussion with users of desired functions when planning systems acquisition or development. The proposed desired functionalities also assist developers and users, in each implementation environment, to reach a consensus regarding which basic data elements would be needed for each application. Suggested basic data elements follow recommendations of the National Committee on Vital and Health Statistics, U.S. Department of Health and Human Services.

An electronic database of application functionalities in MS-Acess format (APFUNC.MDB) is included as a file in the CD-ROM version — with it developers and other interested parties will be able to generate a variety of reports and printouts. The database also can be used as a departure point for the construction of databases of functional descriptions tailored to particular projects.

The heterogeneous development level of societies and health services throughout Latin America and the Caribbean Region is associated with different degrees of infrastructure, organization, and quality of healthcare information. The document dedicates a chapter to the particular issues related to the implementation of information systems in the health sector of Latin America and the Caribbean.

Standards are a central element of open systems — without reliable, approved ways to connect the necessary components, open systems cannot work. Within the healthcare industry there are a very large number of categories of information that require standardization. There is an extensive examination of the complex issue of standards on data, communication, software, and hardware, at a highly specialized and technical level, and four annexes are added as references. The knowledgeable healthcare executive will do well to stay current on healthcare standards development. In addition, vendors demonstrating present and future commitment to standards are those most likely to survive in the very competitive healthcare IS&T marketplace, and should be given top consideration by healthcare enterprises in the process of systems selection.

Finally, references related to the issue of setting up information systems are also included: a listing of World Wide Web sites for Health and Medical Informatics and Standards Organizations, and a listing of Pan American Health Organization and World Health Organization publications in the area of Health Informatics.

This work is the successful result of a collaborative study conducted in the context of a partnership between the Pan American Health Organization and the IBM Corporation directed to the study of health information issues in Latin America and the Caribbean. The study was enriched by the collected experience reflected in several reference sources and by the contributions of a large panel of international experts from public and private organizations. Funding for the organization and conduction of consultation meetings, preparation and editing of manuscripts, translation, and publication was shared by the partners.

The final product is organized in a modular electronic format intended to provide a logical and step-wise framework for study and practical utilization. The electronic format allows the reader to have dynamic access to the different chapters and sections, according to the individual interest of each reader.