Process Analysis and Decision Support Tools in Parenteral Nutrition in Children.

Parenteral nutrition represents a well-established but highly sensitive process associated with several patient conditions. It typically involves assessments of many parameters and a wide range of observations in order to come up with the best possible parenteral solution for a patient. Different calculation tables are used to determine correct ratios of nutritional elements which would later be administered. This work focuses on providing a process map for parenteral nutrition in children using the combination of Petri nets and openEHR methodology to create an overview for the decision-making process.

Development of the quality assessment model of EHR software in family medicine practices: research based on user satisfaction.

BACKGROUND: Family medicine practices (FMPs) make the basis for the Croatian health care system. Use of electronic health record (EHR) software is mandatory and it plays an important role in running these practices, but important functional features still remain uneven and largely left to the will of the software developers. OBJECTIVE: The objective of this study was to develop a novel and comprehensive model for functional evaluation of the EHR software in FMPs, based on current world standards, models and projects, as well as on actual user satisfaction and requirements. METHODS: Based on previous theoretical and experimental research in this area, we made the initial framework model consisting of six basic categories as a base for online survey questionnaire. Family doctors assessed perceived software quality by using a five-point Likert-type scale. Using exploratory factor analysis and appropriate statistical methods over the collected data, the final optimal structure of the novel model was formed. Special attention was focused on the validity and quality of the novel model. RESULTS: The online survey collected a total of 384 cases. The obtained results indicate both the quality of the assessed software and the quality in use of the novel model. The intense ergonomic orientation of the novel measurement model was particularly emphasised. CONCLUSIONS: The resulting novel model is multiple validated, comprehensive and universal. It could be used to assess the user-perceived quality of almost all forms of the ambulatory EHR software and therefore useful to all stakeholders in this area of the health care informatisation.

A methodology to assess experiences in implementing e-Health solutions in Croatian family medicine.

The central information system of primary health care of the Republic of Croatia is in an early stage of implementation which for now covers integration of all family doctors' offices into a single comprehensive eHealth network connecting their software solutions with the national payer institute and public health authority. Measuring the quality and efficiency of information systems at an early stage of development is a very difficult task. The main goal of this work is establishing the foundation for a formal methodology to measure and quantify the experience of family doctors in the current use of this system. A questionnaire has been created to support the work which, on one side carefully follows our assumptions for quality criteria, and on the other collects valuable input from the users of the technology and solutions implemented. Our work is closely aligned with worldwide accepted standards and recommendations carefully analyzed and localized to reflect the current environment and health policy. This paper presents some preliminary results based on the survey conducted with family doctors on the field.

National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care.

In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

HL7 and DICOM based integration of radiology departments with healthcare enterprise information systems.

PURPOSE: Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. However, this requirement represents one of the major challenges for the Information and Communication Technology (ICT) solutions, as systems today use diverse technologies, proprietary protocols and communication standards which are often not interoperable. One of the main producers of clinical information in healthcare settings represent Radiology Information Systems (RIS) that communicate using widely adopted DICOM (Digital Imaging and COmmunications in Medicine) standard, but in very few cases can efficiently integrate information of interest with other systems. In this context we identified HL7 standard as the world's leading medical ICT standard that is envisioned to provide the umbrella for medical data semantic interoperability, which amongst other things represents the cornerstone for the Croatia's National Integrated Healthcare Information System (IHCIS). The aim was to explore the ability to integrate and exchange RIS originated data with Hospital Information Systems based on HL7's CDA (Clinical Document Architecture) standard. METHODS: We explored the ability of HL7 CDA specifications and methodology to address the need of RIS integration HL7 based healthcare information systems. RESULTS: We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers. The outcome of our pilot work proves our original assumption of HL7 standard being able to adopt radiology data into the integrated healthcare systems. CONCLUSION: Uniform DICOM to CDA translation scripts and business processes within IHCIS is desired and cost effective regarding to use of supporting IHCIS services aligned to SOA.

Integrating radiology information systems with healthcare delivery environments using DICOM and HL7 standards.

Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. Interoperability presents data and communication layer interchange. In this context we identified the HL7 standard as the world's leading medical Information and communication technology (ICT) standard for the business layer in healthcare information systems and we tried to explore the ability to exchange clinical documents with minimal integrated healthcare information systems (IHCIS) change. We explored HL7 Clinical Document Architecture (CDA) abilities to achieve radiology information system integration (DICOM) to IHCIS (HL7). We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers.

Primary healthcare information system--the cornerstone for the next generation healthcare sector in Republic of Croatia.

At no time in the history of medicine has the growth in knowledge and technologies been so profound [Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine (IOM), 2001. ISBN 0-309-07280-8]. However, healthcare delivery systems today are not able to keep up with the pace. Studies have shown that it takes an average of about 17 years for new knowledge generated by randomized trials to be incorporated into practice [B. Andrew, S. Boren, Managing clinical knowledge for health care improvement, in: Yearbook of Medical Informatics, National Library of Medicine, Bethesda, MD, 2000, pp. 65-70]. It is safe to say that today healthcare systems "have the data, but not information". In order to provide highest quality patient care, Republic of Croatia has started the process of introducing enterprise information systems to support business processes in the healthcare domain. Two major requirements are in focus: to provide efficient healthcare related data management in support of decision-making processes; and to support continuous process of healthcare resources spending optimization. The first initiated project refers to Primary Healthcare Information System (PHCIS) that provides domain of primary care with state-of-the-art enterprise information system that connects General Practitioners, Pediatricians and Gynecologists offices with the Croatian Institute for Health Insurance and Public Health Institute. In the years to come, PHCIS will serve as the main integration platform for connecting all other stakeholders and levels of healthcare (e.g. hospitals, pharmacies, laboratories) into single enterprise healthcare network. This article gives an overview of PHCIS, explains challenges that were faced in designing and implementing the system, and elaborates PHCIS role as the cornerstone for the next generation healthcare provisioning in Republic of Croatia.

[HL7 standard--features, principles, and methodology]. / HL7 norma--znacajke, principi i metodologija.

The mission of HL7 Inc. non-profit organization is to provide standards for the exchange, management and integration of data that support clinical patient care, and the management, delivery and evaluation of healthcare services. As the standards developed by HL7 Inc. represent the world's most influential standardization efforts in the field of medical informatics, the HL7 family of standards has been recognized by the technical and scientific community as the foundation for the next generation healthcare information systems. Versions 1 and 2 of HL7 standard have solved many issues, but also demonstrated the size and complexity of health information sharing problem. As the solution complete new methodology has been adopted that is encompassed in the HL7 Version 3 recommendations. This approach standardizes Reference Information Model (RIM), which is the source of all derived domain models and message structures. Message design is now defined in detail, enabling interoperability between loosely coupled systems that are.designed by different vendors and deployed in various environments. At the start of the Primary Healthcare Information System project in the Republic of Croatia in 2002, the decision was to go directly to Version 3. The target scope of work includes clinical, financial and administrative data management in the domain of healthcare processes. By using HL7v3 standardized methodology we were able to completely map the Croatian primary healthcare domain to HL7v3 artefacts. Further refinement processes that are planned for the future will provide semantic interoperability and detailed description of all elements in HL7 messages. Our HL7 Business Component is in constant process of studying different legacy applications, making solid foundation for their integration to HL7-enabled communication environment.

Implementing the HL7v3 standard in Croatian primary healthcare domain.

The mission of HL7 Inc. is to provide standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services. The scope of this work includes the specifications of flexible, cost-effective approaches, standards, guidelines, methodologies, and related services for interoperability between healthcare information systems. In the field of medical information technologies, HL7 provides the world's most advanced information standards. Versions 1 and 2 of the HL7 standard have on the one hand solved many issues, but on the other demonstrated the size and complexity of the health information sharing problem. As the solution, a complete new methodology has been adopted, which is being encompassed in version 3 recommendations. This approach standardizes the Reference Information Model (RIM), which is the source of all domain models and message structures. Message design is now defined in detail, enabling interoperability between loosely-coupled systems that are designed by different vendors and deployed in various environments. At the start of the Primary Healthcare Information System project, we have decided to go directly to HL7v3. Implementing the HL7v3 standard in healthcare applications represents a challenging task. By using standardized refinement and localization methods we were able to define information models for Croatian primary healthcare domain. The scope of our work includes clinical, financial and administrative data management, where in some cases we were compelled to introduce new HL7v3-compliant models. All of the HL7v3 transactions are digitally signed, using the W3C XML Digital Signature standard.