Jerry Fahrni

I came across an interesting article recently in the International Journal of Biomedical Engineering and Technology¹. The article discusses the difficulties in designing an EMR system capable of providing optimal access to data elements while remaining efficient and user friendly.  It was a good look at the current state of healthcare data exchange.

Abstract:

This paper discusses how to share medical information between heterogeneous applications via web services. Our design theory is based on a real-options framework, performance analysis and experience building iRevive, a working web-services-enabled pre-hospital documentation application. The trade-offs between efficiency and flexibility are examined in the context of exchanging information based on emerging standards in the healthcare world. These trade-offs are quantified using a real-options approach. We illustrate the importance of uncertainty in deciding the architecture enabling an application to access medical information from Electronic Medical Records (EMRs).

The article goes into quite a bit of detail in describing the trade-offs between getting access to all the information necessary to perform your job and the need for usability and speed in a data driven system. The article centered on building an integrated hospital EMR system designed to collect data via web services instead of the “every day” desktop applications typically seen in a hospital.

Some of the key points from the article include:

• Web services are a good choice for promoting the exchange of information among various systems.
• As uncertainty in data requirements goes up, so does the need for flexibility in the system. Unfortunately the same uncertainty that requires flexibility also creates inefficiency and complexity in design, i.e. how can a developer build software to capture and use data when the end user is uncertain about what data needs to be collected and how they’re going to use it.
• Modularity in EMR data design can be good or bad depending on the needs of the end user and the money available to design the system. However, increased modularity doesn’t necessarily equal increased integration or performance. It has the potential, however to create standardization and simplification.
• There are many different architectures to consider when designing an EMR capable of sharing data, but the design must balance efficiency and flexibility with usability.

The article offers an interesting perspective on system design as the authors delve into the trade-off between flexibility and efficiency in any system. According to the authors “when the designer understands users’ needs, then a focus on efficient web services makes sense”; that about sums it up for me. Anytime someone wants to get away from the desktop I consider it a positive.

The article uses an application called iRevive to illustrate several points. iRevive is a mobile data collection system for use by healthcare professionals in the field. I don’t think the product still exists as the company website looks like it’s been neglected for quite some time.

1. Gaynor, M., Myung, D., Restuccia, J. and Moulton, S. (2010) ‘Designing infrastructure to exchange Electronic Medical Records with web services’, Int J. Biomedical Engineering and Technology, Vol. 3, Nos. ¾, pp. 393-412