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Analysis, design and modeling of an integrated information system supports electronic health records (Doctoral thesis)

Φραγγίδης, Λεωνίδαςς/ Frangidis, Leonidas

The development of Information and Communication Technologies (ICT) in healthcare sector, offers great potential for the implementation of a National Electronic Health Record (NEHR) System. Such a system will offer both to doctors and citizens to have direct access to their medical history. The implementation of a NEHR system is not an easy task. The NEHR system implementation approach will play significant role for the integration of various health information systems which are already in place and their interoperability. The aim of the PhD thesis is the Design and Modeling of an Integrated Information System of a National Electronic Health Record for Greece. The first objective of the dissertation is to specify and verify the good practices that have been applied globally during the implementation of a NEHR system. So far, all the available researches in the implementation of an EHR system are based mainly on bibliography. In the present research, an international survey was conducted and experts’ experience in the field of NEHR system implementation was recorded. The participated experts come from 13 countries, where NEHR systems have already been implemented or the implementation is at an advanced stage. The results of the research shows that most countries adopt the "middle-out" approach for the implementation of NEHR system, where the government sets the rules and policies that should be followed in the field of eHealth. Furthermore, the research shows that the main difficulty in the implementation process of the new EHR system is the user acceptance of the new Information System. Moreover, another interesting finding of the research is that funding of the NEHR implementation is considered as the least problematic issue. As far as the development process of an EHR system is concern, the results of the research shows that, in most countries it is common to outsource the development of the EHR system to private vendors. In addition, both the design phase of the system and the system maintenance are also assigned to private vendors, regardless the implementation approach followed in each country. ICT infrastructure in each country plays a vital role in the implementation process, along with the architecture of the NEHR system. Considering the structure and the infrastructure of the healthcare system in Greece, the architecture for a Greek NEHR system was designed and modeled. The proposed semi-distributed architecture offers a strong interoperability framework (using a middleware in each Health Information System) without the healthcare providers to change their local EHR systems. The proposed system architecture is a realistic approach, considering the current status of e-health in Greece, in order NEHR system to be implemented in an affordable cost. Considering the limitations of this research, especially the heterogeneity amongst the participated country’s health care systems and the proposed NEHR system architecture, this research can be used as a reference point for other countries that intend to proceed in NEHR system implementation.