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models. In this context, although there is great
flexibility, it is necessary bilateral agreements
between the parties involved to be able to achieve
interoperability. To solve this problem a new version
of HL7 (version 3) is developing based on a
reference model called Reference Information
Model (RIM) (Eichelberg et al., 2005). For this
reason, in the totality of the cases we studied it is
necessary bilateral agreements, even when HL7 is
used.
From a management perspective integration is
not valued as a global centralized activity. Our
results show that it is possible to find in the same
hospital technological overlapping approaches. Also,
the same IS uses the same MOM everywhere, and
therefore we conclude that the MOM is imposed by
the supplier, probably because is much faster and
easier to build the integrations with the same product
everywhere.
The construction of regional or national EHR,
are in the centre of attention today, by the potential
benefits involved. However, to make this possible,
first there must be local interoperability at each
health organization so that patient data can be seen
in a comprehensive way when it is accessed from
other institution. Interoperability inside hospitals is
weak, for the reasons presented above, thus
undermining the project of regional and national
EHR, as well as creating enormous obstacles within
organizations.
Our results also show that CIOs are reluctant
regarding the safety of the exchanged data, as in the
majority of cases (51.5%) there is no control
mechanism for the integration.
In the scope of this study we have just
considered clinical IS, and we have not considered
integrations with medical devices. If the analysis is
extended the complexity of the problem is even
greater.
A limitation of our study is the inexistence of
other similar studies for comparison. However it is
our impression that this reality will be identical in
many other regions.
Another important finding relates to the
difficulty on getting the data, due to the lack of
documentation regarding existing systems and their
integrations. In the majority of the cases getting the
data from the healthcare was hard. We have reasons
to believe that being the main author of the paper
also a CIO and therefore a colleague of the
interviewed has helped gathering the data.
5 CONCLUSIONS
Our study concludes that there is a multiplicity of IS,
probably too many. The number of IS per
organization is closely related to the hospital
dimension and the number of integrations is
exponentially related with the number of IS. The
energy necessary to integrate the existing systems
grows rapidly when the dimension of the hospital
increases, with poor results.
Almost all integrations are in the data and
presentation layer, not sharing functionalities and
not taking advantage of the potential of SOA and
BPM technologies
Despite numerous efforts to develop standards, it
seems that there is a large gap between their
development and their application in these hospitals.
To our knowledge, the situation in Portugal
seems even worse as not many (if any) people work
in international standards bodies. We intend to
present these results to national institutions aiming at
raising global awareness on our current situation.
Interoperability inside hospitals is weak, thus
undermining the project of regional and national
EHR, as well as creating enormous obstacles within
organizations.
ACKNOWLEDGEMENTS
The authors acknowledge the help provided by ARS
Norte and also the contribution provided by Drª
Filipa Gomes in the statistical analysis.
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