Designing Electronic Health Records Versus Total Digital Health Systems: A Systemic Analysis

摘要

To date, the digitization of health care typically has focussed simply and solely on electronic records for patients. Most systems are relational databases with a finite number of intra-enterprise applications and are limited to in-house use by health care facilities. Very few of these systems have realized fully functional, scalable, distribution capabilities, not to mention interoperability with external systems. This short-sighted tendency to build large-scale but restrictive automated systems that ignore the interactive nature of health care has resulted in limited operational success and acceptance. That said, this trend is not irreversible. Given the right circumstances, distributed, interoperable, digital health systems could emerge rapidly, offering both intra- and inter-enterprise benefits. To succeed, the design of these so-called total digital health systems (TDHSs) must be approached holi-stically, incorporating such properties of health care delivery systems as softness, openness, complexity, flexibility and generality. Because of the procedural nature of most electronic health record (EHR) applications now in use, traditional system approaches-such as the relational database model to application design-would be adequate for EHRs. This paper discusses the systemic nature of health care information systems and compares and contrasts the traditional EHR with TDHS. A soft systems methodology (SSM) is proposed for TDHS design.