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The use of medical information systems is now prevailing in the whole healthcare environment where the focus is on reducing clinical errors and supporting healthcare professionals in their routine tasks. Hospitals adopt medical information systems to facilitate their healthcare staff in providing efficient services to patients. Studies show that most of the time these systems cannot deliver according to their functional capacities due to certain implementation problems. In this research, we have indicated different implementation problems, their root causes and suggested proper approaches for solving these issues. In the textual analysis, we examined different technical, psychological and social problems that may arise during the implementation process. These theoretical findings have been validated through questionnaires and interviews with doctors, nurses, technicians and people involved in the development of medical information systems. The companies that are providing implementation services are also consulted to validate the theoretical facts. The results show that implementation problems are social and psychological rather than technical, so these problems should be solved with interpersonal, psychological and social skills. The focus of the implementation process should be on the social, psychological and technical effects to avoid any conflict. Reasonable user involvement in the decision making process, motivation and proper training reduces many implementation issues automatically. It is concluded from empirical results that development and implementation teams should have reasonable medical domain knowledge to diminish future implementation and maintenance hazards. The theoretical and empirical results show that data security issues are psychological as well as technical and should be dealt with by high priority.

The thesis is aimed at the quality of health care in the specificmedical facility. The goal of the thesis is to characterize actualsituation of services, which are provided and to find out whether the present information system contribute to increase quality in the medical facility or not. In the first part is defined theoretical knowledge of the quality of medical care and the quality of information systems. This theoretical base is applied in the second part. On the base of data from information system, the indicators by which the quality was evaluated were defined. Used indicators were analysed, compared and consequently evaluated. In the case of ineffective system, which does not contribute to increase the quality of medical facility, there are some recommendation and changes which leads the system to be more effective.

В диссертации был проведен анализ литературы и нормативно-справочной документации по теме диссертации, по результатам исследования была сформирована таблица сравнений медицинских информационных систем. Разработаны требования к медицинским системам. В ходе работы были построены модели исследуемых бизнес-процессов и разработан новый блок медицинской информационной системы для клиники «Геном-Волга». / The analysis of literature and normative-reference documentation on the subject of the thesis was carried out in the thesis, the table of comparisons of medical information systems was formed based on the results of the research. Requirements to medical systems are developed. In the course of the work, models of the studied business processes were built and a new block of medical information system for Genom-Volga clinic was developed.

Актуальность обусловлена ростом объемов обрабатываемой информации, а также необходимостью повышать качество предоставляемых услуг в области здравоохранения. Цель магистерской работы: внедрение и адаптация 1С:Медицина. Стоматологическая клиника в частное медицинское учреждение. Научная новизна диссертационного исследования заключается в развитии теоретико-методической положений управления бизнес-процессами в сфере управления медицинской организации, с целью совершенствовании уже существующих информационных моделей организации с целью направленных на повышение эффективности управления фирмой. Практическая значимость исследования заключается в автоматизация основных процессов частной клиники с помощью ПО «1С: Медицина», что привело к сокращению управленческих расходов и получению дополнительной прибыли. / The relevance is due to the growth in the volume of processed information, as well as the need to improve the quality of services provided in the field of healthcare. The purpose of the master's work: implementation and adaptation of 1C: Medicine. Dental clinic in a private medical institution. The scientific novelty of the dissertation research lies in the development of theoretical and methodological principles of business process management in the management of a medical organization, in order to improve the already existing information models of the organization in order to improve the efficiency of company management. The practical significance of the study lies in the automation of the main processes of a private clinic using the software "1C: Medicine", which led to a reduction in management costs and additional profit.

Einleitung In einem größeren Universitätsklinikum wie in der Charité sind EDV-gestützte Verfahren in verschiedenen Einrichtungen und für verschiedene Aufgaben im Einsatz: Verwaltung, Krankenversorgung, Forschung und Lehre. Diese Subsysteme sind in der Regel nicht in der Lage, Daten untereinander so auszutauschen, daß die in den Daten enthaltene Semantik nicht verlorengeht. Die Ursache liegt im wesentlichen in der Komplexität und in der Unschärfe der medizinischen Informationen. Medizinische Standards (HL7, DICOM, SNOMED, ICD, ICPM, ...) lassen sich für den Austausch von Daten verwenden, die gut formalisierbar und mit einer klaren Bedeutung behaftet sind. Nicht formalisierbare Daten, die z. B. in einem Befund oft vorkommen, lassen sich nicht ohne weiteres mit diesen Standards darstellen. Ziel Entwicklung eines Konzeptes für den Austausch medizinischer Daten, das die o. g. Probleme vermeidet. Material und Methoden Die Analyse der vorhandenen Subsysteme, Standards und Konzepte zeigt, daß das Konzept einerseits eine sehr einfache Syntax und eine simple Struktur aufweisen muß. Andererseits muß die medizinische Semantik voll erhalten bleiben. Als Vorbild kann die relationale Datenbank dienen, die mit einem Datentyp (Relation bzw. Tabelle) und einem einzigen Operator (SELECT) auf diesen Datentyp auskommt. Ergebnisse Das Konzept ist objektorientiert. Es enthält nur einen Datentyp. Das ist das AMICI-Objekt (AMICI: Architecture for Medical Information Exchange and Communication Interface). Über dieses AMICI-Objekt wird der gesamte Datenaustausch vorgenommen. Kann das Empfängersystem ein Objekt nicht oder nicht korrekt interpretieren, so wird die Interpretation vom Sendesystem übernommen. Ein Subsystem wird im Netzwerk über einen medizinischen Kontext angeschlossen, der das Interessengebiet und die Fähigkeit des Subsystems beschreibt. Das Subsystem kann an Hand der im Netz bekannten medizinischen Kontexte feststellen, welche weiteren Subsysteme für den eigenen Zweck interessant sein könnten. Alle AMICI-Objekte erhalten eine weltweit eindeutige Identifikation, so daß die Daten aus verschiedenen Institutionen, auch international, miteinander gemischt werden können. Diskussion Das Konzept kann als Basis für weitere Dienstleitungen in einem Klinikum bzw. einem Krankenhaus dienen. Namentlich zu nennen sind telemedizinische Anwendungen, bei denen nicht nur die Kommunikation zwischen Ärzten, sondern auch zwischen Patienten und Arzt möglich ist. Weiterhin betrifft dies den Einsatz von Software-Agenten, die sich um den Informationsbedarf eines Arztes individuell kümmern. / Introduction Large hospitals like the University hospital Charité use in different units different information systems for recording patient and medical data. There are also different tasks: administration, healthcare, research and education. These medical information systems are often called subsystems. They are usually not able to exchange data without lost of semantic. The complexity and the variability of medical terminology cause this problem. Existing medical standards (e. g. HL7, DICOM, SNOMED, ICD, ICPM, ...) are helpful for well formalised terms. Non-formalised terms that are often used in diagnostic reports can not be represented by existing standards. Aims Development of a concept for medical information exchange which fulfills the requirements mentioned above. Material and Methods The system analysis that is performed based on existing subsystems, medical standards and concepts provides two essential requirements. On the one hand the syntax of such standard must be extremely simple. On the other hand the standard must be able to transfer extremely complex semantics. As an example relational databases (RDB) provide a good idea of such simple syntax and complex semantics. RDB's include only one data type. It is called relation or table. To manipulate tables one needs only one operation. That is the SELECT command in SQL. Result The concept is object oriented. It includes only one object called AMICI-object like RDB's (AMICI: Architecture for Medical Information Exchange and Communication Interface). Data exchange is completely performed by these AMICI-objects. If the receiving subsystem is not able to interpret and represent an object, the sending subsystem will take over this task. Within a network a subsystem uses a special AMICI-object called medical context to describe its features and its area of interest. A subsystem can inquire medical contexts to explore installed and running subsystems in the network. An international unique identifier identifies every AMICI object so that you can mix objects provided by different international institutions, e. g. to use them in multi-center-studies. Discussion This concept can also be used as a basic service for higher level applications in a hospital. Two of them are telemedicine and software agents. Telemedicine is not only a tool for physicians. It should be also a tool for communication and interaction between patient and physician. Physicians can use personal software agents for information acquisition, which meets exactly his specific requirements.

IT is often seen as a solution to many problems concerning effectiveness in organizations. Information systems within the healthcare sector is often viewed as medical devices rather than just systems or services. These medical devices are thoroughly regulated by laws, standards and certifications. In this study I participated in an innovative project that aimed to bring new life and use to the old fashioned patient journal by giving it a visual representation through the use of an avatar. I aimed to study the effects of regulators connected with the patient journal as a source of information for the innovative project. I drew upon Actor-network theory as a theoretical lens to trace the patient journal and connect it with regulatory aspects important to innovative projects such as the studied scenario. I also aimed to research the possibilities and obstacles provided with today’s IT-climate in Swedish healthcare. I found that regulatory aspects according to Actor-network theory proved to be an actor that stabilizes the network that is the innovative project. Certain regulatory aspects such as quality management standards provided support for unifying the vision concerning the innovation. Further the regulatory aspects proved to be an actor that can shift power between project developers and external actors. The regulatory aspects did not show any significant effect on the innovation or its original vision. These aspects did however show proof of being a heavy provider of project complexity and experience concerning these aspects was shown to be hard to find. I also found that there are two distinct ways for an innovator to realize a vision within Swedish healthcare, the healthcare way and the patient way, these two ways are represented in a model framework for future research. Last but not least I presented a framework for future IT-architecture based on modern technology and the results found in this study.

Made available in DSpace on 2016-08-17T14:53:04Z (GMT). No. of bitstreams: 1 Simone Melo.pdf: 2880047 bytes, checksum: c872dc02c29d736c1cca896ec5a17ea2 (MD5) Previous issue date: 2007-05-02 / In this work, we develop a medical information system to support medical diagnosis based on an approach oriented to models, in which the system allows sharing of information between physically scattered specialists. The development of a medical information system is done using MDA (Model Drive Architecture) in which the PIM (Platform Independent Model) is created with UML (Unified Modeling Language), and the PSMs (Platform Specific Model) is done according to Web Services Platforms. To implement this system, we devised meta model s for the Web Services, JWSDP (Java Web Services Developement Pack) and WSOracle. Thus, we provide definitions of transformation of UML for the Web Services, JWSDP and WSOracle. The development of the system puts in evidence the process of transformation of PIM for PSM used in MDA. / Neste trabalho, desenvolvemos um sistema de informação médica de auxílio no diagnóstico médico, baseado em uma abordagem orientada a modelos, no qual o sistema permite o compartilhamento de informações entre especialistas fisicamente dispersos. O desenvolvimento do sistema de informação médica foi feito usando MDA (Arquitetura Dirigida a Modelo) em que o PIM (Modelo Independente da Plataforma) foi feito conforme a UML (Linguagem de Modelagem Unificada), e os PSMs (Modelos Específico da Plataforma) conforme as Plataformas dos Web Services. Para implementar este sistema de informação médica, provemos metamodelos para os Web Services, JWSDP (Java Web Services Developer Pack) e WSOracle. Assim, provemos definições de transformação de UML para os Web Services, JWSDP e WSOracle. O desenvolvimento do sistema coloca em evidência o processo de transformação de PIM para PSM, utilizado em MDA.