INTRODUCTION
The healthcare is undergoing a dramatic transformation from today’s inefficient, costly, manually intensive, crisis driven model of care delivery to a more efficient, consumer-centric, science-based model that proactively focuses on health management.
The electronic health record (EHR) will form the foundation for pervasive, personalized, and science-based care. Other key applications are clinical information systems (CIS) with integrated, outcomes-based decision support, clinical knowledge bases, computerized physician order entry (CPOE), electronic prescribing, consumer knowledge bases and decision support, and supply chain automation.
The international Council of nurses (ICN) Code of ethics for Nurses affirms that the nurse “holds in confidence personal information” and “ensures that the use of technology… [Is] compatible with the safety, dignity, and rights of the people” (ICN, 2000).
DEPENDABILITY COMPRISES THE FOLLOWING SIX ATTRIBUTES:
1. System reliability: The system consistently behaves in the same way.
2. Service availability: Required services are present and usable when they are needed.
3. Confidentiality: Sensitive information is disclosed only to those authorized to see it.
4. Data integrity: Data are not corrupted or destroyed.
5. Responsiveness: The system responds to user input within an expected and acceptable time period.
6. Safety: The system does not cause harm.
GUIDELINES FOR DEPENDABLE SYSTEMS
All computer systems are vulnerable to both human-created threats, such as malicious code attacks and software bugs, and natural threats, such as hardware aging and earthquakes.
GUIDELINE 1: ARCHITECT FOR DEPENDABILITY
A fundamental principle of system architecture is that enterprise system architecture should be developed from the bottom up so that no critical component is dependent on a component less trustworthy than itself.
GUIDELINE 2: ANTICIPATE FAILURES
Unfortunately, minimizing complexity is more easily said than done. Consistent with Moore’s law` (Moore, 1965), the speed of processors in doubling every 18 months, while the cost for that computing power is halving within the same time period.
GUIDELINE 3: ANTICIPATE SUCCESS
The systems planning process should anticipate business success-and the consequential need for larger networks, more systems, new applications, and additional integration.
GUIDELINE 4: HIRE METICULOUS MANAGERS
Good system administrators meticulously monitor and manage system and network performance, using out-of-band tools that do not themselves affect performance.
GUIDLINE 5: DON’T BE ADVENTUROUS
For dependability, one should use only proven methods, tools, technologies, and products that have been in production, under conditions, and at a scale similar to the intended environment.
* ASSESSING THE HEALTHCARE INDUSTRY
Healthcare clearly has a need for dependable systems--both now and after the transformation, as the industry becomes increasingly dependent on IT in the delivery of patient care.
* HEALTHCARE ARCHITECTURE
For adherence to the first guideline “architect for dependability” the clinical care provider community gets a barely passing grade of “D.” Healthcare organizations build—or perhaps “compose’—their systems from the top down rather than from the bottom up.
* The five specified physical safeguards also contribute to system dependability by requiring that facilities, workstations, devices, and media be protected.
1. Access control, including unique user identification and an emergency access procedure
2. Audit controls
3. Data integrity protection
4. Person or entity authentication
5. Transmission security
ANTICIPATING FAILURES
For adherence to the second guideline “expect failures” the clinical care provider community gets another grade of “D.” Medical technology and prescription drugs, as well as clinical treatment protocols, are required to undergo extensive validation before they can be used in clinical practice.
Other healthcare organizations can be grateful for Care Group’s CIO’s willingness to share the details of his experience so that they might benefit from the lessons learned (Berinato, 2003).
* IT MANAGEMENT
For the fourth guideline “hire meticulous managers” the clinical care provider community has been assigned a mediocre grade of “C”. Many provider organizations truly do recognize the criticality of IT to their business success.
These organizations have hired IT managers who appreciate the important role of IT in healthcare in healthcare environment and who recognize the need for dependable systems that can anticipate and recover the failures.
The fifth and final guideline “don’t be adventurous” is the most difficult to assess for healthcare. On the one hand, healthcare givers typically are not early adopters. But on other hand, they seem to cast fate to the wind or technologies that catch their collective fancy.
Healthcare clinicians, including nurses, historically and typically are very resistant to change, largely because they are taught to be circumspect in considering new approaches, treatment protocols, and drug regimens.
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