Systems simulation and health information systems

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Systems simulation and health information
systems
Andrew Georgiou, Johanna Westbrook, Geoff
McDonnell, Farah Magrabi Centre for Health
Informatics, University of New South Wales
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Outline

• What is computerised simulation?
• What role can it play in the implementation and
  evaluation of health information systems?
• Case study involving Computerised Pathology Order
  Entry (CPOE) system

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Systems simulation in health care

• Health care interventions are part of complex
  networks
• What does systems simulation provide?
• Increasing number of Systems simulation studies
  in health care

Fone et al, J Pub Health Med 2003
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The importance of ICT

• Previously ICT was a background niche system
• Today it is presented as a healthcare tool, a
  prerequisite for safe clinical practice

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ICT systems are part of the health care agenda

• ICT is part of the environment
• Health care initiatives are now all accompanied
  by their own ICT strategy
• Decision-support systems
• Computerised Physician Order Entry systems (CPOE)

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The risks involved

• ICT is costly and risky
• Benefits are not always immediately obvious
• Problems and complications are common place

Ash Bates, JAMIA, 2005
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What has the evaluation agenda shown?

• Growing maturity and diversity
• Drawn attention to difficulties and complexities
• Generalisability is a big issue
• Greater attention on systems approach required

Agency for Healthcare Research and Quality (US)
No. j06-E006 (2006)
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Where to from here?
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How can systems simulation help?

• The need to explore, understand and improve
  systems before they go live
• Predictive ability
• We dont always need to fail before we learn?

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The pathology test order process
Georgiou, Williamson, Westbrook, Ray Int J Med
Info 2006
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The end product

• Disconnected data and information
• Variables are interconnected and effect each
  other
• Potential to distort not enlighten

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What really happens?
Time taken to process -
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Emergent properties

• Capacity for change is sometimes only triggered
  in the appropriate circumstances
• Systems simulation provides a safe and cost
  effective environment
• A low-cost learning laboratory

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Screen structure
Westbrook et al J Clin Pathol 2006
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Unexpected consequences
Workarounds Awareness and training
sessions Rules, regulations and enforced changes
Georgiou et al Int J Med Info 2006
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Multi-method approaches

• The ability to utilise different data, theories
  and perspectives
• We dont want information silos
• The ability to integrate data sources

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Simulation development
Performance experiments
Simulation and policy testing
Calibration of model
Conceptual development and construction
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What systems simulation should not be?
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Video game syndrome

• Need to reflect on the outcome of the simulation
• Formulate hypotheses to explain discrepancies
• Need theories to discriminate
• Learn to think

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Important issues

• Examine the practical utility and outcomes of
  simulation models
• Model verification and validation is a must
• Reproducibility is an important issue
• Much to understand, learn and apply

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Thank you