Information and Communications Technology and …varri/ehealthwork/31-FC-C6M10U2-Interfaces.pdfexperienced by users of e-health information •Trust and credibility, which are based

Interfaces

Foundational Curriculum: Cluster 6: System Connectivity

Module 10: Interoperability, Interfaces and Integration of eHealthUnit 2: Interfaces

FC-C6M10U2

This work is produced by the EU*US eHealth Work Project. This project has received funding from the European Union’s Horizon 2020 research and

innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

131/60

Curriculum Developers: Angelique Blake, Rachelle Blake, Pauliina Hulkkonen, Sonja Huotari, Milla Jauhiainen, Johanna Tolonen, and

Alpo Vӓrri

Unit Objectives

• Define interfaces between systems in regards to eHealth• Explain the Interface Design Process• Describe basic interface design standards and design

principles (KB02)• Convey the importance of interfaces between systems, how

systems are interdependent upon each other, and how the health record can be impacted by systems interfacing into and out of the EHR, including the flow of data inputs and outputs in the EHR (KB01)

• Define health information exchange (HIE)• Identify information systems that support health

information exchange, and describe some basic features (KB04)



2FC-C6M10U2

Interfaces in eHealth

• An interface is a point where two systems, subjects, organizations, etc., meet and interact

• An eHealth interface is defined as a shared area across which two or more separate parts or components of a computer system exchange information

• The interface represents the point of interconnection between two systems or subsystems

• The information exchange can be between software programs, hardware devices, peripherals, humans or any combination of these



3FC-C6M10U2

Uses of Interfaces

• Some computer hardware devices, such as a smartphone or tablet, can both send and receive data through the interface; other devices, such as a printer cable or laser pointer, may only provide an interface to either send data to or receive data from a given system

• Literally, an interface can be understood as the “face” of a system “between” components, such as a user and a device

• An interface can also be a device or program that enables a user to communicate with a computer– For example, a graphical user interface (GUI), is a

type of interface that allows users to interact with electronic devices through icons and visual indicators such as windows



4FC-C6M10U2

The Importance of Interfaces in eHealth

• Interfaces are important to eHealth in that they enable disparate modules, systems, and supermodules to communicate

• They frequently act as a bridge between software modules, or between EHR systems, allowing them to communicate with each other

• Interfaces can improve the interoperability of systems and devices that internally use different standards



5FC-C6M10U2

The Importance of Interfaces in eHealth (cont’d)

• For example, within one hospital, an interface may be created to allow laboratory results from an external software vendor to be directly downloaded into (or “interfaced into”) the hospital’s EMR as structured data

• In another example, a hospital from Amsterdam may need to use an interface to send an inpatient’s Epic EHR data to her physician’s office in a hospital wing in Belgium using the Cerner EHR

• These two examples demonstrate not only interfaces, but also show how interfaces can contribute to interoperability



6FC-C6M10U2

Interface Design Process

• The interface design process has five steps:1. Defining the interface

requirements2. Designing the top level of

the interface3. Designing the details of the

interface4. Testing the interface design5. Analysing and modifying

the interface in preparation for deployment



7FC-C6M10U2

Defining requirements

Designing top level

Designing details

Testing design

Analysing/ modifying

Basic Interface Design Standards and Principles

• An interface facilitates communication between two healthcare applications. The interface design should contain:– An import endpoint for the

receiving system or application– An export endpoint for the sending

system or application– A method of moving data between

the two endpoints– A method for handling data and

the queuing messages– A method for logging the flow of

messagesThis work is produced by the EU*US eHealth Work Project. This project has

received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 727552

EUUSEHEALTHWORK

8FC-C6M10U2

ImportEndpoint

ExportEndpoint

Met

ho

d f

or

Mo

vin

g D

ata

Met

ho

d f

or

Han

dlin

g D

ata

Met

ho

d f

or

Logg

ing

Mes

sage

Flo

w

Basic Interface Design Standards and Principles (cont’d)

• Each healthcare system/application must grant access to accept and send patient data– Frequently, the access grant will

contain strict rules (rather than flexible ones) that provide easy methods for exchanging data

– This access to data is usually tightly controlled by each application (or vendor, in the case of external systems) to ensure data integrity within systems



9FC-C6M10U2


• Each system/application must also have rules regarding what it will accept and what it will send

• To implement an interface between two or more applications, organizations or providers usually implement either a point-to-point interface or an interface engine

• A point-to-point interface is where there are software or hardware links between each integrated ambulatory or departmental system and the EHR

• An interface engine is a middleware application (such as HL7) that is used to transform, route, clone and translate messages



10FC-C6M10U2


• Effective interface design can contribute to the trust and credibility experienced by users of e-health information

• Trust and credibility, which are based on perceived quality of the interface, are essential for working eHealth platforms

• Visual design, information architecture and user experience are especially important aspects of perceived quality of the interface



11FC-C6M10U2

10 Rules of Thumb for Interface Design

Jakob Nielsen and Rolf Molich have designed 10 rules for interface design:

1. Visibility of system status– System operations and status should

be clearly visible to the user on the interface, and it should be shown in a reasonable amount of time

2. Match between the system and the real world– Real world experiences should be

taken into account, and mirror the interface design with the targeted end-user and his/her experience

3. User control and freedom– Undo and redo steps should be made

available, to allow the user to have freedom and control of the system



12FC-C6M10U2

STOPPED

DOWN

RUNNING

10 Rules of Thumb for Interface Design (Cont’d)

4. Consistency and Standards– Graphic elements and

terminology need to be maintained throughout the system

5. Error prevention– The system should be designed

so that the number of errors can be kept to a minimum

6. Recognition rather than recall– Task-relevant information should

be kept visible in the interface; additional information should be kept to a minimum



13FC-C6M10U2

10 Rules of Thumb for Interface Design (Cont’d)

7. Flexibility and efficiency of use– Increase in use requires faster navigation

and fewer interactions; this can be provided, for example, with shortcuts and function keys

8. Aesthetic and minimalist design– As with minimizing the cognitive load, also

visual accessories should be kept to a minimum

9. Help users recognize, diagnose and recover from errors– Error messages should be plain and simple,

as the end user cannot be assumed to understand technical details or terminology

10. Help and documentation– Documentation should be available if

needed, and it should be constructed in a way that the end user knows what to do



14FC-C6M10U2

Interdependence of Systems

• Systems both within and between organizations are necessary for patient care, and continuity of the care of the patient

• Therefore, by definition, all health systems are interdependent (dependent upon each other)

• A system is most vulnerable at the interfaces between and among critical processes

• In health care, attention to the nature of relationships and handoffs between elements of the patient care and connected processes, such as administrative processes, is vital



15FC-C6M10U2

Flow of Data Inputs and Outputs

• The role of a computer is, broadly speaking, the conversion of data into information. Every piece of data must be supplied by a person, by another computer system, or by data collection equipment

• Data that is output, once transmitted or delivered to a provider, other system or organization, becomes input to the receiver or receiving system

• The system applies locally defined and general procedures to produce results from new input data, from stored data, and from information obtained from remote external sources. This stresses the importance of the architecture of any applicable interfaces



16FC-C6M10U2

Flow of Data Inputs and Outputs (cont’d)

• A data-flow diagram (DFD) graphically represents the processes and data flows including inputs and outputs, within a computer information system or interface

• Well-structured interfaces transform the available input into the desired output with good transmissions, optimal conversions, without bottlenecks and with reception of the data in the manner intended by the deliverer



17

Data Input

Process

Data Output

Data Output

InterfaceData

Output

FC-C6M10U2

Health Information Exchange (HIE)

• A health information exchange (HIE) is the movement of health care data electronically across organizations within a region, community or hospital system

• In the United States, the term HIE may also refer to an organization that facilitates this information exchange

• The goal of HIE at the data level is the same as what interoperability is at the system level: to facilitate access to and retrieval of clinical data between providers and organization across disparate applications, systems and organizations, often using a standard protocol, such as HL7, or an interface

• The overall aim of HIE is to provide safer and more timely, efficient, effective, and equitable patient-centered care



18FC-C6M10U2

Benefits of Health Information Exchange

• HIE allows care providers and patients to appropriately access and share vital medical information electronically

• HIE has the ability to improve the speed, quality, safety and cost of health care

• Appropriate sharing of vital patient information through HIE allows providers to:– Avoid readmissions– Avoid medication errors– Improve diagnoses– Decrease duplicate testing

• Exchanging of data electronically provides standardized data, which can be integrated to into the organization’s EHR system



19FC-C6M10U2

Forms of HIE

There are three key forms of HIE:• Directed Exchange: Send and receive

secure information electronically between care providers

• Query-based Exchange: Providers find and/or request information on a patient from other providers

• Consumer Mediated Exchange: Patients control the use of their health information among health care providers



20FC-C6M10U2

Information Systems Supporting HIE

• There are various models of HIE in health information systems; some of them are explained below:– The Centralized Model: Medical data is collected from

local sources to a central repository. The transactions are routed through the central repository, which provides autonomy for local entities, but controlled environment for cooperation

– Decentralized or Federated Model: Organizational control over healthcare data provides a framework for sharing data in a wider area, even nationally

– Hybrid Model: A cross between centralized and decentralized architectures. An interface engine is used to communicate between organizational entities



21FC-C6M10U2

Unit Review Checklist

Defined interfaces between systems in regards to eHealth Explained the Interface Design Process Described basic interface design standards and design

principles (KB02) Conveyed the importance of interfaces between systems,

how systems are interdependent upon each other, and how the health record can be impacted by systems interfacing into and out of the EHR, including the flow of data inputs and outputs in the EHR (KB01)

Defined health information exchange (HIE) Identified information systems that support health

information exchange, and describe some basic features (KB04)

22

This work is produced by the EU*US eHealth Work

Project. This project has received funding from the

European Union’s Horizon 2020 research and innovation

programme under Grant Agreement No. 727552

EUUSEHEALTHWORK

FC-C6M10U2

Unit Review Exercises

1. Name the five steps in the interface design process.

2. Complete the details of the interface design graphic, on the right

3. Name six benefits of HIE

4. Define “the hybrid model” of health information system architecture



23FC-C6M10U2

Unit Exam

1. Which of the following statements is not true of an interface?

a) it represents the point of interconnection between two systems or subsystems

b) all interfaces contain icons or windowsc) it is literally the “face” of a system “between” components,

such as a device and a userd) it improves the interoperability of systems and devices that

internally use different standards

2. An interface design should contain which of the following:a) Defining the interface requirementsb) Defining the details of the interfacec) Testing the interfaced) All of the above



24FC-C6M10U2

Unit Exam (cont’d)

3. In an interface design, what happens to the data before it reaches the export endpoint?

a) it is moved, handled, and/or loggedb) it is transposedc) it is interceptedd) it is exported to an external engine

4. What is true regarding the ten Rules of Thumb for Interface Design?

a) Users should not have control or freedom regarding the designb) The cognitive load and visual accessories should be maximized c) Increase in use requires faster navigation and fewer

interactionsd) End users should be able to understand complex technical

details and terminology



25FC-C6M10U2

Unit Exam (cont’d)

5. “Processes and data flows, including inputs and outputs, within a computer information system or interface” best describes which of the following concepts?

a) Interface design processb) Data flow diagramc) Interdependent systemsd) Health Information Exchange

6. “Organizational control over healthcare data providing a framework for sharing data in a wider area” best describes which HIE model?

a) Consumer-mediated exchangeb) Centralized modelc) Decentralized or federated modeld) Hybrid model



26FC-C6M10U2

Documents

Information and Communications Technology and …varri/ehealthwork/31-FC-C6M10U2-Interfaces.pdfexperienced by users of e-health information •Trust and credibility, which are based