No abstract

With the introduction of the Personally Controlled Health Record (PCEHR), the Australian public is being asked to accept greater responsibility for their healthcare. Although well designed, constructed and intentioned, policy and privacy concerns have resulted in an eHealth model that may impact future health information sharing requirements. Thus an opportunity to transform the beleaguered Australian PCEHR into a sustainable on-demand technology consumption model for patient safety must be explored further. Moreover, the current clerical focus of healthcare practitioners must be renegotiated to establish a shared knowledge creation landscape of action for safer patient interventions. To achieve this potential however requires a platform that will facilitate efficient and trusted unification of all health information available in real-time across the continuum of care. As a conceptual paper, the goal of the authors is to deliver insights into the antecedents of usage influencing superior patient outcomes within an eHealth-as-a-Service framework. To achieve this, the paper attempts to distil key concepts and identify common themes drawn from a preliminary literature review of eHealth and cloud computing concepts, specifically cloud service orchestration to establish a conceptual framework and a research agenda. Initial findings support the authors' view that an eHealth-as-a-Service (eHaaS) construct will serve as a disruptive paradigm shift in the aggregation and transformation of health information for use as real-world knowledge in patient care scenarios. Moreover, the strategic value of extending the community Health Record Bank (HRB) model lies in the ability to automatically draw on a multitude of relevant data repositories and sources to create a single source of practice based evidence and to engage market forces to create financial sustainability.

A significant challenge for the design of large scale (national) eHealth systems is the fluid nature of the Patient Journey, particularly in primary healthcare modalities.In this context, a patient's journey is predisposed to organic growth rather than intelligent design. As a result, clinical tasks requiring access to high quality information may occur as a function of known healthcare patterns or as a response to a patient's state of health. Whilst Australia's national eHealth system provides the infrastructure to accommodate the self-organizing flexibility and dynamism characteristic of complex information-based ecosystems, the system neglects certain information quality attributes. Specifically, accuracy, timeliness and completeness, which may lead to improved coordination of patient care. Based on the premise that the quality of patient information plays a significant role in the performance of health professionals, consideration must be given to these information quality dimensions as an overarching goal for eHealth architectural design activities. Framed as a problem concerning the design of large scale eHealth architecture that improves the quality of health information, this perspective presents a timely research opportunity.Within a prescriptive design science research (DSR) framework, this thesis is an example of a multi-methodological approach to create and evaluate a purposeful eHealth-as-a-Service (eHaaS) design artifact, which will improve patient information quality. This was achieved by firstly, deriving abstract meta-requirements from an ethnographic examination of care pathways to establish the technical goals of the solution space. Secondly, defining the functions, organization, and structure of an eHaaS conceptual model as an example of how service-based architectures might deliver high quality information services. Finally, by establishing the validity of the conceptual model with the development of a novel evaluation strategy to explain the predicted change produced by an eHaaS design artifact.Several original contributions emerged from the research. First and foremost, the developed eHaaS conceptual model, which encapsulates a set of design principles, service-based architectural patterns and implementation strategies represents a new class of eHealth solution. One that embodies a shift away from data-centric monolithic eHealth-as-a-Service: A Service-Based Design Approach for Large Scale eHealth Architecture iii architecture to process oriented, event-driven application services. To demonstrate the benefits of this shift, an electronic patient information system (ePIMS) was developed as an original solution for orchestrating clinical information services as personalised patient workflows. Another significant contribution of this thesis is a novel evaluation strategy for validating the utility of large scale eHealth systems at the design stage. It is innovative in its use of business process and data modelling techniques (e.g. data flow diagrams, business process modelling notatio...