Grimson, Jane, William Grimson & Wilhelm Hasslebring.

Grimson, Jane, William Grimson & Wilhelm Hasslebring. (2000). The SI challenge in healthcare. Communications of the ACM. 43 (6): 49-55. According to the article "The SI Challenge in Healthcare," a critical component of business process reengineering in the healthcare system is the implementation of electronic record-keeping. Electronic Health Care Record (EHCR) means that all patient data is stored regardless of is source.

While it "presents obvious integration challenges...linking of records to clinical guidelines and protocols is essential if best-practice is to be embedded as an integral part of the health care delivery process and if the problems associated with widespread variations in treatment costs and outcomes are to be addressed" (Grimson, Grimson & Hasslebring 2000: 49). Medical errors can be reduced if patient records are easily shared and are comprehensively recorded on a general database. Also, outcomes can be more easily compared when medical research is conducted by researchers.

Three major approaches to sharing healthcare information electronically exist: message-based sharing, data warehousing, and common architecture. Message-based approaches allow institutions to share information, even if they have different storage systems. Data warehouses, as the name suggests, are repositories information that can be accessed by providers, and common architecture involves an integrated architecture storage system that links providers. A common domain-specific EHCR data model is regarded as ideal as it is commonly accessible and thus least likely to result in medical errors due to incomplete information.

However, the implementation of this model has proven difficult in the U.S. (Grimson, Grimson & Hasslebring 2000: 50). The European Union nations are already embarking upon an even more ambitious initiative in the form of total unity of all nations' databases, although this too has proved elusive, given an inability to agree upon specific models.

For example, "the Good European Health Record concentrated on providing a comprehensive model that captures all the rich ethico-legal semantics of the EHCR, while the W3-EMRS placed more emphasis on the ability to share records securely between institutions and agreeing on a common data set for the shared record" (Grimson, Grimson & Hasslebring 2000: 50). Much of the article involves discussing the different applications and advantages of specific approaches and software systems.

Ultimately, this is frustrating given that the conclusion of the article is that while the technological implementation will be determined by developments in the non-healthcare markets of business and IT, the methods by which healthcare data will be structured must be determined by pressures and demands of the healthcare community itself in a united fashion. Uncertainty about the value of a truly united system of records and reconciling different security needs for different contexts has made such universal agreement a challenge. Many of.