Applying Architectural Principles to Integrated Clinical Systems

Laura K. Heermann-Langforda,b, Kathryn G. Kuttlera, Joseph W. Halesc,d, Stanley M. Huffa,d

aHomer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, UT, USA

b College of Nursing, University of Utah, Salt Lake City, UT, USA

c Primary Children’s Medical Center, Intermountain Healthcare, Salt Lake City, UT, USA

d Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA



Clinical Information Systems (CIS) often fall short of their envisioned role as a support to the provision of clinical care. CIS frequently comprise a web of multiple specialty systems implemented to meet specific clinical needs. However, they do not always adhere to an overarching clinical systems architecture. This often results in a variety of issues manifested by system incompatibilities, inefficiencies, and failures to meet fundamental operating requirements. Intermountain Healthcare (IH) is an internationally recognized, nonprofit, system of 22 hospitals, a Medical Group with more than 185 physician clinics, and an affiliated health insurance company. IH offers a full range of services, from urgent care to home care to the region's most advanced trauma centers. Providing excellent care of the highest quality at an affordable cost is the heart of their mission. The HELP system at IH continues to be one of the longest running effective tools in assisting to provide low cost high quality care. Since the inception of the HELP system in the early 1960’s, IH has responded to the continually changing environment of healthcare by continued development of the HELP system, augmenting it with other internally developed systems, as well as vended products. How has IH been successful with this amalgamation of systems? Experience has led to the articulation of a core set of architectural principles to promote CIS efficiency and effectiveness. These principles create a common understanding and communicate medical informatics best practices for clinical systems architecture in support of clinical excellence.

The tutorial, taught by thought leaders and chief architects of the clinical systems at IH, will describe these fundamental architectural principles for clinical information systems. Attendees will be challenged to apply the principles learned in the tutorial using a hands-on simulated experience. The real-life examples will form the basis for interactive discussion, interspersed with small group breakout sessions. The experienced instructors will coach attendees as they address their own CIS architecture problems during the breakout sessions assisting attendees to understand how to apply the principles. Instructors will also address when and how to compromise, if it is necessary, when facing real world challenges.


Outline of topics

  • Data storage and retrieval

  • Patient and provider identification

  • Knowledge-driven decision support

  • Application and adherence to standards

  • Support for transactional and analytical data uses

  • Considerations for future evolution in clinical and system needs

Real life clinical examples will be used to demonstrate the implementation of these principles and the resulting challenges when they are not applied.


Learning objectives

  1. Articulate the importance of system architecture in obtaining clinical and operational goals in healthcare. 

  2. Recognize the importance of a single source for data storage and retrieval for clinical information systems.  

  3. Describe the importance of a single master identification of patients and providers in a clinical information system.

  4. Define a content driven system and its importance in successful clinical information systems. 

  5. Identify the multiple points in clinical information systems where standards should be applied and why.

  6. Compare and contrast the application and uses of an enterprise data warehouse and an analytical health repository.

  7. Discuss techniques supporting the graceful evolution of clinical information systems to newer technologies. 

  8. Apply learned architectural principles through course exercises.


Target audience

Leaders in Healthcare responsible for choosing a CIS; Healthcare Informaticists and IT professionals responsible for developing, choosing, implementing or supporting a CIS; Healthcare/Informatics Educators responsible for education regarding implementation and support of CIS; Healthcare informatics students interested in any of the above roles