This Technical Report is concerned with QoS as it applies to interactions between components of distributed healthcare IT systems. The scope is not limited to network infrastructures; it includes the QoS requirements of information storage and processing IT systems. The related areas of security and financial cost considerations are not within the primary scope of the document, although they are considered briefly.
Of course, an informatics system with a high QoS does not guarantee a high standard of healthcare in terms of clinical outcomes or patient care. The quality of healthcare delivered to patients (the ultimate ”users”) depends upon a number of external factors such as the experience and competence of the healthcare professional(s) or institution(s) involved. Potential QoS characteristics for the total healthcare delivery process such as mortality rate, clinical outcome, etc. are therefore not within the scope of this report.
The report contains no provisions to avoid the incorporation of bad or dangerous practice into healthcare IT systems. It is possible to circumvent good clinical practice with technical solutions which may cause bad practice. This vital issue is not covered by this report. To take an example scenario:
A patient consults a doctor, who takes a blood sample and arranges to see the patient again in two weeks.
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A "good" practice doctor sees and reviews the blood test result as soon as it comes back from the laboratory and then files it if no action is required.
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A "bad" practice doctor sees and reviews the blood test results only when he reviews the patient’s case on the patient’s next visit. This case is not defensible if the patient has a preventable adverse event and takes legal action (source: MPS Casebook Summer 1997).
The healthcare information system put into the medical practice in electronic form could build-in either practice (a) or practice (b). This report does not consider the clinical quality assurance mechanism for the IT system.
