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Middleware for the Integration of Hospital Information Systems

Leila Shahmoradi, Mahdi Habibi-Koolaee, Maryam Ebrahimi, Fatemeh Parnian Khoy, Ahmad Soltani



Background: The integration of healthcare information systems is one of the most urgent priorities of healthcare organizations. Middleware has a major role in the integration of hospital information system (HIS). The purpose of this study is to determine the type of middleware used, their configuration and integration approaches in the hospitals of the research community.

Methods: This study was descriptive in nature and was conducted in the form of a survey, with data being gathered via a self-structured questionnaire, in 2014. Seventeen hospitals affiliated to TUMS that have the HIS were recruited for this study. The questionnaire consisted of three parts. Simple statistical analysis was used to determine the integration status of HISs.

Results: The most striking result to emerge from the data is that 64.7% of HISs had database-oriented middleware. Approximately half of surveyed HISs (41.2%) used synchronous mechanism and almost two-thirds of them (70.2%) used web service. Although, 17.2% of HISs use service-oriented integration approach, but the overall response to this question was poor.

Conclusion:  The result of the study indicates that the database-oriented middleware facilitate accessibility of the databases, on a variety of platforms. It might be related to the variety of company those developed the HISs. The result showed that the using web services could be helpful to application integration. The results of this investigation show that the HIS companies and healthcare facilities must be considered to the standards of interoperability for development and selection of the systems. Further research should be done to investigate the integration status of HISs in cross-national level and with other information systems in the field of healthcare.


Degoulet P, Fieschi M. Physiological signal processing. introduction to clinical informatics: Springer; 1997.

El Azami I, Malki MOC, Tahon C. Integrating Hospital Information Systems in Healthcare Institutions: A Mediation Architecture. J Med Syst. 2012; 36(5): 3123-34. PMID: 22086739 DOI: 10.1007/s10916-011-9797-8

Safdari R, Dargahi H, Shahmoradi L, Farzaneh Nejad A. Comparing four soft wares based on ISO 9241 part 10. J Med Syst. 2012; 36(5): 2787-93. PMID: 21755414 DOI: 10.1007/s10916-011-9755-5

Ahmadi M, Shahmoradi L, Barabadi M, Hoseini F. A survey of usability of hospital information systems from the perspective of nurses, department secretaries, and paraclinic users in selected hospitals: 2009. Journal of Health Administration. 2011; 14(44): 11-20.

Safdari R, Dargahi H, Shahmoradi L. Survey of quality ergonomic of Iran's hospital information system and comparison with three other software from users' point of view. Journal of Hospital. 2010; 9(1): 33-42.

Shahmoradi L, Ahmadi M, Haghani H. Determining the most important evaluation indicators of health care information systems (HCIS) in Iran. Health Inf Manag. 2007; 36(1): 13-22. PMID: 18195393

Ahmadi M, Shahmoradi L, Barabadi M, Hoseini F. Usability evaluation of hospital information systems based on IsoMetric 9241. Hakim Health Sys Res. 2011; 13 (4): 226-233.

Ferrara FM. The standard ‘healthcare information systems architecture’ and the DHE middleware. Int J Med Inform. 1998; 52(1-3): 39-51. PMID: 9848401

Wreder K, Deng Y. Architecture-centered enterprise system development and integration based on distributed object technology standard. Computer Software and Applications Conference, 1999. IEEE. DOI: 10.1109/CMPSAC.1999.812712

Larbi E, Edwards JW, Badidi E. An exploration of demographic inconsistencies in healthcare information environments. In:

Wickramasinghe N, Geisler E, eds. The encyclopedia of healthcare information systems. Vol 2. Idea Group Inc. (IGI). 2008: 561-572.

Meyer M, Levine WC, Brzezinski P, Robbins J, Lai,F, Spitz G, et al. Integration of hospital information systems, operative and peri-operative information systems, and operative equipment into a single information display. AMIA Annu Symp Proc. 2005; 2005: 1054. PMID: 16779341

Esmahi L, Badidi E, Edwards JW. Managing demographic data inconsistencies in healthcare information systems. International Journal of Information Systems and Social Change. 2010; 1(1): 56-72. DOI: 10.4018/jissc.2010092905

Ahmadi H, Nilashi M, Shahmoradi L, Ibrahim O. Hospital Information System adoption: Expert perspectives on an adoption framework for Malaysian public hospitals. Computers in Human Behavior. 2017;67:161-189. doi:https://doi.org/10.1016/j.chb.2016.10.023

Lopez DM, Blobel BG. A development framework for semantically interoperable health information systems. Int J Med Inform. 200; 78(2): 83-103. PMID: 18621574 DOI: 10.1016/j.ijmedinf.2008.05.009

Ko L-F, Lin J-C, Chen C-H, Chang J-S, Lai F, Hsu K-P, et al. HL7 middleware framework for healthcare information system. e-Health Networking, Applications and Services conference. IEEE. 2006; 1: 50-165. DOI: 10.1109/HEALTH.2006.246437

Cosimo F. The integration of hospital information systems through user centered design. Sheffield, Sheffield Hallam University; August 1994.

Sujansky WV, Overhage JM, Chang S, Frohlich J, Faus SA. The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems. J Am Med Inform Assoc. 200; 16(3): 285-90. PMID: 19261950 DOI: 10.1197/jamia.M2610

Jingyong L, Yong Z, Yong C, Lichen Z. Middleware-based distributed systems software process. Proceedings of the International Conference on Hybrid Information Technology. Daejeon, Korea. 2009; 345-348.

Zhang J, Xu W, Ewins D. System interoperability study for healthcare information system with web services. Journal of Computer Science. 2007; 3(7): 515-22.

Batra U, Mukharjee S. National healthcare information system integration: A service oriented approach. International Journal of Computers. 2011; 3(5): 354-61.

Siamak M. Need for integration of information systems in hospitals through the implementation of a comprehensive management information system (MIST). Proceeding of First National Conference on Resource Management in Hospital. 2003; Tehran.

Awad EM. Management information system: Concept, structure, and applications. Menlo Park, Calif.: Benjamin-Cummings Pub Co; 1988.

Sumner M. Critical success factors in enterprise wide information management systems projects. Proceedings of the ACM SIGCPR conference on Computer personnel research. 1999; New York.

Tsumoto S, Hirano S, Kawamura T. Statistical estimation of software quality in hospital information system. In: Sawatani Y, Spohrer J, Kwan S, Takenaka T, eds. Serviceology for smart service system: Selected papers of the 3rd International Conference of Serviceology. Tokyo: Springer Japan; 2017: 341-350.

Linthicum DS. Next generation application integration: from simple information to Web services. Boston: Addison-Wesley Longman; 2004.

Gulledge T. What is integration? Industrial Management & Data Systems. 2006; 106(1): 5-20. DOI: 10.1108/02635570610640979

Morris H, Lee S, Shan E, Zeng S. Information integration framework for product life-cycle management of diverse data. J. Comput. Inf. Sci. Eng. 2005; 4(4): 352-58. DOI: 10.1115/1.1818684

Puschmann T, Alt R. Enterprise application integration-the case of the Robert Bosch Group. Proceedings of the 34th Annual International Conference on System Sciences, 2001. IEEE. Hawaii. DOI: 10.1109/HICSS.2001.927242

Winter A, Brigl B, Wendt T. Modeling hospital information systems (Part 1): The revised three-layer graph-based meta model 3LGM2. Methods Inf Med. 2003; 42(5): 544-51. PMID: 14654889

Hasselbring W. Information system integration. Communications of the ACM. 2000; 43(6): 32-38. DOI: 10.1145/336460.336472

Chung S, Tang LH, Davalos S. A web service oriented integration approach for enterprise and business-to-business applications. Web Information Systems–WISE 2004: Springer; 2004:510-515.

Gu C, Zhang X. An SOA based enterprise application integration approach. Proceeding of Third International Symposium on Electronic Commerce and Security (ISECS), 2010; Shanghai.


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