To decay is system: the challenges of keeping a health information system alive.

Health information system (HIS) architecture and socio-technical approaches for system deployment have been topics of systematic research for decades. Sustainable operation in gradually changing environments, however, has not yet received sufficient attention. Even HIS that have gone life to the satisfaction of their developers and end-users may degrade gracefully or fail catastrophically if not continuously and thoroughly kept in sync with their environment. Critical environmental changes may owe their origins to the complexity of health care and its delivery. Seemingly minor environmental changes can result in significant failures on the part of the information system and may adversely affect the quality of health care delivered. Such minor degradation or near failure may go unnoticed for a while and then hit unexpectedly. Five origins of decay will be analyzed. Methods of systematic observation and containment of such decaying processes will tentatively be presented. Some origins of system decay exist in the immediate hospital or regional setting of usage. Indicators to identify processes of decay will be suggested and methods to preemptively reduce the risk of decay will be presented. Other origins span national health care systems or beyond. Not all such risks can hence be controlled locally. Software Oversight Committees may be an instrument to monitor those risks that cannot be controlled through routine local management.