PROTOTYPING OF INFORMATION NETWORKING FOR STRATEGIC HEALTHCARE ALLIANCE

Transcription

1 PROTOTYPING OF INFORMATION NETWORKING FOR STRATEGIC HEALTHCARE ALLIANCE Hsueh-Foo Lin, Department of Information Management, National Pingtung Institute of Commerce, 51 Min Sheng E. Road, Pingtung, Taiwan ROC ABSTRACT The phenomenon of sparse clinical visiting in local clinics and heavy loading among large-scaled hospitals in Taiwan causes the big lump of waste in healthcare resources for so long. Imbalance of healthcare service between cities and suburban is also more severe recently. Taiwanese patients are confronting long waiting time and high healthcare expense daily. Patient transferring system is currently being promoted by the government for improving operational effectiveness and utilization. Many healthcare institutes such as hospitals, clinics, pharmacies, medical inspection, and medicine suppliers have also tried to expand or broaden their value chains for the healthcare networking. However, successful alliances are still very challengeable up to now, it maybe largely dues to the obstacles of medical professionals, but organization behavioral adjustments and Internet information system developing should be also considered. Transitioning from traditional patient s treatment transaction approaches to an e-business model and adopting new technology present many organizational challenges. Building an Internet infrastructure and attracting more participants initially may not ensure the longevity of value chain of healthcare networking. This paper attempts to integrate concepts of value chain, customer relationship management, business process of outpatient treatment on healthcare networking, scheduling, activity based cost, and information system management to construct a Web-based information system for a healthcare strategic networking and empirically explore it. System requirements and decision-making knowledge are collected based on literature reviews and in-depth interviews with several top representatives in few large-scaled hospitals and their partners. Unified Modeling Language (UML) is applied for developing a Three-Tier healthcare information system to assist the daily business process among institutes of a strategic alliance. Keyword: Information System, Outpatient HealthCare, Scheduling, Unified Modeling Language. -2

2 INTRODUCTION In recent years, medical service in Taiwan is facing with the serious pressure of operational cost. Since nationwide implementation of health insurance, the health insurance bureau in Taiwan for actively controlling the waste of medical service resources, has reduced the health insurance finance burdens, the accent falls of the compensated medical expenses, the impetus paying case of illness on compensation, reasonable outpatient service quantity measurements, creates income large reduction in the healthcare institutes nationwide. Therefore for preventing the huge demand, the medical expense of the healthcare institutes surge upward today of with the hospital management specialization, various healthcare institutes are examining and plan its medical service according to upgrade correlative works vigorously, promotes the service efficiency, the medical quality, their internal management and reasonably controlling charge of medical service for achieving long range goals of their enterprise. In the past, the large hospitals, the clinic, the pharmacy all were each one independently operating business, between each other comparatively does not have a very good correlation, therefore the integrity of medical service resources is the focal point of the medical establishment in Taiwan nowadays. Also the second-generation medical service network establishment and the health insurance bureau compensation system and so on all for the promotion of domestic medical service quality, the integrity of domestic medical service resources and the establishment of strategies for achieving a more perfect medical mechanism. A integrity of medical strategy alliance might provides the populace be able to choose a better medical institute for his/her own healthy needs, also will guide hospitals to handle a reasonable quantity of patients, will enhance the entire medical service quality and the sufficient share of medical service resources. For exploring the strategy alliance partnership relations among local hospital, clinic, and pharmacy, the objectives of this study are (1) to explore the application of value-chain management concept for a community of medical service network for promoting the usage of medical service resources (2) to construct a community medical service information networking system by the concept of object-oriented system analysis and design. LITERATURE REVIEW In recent years, the health insurance carrying out, urged the domestic populace expands their medical demand quantity and pursue better service quality and. In order to meet the medical service needs which the populace grows day by day, the hospitals just like the mushroom growth arises at the historic moment also applying the management concepts vigorously. And the trend is also pushing the traditional medical service market unprecedented competition and the impact. The characteristics of Alliance for healthcare are (1) Community is independent (2) The associates restrict, reasonably control the medical expense, and lead the medical behavior (3) Promotes the medical specialized independency, doctor to have the broader service scope, then the participation of community health promotion will be promoted. (4) Providing the populace approachable, completeness and long-enduring medical service of health care attendance. According to the quality service report for a medical center in south Taiwan by Lin et al. (1993), outpatients waiting time obviously reduced in three years by introducing information system into her outpatient service. Waiting from 11 to 30 minutes for a desk registration drops from 24.34% to 19.2%, patients waiting more than 30 minutes for a doctor diagnosis drops from 36.15% to 29.8%, waiting for -2

3 his/her medicine filling time drops from 30 minutes to 10~20 minute. The paper work and data collection of appointment registration, doctor diagnosis, examination, outpatient visiting pricing are all implemented by computers. The medicine flow computerization and the electronic medical record management, comes the effective disperser to receive a medical examination and reduces the waiting time. This online diagnosis may solidly promote the medical service market share and the medical service quality, therefore pulling out the medical information networking from the sole hospital interior to the medical service society group, may provide the populace a medical community conformity transfer service network, perhaps as soon as is worth thoroughly studying and developing an administrative information networking might a feasible plan. According to the Department of Health for the Scotland material comparison, Welch (1964) demonstrated the patients spending 75% time for waiting, doctor only spend 15% time to wait for. This presents the general appointment system comparatively to pay great attention to doctor, but non- patients, but proposed four can affect the appointment system achievements: (1) doctor is punctual (2) patients to be punctual (3) to make an appointment the time gap appraisal and (4) the waiting room space. The implementation of health insurance from 1995 in March, case of illness for calculating compensation, all has not the small impact to various hospitals, and the diagnosis relations group (Diagnosis Relation Groups, DRG), subscribes by the health insurance organization decides respectively diagnoses and treats the payment points which the project and case of illness combines, pays expenses the basis by this points achievement. Therefore no matter in what kind of business condition, cost allocation if hospital itself has not been good in accordance to it road, inevitably will be able to create the medical business difficulty. Adds on the hospital work nature complex, the medical service combined diversification, also hospital department multitudinous, each other mutually supports situation frequent also complex, produces the regular expense if does not have properly sharing to various departments, is easy to create cost distortion. Under the health insurance system tendency, the hospital uses the diagnosis relations group classification to take basis of the declaration, but DRG is concept of the clinical way, it lets the medical flow be possible to divide each step, this cost structure quite suits the use work foundation cost system (Activity-based Costing, ABC) the way calculates. Kuo (1989) pointed out "the inventory management" in the hospital management is by the economical reasonable way, at the right moment, suitably, the suitable nature, right amount, the suitable price provides the hospital various departments to need each kind of goods, enables the medical service smoothly to carry on, and reduction cost of inventory. Second the essential targets inventory management for promote the customer service level and decrease because provide the high standard customer to serve are the result of the cost promotion. Therefore the inventory management is guarantees the medical service station to need medical materials the supply to be complete, and datum of the establishment stock control, provides the best medical service by the most economical order way and the goods in stock control system. Huarng (1998) use 31 Taiwanese hospitals as his research object, discovered the medical materials cost equally approximately composes 30%~40% overall business cost, Correlation statistical data from the health insurance bureau in Taiwan demonstrated health insurance sets up the charges for medicine disbursement is more than 400 hundred million NT dollars 1995, up to 1990 is 828 hundred million NT dollars, the information demonstrated the health insurance enhances year after year in -2

4 the medicine aspect disbursement, the domestic large-scale hospital uses medicine type many, also the medical material inventory management universal existence question like consumption cost is high, the storehouse and the medical unit medicine stores up, stores in a storehouse the space not properly to plan and so on, all can affect business cost and the service efficiency, Therefore is worth thoroughly studying and development information system to manage it. In view of the facts and the above literature reviews, this research plans to integrate the medical service community networking to explore "the specialized medical service logistic center" for carrying on the medical material unification procurement and the inventory management. The affiliation automatically response by the information system networking, unifies the community medical service resources to promote quality and achievements of medical materials management. PROTOTYPING OF INFORMTION NETWORKING The main advantage of object technology in IS environments is in facilitating software maintenance and scalability. UML is used as a standard to capture modelling artefacts. The analysis phase concentrates on system requirements. Requirements are determined and specified. Function and data models for the system are developed and integrated. Non-functional requirements and other system constraints are also captured. The object approach to systems development follows the iterative and incremental process. This study applied In-depth interviews with some healthcare management experts in few large-scale hospitals, and recognize the flowchart of a typical outpatient medical service in Taiwan as Figure 1 shown. And facilitating the community alliance strategy concepts among the service industries, a medical outpatient service strategic networking is proposed as Figure 2. The strategic medical service network contains a large-scale medical center functioning with one newly to be established an alliance department to manage business related to members of alliance, information sharing among members, etc. The medical center may provide members supporting of medical alliance establishment, treaty management, technical training and medical material supply, information sharing and so on. After an alliance member joins the medical strategic alliance networking system, the medical center subsequent visit patients or chronic illness patients may via a hospital transfer to an allied clinic to get doctor diagnosis, an affiliated inspection institute to get a quick examination report, or an allied pharmacy to get his medicine refilling regularly. Also, for a server illness case, patients can be transfer from his local institutes to a large-scale medical center quickly, and using the central information sharing to provide a detailed and original medical diagnosis history for better healthcare services. Furthermore, some severe diseases, such as SARS, might be able to control from very beginning. The best medical care for server illness patients by large-scale medical center, and the outpatient and home-stay slight illness patients visit to an affiliated clinic, or pharmacy to get nice and continuous therapy nearby their residency. This integrity might be able to enhance the medical quality and the reduced medical service resources waste. A medical center may also expand the medical alliance networking system various communities; therefore, how to constructs a medical outpatient service strategic information networking system for aiming the achievement of the alliance is the major concern of this research. According to business flows and concepts of supply chain, a framework of functional requirements for medical outpatient service information prototyping is proposed as Figure 3. Methodology of Object-oriented system analysis and design is applied to develop the -2

5 prototyping in the study, the cycle of system development is divided into three phase as the preliminary system analysis, the system design, and the implementation. Information supporting requirements analyzing is focused in this first phase, according to functional requirements presented in Figure 3 and in-depth interviews with healthcare experts in several large-scale hospitals, the user case diagram in UML is shown as Figure 4. Six actors for the system are doctor, nurse, patient, pharmacy, inspecting personnel. Six use cases are registration, diagnosis, examination, medical pricing and medicine filling in pharmacy so on. Based on functional requirements and user case diagrams in Figure 3 and Figure 4, the class diagram of this networking system is shown as Figure 5, and hardware deployment is shown as Figure 6. Registration Outpatient Timetable Scheduling Doctor Diagnosis Medicine Filling Examination Visiting Pricing Figure 1 Typical Outpatient Service Flowchart in Taiwan Healthcare Community Medical Center Alliance Management Clinic Inspection Institute Pharmacy Figure 2 A Proposed Strategic Alliance among Healthcare Institutes -2

6 Registration Doctor Diagnosis Outpatient Timetable Scheduling Outpatient Healthcare Networking Examination Medicine Filling Authority Control Medical Material Central Procurement Inventory Management Outpatient Visiting Pricing Cost Control Figure 3 Requirements for Prototyping of a Healthcare Information System Figure 4 Use Case Diagrams for Outpatient Healthcare Service -2

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8 Figure 6 Deploy Diagram for Prototyping of a Healthcare Information System ACKNOWLEDGEMENTS This study was supported in part by the National Science Council, Republic of China, under Grant NCS H REFERENCES : ,, 8., 1989.,, 22(2), , 1989., 22(3), Ho, C., Lau, H., Evaluating the Impact of Operating Conditions on the Performance of Appointment Rules in Service System, European Journal of Operational Research, 112, Huarng, F. H., Hospital Material Management in Taiwan: A Survey, Hospital Materiel Management Quarterly, 19(4), Lin, H. F., et al., A Proposed Framework of Service Quality for a Hospital Visiting, Proceeding of the Third International Conference on Electronic Business. -2

9 Miller, H. and Pierce, F., The Implementation of Nurse Scheduling Using Mathematical Programming, Examination Case Studies in Nurse Stuffing, National Cooperative Services Center for Hospital Management Engineering, Proceedings of a Forum Held at New York City, New York, Miller, H. E., et al., Nurse Scheduling Using Mathematical Programming, Operation Research, 24(5), Welch, J., Appointment Systems in Hospital Outpatient Departments, Operational Research Quarterly, 15,