Framework of Informati System for Healthcare Organizati based ve Care Model Arry Akhmad Arman School of Electrical Engineering and Informatics Institut Teknologi Bandung Bandung, Indesia arry.arman@yahoo.com Latifa Dwiyanti School of Electrical Engineering and Informatics Institut Teknologi Bandung Bandung, Indesia dwiyanti.latifa@gmail.com Abstract Today, Informati System and Informati Technology (IS and IT) become a necessity in almost all sectors of life, including health sector or health services. Health sector need very specific IS requirement, also very high availability of IS systems. Organizati need to determine the minimum IS and IT that appropriate to fulfill the need while in other hand should csider best risk, cost, and benefit. There is a mandatory process in Health Care envirment to be fulfilled by the IS system. This work try to design a Framework of Informati System for Health Service Organizati that built based ve Care Model (CoCM) and focused collaborati of compent process, human resources, informati and technology. The framework csist of IS model, descripti of compent as parts of model (including processes), measurement, and the guideline how to apply the framework. The proposed framework can be used as a reference for any parties that want to build Informati System for Health Service Envirment. Keywords healthcare, ve Care Model (CoCM), framework of informati system architecture I. INTRODUCTION Healthcare or health services are known as e of the term in the world of health. Health care is a process of the completi of a job through a series of activities such as planning, organizing, directing, and supervising by using resources effectively, efficiently, and ratial in providing the service of bio-psycho-social-spiritual being comprehensive in individuals, families, and society, both sick and healthy through nursing process to achieve the objectives that have been set [1]. There are various methods that can be implemented in doing health services. One of them is to implement a model of ve Care models or CoCM. This method can be adopted for the provisi of health service because it has proved successful at reducing operatial costs and increase the number of individuals that can be handled [2]. Technology is e of the important aspects in the CoCM. This is indicates that the utilizati of IS and IT has become e of the important aspects in the health service. However there are some problem in the procurement of IT for health care organizatis (E-Health). Based recorded projects, ly 32% of the E-Health sample project in America and Europe who successfully achieve the objective [3]. In additi, in India between 2007-2011, there are 52 E-Health project failed with the major problem is no clear definiti of the system requirements [4]. So, it is important to provide a good reference to build IS and IT system in healt care envirment. This work will propose a framework for determining the informati systems architecture that can be used by healthcare organizatis as a reference of the structure of the data and an applicati that translates from organizati strategy. Applicati of informati system architecture allows the process of alignment between informati systems with business processes that are running in the organizati. In additi, this proposed framework also csider IS or IT Governance, so there will create an alignment between the design process, the operatial processes (management), and the governance of the process. Until today there is no framework for informati systems architecture that that can be referred for implementati of IS in the health services organizati. A. E-Health II. LITERATURE STUDY E-Health is defined by The World Health Organizati (WHO) as the utilizati of informati and communicati technology (ICT) in relati to health aspect [5]. E- Health focus improving the level of acceptance the informati using electric technology as the media that help the systems management in health [6]. To develop the cstructi of E-Health, WHO in the year 2012 has created a framework for the development of E-Health embodied in the book entitled "The Natial E- Health Strategy Toolkit [7]. This framework csists of nine scalable and inter-related process that can be seen Figure 1.
D. Informati System Framework Today, any organizati that apply IT to support their business process usually has to build EA (Enterprise ). TOGAF (The Open Group Framework) is the widely use reference to build EA. Practically, EA is a model to represent Business Layer, Informati System Layer, and Infrastructure Layer in e integrated layered model. Organizati have to build current EA and future EA and finally create a plan and roadmap to move from current EA to future EA. Figure 1 Framework to Develop E-Health [7] B. Healthcare Process There is an internatial standard method which is known as Nursing Process Theory that proposed firstly by Ida Jean Orlando in 1958. This model try to describe the entire sequences of processes happens in health services [8]. Processes in Nursing Process Theory divided into five steps as can be seen in Figure 2. Each step has a standardized activity in implementing comprehensive health care services. Figure 2 Nursing Process Theory [8] C. ve Care Model ve Care Model or known by the CoCM acrym is an approach for health care that involves the implementati of the integrati process of the parties ccerned in [10]. CoCM is a methodology that csists of four main areas such as Human Resources, Process, Informati and (Technology) like we can see in Figure 3. Figure 3 Layer of Enterprise [12] Informati system architecture describes the applicati systems and its role in supporting business processes, such as: (1) key applicati ccepts or technology is required; (2) logical structure of informati system; the descriptis of system informati exchange between applicatis, and between applicati systems with users; and (3) structure/compositi of the informati system modules [12]. E. Informati Technology Governance COBIT 5 represent IT governance and management in two different layer, but correlated each other as seen in Figure 4. This view align with the ccept of Corporate Governance, proposed by Sir Adrian Cadbury. He stated that Corporate Governance as a system which serves to give directi and ctrolling of an entity [13]. Figure 4 IT Governance [14] Figure 3 ve Care Model [11]
III. ANALYSIS & DESIGN This part will describe the analysis & design process to produce the proposed framework. The process will be started with the identificati of requirements for the framework and the ctinue with the design. Refer to four layer TOGAF architecture, this proposed framework will focus IS (Informati System) layers that csist of Data Layer and Applicati layer. Business layer assumed to be limited ly to Basic Nursing Process that already described in part II. No Types of 2 Applicati Characteristic process Listed informati requirement of every pers Mapping modules/tools requirements Mapping informati mapping by modules Mapping the use of modules by user How to Achieve of process Provide matrix/diagram of informati requirement of every stakeholder (RACI table) Analysis modules/tools requirement based process Provide matrix/diagram of critical informati management by modules/tools Provide matrix/diagram the us of modules by each user A. Identify the Requirements The requirement analysis was cducted to define characteristics and compents of informati systems architecture framework that can support the IT governance for Health Care envirment. Requirement analysis is cducted by observati, interviews, and literature studies. Through the process of observati and interview in three health organizatis, it can be ccluded that up to now there has been no formal framework used for determining the architecture of the informati systems in their organizatis. On that three organizatis, the welldocumented IT or IS Governance do not applied yet. Table 1 and Table 2 show the requirements or characteristics of the framework to be built. Table 1 show the Governance characteristic, and Table 2 show IS characteristic. Each table also have How to Achieve column, describe about how to achieve the characteristic that stated in characteristic column. TABLE 1 CHARACTERISTIC OF IT GOVERNANCE No Characteristic Descripti How to Achieve 1 Providing strategic directi Facilitate process of alignment between business needs with IT procurement Provide model for mapping between business processes with IT needs 2 Measure the objective 3 Ensure risk management 4 Verify the using of resources Facilitate the implementati to measure the objective, both business and IT objectives Facilitate implementati of any IT risk mitoring Facilitate mitoring of the allocati and use of resources Objectively documenting the process objective Objectively documenting IT objective Provides informati maturity model Provide a model for risk analysis Provides mapping of human resource requirement (using tables RACI) Provides mitoring of mey resources (using ROI) Provides mapping of informati requirements TABLE 2 CHARACTERISTIC OF INFORMATION SYSTEM ARCHITECTURE No Types of 1 Data Characteristic Provide critical informati Mapping linkages between informati Listed informati requirement of every How to Achieve Analysis and listed critical informati Provide matrix/diagram of linkages between informati Provide matrix/diagram that mapping both input and output B. Identify Framework Compents Based CoCM (ve Care Model), the compent of this framework will divided into 4 compents: (1) Process, (2) People, (3) Informati, and (4) Technology. The four compents detailed into sub compents listed in Table 3. TABLE 3 FRAMEWORK COMPONENTS OF IS ARCHITECTURE No Compent Name Sub Compents of the Compents 1 Process Clinical Process 1. Assessment 2. Diagnosing 3. Planning 4. Implementing 5. Evaluati Operatial Process 1. Registrati 2. Implementati 3. Terminati 4. Costumer Service Funding Process Define why, what, when, where, who, and how. Descripti Processes that related to clinical interactis cducted over health care Processes relating to the management of health care processes Processes associated with the financial management in the health service 2 People Provider Is a stakeholder who carry out health services to patients Patient & Family Is a party to be charged by the health services Employee A stakeholder who is bound by ties of organizatis Payers An entity outside of the patients who did payment or reimbursement of the costs of health care. Regulatory Body A party which sets the rules of implementati in health services 3 Informati Operatial Informati relating to clinical interactis cducted over health care Clinical Informati relating to the management of health care processes Funding Informati relating to the financial management in the health service 4 Technology Individual electric health informati Functiing services to assist in the collecti and storage of medical informati for each individual Health-care communicati and collaborati Health-care service delivery tools Health informati IT-based services that enable the implementati of the communicati and disseminati of informati amg the parties involved in the implementati of health services Services to assist the health service delivery in making a diagnosis, determinati of the type of therapy, and manage the process of giving with services to patients, either electrically or individual Services that ensure the patient and
No Compent Name Sub Compents of the Compents and knowledge Health-care management and administrati Descripti health service delivery can gain access to informati and knowledge about health trustworthy Services for the provisi of informati management and administrative services to support the effectiveness of the implementati of health care to patients. Tools also helps to mitor the health of the populati C. Design the Framework s Compents Processes and sub-processes listed in Table 3 still grouped into the clinical, operatial (administrative), and financial processes. In fact that processes should be integrated. By analyzing all the processes from many perspectives and learning from best practices in 3 health organizati, the proposed integrated processes describe in Table 4. By exploring CoCM and combining with other resources, three other compents also determined as shown in Table 5, Table 6, and Table 7. N o Process Name TABLE 4 COMPONENTS OF PROCESSES Code of Process Activity Name 1 Preliminary P1 Registrati P1.1 2 Assessment P2 Collect, manage, validate, P2.1 and documented data 3 Diagnosis P3 Data analyzing, problem P3.1 identificati, and formulate the diagnosis 4 Planning P4 Setting goals and priority P4.1 Set and documenting the P4.2 nursing interventi (NI) 5 Implementing P5 Reassessment of patient s P5.1 cditi Setting the human resources P5.2 Implementati of nursing P5.3 interventi (NI) Supervise other party that P5.4 help to provide services 6 Evaluati P6 Collect and linkage data to P6.1 evaluati Comparing data P6.2 collected about implementati process with the results obtained, and making cclusis related to obtains status (ctinue, modify, or disctinue the treatment plan process has been made). 7 Terminati P7 Payment P7.1 Costumer services P7.2 Educatial grant P7.3 Code of Activity TABLE 6 COMPONENTS OF INFORMATION No Critical Informati Code Category 1 Patient Identity Operasial 2 HR Allocati I2 Operasial 3 Reference I3 Operasial, Clinical 4 Anamnesis I4 Clinical 5 Patient Diagnosis I5 Clinical 6 Nursing Interventi (NI) I6 Clinical 7 Implementati of NI I7 Clinical 8 Medicine I8 Clinical, Operatial, Funding 9 Use of Medical Devices I9 Clinical, Operatial, Funding 10 Room Patients 0 Operatial, Funding 11 Payment 1 Funding 12 Mortgage Payment 2 Funding 13 about 3 Clinical Healthcare 14 Evaluati 4 Clinical TABLE 7 COMPONENTS OF TECHNOLOGY No Katagori Kode 1 Individual electric health informati T1 2 Health-care communicati and collaborati T2 3 Health-care service delivery tools T3 4 Health informati and knowledge T4 5 Health-care management and administrati T5 D. Objective Measurement Model The design of objective measurement model is adopted from COBIT 4.1 measurement and model. Measurement scale is given as the benchmark for the quantificati of achievement. There are 6 levels that quantified into a scale of 0-5, the highest rating, 5 and 0 the lowest value as shown in Table 8. TABLE 8 MEASUREMENT SCALE Skala Level Deskripsi Kematangan 0 N-existent There has been no attempt to informati management 1 Initial / Ad Hoc Informati management have been started but still initiati and ly performed by some stakeholder 2 Repeatable but Intuitive Informati has been managed in a way that has not been defined, but it is de based the habits 3 Defined informati has been de with the implementati of the rules that have been defined and documented 4 Managed and Measurable Informati management process has been cducted, managed, and can be measured 5 Optimized Informati management process has been defined, well managed, and there are some intuiti to develop the informati management processes There are seven aspects of assessment which are grouped into four main compents of the framework as shown in Table 9. TABLE 9 PARAMETER OF ASSESSMENT TABLE 5 COMPONENTS OF PEOPLE No Category Code of Category 1 Patients & Family S1 2 Providers S2 3 Employees S3 4 Payers S4 5 Regulatory Body S5 Compent Process Parameter of Assessment Awareness and communicati Code KP1.1 Descripti Linking with the awareness of the importance of managing informati in a process and communicati efforts are being made to increase csciousness would be an implementati of informati management. Determining goals KP1.2 Associated with the
Compent Parameter of Assessment and measuring success Policy and procedure Code KP1.3 Descripti determinati of clear objectives related to the management of informati in it and the availability of tools for quantitative calculatis related to achievement in informati management Associated with the availability of the rules and procedures governing the implementati of informati management procedures People Respsibilities KP2.1 Associated with the divisi of roles and respsibilities of each HR in a process Skill and training KP2.2 Associated with the skill of human resources and informati processing to organize training for increase people skill Informati Informati ownership KP3.1 Associated with ownership of the informati, whether solely owned by the manager, in the sense that most of the parts of the organizati, or distributed so that it can be used by other parties Technology Tools availibility KP4.1 Associated with the procurement of tools that used for informati processing I = Input ; Process needed the critical informati O = Output ; Process produce the critical informati 3) Identify Roles and Respsibilities Use RACI table to define roles and respsibilities for every stakeholder in each process. This table can mapped the linkage between process and people as shown in Table 11. The acrym RACI stands for Respsible, Accountable, Csulted, and Informed. TABLE 11 MATRI OF THE LINKAGE BETWEEN PROCESS AND PEOPLE S1 S2 S3 S4 S5 P1.1 R I R/A I C P2.1 R R/A P3.1 I R/A P4.1 I R/A P4.2 I R/A I C P5.1 R/A I P5.2 R/A I P5.3 I R/A I P5.4 R/A P6.1 R/A P6.2 I R/A P7.1 R A R P7.2 R R P7.3 I R R IV. USING THE FRAMEWORK This part will describe about step by step process of using proposed framework, so organizatis can build their own informati system architecture. The steps csist of 5 steps that will describe below. 1) Identify The Process Identify processes that already running or will be initiate in organizati. Check the 14 processes that mapped in this framework and identify each of them, is that process running in that organizati or not. 2) Identify The Informati There are 14 Critical Informati that suggested to be managed by the organizati. Identify every critical informati in each process that already defines in step 1. Create a matrix that describes the linkage between process and critical informati that is presented in Table 6. TABLE 10. MATRI OF THE LINKAGE BETWEEN PROCESS AND CRITICAL INFORMATION I2 I3 I4 I5 I6 I7 I8 I9 0 1 2 3 4 P1.1 I/O O O P2.1 I I I/O P3.1 O I O I P4.1 I O I P4.2 I/O O O O I P5.1 I P5.2 O I P5.3 I O P5.4 I O P6.1 I I I I I O P6.2 I/O P7.1 I I I I I I O O P7.2 I O P7.3 O There are two symbols for describe relati between process and informati: 4) Define Technologies Define technologies requirement for each process. Technologies can be a module or a tool. This modules/tools become reference for organizati to build their informati system. Make a matrix to mapped modules/tools requirement as shown in Table 12. P1.1 P2.1 P3.1 P4.1 P4.2 TABLE 82. MATRI OF MODULES/TOOLS REQUIREMENT T1 T2 T3 T4 T5 Registrati P5.1 P5.2 Registrati Laboratory Medicine Registrati Reference Reference P5.3 Clinical Tools P5.4 P6.1 P6.2 Dashboard P7.1 Billing P7.2 P7.3
5) Detail The After define technologies in step 4, the modules/tools will be available as references for organizati, each of that should be detailed using matrix of informati management as shown in Table 13 and matrix informati requirements for stakeholder as shown Table 14. TABLE 13. MATRI OF INFORMATION MANAGEMENT BY MODULE/TOOLS Registrati o n Laboratory Managemen t Reference Clinical Tools Billing Medicine Dashboard Managemen t I I I I I I I I I 1 2 3 4 5 6 7 8 9 0 TABLE 9 MATRI INFORMATION REQUIREMENTS FOR STAKEHOLDER S1 S2 S3 S4 S5 Registrati Laboratory Reference Clinical Tools Billing Medicine Dashboard V. IMPLEMENTATION AND TESTING In order to validate the framework that has been built, there was two tests: (1) applicability and (2) completeness. Applicability will map informati system of the real health care organizatis (hospitals) to test the suitability of the framework with reality. It can be ccluded that the developed framework of informati system architecture can be applied to the real organizatis that implementing health services. For completeness, there are two tests, which is as follows: (1) Completeness of the characteristics of the informati system architecture and IT governance framework; this test is based the fulfillment of Table 1 and Table 2; it can be ccluded all of the characteristics are met; (2) Completeness of ctent and suitability of the 1 2 3 4 specific needs of health care organizatis; cducted by interviews speakers who work as stakeholder who implementing health services. Based the assessment ccluded that the framework feasible to be used for the determinati of good informati system architecture and IT governance. All compents have correspded to the processes that occur in health care organizatis. VI. CONCLUSIONS AND SUGGESTIONS Based the evaluati, this work proposed the new framework of IS fot Healt Care Services with following characteristic: csist of four main compents that detailed into 14 processes, 5 types of human resources, 14 critical informati, and 5 types of technology; five steps executi guideline, and measurement model. In additi there are some suggestis are proposed for further development of the framework, which is as follows: (1) the detail of functi for each module / suggested tools, and (2) mapping the informati systems architecture into technology architecture. REFERENCES [1] Asmuji. Manajemen Keperawatan. Jogjakarta, 2012 [2] Unutzer, Juregen, Michael Schoenbaum, and Benjamin Druss. The ve Model Care Model : An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes. 2013. [3] The Standish Group. Chaos Summary. Canada, 2009. [4] Abouzahra, Mohamed. Causes of failure in Healthcare IT Project. Internatial Cference Advanced Science, 2011 [5] World Health Organizati. Building foundatis for E-Health : progress of Mamber State : report of the WHO Global Observatory for E-Health. Geneva, 2006. [6] J., Dzenowagiz. The health and care revoluti. Ghent: EAI Pubhlising, 2011. [7] World Health Organizati and Internati Telecommunicati Uni. Natial E-Health Strategy Toolkit. Geneva, 2012. [8] Departement of Development Services. Nursing Process Standard. Cnecticut, 2009. [9] Peek, C.J. Planning Care in the Clinical, Operatial, and Financial Worlds. Springer, 2008. [10] Community Preventive Service Task Force. Recommendati from the Community Preventive Services Task Force for Use of ve Care for the of Depressive Disorders. 2012. [11] Murphy, Gail Tomblin, Rob Alder, Adrian MacKenzie, and janet Rigby. Model of Care Initiative in Nova Scotia (MOCINS) : Final Evaluati Report. Delhousie University, 2010. [12] The Open Group Framework. 2014. www.opengroup.org [13] The Cadbury Report. 2014. www.governance.co.uk [14] Barger, Teresa. Corporate Governance - A Working Definiti. 2004. [15] ISACA. COBIT 5 : A Business Framework for the Governance and of Enterprise IT. United States of America, 2012. [16] IT Governance Institute. COBIT 4.1 : Executive Summary Framework. United States of America, 2007. Davis, J et al. Informati Revoluti : Using the Informati Evoluti Model to Grow Your Business. New Jersey, 2006.