Strategic Business IT
I. Introduction
Today’s health industries are undergoing an accelerated change. A strong focus on the current change is the area of productivity improvements. Health care organizations are increasingly pressured to reduce costs and make the more with the same sources. Thus, they began to embrace information technology to a greater extent than before. Information technologies are transforming the way health care is delivered. Innovations such as computer based patient records and tele-home health care are beginning to affect the cost, quality and the accessibility to health care.
In Curbishley Royal Hospital, the delivery of cost effective medical services is paramount among the priorities. The hospital management has recently considered adopting information technology as a means of mitigating its financial constraints. The strategic intent behind the project is to create an electronic presence among the hospital’s stakeholders (patients, medical providers and internal staff). However the relative inexperience with the technology and the new application associated with it makes it complex. Therefore the objective of this report is to provide a thorough analysis of the technologies available for adaptation. The specific objectives of the study will include the following:
- Identify available technologies
- Select the most suitable technology for the hospital
- Identify the stages for implementation
- Assess the risk associated with the technology
- Assess the impacts on the staff, patients and hospital’s strategy
- Evaluate the overall outcome
II. Methods of Inquiry
The method of inquiry is qualitative in nature which provides an in depth description of the various settings. It involves the use of qualitative data such as documents to explain and understand the social phenomenon. One of the common qualitative research methods in information systems is the case study research which has been used for the purpose of this report. A case study is an empirical inquiry which investigates the phenomenon in the context of real life when the boundaries between the phenomenon and the context are not clearly defined. This case study research is well suited to Information Systems research since the object of the discipline is the study of information systems within organizations and the interest has moved from the technical to the organizational issues.
III. Internet Technology
3.1 The Concept and Use of IT
The quality of health care is judged by the impact of the health services in the health status of the patients. Improving quality means using health services that when properly executed would produce greater results in the patient’s health status. The most direct contribution of information technology in this respect is to provide the health care professionals with better information about the patient and his health problem and the immediate treatment for that problem at the point of care. The ease with which the access to information is integrated depends on the use of IT in the healthcare. Potential use range form the stand alone information systems (IS) to integrated hospital information systems (HIS) to sophisticated artificial based clinical decision support system (CDSS). Today, hospitals are moving from stand alone information systems to an integrated HIS and CDSS. Those with integrated HIS may include an admission/discharge/transfer (ADT) system, scheduling and registration, electronic patient record (EPR), laboratory information system (LIS), pharmacy system, financial management systems for reporting and billing and telemedicine (, 2003, ). Given the wide rnage of available technologies, this report will focus on two areas which are prioritized by the CurbishLey Royal Hospital. This will include the use large scale medical records by upgrading information systems and the use of telemedicine.
As with today’s information intensive environment, patients demand more information about their health options and easier access to relevant health information. In this regard, the internet plays a crucial role in bridging the gap between the health care providers and the patients. One of the issues of concern is the development of applications that will capture, organize, store and present health information in user friendly interfaces. The internet can be used as an active research and communication tool in searching for health related information. In addition to this, the intranet and extranet can also be used as extensions of the internet. These virtual private networks are provided by security software to keep the unauthorized users from accessing the web site. Essentially, the intranet is a private computer network that is created to provide internet based services to inside organizational member. Similar to this, the extranet extends the network access to certain partners by giving them access to selected areas within the virtual network, thereby creating a secure network (, 2003, )
There a number of ways in which data can be stored using conventional software packages. The database which is a collection of files that are related based on specific criteria and contains entries in list order. It may contain information such as names, addresses and contact details that are traditionally recorded on cards. These databases are used to organize and record information systematically while allowing the easier access to utilize or update information and produce data for report purposes.
The dominance of internet based communication and data sharing is likely to characterize the future of health care. The advent of cable modems, ISDN and DSL, and computer camera systems for home use means that the direct service options are possible for home monitoring applications. Also the cost of videoconferencing systems is dropping over the 90s. The consolidation in this industry has led to fewer providers and lower costs fro all types of systems. Video streaming allows almost full motion audio and video with no delays. The costs and size of these units continue to drop while their performance is improving continuously (, ).
Telemedicine has primarily been concentrated in rural and special populations. However, it is increasingly used as a means for home care. Telemedicine is an electronic means of delivering care that provide faster and more convenient treatment. The ability to receive the medical services without having to leave the home also provides a continuity of the care given. Among its benefits is to reduce the amount of disruption in the patient’s life and reduce the amount of working time. Follow up care is well suited for such method and it may be carried out through electronic means which reduces the costs of time and travel used for office visits. Telemedicine is widely defined as the use of information and communication technologies to deliver medical services and information when distance separates the participants.
The system is designed to bring real time consultations involving the patient and the health care provider (physician, nurse, physician assistant) at the distant end and the specialist at the hospital. Full motion and compressed two-way video is used. Ordinary telephone calls to the doctor are so common that they are rarely considered as telemedicine applications. However, when visual information is crucial part of the consultation, the relevant option must include the use of moving images. With the telephone, delay is common and accepted. For instance, the nurse says she will give the information to the doctor and will get back to the patient.
However, telemedicine provides a more effective way of delivering care. An example of this kind of driver that enables home base health care is the Health Hero Network (HHN). Its monitor requires a standard telephone line for the patient and internet access of the health care provider. This combination provides a rapid transmission of information from the patient to the health care providers and allows the latter to monitor the patient’s illness from their offices while the patients remain in the comfort of their homes (, ). The remote monitor is a two way communication link between the patient and the website and consists of simple button device that plugs into any phone outlet. The device prompts the patient to answer questions and the responses are transmitted to the secure database. From the data collected, the healthcare provider assesses the condition and performs a health care management to avoid critical situations.
IV. Risk Assessment
4.1 Impacts
The use of information systems provides administrative support for patient care. A study of health management system in Korea revealed that the system reduced the patient’s waiting time in the health center and simplified the administrative process. The use of IT to simplify administrative process means that the health staffs are able to spend more contact time with the patients. IT systems for the development of patient interface for computerized medical records also save time and money. Electronic patient records will revolutionize the availability of patient information from several locations ( & , 1998, ). The result of the networked information system enables the clinician to make better treatment decisions.
The use of IT can also provide enhanced productivity. For the health care providers, telemedicine serves as an effective tool to provide high quality services. The capacity to acquire timely and up to date information, continuing medical programs, decision support systems and consultations with specialist of larger medical institutions increases the provider’s options and ability to diagnose and treat patients better. For medical centers faced with reduced revenues, telemedicine provides an option to develop regional, national and international markets for their highly specialized clinicians. The intense price competition also threatens the mission and even the existence of health canters whose costs are increased by research and the care for the insured and the uninsured (, 1996, ). In this regard, the information and telecommunication technology that constitutes telemedicine has the potential to alter the health care system both in positive and negative ways.
Nevertheless, significant hurdles remain which includes legal and regulatory barriers. Aside from this, the use of telemedicine by conventional medical establishments has not been fully accepted. Like other advanced technologies, the use of telemedicine depends on complex technical and human infrastructures operating within the discrete institution and across organizational and geographic boundaries. The individual components are often quite complicated and when taken together can be difficult to analyze and reconfigure.
Human acceptance of technology is also important for the effective implementation of IT systems. The organizational culture or the human factor can prove to be a barrier to the IT implementation. When financial and authority relationship is not present to boost cooperation, the use of IT may become problematic. Another factor is data security. Ensuring the integrity and confidentiality of patient related data is a critical element of health care networking strategies. The availability and easier access to information allows the rapid transmission of patient information to various organizations increases the risks of violating information confidentiality ( & , 1998, ). Because of the convenience and the efficiency, hospital staff may forget about the implications of privacy. Thus, IT can reduce the patient satisfaction and the quality of care delivered.
4.2 Consequence Analysis
New information systems have great potential to improve the function of the health care organization. However, the potential can be realized only if the information systems are successfully developed and implemented. Studies indicate that half of computer based information systems fail. Many health care organizations spent huge amount of money and frustrated many people in wasted efforts to implement information systems. The same failure can be found in studies of particular health care applications. Many of electronic patient records initiatives have failed so that systems largely consisted of paper records (, 2000, ). This means that a larger amount of money are invested to new information systems but the substantial part of this will go to waste on unimplemented or ineffective systems.
4.3 Summary of Risk Profile
Information systems also include open problems. Information systems in the healthcare are not at all open systems. For instance, the architecture of some system does not meet state of the art in software technologies. Even when the system is installed, there can still be problem and disappointments. There are four generic issues that give rise to the failure of systems: (1) correspondence failure – the system as implemented does not correspond to what has been required of it (2) process failure- the system is not forthcoming within the time and resource constraints (3) interaction failure- systems as implemented fail to satisfy the needs of the users (4) expectation failure- systems which are unable to meet the stake holder’s expectations (, 1999, ).
Problems on the management may include the lack of experience of IT department within the health care organization. The problems of change management are also a pressing issue. These problems result from organizational cultures in health care, shortcomings in process management and inefficient management structures. These may lead to risk and difficulties if the technology–driven change management will adapt the health care organization into a new situation. The acceptance of the new technology is important as it may impede the successful implementation.
Another compelling issue is information security. This concern has been paramount among health care organizations adopting information technology. As the information system serves the diverse needs of the organization, attention must be given to the exposure of the systems to internal and external sources. One of the steps that must be carried out is to develop a systems security policy which will provide instruction in developing and implementing a security posture as well as a guide for acceptable and expected uses of the systems. This will ensure the confidentiality of the patient information and restrict the access authorized personnel.
V. Key Issues
5.1 Scope of IS Protect
Security is about the protection of information. It deals with the protection of information in a given domain. In this context, protection is expanded in three different directions: (1) Confidentiality, assurance in the accessibility of particular information by the authorized personnel only; (2) Integrity, assurance that no unauthorized changes of information is made during the processing; (3) Availability, assurance that the information is usable at will (, 2000, )
Database security is an area of substantial interest in information system security. From the security view point, this system may be viewed as an application requiring protected subsystems and trusted processes. It ensures that the security is enforces at a record or at the data item level. Thus, the security of a single element may be different from the security of other elements of the same record. That is, the security of one element is different from other elements of the same database row or column. Security interest can also reduce the ability of the system to provide data to the users by restricting some queries (, 2002, ). Also, the health care organization must develop its own policies that will guide and manage support to the members of the personnel involved in the processing of health information. The level of the security included in the information system must involve certain judgments about the dangers associated with the system and the means of avoiding such dangers.
5.2 Initial Stages of SSM
The Soft Systems Methodology (SSM) is an approach that is based on the belief that the complex problems can be resolved on the innate subjective view of the participants. The main principle behind this method is to engage the participants in changing the operation and to improve commitment to outcomes. The SSM will enable the elaboration of view points by the management allowing them to make informed choices for the future. The approach breaks down into a seven stage process of inquiry that will lead to changes in three dimensions: in attitudes, structure and procedures.
Stage 1
Finding out
Stage 2
Rich picture
Stage 3
Root definitions
Stage 4
Redesign
Stage 5
Real-world comparison
Stage 6
Debate and decision
Stage7
Taking action
Figure1. Seven Stages of SSM
Stage 1
The first stage will consist of exploring the problems situation and gathering information about it through formal data and interviews. One of the identified problems at Curbishley Royal Hospital is the improvement of quality health care delivery. Due to the conventional process, the initial contact of the patients is rather slow. Another is the reduction of patient visits to the hospital through tele-home care. The Hospital management can acquire a clearer view of the problem situation by consulting with the hospital employees regarding their perceived problems. For example, the difficulties in accessing patient related health information, scheduling of medical visits and consultations.
Stage 2
Having identified the problem situation the second stage can be expressed in the form of cartoon called the ‘rich picture’ which represents the problem situation as experienced by the hospital employees. The manual system implemented by the hospital makes it difficult for hospital employees to access health care information. Also, a minimum number of patients can be accommodated at a time, thus reducing the health care delivered. From these two stages, it can be argued that the hospital needs to implement an information system and develop a technology to encourage the patients to receive treatment at the comfort of their homes.
Stage 3
The third and fourth stages are abstract processes designed to discover how things could be as compared to how they are as perceived by the hospital employees. This concerns what is called as the ‘idealized design’. The third stage develops brief statements of the various systems or processes called the ‘root definitions’. The root definition presents an ideal view of what the relevant system ought to achieve. Based on the problem situation presented, the management and the employees will develop their idealized design of what out to be changed. The automation of the tele-home health care and the development of either a stand alone or integrated hospital information systems are some of the identified changes. The tele-home health care aims to reduce the number of patient visits by providing them an alternative treatment that can be delivered on their homes. On the other hand, the development of an information system will provide a means for easier access and fast transmission of information.
Stage 4
The fourth stage uses the validated root definition to redesign the activities or transform the process. A conceptual model that has been developed will identify the minimum set of activities necessary to ensure that the transformation achieves its purpose. From the design, the management shall alter its activities so that the transformation is accommodated. For instance, identifying which activities will be supported by the system such as administrative and clinical processes.
Stage 5
The fifth stage is concerned in comparing the models constructed in the real world understanding of the participants. This will enable them to emphasize the possible changes in the actual situation to bring it closer to the idealized system that has been developed. Forming the comparison may involve the highlighting the areas of differences, evaluating options and generating the projections of possible futures. At this stage, the management determines the changes in the present situation so that they can be aligned with the system to be implemented.
Stage 6
At the sixth stage, the comparison drawn from the previous stage are discussed and debated. This leads to the selection of feasible changes to the actual situation. That is whether the changes are systematically desirable and are achievable considering the structure of the organization. The final outcome should be the set of changes that are willing to adopt and commit to by the participants. The various stakeholders will discuss the differences from the previous situation to the proposed change. This will include the debate whether the automation is desirable for those whose jobs will be affected by it. It must also be discussed whether such systems are feasible based on the structure of the hospital. For instance, evaluating whether the hospital can efficiently implement the tele-home health care and its implications on the quality of care provided.
Stage 7
In the final stage, the changes are taken into action. That is, implementing the proposed changes within the real world situation. These actions may affect the totality of the organization including its structure (organization design and job design), attitudes (culture and values) and procedures (actual operations of the organization). After the series of discussion and evaluation, the management will have to decide the systems to be adopted. Thereafter the changes are implemented in accordance to their identified purpose.
5.3 Overview of Key Issues
· Area for systems development
One of the central issues in the system development is the identification of the areas to be affected and changed. This can be done by exploring the current situation and the problematic areas. The management must collaborate with the hospital employees and other stake holders in assessing the problem situation
· Systems Design
Upon the identification of the problem, the changes that ought to resolve and improve the current situation must be laid out. Stake holders must participate in formulating the idealized design and the necessary changes to be implemented
· Implementation
Before the actual implementation, the management must ensure a sound transformation. At this stage, the management should provide guidelines and policies to assist the personnel involved in the processing of the system. This is to ensure that the system is carried out properly. The management must also implement change management since the new system is likely to affect the totality of the organization.
· Impacts
The effectiveness of the new system is evaluated through its impact in the quality of health care. The management will have to monitor whether or not the implementation has achieved its purpose.
VI. Evaluation
The adoption of an IT system can provide a foundation for major transformation in the healthcare delivery system. If the implementation of such system is to be successful, the needs of the various stake holders and the types of applications should be match to produce benefits. The management and delivery of such benefits requires the understanding of the interest and the implementation of applications that are suitable for those interests.
The management’s plan of adopting an information system and the automation of its tele-home health care will meet the need to improve the quality of health care delivered. First, the information system will provide a better means for acquiring, organizing, storing and accessing health information in user friendly interfaces. With such system, the administrative process is simplified and done faster thus allocating more contact time with the patient. Electronic medical records also changed the availability of information from various locations. Other stake holders can be provided access on selected areas. Most importantly, the information system enables the physician and health care practitioners to make better medical judgments and treatment.
On the other hand, the automation of the tele-home health care will help achieve the hospital’s goal of reducing its patient visits. With the aging of the population in most developing countries, the tele home care has a great potential for rapid growth. In addition to his, the changing tradition in caring for the elders at home creates challenges and unique opportunities for implementing tele-home care. Indeed, the promise of telemedicine provides improved and cost effective access to quality health care. Telemedicine helps to transform the delivery of health care and improve the lives of many people.
VII. Conclusion
The pressures on health care organizations to reduce costs and improve the quality of care have been the primary drivers for embracing information technology. The quality of heath care delivered is evaluated through the impact of information technology in improving health services and the heath status of the patients. In this respect, IT can contribute in the fast and accurate information about the patient and immediate treatment for them.
The plans of the Curbishley Royal Hospital to develop an information system and automate its tele-home heath care manifest the benefits of information technology. Such developments will assist the hospital in achieving its goals. However, it must be noted that the success of such systems depends on the appropriate implementation. Adopting a system does not readily guarantee advantages. The process must involve the involvement of various stake holders in formulation, design, implementation and monitoring of the new systems. Ultimately, the success of the system will be evaluated based on its impact on the patient, the staff and the structure of the organization.
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