Information Systems Architecture for University Hospitals E-Book

Silvano Herculano da Luz Júnior

• Herausgeber: Editora Dialética
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 127

Veröffentlichungsjahr: 2022

Beschreibung

The implementation of the Information Systems (IS) Architecture is one of the steps in the construction of the Enterprise Architecture (EA), according to The Open Group Architecture Framework (TOGAF), and can bring notable benefits in supporting the management and governance of Information and Communication Technology (ICT) in organizations, including of health. However, this task is usually followed by several challenges, even more so when we refer to University Hospitals (HU), which are hospitals dedicated to teaching, research, and extension. The purpose of this book is to disseminate an empirical research whose methodological course was carried out in three phases: 1- an extensive Systematic Literature Review, based on 9 specific research questions, to explore the state of the art of the application of EA in health. 2- proposed the 5tep Model, with five well-defined steps to help the implementation of the IS Architecture in HUs. 3- practical application of the 5tep Model together with TOGAF 9.2 and the Archi tool to build and deliver the IS Architecture of a large HU which seeks to improve the provision of services to the population through investments in ICT. As result, in addition to relevant data to the literature on EA and IS through the SLR and the 5tep Model, the delivered IS Architecture for this UH offers a holistic view of the entire ICT, in which identified problems, challenges, possible solutions, and critical success factors for the hospital business.

Leseprobe

ACKNOWLEDGMENT

First of all, I thank God for giving me all the necessary conditions to attend this master’s degree, which is so important in my personal, professional, and academic life.

To my son Guilherme, my reason, my joy of life, and my unconditional love, which gives me the strength to always seek the best for my growth as a father and as a person.

To my family, who have supported me intensely in all stages of my life. Especially to my mother, my father, and my dear brothers.

To my professor and advisor Prof. Dr. Petrônio and to my co-advisor Prof. Dr. Heremita, for their intense dedication in guiding me in carrying out this research.

SUMÁRIO

Capa

Folha de Rosto

Créditos

1. INTRODUCTION

1.1. MOTIVATION AND JUSTIFICATION

1.2. DELIMITATION OF RESEARCH

1.3. OBJECTIVES

1.3.1. GENERAL OBJECTIVE

1.3.2. SPECIFIC OBJECTIVES

1.4. METHODOLOGY

1.4.1. SYSTEMATIC LITERATURE REVIEW (SLR):

1.4.1.1. ELABORATION OF RESEARCH QUESTIONS FOR SLR

1.4.1.2. ELABORATION OF A PROTOCOL FOR SLR

1.4.1.3. CONDUCTING SLR

1.4.2. CASE STUDY

1.5. CONTRIBUTIONS

1.6. WORK ORGANIZATION

2. THEORETICAL BACKGROUND

2.1. ENTERPRISE ARCHITECTURE (EA)

2.2. TOGAF 9.2

2.3. ARCHIMATE 3.1 SPECIFICATION

2.4. ARCHI® SOFTWARE

2.5. RELATED WORKS

3. ENTERPRISE ARCHITECTURE IN HEALTHCARE SYSTEMS: A SYSTEMATIC LITERATURE REVIEW

3.1. SYSTEMATIC LITERATURE REVIEW PROTOCOL

3.2. DATA EXTRACTION STRATEGY

3.3. DATA SYNTHESIS

3.4. RESULTS AND DISCUSSION

3.4.1. RQ2 – WHAT ARE THE MOST USED METHODOLOGIES, FRAMEWORKS AND BEST PRACTICES GUIDE FOR THE EA APPLICATION IN HEALTHCARE SYSTEMS?

3.4.2. RQ3 – WHAT ARE THE MOST USED TOOLS AND MODELS FOR THE DEVELOPMENT OF THE EA IN HEALTHCARE SYSTEMS?

3.4.3. RQ4. – WHAT ARE THE CRITERIA FOR CHOOSING THE METHODOLOGY, FRAMEWORK, AND TOOL USED FOR EA APPLICATION IN HEALTHCARE SYSTEMS?

3.4.4. RQ5 – WHAT PROBLEMS OR CHALLENGES THE EA APPLICATION IN HEALTHCARE SYSTEMS FACE?

3.4.5. RQ6 – WHAT ARE THE MAIN POSITIVE IMPACTS ACHIEVED WITH THE EA APPLICATION IN HEALTHCARE SYSTEMS?

3.4.6. RQ7 – WHAT IS THE CONTEXT FOR THE EA APPLICATION IN HEALTHCARE SYSTEMS?

3.4.7. RQ8 – WHO ARE THE MAIN PUBLICATION CHANNELS AND THE MOST INFLUENTIAL AUTHORS ON THE TOPIC OF EA IN HEALTHCARE SYSTEMS?

3.4.8. RQ9 – WHAT ARE THE MAIN CRITICAL SUCCESS FACTORS MENTIONED FOR EA APPLICATION IN HEALTHCARE SYSTEMS?

3.4.9. CONSIDERATIONS OF THE SYSTEMATIC LITERATURE REVIEW

4. CASE STUDY

4.1. 5TEP MODEL

4.2. DATA COLLECT AT HC-UFPE

4.3. BUILD HC-UFPE IS ARCHITECTURE

4.3.1. ORGANIZATIONAL STRUCTURE OF HC-UFPE

4.3.2. INFORMATION TECHNOLOGY PROCESS MANAGEMENT SECTOR (ITPMS)

4.3.3. ITPMS SYSTEMS AND APPLICATIONS PORTFOLIO

4.3.4. ITPMS DATA CENTER

4.3.5. FUTURE INFORMATION SYSTEMS ARCHITECTURE (TO-BE)

4.4. THREATS TO RESEARCH VALIDITY

4.5. DISCUSSION

5. CONCLUSION

BIBLIOGRAPHIC REFERENCES

Landmarks

cover

titlepage

copyright-page

Table of Contents

bibliography

1. INTRODUCTION

University hospitals (UHs) are centers for training human resources and developing technologies for the health field. These hospitals are dedicated to teaching, research, and extension. Their adequate provision of services to the population enables constant care and technical protocols for various pathologies. Their continuing education programs offer opportunities for technical updates to health system professionals (Educação, 2018).

Every UH has particularities and is highly heterogeneous in terms of installed capacity, technological incorporation, and comprehensive care. All UHs have a prominent role in the community in which they function (Educação, 2018). Of fifty Brazilian UHs, the Empresa Brasileira de Serviços Hospitalares (EBSERH) currently manages forty-one. Since 2011, when the Brazilian government established EBSERH, there have been significant challenges in managing the resources and policies of these university hospitals. The Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE) is a large UH (with an area of 64,000 m2) managed by EBSERH, with 2,823 employees, of which 1,124 are UFPE employees, 1,137 are EBSERH public employees, and 562 are outsourced, working in medium- and high-complexity pathologies. The HC-UFPE has 418 beds and performs a monthly average of 5,600 outpatient consultations and 748 hospitalizations. (BRAZIL, 2021).

Information and communications technology (ICT) plays a fundamental role in these hospitals, as observing the growing immersion of technology in health is easy, which facilitates medical procedures and optimizes administrative and governance processes, adding value to the hospital’s business. However, as they are primarily public institutions whose main area of activity is health, encountering some resistance regarding investments in technology is still common, in addition to the lack of strategic ICT alignment with other hospital areas. This problem is reflected in the provision of services to patients and in the acquisition and management of technological resources that streamline and improve the hospital’s business processes. Talmon et al. (2009) stated that health information is a significant investment area in the health sector and potentially affects all professionals and patients. Developing countries face several challenges compared with developed countries, such as a lack of infrastructure, time, cost, skilled labor, and regulatory policies in the health information field (Anwar & Shamim, 2011). Therefore, understanding these bottlenecks is necessary to improve business processes and effectively address strategic issues.

Therefore, an alternative for enabling projects that can minimize this gap is to implement enterprise architecture (EA). Gartner (2020) defined EA as a discipline for holistically leading corporate responses to disruptive forces by identifying and analyzing the execution of changes towards desired business visions and outcomes. EA aims to align a company’s strategy and configure its IT assets (Weil, 2007). EA allows organizations to see themselves in terms of a holistic and integrated view of their strategic direction, business practices, information flows, and technological resources (Bernard, 2012). Some countries’ governments have introduced EA to address IT challenges (Shaanika and Iyamu, 2015).

EA can offer subsidies to assist hospital management in decision-making. Strategic projects for the acquisition of ICT goods and services that align with corporate business and stakeholders’ needs are also expected. The Information and Communications Technology Strategic Plan (ICTSP) is a formal document that defines the entire strategic field in which hospital ICT must operate, including goals, strategic objectives, and guiding pillars of ICT governance in UHs. Implementing the ICTSP leads an organization along a path designed to enable it to fully leverage and exploit information technology (IT) for opportunities that manifest in the market (Gabriel and Lupiana, 2018).

Concerning EA, building information systems (IS) architecture is a phase of the architecture development method (ADM) to be achieved, according to The Open Group Architecture Framework (TOGAF) (Group, 2020). In this phase, we describe the information system architecture for an architectural project, including the development of data and application architecture. Its main objectives are to develop the target data architecture that enables the business architecture and architecture vision to address the statement of architecture work and stakeholder concerns and identify candidate architecture roadmap components based on gaps between the baseline and target data architectures (Group, 2020).

Although several frameworks are available in the literature to support the implementation of EA, which we found during a Systematic Review of the Literature (SLR), which will be presented later, still lacking models that provide adequate support to assist in the construction of the IS architecture in UHs. We miss a model that provides a well-defined step-by-step guide so that professionals and researchers can guide themselves during the construction of EA artifacts. Similarly, empirical studies on EA remain lacking (Boh and Yellin, 2007; Bradley et al., 2011; Kappelman et al., 2008); Niemi, 2006; Radeke, 2010; Tamm et al., 2011). A significant challenge in the area is the lack of integration between theory and practice, which is present in many studies on EA, where a gap exists between the “what to do” or “what was done,” which focuses more on results, and the “how-to” or “how it was done,” which should focus on the step-by-step creation of EA artifacts or on well-defined activities to obtain data and organize them to construct the architecture.

In response, researchers have chosen to investigate and develop a model to be implemented at UHs, in order to build and deliver the HC-UFPE IS architecture, and that can encourage and help other UHs to obtain benefits for the management of hospital ICT. The implementation of the IS architecture aims engage a greater ICT alignment with other areas of the hospital and improve the delivery of technology services.

1.1. MOTIVATION AND JUSTIFICATION

The main motivation of this research was that HC-UFPE encounters several problems arising from the lack of alignment of ICT with strategic internal sectors. Some ICT projects and actions are not conducted optimally, generating stakeholder dissatisfaction and even impacting patient care. This study considered the concepts of EA to support the resolution of these problems. The identification of these problems was facilitated by the fact that the main researcher is a systems analyst at this hospital. Therefore, an alternative to enable projects that can minimize this gap is to implement EA. Gartner (2020) defined EA as a discipline for holistically leading corporate responses to disruptive forces by identifying and analyzing the execution of changes towards desired business visions and outcomes. EA aims to align a company’s strategy and configure its IT assets (Weil, 2007). EA allows organizations to see themselves in terms of a holistic and integrated view of their strategic direction, business practices, information flows, and technological resources (Bernard, 2012). Some countries’ governments have introduced EA to address IT challenges (Shaanika and Iyamu, 2015).

With the systematic literature review carried out in this work was possible to identify relevant benefits with the application of EA in healthcare, such as:

• Describe and categorize the architecture and operation of business processes;

• Promote improvements in the management of changes and processes;

• Systematize elements for decision making;

• Contribute to the maturity of management and governance, among other positive impacts that can assist hospital management.

However, implementing EA in an organization is not simple and often presents several challenges. The main challenges raised in this review were the organizational complexity of healthcare environments, the difficulty in integrating or accessing data of various types, the stakeholders’ conflicts of interest, communication problems, and others. Therefore, there is a necessary effort to implement EA in a hospital environment regarding stakeholders’ issues, necessities, and expertise.

In several recent surveys, EA has been shown to be efficient in supporting corporate governance processes worldwide, including to the ICT in hospitals. Therefore, in order to identify how EA can support the hospital ICT governance of UHs, this work aims, in a first methodological step, through a broad and deep systematic literature review (SLR), to understand how enterprise architecture is being applied in health environments worldwide. In the second stage, carry out a case study at HC-UFPE, where a model will be developed and presented to assist in the construction of the IS architecture for UHs, as well as a practical application of this model with the TOGAF 9.2 framework and Archi software to develop and deliver the HC-UFPE IS architecture.

1.2. DELIMITATION OF RESEARCH

The boundaries of this research can be classified into two phases. The first refers to the SLR, which searched for complete articles between the years 2015 to 2019, on four scientific bases, answering nine specific research questions related to the application of EA in Hospitals and others environment health. The second phase is limited to the development and presentation of a model to assist in the construction of IS architecture for UHs, as well as a practical application of this model to build and deliver the SI architecture to HC-UFPE. The implementation of the IS architecture is a step in constructing EA and is concerned, in brief, with ICT and its relationship with the organizational business. The theoretical frameworks, methodologies, and tools used in this research were selected from information extracted from the SRL. The IS architecture built was the result of multimode research, with the objective of investigating the problems and needs of UHs.

1.3. OBJECTIVES

1.3.1. GENERAL OBJECTIVE

The research objective is to investigates and proposes an IS architecture model for UHs through a case study conducted at Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE), from methodological factors found in the systematic literature review.

1.3.2. SPECIFIC OBJECTIVES

i. Systematize, through a systematic literature review, the benefits brought by enterprise architecture according to each health environment’s specific characteristics, such as whether they are public or private hospitals, health information systems (SIS), and digital health (e-health).

ii. Systematize the methods and frameworks used to implement the enterprise architecture in reference hospitals based on the systematic literature review.

iii. Develop a model for systematizing and assisting the construction of the IS architecture for UHs, with steps for data collection and analysis, construction of the IS architecture, and delivery of EA artifacts.

iv. Apply the built model to develop the current (AS-IS) and future (TO-BE) IS architecture of the HC-UFPE, aligned with the needs of stakeholders and to the ICTSP, where the hospital’s ICT macro-processes should be categorized, identifying problems, challenges, limitations, critical success factors and possible solutions to the problems encountered.

1.4. METHODOLOGY

The methodology used in this work comprises two main steps:

1.4.1. SYSTEMATIC LITERATURE REVIEW (SLR):

The SLR was a method chosen to start this research, and supporting for the realization of the case study at Clinics Hospital of the Federal University of Pernambuco. The SLR allowed us to understand relevant and current factors on the state of the art of applying business architecture in health and collect information on how it was applied, its application, the success factors, and the difficulties encountered. Five researchers conducted the SLR, which they composed of two teams. The researchers were two undergraduate students, and two advisors, and this graduate student managed all the processes.

1.4.1.1. ELABORATION OF RESEARCH QUESTIONS FOR SLR

The researchers defined the main research question and the eight specific questions that provided a theoretical scientific basis for the case study. The main question is “RQ1 - What is the state of the art of applying enterprise architecture in healthcare systems?” The specific questions aimed to analyze the primary and empirical studies about EA’s practical application in healthcare systems, such as methodologies and tools most used and the criteria for their choice. SLR also identified the main positive impacts, challenges, and critical success factors described by the articles’ authors and listed the main publication channels and authors who have published the most on the topic.

1.4.1.2. ELABORATION OF A PROTOCOL FOR SLR

The SLR protocol followed the methodology used by Kitchenham (2007) and Dybå & Dingsøyr (2008). The protocol defined four phases: phase one and two - selection of studies, phase three - Data extraction, and phase 4 - data synthesis. The publications were collected from a search string used in four scientific databases. They were Hubmed, Scopus, IEEE, and Science Direct.

1.4.1.3. CONDUCTING SLR

The SLR’s tasks were selecting, reading, extracting, and synthesizing data. Cohen’s Kappa method was used to assess the researchers’ level of disagreement, based on a table of values that guide the teams on the differences and offer greater transparency to the research. Disagreements were dealt with through meetings, in which researchers re-read and discussed disagreed topics until there was a consensus on the decisions.

1.4.2. CASE STUDY