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  1. 1. Designing Distributed Electronic Patient File System Integration Framework for Ethiopian Hospitals By: Eid Ahmed Advisor: Nune Sreenivas (PHD)
  2. 2. Outlines Of The Thesis • 1. Introduction • 2. Statement of the problem • 3. Research questions • 4. Objective of the study • 5. Review of related literature • 6. Research Model framework • 7. Methodology • 8. Result • 9. Conclusion and recommendation
  3. 3. 1. INTRODUCTION • Health information system integration is bringing together different systems into one so that the system is able to deliver the overarching functionality and ensuring that the different systems function together as a system. • According to (WHO, 2008) report Health information system provides the underpinnings for decision-making and has four key functions: data generation, compilation, analysis and synthesis, and communication. • In recent years enterprise architecture is gaining growing importance in Integrating various HIS into several health services that gives value through new approaches to the system.
  4. 4. ---cont • many scholars articulate the need for health care system integration framework, emphasized on patient information system integration. • All healthcare organizations strive to provide cost-effective, high-quality, shared, and seamless healthcare delivery while reducing medical errors, safeguarding patients' data, and streamlining clinical and administrative
  5. 5. 2. Statement of the problem • Sabian General Hospital & Dilchora General Hospital are health care that are found in Dire Dawa . • Both of the hospitals have employed Health information system. • As observed by the researcher of this study, their is lack of an integrated HIS, notably the lack of an integrated patient medical record. • public health information from one hospital may not be used in another place
  6. 6. ---cont • Generally, previous studies haven’t been made on integrating patient record in our country . • As such, studies carried out in other countries their was different kind of HIS integration within gap that have been found. • Thus, this research will fill the identified knowledge gap in the current literature. • This study will also investigate what factors is blocking HIS of hospitals from
  7. 7. 3. Research questions • Therefore, the study will address the following research questions: 1. How the existing patient records in HIS of different hospitals in Dire Dawa are characterized? 2. What are the basic need and requirement to be incorporated in the design of integrated patient record framework among hospitals in Dire Dawa? 3. Which enterprise architecture is better in designing a framework for an integrated patient record system? 4. What kind of patient record systems integration framework can be designed
  8. 8. 4. Objective of the study • The General objective of this study is to design patient information record system integration framework of health information system for Dire Dawa public hospitals. • Specific objectives 1. To examine the existing HIS of different hospitals 2. To set the architecture vision and business architecture of hospitals based on the existing system of hospitals information system 3. To design and organize data architecture by defining data entity catalog 4. To integrate the patient record system 5. To categorize opportunities and Solutions that identify and scope change initiatives 6. To suggest Requirement management that the hospitals need to do to meet the architecture vision
  9. 9. 5. Review of Related Literature  Bobarshad, Rezaei, Saghafi, and Bagherzadeh (2018) They designed hospital enterprise architecture framework on their article. – A exploratory research approach was taken as a methodology. – The study discovered that “the process of creating a TOGAF Enterprise architecture framework, for hospital starts with recognizing the present original situation of the hospital, and it all continues with designing a long-term plan in which there is a way to achieving all the objectives of a Hospital. – In addition, the result of the study argued that, TOGAF defines a hospital as a set of units which have common aims, and it also creates a logical structure for classifying and organizing complicated information and it also explains different perspectives. – The study, therefore, recommended the findings of this research was introducing TOGAF as a framework with the highest appropriateness with hospital’s procedures in mind.
  10. 10. Cont--- • 1. Chaczko, chiu, and Kohli (2010) – They studied an approach in architecting solutions which can be utilized as framework to address common issues in integration of enterprise level solutions. – The TOGAF version was used as methodology. – The finding of the study is that TOGAF based Integration Framework enables several hospitals and mobile units to operate concurrently in various parts of the nation (Austria). – This finding concentrated on integrating the data architectures of several institutions. However, it will be possible if businesses are
  11. 11. Cont--- • Azanfack and Soriyan (2011) – Conducted study on Integration of Patient Information System with Picture Archiving and Communication System through Radiology Information System platform: case of OAUTHC”. – The study ” used an interview to identify the basic requirements for designing the integrated system. then After identifying the requirement for the designing the integrated system, they classified the integration process in to four steps. – By following those four steps they propose the integration framework they developed. – Based on result of their integration framework they were able to conclude that, the system allows the user to work in a consistent environment without switching between applications and also the system will respond quickly to the needs of imaging specialties and help clinicians in their decision process – The paper presented an integration framework that can
  12. 12. 5. Research Model framework • In the design of organizational enterprise architecture, several frameworks are employed, however the two most widely used and acknowledged enterprise architectures TOGAF and ZEAF was compared in this study. • In their study of selecting better enterprise architecture for knowledge based medical diagnosis system, Sajid and Ahsan (2016) compare TOGAF and ZEAF based on different criteria’s. The first criteria contain nine points as shown in table 1. Table 1 The TOGAF and ZEAF comparison Sajid and Ahsan (2016) Criteria TOGAF ZEAF Methodology to categorize the different architectural artifacts Poor Good Methodology to guide a step-by-step process for designing EA Good Poor Instructions for building a set of reference models Good Poor Focus on a technology that reduced expenses and increased income Good Poor Practice guidance Good Poor Governance guidance Good Poor Guidance on effective autonomous separate sections of the organization which is used for managing complexity Good Poor Catalogue management about architectural assets that can be reused in future Good Poor Information availability Good Poor
  13. 13. --cont • The additional comparison criteria included eight points as well, and they are presented below according to Sajid and Ahsan (2016). • Table 2 The TOGAF and ZEAF comparison Sajid and Ahsan (2016) Criteria TOGAF ZEAF Definition of Architecture and Understanding Fully supports Partially support Process of Architecture Fully supports No support Evolution of Architecture Support Fully supports No support Standardization Fully supports No support Knowledge-Based Architecture Fully supports No support Drivers of Business Fully supports Partially support Model of Business Fully supports Fully supports Visualization tool Fully supports Fully supports
  14. 14. --cont • From these two comparisons, it is clear that TOGAF is the greatest enterprise architecture for constructing an integration prototype for the case of Dire Dawa administration hospital by allowing researchers to design the best architecture by implementing the TOGAF lifecycle.
  15. 15. 7. Methodology • This study followed a qualitative research approach. • This study was intended to collect primary data from the sample two hospital using observation and interview and secondary data from literature. • The open group Architectural development method is chosen because it is practical, cost-effective, and less rework on the current system, and offers flatter transition of system. • Related studies have used the open group
  16. 16. 7.1 Sampling Technique and Sample Size • Purposive sampling was used since the main objective of hospital is delivering health care to the patient. • Two hospital from Dire Dawa were used as sample . • 8 people were used as a sample size in the analysis so generalizations can be made justifiably to represent the two hospital integration framework.
  17. 17. 7.2 Procedures of Data Collection • The process of data collection is self- administered. • The researcher visited the two hospitals several times and inform them about the aim of the research and asked their willingness to participate in the interview. • Their positive response helped to be interviewed by the researcher , 2 administrative staff and two ICT staff were the respondent of the interview. • By designing an observation & interview checklist the data was gathered. • But due to the presence of COVID 19 the process didn’t go as expected. • The data was collected from 03 May to 30
  18. 18. 7.3 Methods of Data Analysis • The collected data is then analyzed by using TOGAF data analysis tools. • The Architectural vision and business architecture of the two hospital were used to describe the data collected. • All qualitative data were analyzed using ArchiMate modeling tools.
  19. 19. 8. Result • The report of the result has been organized by following TOGAF approach. The existing enterprise has been discussed, the architecture vision and principle has been set, the business architecture, data architecture, application architecture, technology architecture of the hospitals has been described for both the baseline and target. The opportunities and solutions with the requirements management has been presented for the target architectures and the summary have been done depending on the gap analysis done between the baseline architecture and the target architecture. A diagram
  20. 20. ---cont 8.1 Analyzing business activity • Using value chain diagram presents the architectural vision as a value chain diagram in figure 1 where the Primary activities and supportive activity identified.
  21. 21. ---cont 8.2 solution concept diagram • Solution concept diagram represents a pencil sketch of the expected solution at the outset of the engagement • The purpose of this diagram is to quickly onboard and align stakeholders for a particular change initiative.
  22. 22. 8.3 boundary context model
  23. 23. 8.4 business service diagram of integrated system to make high quality business service
  24. 24. 8.5 data references model Cont-- - • is used from the architecture continuum to enable information sharing and reuse across the integrated patient record system. It provides a standard means by which data may be described, categorized, and shared.
  25. 25. 8.6 Data architecture building blocks of the target architecture • There are among eight building blocks for the integrated HIS. These building blocks are: Patients, Information, Service delivery, Human resource, Medicine and technologies, Financing and Leadership and governance. • The capability of this architecture building block is to meet the business need across the integrated patient record system
  26. 26. 8.7 Database architecture of integrated HIS The integrated HIS database share data from the legacy application databases by a data transmitter
  27. 27. 8.8 Model of the target application architecture • The application architecture of the target integrated HIS is shown below by using a diagram that relates the users of the system the application and the technology aspects such as the HIS database, the server and the hardware devices to be used in the integrated HIS.
  28. 28. 8.9 Platform decomposition diagram • The Platform Decomposition diagram shows the technology platform that supports the operations of the Information Systems Architecture.
  29. 29. 8.1.0 Integrated HIS environment benefit
  30. 30. 8.1.1 Integrated patient record system framework
  31. 31. 9. CONCLUSION • The study was evaluated based on outcome impact evaluation which assesses the changes that can be recognized to a particular intervention, such as a project, program or policy, both the intended ones, as well as ideally the unintended ones. • An impact evaluation has also been done to show weather the open group architecture framework can be used to integrate the health information system of the selected hospitals. The system administrators of both Sabian General Hospital and Dilchora General Hospital have an idea that the open group architecture framework can be employed to integrate Health information system of their hospitals and the data has been properly used in the study.
  32. 32. --cont • The data architecture was also established and opportunities & Solutions that identify and scope change initiatives have been identified. The requirement management that the hospitals should follow was presented and the open group architecture framework methodology is proposed as a systematic approach to implement integrated patient information record. • Though the research has the above outcome it only focuses on showing how the open group architecture framework phases can be used in integrating health information system of hospitals. The implementation has not been done which has to be explored further the way it has to be implemented
  33. 33. 9.1 Recommendation • 1. Hospitals with computerized health information should implement the integrated HIS framework proposed with trainings. • 2. Hospital Governance, leadership should set clear business strategy as they are a starting point for reflection in the planning and practices of organizations • 3. TOGAF based change management should be performed in hospitals
  34. 34. 9.2 Limitations of the study • Several limitations were drawn from this research study. Because most of Ethiopian hospital are not yet employing HIS the study was limited by only two hospital from insufficient sampling. • Second, the lack of previous research studies on health information integration utilizing the open group architectural framework (TOGAF).
  35. 35. 9.3. Future research outcome • The study presents an integrated HIS framework as an output, the framework is evaluated thus it can become useful if implemented and become real work. So, it can be used as a base for implementation of hospital system integration in future studies. Everything that is necessary for implementing the integrated HIS framework is identified and set on the opportunities and the requirement management phase of TOGAF so depending on this outcome future studies can be done on implementing the integrated HIS framework. • Future studies can also be done on the idea of integrating HIS system of public hospitals and even different health centers found in Ethiopia so that the work environment for health
  36. 36. Thank you!

Notas del editor

  • A quantitative approach is used in research to test hypotheses, quantify variables numerically, classify factors, and consider the best predictors of outcomes. Collis and Hussey (2014) note that quantitative approaches require a deductive approach where the current theory will direct the study.

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