Management Information Systems in Process-oriented
Healthcare Industry


Dr. Surendra Kumar
Associate Professor
Nisha Kala
Jayoti Vidyapeeth Women's University


Rajasthan India healthcare industry's' are required by law to maintain a holistic view of their processes (Prop. 1999/2000:149). Thus, such industrys need to haven overview of the entire scope of health service delivery. As a result, system thinking is vital (Senge, 1990). An industry must be able to collect data from its operational processes and furnish health service management with data concerning the way in which they have utilized their resources (Kaplan &Norton, 1996). As a response to this imperative, many healthcare providers have begun to introduce process-oriented structures recently. There are a number of theories about how to design such structures. One theory is based on Business Process Reengineering (BPR), the purpose of which is to identify and redesign

Industrial processes (Davenport, 1993). Another approach is to analyses a healthcare industry asa Complex Adaptive System (CAS), an interdisciplinary method that focuses on the self-industry of systems and patterns, as well as the way in which outcomes emerge. The purpose of a CASE analysis is to resolve issues associated with adaptable systems (Zimmerman,Lindberg & Pl sek, 2001). Regardless of whether a BPR or CAS approach is employed, process-oriented industryal structures face difficulties stemming from the fact that healthcare industrys operate on multiple levels, including

county councils, hospital management, clinical management, and care providers, each with its own information requirements (Andersson, Vimarlund & Timpka,2002). Each level struggles to survive under difficult economic constraints, limited growth and the constant threat of regulation (Luce & Elixhauser, 1990).Healthcare industry's need an integrated structure in order to quickly disseminate information among managers and care providers (Van de Velde,2000). The first challenge is to structure information systems such that they support the workflow in a healthcare environment (Strauss et al., 1985).Thus, it is not surprising that healthcare managers are increasingly seeking help from health information systems (HIS). Their objective is to minimize the overall costs of healthcare delivery, to improve the quality of their services (Greenes &Lorenzi 1998; Clayton & van Mullingen, 1996) and to correlate costs with resources consumed (Stead & Lorenzi, 1999). One option for gathering data in an Management Information Systems in Process-oriented Healthcare Industry's.  HIS is to use censors and other devices that continuously furnish the healthcare industry with data about its finances, quality, competence and level of satisfaction. However, before an HIS can be designed, both managers and developers need to be familiar with work routines, information requirements, and other key parameters at the clinical level, given that medical information is linked to the environment in which it is generated (Berg & Goorman, 1999).Thus, the industry must outline its information requirements and work procedures. The HIS that ultimately emerges will be embedded in the industry's processes and must satisfy the care provider's information needs(Berg, 1999).Tosum up, in or detrude sign an HIS in process-oriented healthcare industries, attention must be paid to issues such as patient focus, cost effectiveness, service quality, adaptability to the constraints of the organisation,and integrated use of information at both the hospital and clinic level (Övretveit,1992; Flarey, 1995). Moreover, a holistic overview based on system thinking is vital, including the gathering of data from multiple sources in order to correlate costs with the utilization of resources. The challenge is to define models that can support the design of an HIS.

1.1.1. Organisational and work process models in medical informatics

The main purpose of reengineering was to focus on the processes rather than thefunctions or an industry (Hammer, 1990). Further industrial enhancement could be achieved with quality methods such as Total Quality Management(TQM), which included process-oriented models. Another approach is to modify the business culture such that it becomes a learning industry (Senge, 1990). In the financial area, Balanced Scorecard has bemused to translate mission and strategy statements into operational objectives and measurement variables (Kaplan & Norton, 1996). When it comes to medical informatics, attempts have been made to design various kinds of industrial models, such as socio-technical modeling (Berg et al.,1998). The rationale for introducing these models is to gain a greater understanding of the ways in which an HIS will affect the allocation and content of work tasks. Changes in work activities require modification of information management (Berg, 2001). The validity of a technology rests not only on the fulfillment of functional specifications, but also on the interaction of the technical system with its Management Information Systems in Process-oriented Healthcare, Industrys industryal environment (Brender, 1998). The resulting conclusion that has-been drawn today is that social, industryal, cultural and contextual issues should be taken into consideration at an early stage of the development process(Kaplan, 2001).Moreover, approaches such as cultural-historical activity theory have been used to perform contextual analyses of clinical cognition and activity. Cultural-historical activity theory argues that studying the present healthcare setting is insufficient – a researcher must also become acquainted with the history of the setting, given that clinical cognition is embedded in broader institutional structures and longstanding evolution (Engeström, 1995).

1.2. Aims of the study

The aim of this thesis is to develop management information system model for process oriented healthcareorganisations,basedontwoquestions:"Whatkindsofrequirementsdohealthcarmanagersplaceoninform ationsystems?"And"Howcantheworkandinformation systems of healthcare managers and care providers be incorporated into process-oriented healthcare industry's?"  The work is based on a circular process, during which models are developed by collecting and categorizing as well as by designing small scale Theories about information systems. Industrials process is defined as "a sequence e of work procedures that jointly constitute complete healthcare services". Work Management Information Systems in Process-oriented Healthcare Industries.

2. Research methods

A qualitative research strategy, based on aidiographiccasestudy, wasemployed.Qualitative research, which has evolved within several disciplines, consists of a set of interpret practices.

2.2.3.Diary met


2.2.6.Feedback loops

2.3. Analyses.

It does not accord priority to any single methodology for data collection and analysis, nor does it have a theory or paradigm that is distinctlyitsown (Denzin&Lincoln,) Qualitative researches best suited for understanding the processes inherent to a situation, along with the beliefs and perceptions of the people involved. Nevertheless, qualitative researchers can make their findings more widely applicable (Firestone,1993).Furthermore, a case study is both a process of inquiry and the product of that inquiry (Stake, 2000). The researcher needs a wide array of information about the case in order to provide an in-depth assessment (Creswell, 1998). A primary distinction is between single-case and multiple–case designs of such studies (Yin,1994). A case study whose primary mode of research is hermeneutic is idiographic in a natural setting - its main type of data is qualitative and its fundamental level of analysis is holistic (Fishman 1999). Interpretive studies are well sea considerable degree of openness to field data, along with willingness to re-examine initial assumptions and theories.

2.1. The setting of the case study

The setting of the study was a pediatric clinic at a county hospital in Sweden. In1996,the county council adopted a wide-ranging quality program based on TQM and a Plan-Do-Check-Act (PDCA) cycle. In 2000, the county council started using Balanced Scorecard to measure the healthcare industry's outcomes. At the time of the study, the county's development and change program for Management Information Systems in Process-oriented Healthcare Industrys quality was based on a CAS strategy. Furthermore, a process-oriented healthcare information system was being designed. With some 30 clinics and 3,200 employees, the hospital had identified its main industryal objectives as the delivery of emergency and specialist healthcare, as well as county-wide rehabilitation and habilitation services. The purpose of habilitation is to enable someone with a congenital impairment, whereas rehabilitation focuses on recovering lost ability. Above and beyond the responsibilities of healthcare managers in accordance with the functional structure, all clinics at the hospital (including pediatrics) had developed work processes for specific groups of patients. These Patient Need Group Processes(PNGPs) centered on the healthcare needs of individual patients. The main objective of the PNGPs was to cultivate and maintain a high level of knowledge about medical care at the pediatrics clinic. The scope of the processes varied considerably. However, a PNGP unit always comprised at least a doctor, nurse and secretary. If necessary, several clinics, hospitals and county councils could collaborate on the same process. In order to improve nursing care, development teams, staffed by practitioners interested in development work, were set up. Specific development areas included palliative care and the use of technical equipment. The teams produced documents concerning their specific areas that could prove of value for their co-workers.

2.2.The data collection

The collection of data was conducted throughoutdocuments,archives,interviews,observations, diaries, focus groups and feedback loops.

2.2.1. Archival data

Archival data was used to place the research into context before, during and after the studies at the clinical site (Drury, 2002). An obvious danger posed by fixed data is that it can easily become outdated unbeknownst to the researcher. In these studies,

2.2.2. Interviewing

A common interviewing technique is to meet face to face (Fontana & Frey, 1998).The interview may be structured, semi-structured or unstructured. The scope of an interview can range from five minutes to the lifetime of the subject (Fontana& Frey, 2000).

2.2.3. Diary method

The holistic perspective of this approach identifies connections among the individual, societal and industrial levels. One of the techniques that have evolved is the diary method, which proceeds from subjective assessments of time utilization.

2.2.4. Observation

Observation involves gathering impressions of the surrounding world. Qualitative observational research is fundamentally naturalistic (Adler & Adler,1998). There is "descriptive observation", in which the researcher assumes that he or she knows nothing about what is going on and takes nothing for granted. He or she employs "focused observation", ignoring that which is defined as irrelevant. Finally there is "selective observation", the most systematic approach, during which the researcher concentrates on the attributes of various activities (Angrosino & Mays de Pérez, 2000). This type of observation requires a note book, a storage location for the data tha is collected during the process (Ely,1993). The researcher observes and interacts with care providers at the pediatric wards before and after their rounds.

2.2.5. Focus groups

A focus group's planning process should begin as soon as it is set up. The process includes the followingsteps: establishresearchobjectives,appointamoderator,developmoderatorguidelines and draw up procedures.

The moderator plays anymore tan role during the group session. He or she conducts the interviews. It is important that the moderator not be the same person thatput together the moderator guidelines and questions.

2.2.6. Feedback loops

Feedback loops throughout the research project permitted the generation of reports for evaluating data collection. A total of four reports were sent to the practitioners as a result of the case study.

2.3. Analyses

There was no theory at the beginning as to how the material should be analysed.The first step was to break down healthcare management into the hospital, clinical and care process levels.Statementsfromthevariousmanagementlevelswereinterpretedonthebasisofinformation requirement, i.e. main objectives, system functions, expected benefits and risks to be avoided. The second step waste analysis of three main work activities, each with three work procedures, at the clinic level. The third step involved the design of a management information system model. All empirical  data was categorized. Various theme swerve identified and classified.

2.4. Modeling

In order to conduct the final analysis, the two small-scale theories were applied to the modeling of a management information system. Various possible approaches included data modeling (Connolly, Begg & Strachan, 1996), function  dealing andobjectoriented modeling (Booch, Rumbaugh & Jacobson, 1999).To handle such approaches, various modeling languages have been developed, including the object-oriented Unified Modeling Language (UML) (Fowler &Kendall 1999).

3. Excepted Results

The results will  present in accordance with the three sub-analyses. The first sub-analysis focused on the requirements of healthcare managers for an HIS. The second sub-analysis focused on interpreting industrial and work processes in relation to the HIS.

3.1. The requirements1 of healthcare managers for an HIS

Hospital management expressed its intention to use an HIS to empower patients while maintaining control of resource utilization. Thus,  the planned HIS was expected toencourage a greater overall awareness of cost effectiveness with respect to the services provided by various units of the hospital. The biggest risk noted was that of a mismatch between the system and the existing industry l culture, in which it was easy to identify and reward employees who handled.

3.2.Interpretation of industrial and work processes in relation to HIS Work activities included:

(1) co-ordination of information exchange management;

(2) care, including documentation of the care provided and the practice that had evolved at the clinic;.

(3) supply, including patient assistance and psychosocial support. The work procedures of the various activities were often related to and dependent on each other.

3.3. A management information system model for process-oriented healthcare

The county council formally required that hospital management monitor and report on service production with regard to quality and cost. As a result, hospital management needed data about resource utilization and healthcare quality from the hospital industry along with information systems that could support methods such as Total Quality Management (TQM) and Balanced Scorecard. To monitor costs and quality, hospital management needed data from the functional units after determining what needed to be collected.

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Source: E-mail December 2, 2010


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