Clinical Decision: Decision-Making Systems - Research Paper Example

Clinical Decision: Support/Decision-Making Systems Business Scenario in a Graduate Level Informatics and Application Systems in Healthcare Course Instructor’s Name Date Abstract The business challenge of this essay is the application of information technology in the healthcare system, particularly the delivery of health care services in the critical care setting. Major issues circulating the essay is the legal and ethical dilemmas and the problems relating to the appropriateness of applying information technology in the complex critical care setting as well as the management problems. One of the technological advancements made in the field of health care is telemedicine, Virtual Critical Care Unit and the eICU and have successfully demonstrated the provision of critical care services through distance-caring. However, these technologies have minimum threshold needed to support the complex critical care units. Analysis of the business process found out that Australia was the first to adopt and develop effective e-health solutions particularly in improvements of supply chain management, evidence-based practice, use of internet to deliver health services, intranets, and implementation of electronic health records. Analysis of the organizations and business processes starts when current methodologies used in delivering care were no longer efficient and productive thus, business process redesign/re-engineering (BPR) was reconstructed. BPR portray the real image of the process and the simulation such as BPR framework applied in informatics such as telemedicine, intensive care units, ViCCU and eICU, thus the integration of BPR framework in analyzing the application of telemedicine in Australian healthcare system will lead to the development of a new approach in delivering healthcare to the ICU. After analysis of the business process scenario is the analysis of the requirements for the solution to the business problem. Requirements analysis is one of the fundamental systems engineering activities and is designed to identify the customers’ needs. The basis for requirement analysis in information technology applied in critical care units depends upon the process input which includes customer needs/objectives/requirements in critical care units encompassing missions, measures of effectiveness, environments, and constraints, technology base, output requirements from prior development effort, program decision requirements, and requirements applied through specification and standards. Requirements analysis analyzes missions and environments in healthcare ICU, identifies functional requirements, define/redefine performance and design, and constraint requirements. Requirements for the business problems include increase funding or budget, transformation of health care informatics management, development of a national collaborative approach, guidelines on legalities and confidentiality issues of clients, and standards of health information management and technology, of staff education, change, attitudes, organizational culture, fact finding tools, project management, and hardware installation. Based on the requirements analysis, solutions identified are: clearly state the role of federal government in policymaking and health financing to update the application of telemedicine, exploitation of Australian government to develop health connect, and use of mobile communication technology in delivering health services. After thorough analysis of the business scenario, the following recommendations are made: Increase federal funding of information technology applied in health care to support the complexity of applied-information technology in critical care units and to reduce the cost of health care Health care professionals need to be trained in information technology particularly in telemedicine, eICU, and ViCCU. Impose directive change among health care staff to avoid resilience from applying information technology to the field of health care. Improve the organizational structure of health care in Australia by re-engineering the business process, placing more emphasis on the influence of inputs and results of outputs. Use fact-finding tools to emphasize the importance of people and documentation. Organizational policy must also be modified in order to protect the ethical and legal rights of the patients from privacy and confidentiality. Maintain collaboration among health care teams including the Occupational Health and Safety Officer and the Business Process Engineer. Restructuring the business process will benefit the healthcare business as this will speed-up and improved the quality of care leading to positive feedbacks from clients and increase revenue to the health institutions. Clinical Decision: Support/Decision-Making Systems Business Scenario in a Graduate Level Informatics and Application Systems in Healthcare Course Statement of the Business Scenario The present health care system utilizes the use of information technology and along with the technological advancement is the adaption of telemedicine. Telemedicine is well-established among different health departments and is beginning to create an impact on complicated health care systems such as in the critical care setting. New systems were introduced such as the Virtual Critical Care Unit and the eICU and have successfully demonstrated the provision of critical care services through distance-caring. However, application in critical care setting identified that the telemedicine system has minimum threshold of technology complexity needed to support application of telemedicine. The eICU relies on transmitting data to a remote-located specialist while the ViCCU relies on presence (Latifi, 2008, p. 117). In this way, access to structured and patient-specific data and provision of assistance to decision support was made ready and easily accessible. Potential problems such as legal risks associated with use of telemedicine as well as the assessment of the size of the problem might arise because of lack of a clear organizational structure and supporting systematic research (Smith, 1998, p. 190). Knowing the business scenario stated above, the major problem presented in the business scenario is the complexity of applying informatics such as telemedicine in the health care course, particularly in the intensive care units. In addition, sub-problems such as legal concerns and assessment difficulties will possibly arise due to application of informatics to complex intensive care units which lacks clear organizational structure and supporting systematic research thus, analysis of the organizations, business process, and informatics application in ICU will be addressed in the next topic. Analysis of the Organizations and Business Processes Australia was the first to adopt and develop effective e-health solutions which had helped health service providers, consumers, funding bodies and health-industry suppliers driven by internet-based activities (Harris, 2006, p. 224). Causes of problems in application of information technology in critical care setting are the lack of appropriate tools needed to support complex health care systems and the management process itself. Harris (2006) identified opportunities to apply information technology in health through improvements of supply chain management, evidence-based practice, use of internet to deliver health services, intranets, and implementation of electronic health records. Analysis of the organizations and business processes starts when current methodologies used in delivering care were no longer efficient and productive. Analysis will further result to the business process redesign/re-engineering (BPR) or the business management plan which changes the involved processes using the high-touch information technology system (Netjes, Mans, Reijers&Aalst, 2009, p. 1). BPR focuses on the organization and structure and not on improving the healthcare domain. An example of a BPR framework is shown in Appendix A to further analyze the organization and business processes. The BPR framework is modeled in a way that it will portray the real image of the process so that it can be used in the simulation process. It should be validated to the process owner or what we call the healthcare institution. In a BPR framework, each part and processes are analyze to determine the impact of each part to the process and vice versa. For each process part, the owner of the healthcare institution and the consultant for BPR will decide for the best structure or process that can be applied in the healthcare system. Using the initial process as the evaluation tool, the new business process model will be compared to the previous business process model and then being validated to the healthcare institution owner. The final step involves the decision-making as to whether which part or business processes will be adapted or is it better to retain the initial business process (Netjes, Mans, Reijers&Aalst, 2009, p. 3). Applying the BPR framework to informatics such as telemedicine in intensive care units, ViCCU and eICU must be modeled in a way that it would reflect the real scenario in the critical care units. The simulation process must match what is really happening in an ICU and this must be validated with the owner of the healthcare institution. Each part and processes is important as it will affect the whole process and the patient themselves. It is important that during analysis, each part are taken into consideration for future assumptions. After seeing the result of the simulation, the BPR consultant the owner of the health care institution will decide on what part or process will be integrated in the critical care units and this will be included in the new plan for organizations and business processes. The integration of BPR framework in analyzing the application of telemedicine in Australian healthcare system will lead to the development of a new approach in delivering healthcare to the ICU. In fact, research findings on the eHealth features of Australia has improved communication between hospitals, staffs, and health care recipients regarding critical care and has led to the revolutionary developments of telemedicine in diagnosing and treating client’s condition (Bryce, 2010, p. 127). Analysis of the Requirements for a Solution to the Business Scenario Requirements analysis is one of the fundamental systems engineering activities and is the first stage in the systems engineering process and software development process (Department of Defense, 2001, p. 35). Requirements analysis is designed to identify the customers’ needs and these needs will be the basis of standards that must be followed. See Appendix B for the requirements analysis framework integrated in systems engineering process. The basis for requirement analysis in information technology applied in critical care units depends upon the process input. This includes customer needs/objectives/requirements in critical care units encompassing missions, measures of effectiveness, environments, and constraints, technology base, output requirements from prior development effort, program decision requirements, and requirements applied through specification and standards. Enclosed in the process is the requirements analysis which analyzes missions and environments in healthcare ICU, identifies functional requirements, define/redefine performance and design, and constraint requirements. Appendix C shows Input Requirements Analysis with 15 Requirements Analysis Task Areas and questions related to Operational Analysis Task.As seen in Appendix B, included also in the business management process are systems analysis and control, functional analysis/allocation, synthesis, and process output. The process output encompasses the development level dependent which includes decision database/system/configuration item architecture in the ICU and specifications and baselines of applying information technology in the critical care units (Department of Defense, 2001, p. 31). Proposing solutions for the identified business problems must have certain requirements to meet its goal, which is transformation of health care informatics management and application to meet the needs of the complex critical care setting. In line with this transformation is the need to increase funding or budget. Bennett (2001) stated that Australia have been lagged behind other countries in terms of health information technology, allotting only 1.5% on health expenditure (p. 2). Aside from budget, the development of a national collaborative approach, guidelines on legalities and confidentiality issues of clients, and standards of health information management and technology need to be addressed first before pursuing and implementing the solutions. In addition to business process re-engineering, Feeney (2001) stated that for a successful implementation of information technology in health care, it is essential that a thorough analysis will be made in terms of staff education, change, attitudes, organizational culture, fact finding tools, project management, and hardware installation (p. 1). Discussion of Healthcare Application Systems Solution Based on the requirements analysis of the business scenario presented, it has been identified that cost, structure and processes of organization, and output implications affect the application of information technology to healthcare course. In line with the requirements analysis result, Remenyi (2008) identified three possible solutions for the business problems of Australia in applying health information technology: clearly state the role of federal government in policymaking and health financing to update the application of telemedicine, exploitation of Australian government to develop health connect, and use of mobile communication technology in delivering health services. Clearly identified roles of federal government in policymaking and health financing will facilitate delivery and execution of healthcare services to the nation. However, it has the advantage over local governments in Australia as they have limited roles in strategic planning and delivery of health care services. Then, the use of Health Connect integrates electronic records and centralized between public and private health system in terms of decision making, improving quality care, and coordination of care for patients and easy access to patient’s records will be acquired especially during emergency. However, Health Connect is facing an ethical dilemma of such as breach of confidentiality of information and self-determination of the client to withhold certain information from the provider. Lastly, Australian government proposed the use mobile telecommunication technology that delivers accessible medicine to Australia’s rural population. It allows the health practitioner to use the business grade broadband services to access electronic health information and deliver quality care in resident-aged facilities through the use of medical sensors. Again, the only disadvantage noted is the issue regarding confidentiality of information and preservation of patient’s autonomy. Meanwhile, Feeney also added solutions to the Australia’s problem in application of information technology to heath care such as staff education, change, attitudes, organizational culture, fact finding tools, project management, and hardware installation. Since health care practitioners will be the one to used health care information technology, it is essential that they will be provided education on how to use and apply information technology to deliver effective care by not losing control and confidence (Feeney, 2001, p. 1). Staff education will include theoretical supplementation of concepts related to information technology such as definition of terms. Effective staff education of information technology will happen if staffs were also taught and guided about software and hardware application of the desired information technology tools or processes. The aim of staff education is to alleviate the technophobia some health professionals might experience especially the older adults and to introduce information technology into health care efficiently. Troubleshooting must also be included in order to secure the data and privacy of client from possible leak of information due to unfamiliarity of the health care staff to the applied information technology in health care. In line with staff education is attitude change. Some of the health care staffs preferred to adhere to the traditional health care because of resilience to the new information technology. Information technology has heightened the fears the users are becoming subservient to machines and stiffened user resistance to technology (Feeney, 2001, p. 2). Even those at the managerial level of the structure may experience resilience over the new technology thus, behavior alteration strategies such as directive change shall be imposed by the management to maximize the use of information technology and health care and teach the health care how to make decisions in health care regarding used of information technology. Feeney also discussed about changes which is necessary in order to adjust to the internal and external changes in the inputs such as cost, structure, policy, consumer expectations and technology (Feeney, 2001, p. 2). The application of health care technology in the field of health care has brought enormous changes in the health care arena. With the application of proposed solutions like telemedicine in ICU, Health Connect, and used of mobile technology in health care, changes like government cutbacks, increasing costs of health care, and service changes are redesigned or re-engineered from the traditional health care delivery in order to maximize the advancement made in information technology (Feeney, 2001, p. 2). It has been identified in the business process analysis and requirements analysis that in order to integrate information technology into the health care system, re-designing or re-engineering of the organization’s structure and processes is necessary. Organization’s structure encompasses one of the influencing inputs in the re-engineering process which is the organization policy or culture. There are three levels of organizational culture: (1) artefacts and creations which include the physical lay-out of the premises, the technology, the signs, rituals and stories; (2) values which include what ought to do; and (3) basic underlying assumptions which developed when values organization values are taken for granted (Feeney, 2001, p. 3). In implementing the information technology in health care, one must understand the organizations culture and policy to enable staff education of information technology more efficient and fulfilling. Another solution proposed by Feeney is the application of fact-finding tools which primarily involves consultation of health care staff. Other tools identified in integrating information technology to health care are sample existing documentation, forms, and files, research and site visits, observation of the work environment, interviews and group work sessions, time-motion analysis, personal record of activities, and subjective evaluation (Feeney, 2001, p. 4). After all the solutions in inputs are done, the next step is finding solution on effective management which includes planning, organizing, and leading (Feeney, 2001, p. 4). It is very helpful to use the PERT chart and the Gannt chart in the project management and make sure that all phases are documented specifically and time-bounded. The length of project management is important in the application of information technology to health care because this will determine if inputs, processes, and preparation are enough to apply information technology such as telemedicine, Health Connect, and mobile technology in the critical care units or intensive care units. The last application discussed by Feeney is the hardware and software installation. The underlying question is where to install the hardware and software of the new system. In this case, Feeney (2001) suggests that installation of the new system needs the collaboration of Occupational Health and Safety Officer to provide expert knowledge of sound replacement of hardware and the business process engineer to complete the work flows of installation (p. 7). Recommended Solution and Implementation Issues Much of the recommendations in the business scenario were included in the proposed solutions. Updating the application of healthcare information technology are hindered by several factors including human and organizational factors such as financial support, readiness of the involved professionals, telecommunication infrastructure, and legal and ethical issues (Conrick, 2006, p. 274). Problems related to telemedicine and application of healthcare information technology can be resolved by overcoming these barriers. Thus, recommended solutions and implementation issues include: Increase federal funding of information technology applied in health care to support the complexity of applied-information technology in critical care units and to reduce the cost of health care Health care professionals need to be trained in information technology particularly in telemedicine, eICU, and ViCCU. Impose directive change among health care staff to avoid resilience from applying information technology to the field of health care. Improve the organizational structure of health care in Australia by re-engineering the business process, placing more emphasis on the influence of inputs and results of outputs. Use fact-finding tools to emphasize the importance of people and documentation. Organizational policy must also be modified in order to protect the ethical and legal rights of the patients from privacy and confidentiality. Maintain collaboration among health care teams including the Occupational Health and Safety Officer and the Business Process Engineer. Appendix A: Business Process Re-Design/Re-engineering (BPR) Framework BPR Framework (Framework Adapted from Netjes, Mans, Reijers & Aalst, 2009, p. 3) Appendix B: Requirements Analysis Framework Integrated in Systems Engineering Process (Framework Adapted from Department of Defense, 2001, p. 31) Appendix C: Requirements Analysis Input Analysis(Framework Adapted from Department of Defense, 2001, p. 37) Input Analysis Task Areas(Framework Adapted from Department of Defense, 2001, p. 41) Operational Requirements Analysis(Framework Adapted from Department of Defense, 2001, p. 35) References Bennett, B. (2001). New Challenges for Old Laws. The Development of E-Health in Australia (p. 1-18). Retrieved on August 4, 2011, from http://kirra.austlii.edu.au/au/journals/SydLRev/2001/18.pdf Bryce, M. (2010). The IPswich InfoCity Plan and the Broadband Economy. Australias First Online Community Ipswich Queensland (p. 109-132).Queensland: Xlibris Corporation. Conrick, M. (2006). Telehealth and Communication. Health Informatics (p. 266-278).Australia: Cengage Learning Australia. Department of Defense. (2001). Systems Engineering Fundamentals. (p. 1-222). Retrieved on August 20, 2011, from http://www.dau.mil/pubs/pdf/SEFGuide%2001-01.pdf Feeney, P. (2001). Preparing Staff for Information Technology. (p. 1-9). Retrieved on August 20, 2011, from http://www.achi.org.au/docs/HNI_Book/Chapter_24.pdf Harris, M. (2006). Working with Information and Knowledge. Managing Health Services: Concepts and Practice (2nd ed.) (p. 206-237). Marrickville: Elsevier Australia. Latifi, R. (2008). Intensive Care Telemedicine: Evaluating A Model for Proactive Remote Monitoring and Intervention in the Critical Care Setting. Current Principles and Practices of Telemedicine and e-Health (p. 131-148).Australia: IOS Press. Remenyi, D. (2008). An Exploration of eHealth in the Public Sector: The Australian Perspective. 4th International Conference on e-Government (p. 99-108). Melbourne: Academic Publishing limited. Netjes, M.N., Mans, R.S., Reijers, H.A. and Aalst, W.M. (2009). BPR Best Practices for the Healthcare Domain. (p. 1-12). Retrieved on August 20, 2011, from http://is.tm.tue.nl/staff/mnetjes/HealthcareBPs.pdf Smith, R. (1998). The Regulation of Telemedicine. Health Care, Crime and Regulatory Control (p. 190-203).Sydney: Hawkins Press. Read More