Methods Inf Med 2005; 44(01): 4-10
DOI: 10.1055/s-0038-1633916
Original Article
Schattauer GmbH

Demand-driven Evolution of IT Systems in Healthcare

A Case Study for Improving Interdisciplinary Processes
R. Lenz
1   Institute for Medical Informatics, University Medical Center, Marburg, Germany
,
F. Buessecker
1   Institute for Medical Informatics, University Medical Center, Marburg, Germany
,
H. Herlofsen
2   Department of Orthopedics and Rheumatology, University Medical Center, Marburg, Germany
,
F. Hinrichs
2   Department of Orthopedics and Rheumatology, University Medical Center, Marburg, Germany
,
T. Zeiler
3   Department of Transfusion Medicine, University Medical Center, Marburg, Germany
,
K. A. Kuhn
1   Institute for Medical Informatics, University Medical Center, Marburg, Germany
› Author Affiliations
Further Information

Publication History

Received: 24 March 2004

accepted: 07 October 2004

Publication Date:
06 February 2018 (online)

Summary

Objectives: To analyze and to optimize interdisciplinary clinical processes, to introduce an IT-supported model for demand-driven system evolution in healthcare, and to demonstrate the feasibility of the approach for a clinical example and to present an evaluation.

Methods: System evolution and change management are viewed as two sides of the same coin, thus formal methods for process analysis and IT system evolution were embedded into a goal-oriented change management model. Based on a process model, a Failure Mode and Effects Analysis (FMEA) and a computer simulation were performed. A tool for rapid application development (RAD) was used to incrementally improve the healthcare information system according to newly arising needs.

Results: Each of the formal methods used contributed to the successful reorganization of the interdisciplinary clinical process. An evaluation demonstrated significant improvements. An integrated IT application was implemented to support the optimized process.

Conclusions: Process improvement is feasible and effective when formal methods for process analysis and requirements specification are used in a reasonable and goal-oriented way. It might be necessary to trade off costs and benefits or simplify a given method in the context of a particular project. As the same information is utilized in different tools, it is supposed that the efforts for process analysis, documentation and implementation of adapted applications could be reduced if different tools were integrated and based on a single coherent reference model for description of clinical processes.

 
  • References

  • 1 Berg M, Toussaint P. The mantra of modeling and the forgotten powers of paper: a sociotechnical view on the development of process-oriented ICT in health care. Int J Med Inf 2003; 69 2-3 223-34.
  • 2 Lenz R, Kuhn KA. A strategic approach for business-IT alignment in health information systems. In. Meersman R, Tari Z, Schmidt DC. (eds.) On the Move to Meaningful Internet Systems 2003: CoopIS, DOA, and ODBASE. Springer Verlag: Lecture Notes in Computer Science; 2003: 178-95.
  • 3 Lorenzi NM, Riley RT. Organizational issues = change. Int J Med Inf 2003; 69 2-3 197-203.
  • 4 Sauer C. Deciding the future for IS failures: not the choice you might think. In. Curie W, Galliers R. editors Rethinking management information systems. Oxford: Oxford University Press; 1999: 279-309.
  • 5 Dorenfest SI. The Decade of the '90s. Healthc Inform 2000; 17: 08.
  • 6 Strassmann PA. Information Payoff – The Transformation of Work in the Electronic Age. New York: The Free Press; 1984
  • 7 Iles V, Sutherland K. Organizational Change: A Review for Health Care Managers, Professionals and Researchers. London: National Co-ordinating Centre for NHS Service Delivery and Organization R & D; 2001
  • 8 Dawson S. Analysing Organisations. Hampshire: Macmillan; 1996
  • 9 Weick KE, Quinn RE. Organizational change and development. Annual Review of Psychology 1999; 50 (February) 361-86.
  • 10 Dunphy D. Organizational change in corporate setting. Hum Relat 1996; 49 (05) 541-52.
  • 11 Ackerman L. Development, transition or transformation: the question of change in organisations. In. Van Eynde D, Hoy J, Van Eynde DC. editors. Organizational Development Classics. San Francisco: Jossey-Bass; 1997: 45-58.
  • 12 Lewin K. Field Theory in Social Science. New York: Harper & Row; 1951
  • 13 Redfern S, Christian S. Achieving change in health care practice. J Eval Clin Pract 2003; 9 (02) 225-38.
  • 14 Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: the importance of special people. Int J Med Inf 2003; 69 2-3 235-50.
  • 15 Narine L, Persaud DD. Gaining and maintaining commitment to large-scale change in healthcare organizations. Health Serv Manage Res 2003; 16 (03) 179-87.
  • 16 Lorenzi NM, Riley RT, Blyth AJ, Southon G, Dixon BJ. Antecedents of the people and organizational aspects of medical informatics: review of the literature. J Am Med Inform Assoc 1997; 4 (02) 79-93.
  • 17 Locock L. Healthcare redesign: meaning, origins and application. Qual Saf Health Care 2003; 12 (01) 53-7.
  • 18 Sjoberg C, Timpka T. Participatory design of information systems in health care. J Am Med Inform Assoc 1998; 5 (02) 177-83.
  • 19 Truex D. Growing Systems in Emergent Organizations. Communications of the ACM 1999; 42 (08) 117-23.
  • 20 Smith H, Fingar P. Business Process Management: The Third Wave. 1st ed. Meghan-Kiffer Press; 2002
  • 21 Lenz R, Kuhn KA. Towards a Continuous Evolution and Adaptation of Information Systems in Healthcare. Int J Med Inf 2004; 73 (01) 75-89.
  • 22 Kuhn KA, Lenz R, Elstner T, Siegele H, Moll R. Experiences with a generator tool for building clinical application modules. Methods Inf Med 2003; 42 (01) 37-44.
  • 23 Lenz R, Elstner T, Siegele H, Kuhn KA. A practical approach to process support in health information systems. JAm Med Inform Assoc 2002; 9 (06) 571-85.
  • 24 Beck K. Extreme Programming. München: Addison- Wesley. 2000
  • 25 Schein E. Process Consultation. Wokingham: Addison- Wesley; 1987
  • 26 Bozak MG. Using Lewin's force field analysis in implementing a nursing information system. Comput Inform Nurs 2003; 21 (02) 80-5.
  • 27 Baulcomb JS. Management of change through force field analysis. J Nurs Manag 2003; 11 (04) 275-80.
  • 28 Booch G, Rumbaugh J, Jacobson I. The unified modeling language user guide. Reading, Mass: Addison-Wesley; 1999
  • 29 Scheer A-W. Business Process Engineering. Reference Models for Industrial Enterprises. Springer: 1995
  • 30 Hinrichs F, Hauser M, Löser S, Lenz R, Kuhn K, Griss P. Modellierung und Prozessoptimierung in einer orthopädischen Klinik. Orthopädische Praxis 2002; 38: 522-5.
  • 31 Spath PL. Using failure mode and effects analysis to improve patient safety. AORN J 2003; 78 (01) 16-37.
  • 32 Burgmeier J. Failure mode and effect analysis: an application in reducing risk in blood transfusion. Jt Comm J Qual Improv 2002; 28 (06) 331-9.
  • 33 Bateman RE, Bowden RG, Gogg TJ, Harrell CR, Mott JRA. System Improvement Using Simulation. 5th ed. Orem, Utah: Promodel Corporation; 1997
  • 34 Maij E, Toussaint PJ, Kalshoven M, Poerschke M, Zwetsloot-Schonk JH. Use cases and DEMO: aligning functional features of ICT-infrastructure to business processes. Int J Med Inf 2002; 65 (03) 179-91.
  • 35 Fayad M, Schmidt DC, Johnson R. Building application frameworks object-oriented foundations of framework design. New York: Wiley; 1999
  • 36 Fayad M, Johnson R. Domain-specific application frameworks frameworks experience by industry. New York: John Wiley; 2000
  • 37 Patel N. Adaptive Evolutionary Information Systems. London: Idea Group Publishing; 2000