In the world today, technology takes up crucial roles in all industries and also the personal lives of all individuals. Health care information systems have become an important part of operations in the hospitals and clinics. For this reason, Chief Information Officers are under immense pressure to make proper prioritization of their resources and provide the best health care systems that they can. Technology and health care play a crucial role in saving and improving the lives of people and animals all over the world. Now, people are living longer, chronic and infectious diseases seem to be getting more pervasive; these are changing the cost dynamics of health care as new people enter the health care market, and new approaches to health care developed day by day. This was majorly influenced by the increases the number of network connectivity and the fact that database management systems were now able to execute multiple tasks across numerous databases and networks.
The 1990s saw the advancement in Internet Technology. Hence, processing, storage, retrieval and distribution of data and information were done from anywhere and at any time. Making the way in which health care organizations operated to change dramatically. With the internet, people could easily access information about products and services from different providers and make their assessments about the quality based on feedback from other users. Making the customer more empowered based on the large volume of information that was at their disposal (Nabil Almunawar, n.d.). At the beginning of 1991, information technology created a network of technology which was considered to be of a new generation. This networked technology’s effect was felt in all industries including health care services. In the mid-90s the World Wide Web became popular channels were information for products and services were delivered for many industries including the healthcare industry.
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Clinical workstations have increasingly embraced the use of web browsers as they offer intuitive and simple user interfaces. In 1996 the feasibility of developing web based interfaces for healthcare information systems was shown and reports of successful development soon followed. An instance of creating a web server which is a top healthcare information system architecture that has a data repository that is central was WebCIS. In 2000, the providers of health services embarked on the search for an EHR that is viable due to a wide range of medical anomalies and deaths of patients. The EHR's primary goal was to enable healthcare providers to make better decisions and provide better care as well as reduce medical errors through improvement of the medical records accuracy and clarity. In his 2004 State of the Union Address, President George W. Bush made a call for the computerization of health records and that begun an evolution of EHR. Presently, health care organizations are more intensely implementing functional EHR systems since the American Recovery and Reinvestment Act (ARRA) was passed in 2009. The act required that Electronica medical care is adopted by 2014 in about 70 percent of primary care providers. Because of this requirement, the Office of the National Coordinator for Health Information Technology has created about sixty-two Regional Extension (RECs) Centers nationwide (Brooks, 2015). The RECs support healthcare providers as they implement EHRs with the aim of documenting all health care records electronically.
System Development Life Cycle is a framework for project management that is used to improve information systems projects’ quality. Following a project management framework that is consistent can help improve the quality of systems that are developed for health care purposes. This paper provides a description of how SDLC can be used in patient journey modeling projects. SDLC used to manage, plan and control people, the development process and solutions for problems from when the development of the required system is started to when delivered.
This kind of structure can also be applied to the improvement of health care. People involved in a project need to have a detailed plan to follow for it to be successful. For goals to be attained there has to be a plan that has a sequence of tasks and activities that are organized and methodical. The Main aim of SDLC is this. The SDLC for patient journey modeling is Project initiation, project analysis, project design, project implementation and project evaluation. In the initiation phase, the patient journey modeling project scope is set (M. Curry, McGregor, & Tracy, 2007). It determines those who will be affected by the results of the project and what will take place during the cause of the project. The analysis phase focuses on making a graphical representation of which the situation is currently and how the project will be improved by looking at the perspectives of the patients. The design phase makes use of the findings from the analysis to make a redesign of the patient journey and improve health care quality. The implementation phase develops and implements the output designs from the design phase. Project evaluation performs an examination to determine if the designs meet implemented the goals that they were set to meet and how they can be improved. The output for this phase triggers another cycled of development.
Project Management Life Cycle (PMLC) is a project management methodology that is used to implement and plan for projects. It provides a process clearly defined on how a project can transform from just being an idea to when the idea is brought to reality while at the same time applying principles for project management to ensure expectations are clarified, and communications are streamlined and make sure that planning and execution are thorough. It also enables ownership and project leadership is empowered (Health IT, 2013).
Lean is an example of quality improvement methodology instigated in many industries. It has also applied in health care with some great success. It has a set of philosophies and methods aimed at maximizing value for patients by minimizing waits and wastes. It stresses that the needs of customers, the involvement of employees and continuous improvement should always be put into consideration (Lawal et al., 2014). The application of lean principles in the health care industry has been demonstrated to be of success in Australia, Canada, United Kingdom and the United States of America. It can apply in healthcare through a holistic transformation of the entire business strategy. Many studies have little documentation of the barriers that the implementation of lean is facing in health care. For this reason, it is vital to record and synthesize the literature that already exist using a methodical evaluation of the effects of lean implementation and more so it's probable consequences on specialized practice and health care outcomes in different settings.
Another improvement model is Six Sigma. The word Sigma comes from the Greek Letter Sigma that denotes standard deviation. Six Sigma is a strategy used for improving processes and reducing problems via the application of improvement projects (M. Curry, McGregor, & Tracy, 2007). For this to be accomplished, Six Sigma models such as DMAIC and DMADV are used.
Agile method is a software development approach that is iterative, interactive and exploratory in nature. It produces new working functionalities in small increments making it iterative. The end users of the system provide an evolution of the delivery of the most recent iteration and are involved in making plans for the contents of the next iteration. This makes it interactive (M. Curry, McGregor, & Tracy, 2007). The full specification only comes as the result of subsequently planned iterations this makes it exploratory. The main aim of agile development is to focus on making the coding simple, testing the software often and making delivery of functional bits of the software when they are ready.
Just in time (JIT) is a technique for the operation that was founded in Japan and is a bit new to the health care industry. The JIT technique requires a lot of planning, and for hospitals to implement JIT profitably, they need to commit to a few suppliers, exchange some crucial information about their operations and get rid of functions the functions that they are performing currently and let suppliers provide additional services. Therefore, a successful implementation of JIT results in costs reduction, increased productivity, better utilization of equipment, lowered indirect labor and increased profits (Dennision, Kathawala, & Elmuti, 1992).
The government does not determine or dictate systems that can be used in hospitals or by doctors. However, since the health information systems help improve the quality of care in a cost-effective way, the government is involved. It encourages the adoption of health information systems, supports the privacy of health information, provides support for research to be done on the appropriate ways for the use of health information systems and encourages government operated hospitals to use health information systems. Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH). It gave approximately $20 billion to doctors and hospitals to help in the installation and use of EHRs. The Office of the National Coordinator for Health Information Technology formulated strict guidelines to ensure that physicians and hospitals were using the HER systems to improve health care. The Office of Civil Rights a division of the U.S. Department of Health and Human Services (HHS) ensures the protection of health information of individual which also include electronic health information (Health IT, 2013). A department within the HHS known as The Agency for Healthcare Research and quality provides help for research is done on ways to improve health care to people. Various government organizations have adopted the use of Health Information Systems. For example, The Veterans Health Administration which is the biggest and most technologically advanced health care system in the United States gives millions of people access to EHR known as VistA. VistA tracks the medical information of thousands of veterans who receive health care. PHR called My HealtheVet works towards informing patients to make better health-related choices. There is also Indian Health Service (IHS) which has an EHR called Resource and Patient Management System (RPMS). It gives access to personal health information data and epidemiological data that are stored for decades. The NASA also used an EHR in the management of health and safety of its astronauts and employees who are using its occupational clinics (Health IT, 2013).
Hospitals have progressively adopted heath IT but there some barriers that exist. They include the initial costs of deploying and also the costs of maintaining the IT systems. Also the lack of staff trained in the implementation of technology and the lack of interoperability of different systems (Allen & Fenwick, 2006). Historically, health care providers are constrained by government anti-kickback and self-referral laws of physicians, making it impossible for them to provide their staff with tools necessary to maintain and share medical records electronically. However, the establishment of the HHS rules has helped reduce those obstacles.
References
Allen, D., & Fenwick, M. (2006). New survey shows information technology use in hospitals continues to grow . Retrieved from http://www.aha.org/presscenter/pressrel/2007/070227-pr-hitreport.shtml.
Brooks, A. (2015, March 23). Health information management history: Past, present & future . Retrieved http://www.rasmussen.edu/degrees/health-sciences/blog/health-information-management-history/.
Dennision, R., Kathawala, Y., & Elmuti, D. (1992). Just-in-time: Implications for the hospital industry. Journal of hospital marketing , 8 (1), 131–42. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10135495
Lawal, A. K., Rotter, T., Kinsman, L., Sari, N., Harrison, L., Jeffery, C., Flynn, R. (2014). Lean management in health care: Definition, concepts, methodology and effects reported (systematic review protocol). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171573/
M. Curry, J., McGregor, C., & Tracy, S. (2007). A Systems Development Life Cycle Approach to Patient Journey Modeling Projects. IOS Press, 2007
Nabil Almunawar, M. (n.d.). Health Information Systems (HIS): Concept and Technology. Retrieved from https://arxiv.org/ftp/arxiv/papers/1203/1203.3923.pdf.
Heath IT. (2013, January 15). The government and health IT . Retrieved from https://www.healthit.gov/patients-families/government-health-it.
