Making the Case for Business Process Re-engineering in Health Informatics - Focusing on MDRTB in South Africa
Harsha Desai, Rosemary Quiling
2013
Abstract
The potential misalignment between new technologies entering healthcare requires attention. This paper will compare the fit between an Open Source Electronic Medical Record Solution (OpenMRS) and a clinical guideline that outlines the requirements for the care of a patient. Design/methodology: A process analysis technique is used to construct and analyse the fit between the processes as stipulated by the South African clinical guidelines for Tuberculosis (TB) and that of the OpenMRS. This technique has been used to identify inefficiencies and opportunities. Lean principles are applied in the analysis to identify waste in the process. Findings: Process analysis has provided valuable insight into the working of both the system and the provision of this healthcare service. The OpenMRS solution has a good fit to the South African healthcare context with some minor gaps between the system processes and that of the clinical guidelines. In addition, wasteful tasks have been flagged within the clinical guideline processes which appear to be due to limited consideration being paid to the patient's end-to-end care process.
References
- Albert, H., Bwanga, F., Mukkada, S., Nyesiga, B., Ademun, J. P., Lukyamuzi, G., Haile, M., Hoffner, S., Joloba, M. & O'Brien5, R. (2010) Rapid screening of MDR-TB using molecular Line Probe Assay is feasible in Uganda. BMC Infectious diseases, 10, 10.1186/1471-2334-10-41.
- Allen, C., Jazayeri, D., Miranda, J., Biondich, P. G., Mamlin, B. W., A.Wolfe, B., Seerbregts, C., Lesh, N., Tierney, W. M. & Fraser, H. (2007) Experience in Implementing the OpenMRS Medical Record System to support HIV treatment in Rwanda. Studies in Health Technology and Informatics, 129, 382-386.
- Andersson, A., Hallberg, N. & Timpka, T. (2003) A model for interpreting work and information management in process-oriented healthcare organisations. International Journal of Medical Informatics, 72, 47- 56.
- Anokwa, Y., (2010) Delivering Better HIV Care in SubSaharan Africa Using Phone-Based Clinical Summaries and Reminders University of Washington Available from: cs.washington.edu/homes/ yanokwa/.../2010_UW_Generals_Paper.pdf [Accessed November 2010].
- Berg, M. & Toussaint, P., (2003) The mantra of modeling and the forgotten powers of paper: a sociotechnical view on the development of process-oriented ICT in health care. International Journal of Medical Informatics, 69, 223-234.
- Bergman, R., (1994) Re-engineering Health Care. Hospital & Health Networks, 64, 23-36.
- Blaya, J., Holt, B. & Fraser, H. S., (2008) Evaluations of the Impact of eHealth Technologies in Developing Countries: A Systematic Review. Working paper for Rockefeller eHealth Meeting. Harvard-MIT Division of Health Sciences and Technology, Partners In Health, Division of Social Medicine and Health Inequalities.
- Blaya, J. A., Shin, S. S., Yagui, M. J., Yale, G., Suarez, C. Z., Asencios, L. L., Cegielski, P. & Fraser, H. S., (2007) A web-based laboratory information system to improve quality of care of tuberculosis patients in Peru: functional requirements, implementation and usage statistics. BMC Medical Informatics and Decision Making, 7, 10.1186/1472-6947-7-33.
- Boston-Fleischhauer, C., (2008a) Enhancing healthcare process design with human factors engineering and reliability science, part 1: setting the context. J Nurs Adm, 38, 27.
- Boston-Fleischhauer, C., (2008b) Enhancing healthcare process design with human factors engineering and reliability science, part 2: applying the knowledge to clinical documentation systems. J Nurs Adm, 38, 84-9.
- Cegielski, J. P., (2010) Extensively Drug-Resistant Tuberculosis: “There must be some kind of way out of here”. Clinical Infectious Diseases, 50, S195-S200.
- Chan, C. V. & Kaufman, D. R., (2010) A technology selection framework for supporting delivery of patientoriented health interventions in developing countries. Journal of Biomedical Informatics, 43, 300-306.
- Chassin, M. R., Loeb, J. M., Schmaltz, S. P. & Wachter, R. M., (2010) Accountability Measures - Using Measurement to Promote Quality Improvement. The new England Journal of Medicine, 363, 683-688.
- Choi, S. & Fraser, H. (undated) Developing Multidrugresistant TB Systems Using OpenMRS Partner in Health - Harvard Medical school Available from: http://archive.openmrs.org/images/f/f1/TB_Presentatio n.pdf [Accessed 12 June 2010].
- Clifford, G. D., Blaya, J. A., Hall-Clifford, R. & Fraser, H. S., (2008) Medical information systems: A foundation for healthcare technologies in developing countries. BioMedical Engineering Online, 7, 10.1186/1475- 925X-7-18.
- Cohen, K. & Maarstens, G., (2004) Management of HIV and tuberculosis co-infection in South Africa. The Southern African Journal of HIV Medicine, 8-12
- Elkhuizen, S. G., Limburg, M., Bakker, P. J. M. & Klazinga, N. S., (2006) Evidence-based reengineering: re-engineering the evidence A systematic review of the literature on business process redesign (BPR) in hospital care. International Journal of Health Care Quality Assurance, 19, 477- 499
- Elske, A., Carola, I. & Mahler, C., (2006) IT - Adoption and the interaction of task, technology and individuals: a fit framework and a case study. BMC Medical Informatics Decision Making, 6, 1472 - 6947
- Ford, R. E., (2009) Integrating Global Information Systems into ehealth initiatives in Africa University of Rwanda Available from: http://idrcgisworkshop.pbworks.com/ f/FINAL_eHealth_GIS_Report8rev.pdf [Accessed June 2011].
- Francis, S. D. & Alley, P. G., (1996) A “patient focus review” of surgical services Business process reengineering in health care. Business Process Reengineering & Management Journal, 2, 48-62
- Frasier, H., May, M. A. & Wanchoo, R., (2008). e-Health Rwanda Case Study.
- Gerntholtz, T., Heerden, M. V. v. & Vine, D. G. (2007) Electronic Medical Records -Why should you consider implementing an EMR? Continuing Medical Education, 25, 24-28
- Hancock, B., (2002) An Introduction to Qualitative Research. Trent Focus Group.
- Harrison, D., (2009) An Overview of Health and Health care in South Africa 1994 - 2010: Priorities, Progress and Prospects for New Gains A Discussion Document Commissioned by the Henry J. Kaiser Family Foundation* to Help Inform the National Health Leaders' Retreat Muldersdrift - Johannesburg Available from: [Accessed April 2010].
- Hartung, D. & Biglin, J., (2010) Clinical effectiveness Achieving results - not just the latest buzzword Deloitte Available from: http://www.deloitte.com [Accessed October 2010].
- Haux, R. (2006) Health Information systems - Past, Present and future. International Journal of Medical Informatics, 75, 268 - 281.
- Heeks, R. (2006) Health information systems: Failure, success and improvisation. International Journal of Medical Informatics, 75, 125 - 137
- Isern, D. & Moreno, A. (2008) Computer-based execution of clinical guidelines: A review. International journal of medical informatics, 77, 787 - 808
- Keshavjee, S., Seung, K., Gupta, R., Nicholson, T., Talbot, J. R., Vanderwarker, C. & Zintl, P. (2008) Stemming the tide of multi-drug resistant tuberculosis: major barriers to addressing the growing epidemic A white paper for the institute of medicine of the national academies Harvard Medical School, Partners In Health, Francois - Xavier Bagnoud Center For Health and Human Rights, Brigham and Women's Hospital Available from: [Accessed
- Kumar, A., Chen, J., Paik, M. & Subramanian, L. (2010) ELMR: efficient lightweight mobile records Proceedings of the 1st ACM workshop on Networking, systems, and applications for mobile handhelds. New York USA Available from: http://dl.acm.org/citation. cfm?id=1592606 [Accessed May 2011].
- Lenz, R. & Kuhn, K. A., (2004) Towards a continuous evolution and adaptation of information systems in healthcare. International Journal of Medical Informatics, 73, 75 - 89
- Littlejohns, P., Wyatt, J. C. & Garvican, L., (2003) Evaluating computerised health information systems: Hard lessons still to be learn't. Bio Medical Journal, 326, 860 - 865
- Ludwicka, D. A. & Doucettea, J., (2009) Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries. International Journal of Medical Informatics, 78, 22 - 31
- Marc Mitchell, M., M. S., Neal Lesh, P., M. P. H., Hilarie Cranmer, M., M. P. H., Hamish Fraser, M., MSc, Irina Haivas, M. D. & Kate Wolf, M. S., (2007) Improving Care - Improving Access: The Use of Electronic Decision Support with AIDS patients in South Africa Harvard University Available from: www.hsph.harvard.edu/ihsg/.../ImprovingCareImprovi ngAccess.pdf [Accessed September 2009].
- Max R. O'Donnell, Jarand, J., Loveday, M., Padayatchi, N., Zelnick, J., Werner, L., Naidoo, K., Master, I., Osburn, G., Kvasnovsky, C., Shean, K., Pai, M., Walt, M. V. d., Horsburgh, C. R. & Dheda, K. (2010) High Incidence of Hospital Admissions With MultidrugResistant and Extensively Drug-Resistant Tuberculosis Among South African Health Care Workers. Annals Of Internal Medicine, 153, 516-523
- Munir, S. K. & Kay, S. (2005) Simplifying the complexity surrounding ICU work processes--Identifying the scope for information management in ICU settings. International Journal of Medical Informatics, 74, 643 - 656
- Muthu, S., Whitman, L. & Cheraghi, H. (1999) Business Process Reengineering: A Consolidated methodology The 4th Annual International Conference on Industrial Engineering Theory, Applications and Practice San Antonio, Texas, USA Available from: http://webs.twsu.edu/whitman/papers/ijii99muthu.pdf [Accessed September 2009].
- Mykkänen, J., Riekkinen, A., Sormunen, M., Karhunen, H. & Laitinen, P. (2007) Designing web services in health information systems: From process to application level. International Journal of Medical Informatics, 76, 89 - 95
- Nathanson, E., Weezenbeek, C. L.-v., Rich, M. L., Gupta, R., Bayona, J., Blöndal, K., Caminero, J. A., Cegielski, J. P., Danilovits, M., Espinal, M. A., Hollo, V., Jaramillo, E., Leimane, V., Mitnick, C. D., Mukherjee, J. S., Nunn, P., Pasechnikov, A., Tupasi, T., Wells, C. & Raviglione, M. C. (2006) Multidrugresistant Tuberculosis Management in Resourcelimited Settings. Emerging Infectious Diseases, 9, 1389-1396
- Needleman, J. & Hassmiller, S. (2009) The Role Of Nurses In Improving Hospital Quality And Efficiency: Real-World Results. Health Affairs, Available from: http://www.healthpolicyfellows.org/pdfs/TheRoleOfN ursesInImprovingHospitalQualityandEfficiency-RealWorldResultsbyNeedlemanandHassmi.pdf [Accessed October 2011].
- Noormohammad, S., Mamlin, B., Biondich, P., Mcknown, B., Kimaiyo, S. & Were, M. (2010) Changing course to make cllinical decision support work in an HIV clinic in Kenya. International Journal of Medical Informatics, 79, 204 - 210
- O'Donnell, M. R., Padayatchi, N., Master, I., Osburn, G., Robert, C. & Horsburgh (2009) Improved Early Results for Patients with Extensively Drug Resistant Tuberculosis and HIV in South Africa. International Journal Tuberculsosis Lung Disease, 13, 855-861
- Patwardhan, A. & Patwardhan, D. (2008) Business process re-engineering - saviour or just another fad? One UK health care perspective. International Journal of Health Care Quality Assurance, 21, 289 - 296
- Paulus, R. A., Davis, K. & Steele, G. D. (2008) Continuous Innovation In Health Care: Implications Of The Geisinger Experience. Health Affairs, 27, 1235-1245Available from: [Accessed November 2011].
- Pickles, J., Hide, E. & Maher, L. (2008) Experience based design: a practical method of working with patients to redesign services. Clinical Governance: An International Journal of Biomedical Informatics, 13, 51- 58
- Seebregts, C., Mars, M., Fourie, C., Singh, Y. & Weyer, K. (2006) Inexpensive Open Source TB and HIV electronic medical record system (OpenMRS) in South Africa Collaborating Toward an EMR for Developing Countries. AMIA Annual Symposium. Available from: http://www.mrc.ac.za/conference/satelemedicine/Seeb regts.pdf [Accessed June 2010].
- Seerbregts, C., Mamlin, B., Biondich, P., Fraser, H., Wolfe, B., Jazayeri, D., Allen, C., Miranda, J., Baker, E., Musinguzi, N., Kayiwa, D., Fourie, C., Lesh, N., Kanter, A., Yiannoutsos, C., Bailey, C. & Network, T. O. I. (2009) The OpenMRS implementers network. International Journal of Medical Informatics, 78, 711 - 720
- Seung, K. J., Omatayo, D. B., Keshavjee, S., Furin, J. J., Farmer, P. E. & Satti, H. (2009) Early Outcomes of MDR-TB Treatment in a High HIV-Prevalence Setting in Southern Africa. PLoS One, 4, e7186
- Singh, J. & Padayatchi, N. (2007) XDR-TB in South Africa: No time for denial or complacency. PLoS Med, 4, e50
- Stausberga, J. r., Bilira, H. s., Waydhasb, C. & Ruchholtz, S. (2003) Guideline validation in multiple trauma care through business process modeling. International Journal of Medical Informatics, 70, 301 - 307
- Syed, A. M., Hjarone, L. & Aro, A. R. (2009) The Delphi Technique in developing Internationl Health Policies: Experience from the SARSControl Project. The International Journal of Health, 8
- Tanevaa, S., Groteb, G., Easty, A. & Plattnera, B. (2010) Decoding the perioperative process breakdowns: A theoretical model and implications for system design. International Journal of Medical Informatics, 79, 14 - 30
- Terazzi, A., Giordano, A. & Minuco, G., (1998) How can usability measurement affect the re-engineering process of clinical software procedures? International Journal of Medical Informatics, 52, 229 - 234
- Thomas, D. (2008) MDR-TB Module Documentation. OpenMRS.
- Thorne, S., (2000) Data analysis in qualitative research. EBN Notebook..
- Tierneya, W. M., Achiengb, M., Bakerc, E., Bella, A., Biondicha, P., Braitsteina, P., Kayiwae, D., Kimaiyod, S., Mamlina, B., McKowna, B., Musinguzif, N., Nyandikod, W., Rotichd, J., Sidlea, J., Siikad, A., Werea, M., Wolfea, B., Wools-Kaloustiana, K., Yeunga, A., Yiannoutsosa, C. & Consortium, T.-U. O. (2010) Experience Implementing Electronic Health Records in Three East African Countries MedInfo 2010 Capetown Available from: [Accessed
- Towers, S., (2010) Outside -in The secret of the 21st century leading companies. 2nd ed., BP Group Press.
- Trkman, P., (2010) The critical success factors of business process management. International Journal of Information Management, 30, 125 - 134
- Tsiknakis, M. & Kouroubali, A., (2009) Organizational factors affecting successful adoption of innovative eHealth services: A case study employing the FITT framework. International Journal of Medical Informatics, 78, 39 - 52
- Vine, D. G., (2007) Communicating between colleagues - pitfalls and practical solutions. Continuing Medical Education, 25, 14 -16
- Wei-Chih, L., Tierney, M., Chen, J., Kazi, F., Hubard, A., Pasquel, J. G., Rao, B. & Subramanian, L., (2010) UjU: SMS-based applications made easy Proceedings of the First ACM Symposium on Computing for Development New York USA Available from: http://dev2010.news.cs.nyu.edu/papers/16-lu.pdf [Accessed March 2011].
- White, S. A., (2004) Introduction to BPMN BP Trends IBM Corporation Available from: http://www. omg.org/bpmn/Documents/Introduction_to_BPMN.pd f [Accessed 15 May 2010].
- WHO, (2009) The key bottlenecks hampering the prevention and scale-up of M/XDR TB control and patient care A ministerial meeting of high M/XDR TB burden countries Beijing China Available from:www.who.int/entity/tb/challenges/mdr/bottlenec ks/bottlenecks_full_version.pdf [Accessed June 2010].
- WHO, (2009) Global Tuberculosis control WHO report 2009 WHO Report World Health Organisation Available from: http://www.who.int/tb/publications/ global_report/2009/en/index.html [Accessed 12 April 2010].
- WHO, (2010) Multidrug and extensively drug-resistant TB (M/XDR-TB) 2010 Global report on surveillance and response World Health Organisation Available from: http://www.who.int/tb/features_archive/m_xdrtb _facts/en/index.html [Accessed April 2010].
Paper Citation
in Harvard Style
Desai H. and Quiling R. (2013). Making the Case for Business Process Re-engineering in Health Informatics - Focusing on MDRTB in South Africa . In Proceedings of the International Conference on Health Informatics - Volume 1: HEALTHINF, (BIOSTEC 2013) ISBN 978-989-8565-37-2, pages 144-154. DOI: 10.5220/0004187801440154
in Bibtex Style
@conference{healthinf13,
author={Harsha Desai and Rosemary Quiling},
title={Making the Case for Business Process Re-engineering in Health Informatics - Focusing on MDRTB in South Africa},
booktitle={Proceedings of the International Conference on Health Informatics - Volume 1: HEALTHINF, (BIOSTEC 2013)},
year={2013},
pages={144-154},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0004187801440154},
isbn={978-989-8565-37-2},
}
in EndNote Style
TY - CONF
JO - Proceedings of the International Conference on Health Informatics - Volume 1: HEALTHINF, (BIOSTEC 2013)
TI - Making the Case for Business Process Re-engineering in Health Informatics - Focusing on MDRTB in South Africa
SN - 978-989-8565-37-2
AU - Desai H.
AU - Quiling R.
PY - 2013
SP - 144
EP - 154
DO - 10.5220/0004187801440154