Enterprise Architecture based Assessment of Healthcare Information
System Strategic Alignment
Nabil Alrajeh
1
, Kaoutar Elhari
2
and Bouchaïb Bounabat
2
1
Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
2
Al Qualsadi Research Team ENSIAS, Université Mohammed V, Rabat, Morocco
Keywords: Strategic Alignment, Healthcare Information Systems, Enterprise Architecture, Assessment.
Abstract: Traditionally, most Information Technology (IT) implementations in healthcare are concerned primarily
with improving the efficiency of operational tasks, without considering the effectiveness of the strategic
management decision processes. This paper objective aims at filling this lack by presenting a new approach
for Assessment of Healthcare Information Systems (HIS) Strategic Alignment. The underlined concepts are
based on Enterprise Architecture (EA) related concepts, providing a clear and comprehensive view of the
structure and operations of the healthcare system. This paper focus on how to carry out an internal EA
analysis that aims at measuring HIS alignment via a set of metrics determining if the business processes,
sub-processes, applications and databases are actually achieving their purpose. This will enable all parties
involved in the HIS management process to stay abreast of what has been really attained, which goals are
being met, and what needs to be changed.
1 INTRODUCTION
In today’s highly automated business world,
decisions made about the IT infrastructure influence
the organization management, as well as its
competitive position, and often dictate its ability to
respond to beneficiaries’ requirements. Failures, sub-
optimum performance, misaligned solutions at the
operational level, or even a poorly designed
application can have immediate effects on the
business level. Thus, it is not a surprise that aligning
IT strategy with Healthcare organization objectives is
one of the hot topics of both researchers and
executives.
Indeed, over the last decade, the need to develop
and organize new ways of providing efficient health-
care services has been accompanied by major
advances in information technology, and particularly
by the ability to record easily and inexpensively
information about every health transaction and to
access this information instantly no matter where it is
stored. Nevertheless, traditionally most IT
implementations in healthcare have not been
considered on a strategic level. Nonstrategic IT
systems are focused on information processing tasks
such as patient data management systems, and
customer relationship management systems.
The effectiveness of the strategic management
decision processes requires an IT usage in a strategic
and innovative manner to support the delivery of
healthcare services. This objective represents a great
challenge for all parties involved in the process:
healthcare managers, care providers, as well as
systems developers, and a complete alignment
between Healthcare System and IT levels is hugely
required. This paper discusses how Enterprise
Architecture (EA) paradigms can provide an
important measurement tool for evaluating HIS
Strategic Alignment (SA) by checking if its layers’
components (processes, applications, and IT
infrastructure) truly collaborate to provide better
solutions to meet the Healthcare system strategic
needs.
The remainder of this paper is organized into five
sections. Section 2 provides a literature review of
related works to HIS Strategic Alignment. Section 3
describes the use of EA as a model to structure a HIS,
where section 4 depicts how to use this structure to
assess HIS Alignment. The proposed approach is
illustrated by a study case evaluating strategic
alignment of the IT system underlying to an
automated process. This section also presents the
platform developed in order to support the proposed
approach. Finally, in section 5, we conclude and give
284
Alrajeh N., Elhari K. and Bounabat B..
Enterprise Architecture based Assessment of Healthcare Information System Strategic Alignment.
DOI: 10.5220/0004362602840289
In Proceedings of the International Conference on Health Informatics (HEALTHINF-2013), pages 284-289
ISBN: 978-989-8565-37-2
Copyright
c
2013 SCITEPRESS (Science and Technology Publications, Lda.)
an idea about our future work.
2 RELATED WORKS
IT alignment can be defined as applying IT in an
appropriate and timely way, in harmony with
business strategies, goals and needs (Papp, 1998).
The definition addresses both how IT is aligned with
the business, and how the business should/could be
aligned with IT. (Keen, 1996) suggests that IT
architecture, integration, infrastructure, and
standards should be defined from the organization’s
goals and that IT infrastructure should be an early
consideration when defining business goals.
Therefore, the degree of alignment among IT and
business is facilitated by a complex interaction of
management practices and strategic IT choices
which an organization makes.
(Luftman, 2000) proposes the Strategic
Alignment Maturity exhibiting these concepts and
involving five conceptual levels of strategic
alignment maturity (Initial/Ad Hoc Process,
Committed Process, Established Focused Process,
Improved/Managed Process, and Optimized
Process). Each of the five levels of alignment
maturity focuses on a set of six criteria
(Sledgianowski et al., 2004): Communication,
Competency/Value Measurement, Governance,
Partnership, Scope and Architecture, and Skills.
These approaches are management oriented, as they
investigate management practices and strategic IT
choices that facilitate IT-business alignment, and
develop an instrument to measure the degree to
which those practices are in place in an organisation.
Concerning HIS strategic alignment related
works, (Sims, 1999) is one of the earliest approaches
studying clinical information systems alignment
with the overall business strategy of the healthcare
organization, and proposing that these systems
assessments to be based upon their ability to
accomplish business objectives and solve problems
for the patient care team.
(Cunningham, 2001) focuses on the challenges
that are inherent in developing an IS strategy for a
public healthcare system. It criticizes IS planning as
being technology-lead and objective driven with the
actual processes being ignored. In that respect, and
in order to achieve alignment of strategy between
entities, RISC (Role of Information Systems in
Change) model is introduced as a way of describing
where SISP (strategic information systems planning)
fits in the process of organizational change. This
continuous integration is one of the central
components of Earl’s organizational approach (
Earl,
2003).
(Vimarlund et al., 2003) proposed a framework
classifying healthcare organizations into three types:
(i) traditional (with a centralized management and
information systems); (ii) developing, where IT
operates in a distributed computing model and is
used for coordinating the different parties
throughout the organization, and (iii) flexible,
designing the organization structure and the
information system as a holistic, integrated process
where the two are created in a simultaneous
coordinated manner.
On the other hand, (Wager et al., 2005) proposes
a normative approach to developing alignment and
IT Strategy in HS, based on the fact that the process
for developing IT strategy should be similar in
approach and nature to the process used for overall
strategic planning. However, it considers that
organization strategy is often volatile and uncertain
the ability of IT to support a strategy can be unclear
and the trade-offs between IT options can be
difficult to assess.
We propose in this paper an EA oriented
approach consisting in 2 steps: (i) modelling HIS in
compliance with EA structuring principles; and (ii)
checking if HIS sub-architectures truly collaborate
to provide better solutions to meet the Healthcare
system strategic needs.
3 EA BASED HIS MODELING
3.1 EA Overview
The “2001 Practical Guide to the Federal Enterprise
Architecture” defines an EA as “a strategic
information asset base, which defines the mission,
the information necessary to perform the mission,
the technologies necessary to perform the mission,
and the transitional processes for implementing new
technologies in response to the changing mission
needs. Enterprise architecture includes baseline
architecture, target architecture, and a sequencing
plan” (FCIO, 2001).
Since Zachman introduced his framework (Sowa
and Zachman, 1992) providing a deeper, more
detailed understanding of the enterprise architecture,
a number of other frameworks have been proposed.
The list includes well-known frameworks, such as
the Federal Enterprise Architecture Framework
(FCIO, 2001). the Open Group Architecture
Framework TOGAF (TOGAF, 2003), And the
DoDAF: DoD Architectural Framework (DoDAF)
EnterpriseArchitecturebasedAssessmentofHealthcareInformationSystemStrategicAlignment
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(Stenbit, 2004).
EA is much more than just a list of IT standards
to be followed by an enterprise. It covers the entire
information system management process in order to
provide a common basis for understanding and
communicating how systems and internal layers
(process, Application, Data and Technological
Infrastructure) are structured to meet strategic
objectives, and then to attain SA.
In this objective, we propose: (i) an EA based
HIS standard structure; and (ii) a SA assessment
approach consisting in evaluating the internal links
existing between the modelled HIS layers.
3.2 EA based HIS Structure
The proposed EA based HIS is composed of four
distinct layers: Healthcare process, Application,
Data and Technological Infrastructure.
3.2.1 Healthcare Process Layer
This layer describes the “what” of the healthcare
business model, activities, processes, functions,
information and metrics. The overall healthcare
processes and services are identified and hierarchical
process decomposition is established as well as
procedures, tasks and roles that characterize these
processes and sub-processes.
3.2.2 Healthcare Application Layer
This layer encompasses the application components
and services to be deployed in order to implement
the Healthcare processes and their sub-process.
Generally, HIS application layer is organized by
speciality, loosely coupling the components but
taking into account that there are common
requirements that span all departments within the
hospital – e.g. patient data.
According to the speciality based-system
approach, the following Application components
should compose this layer: Medical Records and
Patients System, Managed Care System,
Order/Request Management System,
Pharmacy/Medication Management System, Practice
Management System, Picture Archival and Imaging
System (PACS) (Youngblood et al., 2008); (Zheng
et al., 2008) and (MARKLE, 2003).
3.2.3 Healthcare Data Layer
This layer covers the persistent data used and
updated by Healthcare processes and applications.
This includes patient's records, pharmacy stock,
practices records and medical images. The main data
is the patient's record, medical record or health
record. It is a systematic documentation of a patient's
individual medical history and care.
Although medical records are traditionally
compiled and stored by health care providers,
Personal Health Records (PHR) maintained by
individual patients have become more popular in
recent years (Baethmann et al., 1999).
PHRs enable individual patients and their
designated caregivers to view and manage health
information and play a greater role in their own
health care.
3.2.4 Technology Layer
The objective of this layer is to describe the
technologies required, as well as the software and
hardware components necessary to run applications
and to store any type of health data. All defined
components would work together in order to
implement an integrated HIS. In this vein, a HIS
should as far as possible try to get standardized on
the basis of one component technology, to be built
following the most suited architectural template for
distributed and heterogeneous environments, and to
adopt sustainable standards for health-related data
exchange, integration, conversion and storage.
4 HIS STRATEGIC ALIGNMENT
ASSESSMENT
The proposed approach aims at evaluating the
internal links existing between the modelled HIS
layers. The goal consists of checking if HIS layers’
components (processes, applications, and the IT
infrastructure) truly collaborate to provide better
solutions to meet the Healthcare system needs.
4.1 Internal EA Relationships Analysis
Alignment is not guaranteed by simply creating
diagrams and models showing how a given strategy
is supported by healthcare processes that are
implemented by specific software applications,
databases and technological infrastructure.
It is necessary to establish a set of relevant
metrics with the aim to assess and measure HIS
alignment following a breakdown structure, i.e. to
determine if the processes, sub-processes, activities,
applications and databases are actually achieving
their purpose. Necessary Information for building
such metrics system, are provided by the analysis of
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the relationships and dependencies between these
architecture layers (see Figure 1 below).
Figure 1: Internal Enterprise Architecture links.
Such inter-layers links are stressed by the EA
meta-model shown in Figure 2, identifying
numerous relevant metrics (Elhari and Bounabat,
2010) allowing organizations to locate their strategic
alignment.
On the basis on this meta-model, a the S2AEA
(Strategic Alignment Assessment based on
Enterprise Architecture) platform is developed
(Elhari and Bounabat, 2011). It supports the
approach consisting in: (i) modeling the EA, (ii)
detecting elements that harm HIS strategic
alignment, and (iii) proposing solutions to the
detected problems.
Figure 2: Enterprise architecture metamodel.
4.2 e-Health Case Study
The objective is to illustrate the proposed approach
by assessing an automated e-Health process: “Pass a
consultation in the neurology service in a hospital”,
and identifying factors that affect the HIS strategic
alignment. The studied e-Health process consists of
five activities:
Scheduling an Appointment: Making an
appointment is necessary to have a consultation with
a doctor in the service.
Receiving Patient: The patient goes to the
reception desk to complete the formalities, and to
provide some information: personal information,
health insurance, etc.
Receiving Patient in Neurological Service: In the
neurology department, a file is opened containing
the patient's personal information, a history of
illness, specific allergies, etc.
Passing Consultation: the sounding of the doctor
is done through this activity. This consultation is
assisted by computer.
Charging Consultation: The consultation is
estimated at a price depending on the nature of the
examination carried out in the consultation.
The elements of the enterprise architecture are
represented by the following stereotypes (see Table
1).
Table 1: Symbols and stereotypes used in the S2AEA
plateform.
Symbol Name
Process
Activity
User
Application
Functionality
Data source
Information entity
Operating system
Technology
4.3 SA Assessment of the Process
Implementation
As shown in Figure 3 S2AEA is used to the
description of the “Passing a consultation” process
in the EA based HIS model, by defining the
components belonging to each layer and supporting
the process (5 activities, 4 applications, 3 data
sources and 2 operating systems).
Once the e-Health process implementation
(existing or targeted) is defined, the Strategic
Alignment Assessment can start (“SA Assessment”
item in “Figure 4”), following 3 metrics presented
and validated in (McCall et al., 1977); (Wegmann et
al., 2005) and (Sousa et al., 2005):
Frameworks
Blueprints
Data models
Link to
applications
Data
Data
Data
Business Area
and Domains
Processes
Sub-processes
FrameworksFrameworks
BlueprintsBlueprints
Components
Link to processes,
sub-processes,
and activities.
Application
Is supported by
Manipulates
Uses
Business Architecture
Application Architecture
Data Architecture
Domain
Technology Architecture
v
v
v
v
Uses
Uses
EnterpriseArchitecturebasedAssessmentofHealthcareInformationSystemStrategicAlignment
287
m1: Number of not automated activities
m2: Number of applications supporting the same
business process activity, evaluating severity of
certain deficiencies as redundancy in data insertion,
multiple logins, etc.
m3: Number of operating systems on which turn
an application, assessing the applications portability
and technical interoperability capacities.
Figure 3: EA Description and Strategic Alignment
Assessment using the S2AEA Platform.
After the 3 metrics are evaluated, the S2AEA
platform identifies, via adequate messages
(commentaries, recommendations, etc.), the changes
to be made in order to attain a higher SA level:
The "Schedule an appointment" activity harms
the alignment in the sense that it is not automated
(identified by the red colour in Figure 3). It can be a
real deficiency to deal with in order to reach SA,
since non automated activities require more human
resources and more time.
The “Charge a consultation” activity harms the
alignment because it is supported by two different
applications (Accounting, Doctor Consultation).
Indeed, an activity should be supported by a
minimum number of applications: this can facilitate
modification in case of business process activity
change and can reduce the need for distributed
transactions across applications (Bounabat, 2006)
and (Vasconcelos, 2007).
The application “neurology Patient” turns on
only one operating system. This harms alignment
because the application is neither portable nor
interoperable. This generates problems if we want to
interoperate two applications to reach a business
goal (Sousa et al., 2005) and (Vasconcelos, 2007).
As this study case demonstrates, the proposed HIS
strategic alignment assessment approach contribute
to the efforts aiming at changing the view of
healthcare delivery to a business process oriented
approach. This evolution will permit the setting-up
of a more appropriate and efficient organizational
and information infrastructures to support the
clinical and business processes of the organization.
5 CONCLUSIONS
The IT expansion applies to all the healthcare
stakeholders to take inevitable steps to align and
assess the HIS development to their business
strategies. In this respect, this paper presents a novel
approach to use EA in HIS strategic alignment
evaluation. It depicts, analyzes and assesses the
relationships between the various informational
architecture components and how the architecture
serves as a strategic asset for the healthcare
organisation.
Such IT alignment assessment is useful to help a
Healthcare organisation to estimate the gaps for each
component of the HIS Architecture to be
strategically aligned, and to evaluate the necessary
efforts to attain this objective.
Our research efforts are currently focusing on
two main objectives. The first consists in improving
S2AEA by adding more interesting assessment
metrics and by developing other platform
functionalities. On the other hand, EA is a really
promising discipline aimed at capturing the as-is
architecture of an enterprise, defining the target and
the roadmap to get from existing to desired state.
Therefore, the second objective aims at setting up a
new methodology for IT Strategic Planning based on
Enterprise Architecture and applying it in Healthcare
domain.
ACKNOWLEDGEMENTS
The authors extend their appreciation to the
Research Centre, College of Applied Medical
Sciences and the Deanship of Scientific Research at
King Saud University for funding this research.
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