A BUSINESS PROCESS MODEL FOR PUBLIC HEALTH

INFORMATION SYSTEMS: A GOVERNMENTAL

PERSPECTIVE

Daniel Polónia, Ilídio Castro Oliveira, José Luís Oliveira

Universidade de Aveiro, DET/IEETA, 3810-193 Aveiro, Portugal

Keywords: Business Process, Business Models, Proc

ess Modelling, Health Care ICT.

Abstract: The business process models available for th

e telecom industry have, in the recent past, made significant

developments and reached leading-edge maturity levels. The 1997-2000 technology bubble has injected

significant amounts of cash in the market, which has allowed a quick maturing of both the process models

and its supporting software applications and integration tools. In its turn, the health industry, in what

concerns to technology and associate processes has been maturing more slowly, with lower levels of

integration and process models more “institution oriented” than “client oriented”.

In this paper it is proposed a process model for the health industry, derived from the enhanced Telecom

Operations Model (eTOM), from which is derived a functional architecture that intends to support

applications that respond to the current technological, political and economical challenges of the Portuguese

national health service.

1 INTRODUCTION

The Portuguese national health service, (from now

on designated as the SNS), is constituted of 364

primary care health centres and 205 secondary care

hospitals, of which 34 are in the process of

becoming “private” entities, wholly state owned

(Sociedades Anónimas de Capitais Públicos) (Law,

2002).

2 THE SNS STRUCTURE

The national health policy is defined by the Health

Ministry and is administratively organized in 5

health regions (one per each NUTS II region). In

the Autonomous regions, the health policy is

defined by each of the regional governments.

The SNS is financed by the Portuguese state

dget, although the service providers can charge

some minimal fees for some special services or in

order to regulate the access to some services.

Currently the Health Ministry takes 7.565.000.000

€, which is 5,6% of the GNP, with 98,6%

dedicated to the SNS.

3 THE DUALITY TELECOM-

HEALTH

As it was mentioned previously, the main

argument of this paper is based on the fact that the

health industry, when properly automated, is an

information intensive industry that can be

compared to the telecom industry, in what

concerns to the information management

In fact, the volume of information handled by

e telecommunication systems can be compared

with the volume of information handled by the

health information systems.

Another item that makes the

elecommunication service provider and the health

service provisioning dual is the fact that both are,

at least potentially, information intensive,

demanding similar management processes and

supporting information systems (Collen, 1999),

(McDonald, 1997).

The health care industry did not give to

siness Process models the same attention that its

telecom counterparts have offered to it. There are

no currently integrated approach that allows

mapping easily government policies into health

information systems and vice-versa. This is the

result of development of the business models in the

573

Polónia D., Castro Oliveira I. and Luís Oliveira J. (2004).

A BUSINESS PROCESS MODEL FOR PUBLIC HEALTH INFORMATION SYSTEMS: A GOVERNMENTAL PERSPECTIVE.

In Proceedings of the Sixth International Conference on Enterprise Information Systems, pages 573-576

DOI: 10.5220/0002651905730576

 SciTePress

telecommunications sector, due to the 1997-2000

investment bubble, provided the sector with much

more mature models that can now be reused for

other purposes.

3.1 Defining the concepts

Making a duality with the provision of health

services, the following comparisons can be made.

The customer of a telecom service provider can

be compared to the customer of the SNS, as “the

customer buys products and services from the

enterprise or receives free offers or services”

(TeleManagement Forum TM Forum Glossary

[online]).

The supplier of a telecom service provider can

be compared to the supplier of the SNS as

“suppliers interact with the enterprise in providing

goods and services, which are assembled by the

enterprise in order to deliver its products and

services to the customer.” (TeleManagement

Forum TM Forum Glossary [online]).

The intermediaries of a telecom service

provider can be compared to the intermediary of

the SNS as “intermediaries provide products and

services that the enterprise either cannot provide

itself or chooses not to due to cost and quality

considerations.“ (TeleManagement Forum TM

Forum Glossary [online]).

The complementary provider of a telecom

service provider can be compared to a

complementary provider of the SNS since “the

complementary provider provides additional

products and services to extend the attractiveness

of an enterprise’s products and services and scope

of the value network.” (TeleManagement Forum

TM Forum Glossary [online]).

It should be noted that it is understood as value

network “[...] the collaboration of the enterprise, its

suppliers, complementors and intermediaries with

the customer to deliver value to the customer and

provide benefit to all the players.”

(TeleManagement Forum TM Forum Glossary

[online]).

3.2.1 The structure

As such, and keeping the duality with the

TeleManagement Forum eTOM Business Process

Framework, it can be said that the SNS business

process framework represents the whole SNS

environment and is composed of the following

three major areas of process (Figure 1)

(TeleManagement Forum, 2002):

• Strategy, Infrastructure & Product -

covering planning and lifecycle

management.

• Operations - covering the core of

operational management.

• Enterprise Management – covering

support or business support

management.

STRATEGY,

INFRASTRUCTURE &

PRODUCT

OPERATIONS

ENTERPRISE MANAGEMENT

Figure 1: eTOM in SNS major areas

These three areas are composed of the

following macro processes [5]:

• Market and Product processes.

• Services processes.

• Resources processes.

• Suppliers/Partners processes.

• Enterprise Management processes.

Additionally, it must be added the major

entities with which the SNS interacts, such as the:

• Customers, to whom service is

provided.

• Suppliers, who provide products or

resources used by the SNS.

• Partners, with whom the SNS co-

operates in a shared area.

• Employees, who work for the SNS.

From here, it is possible to derive the Business

Process Framework Conceptual Structure as shown

in Figure 2:

STRATEGY, INFRASTRUCTURE &

PRODUCT

OPERATIONS

ENTERPRISE MANAGEMENT

Market and Product

Services

Resources

Suppliers/Partners Relationship Management

Customer

Employees

Suppliers

Figure 2: Business Process Framework Conceptual

Structure

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4 DERIVING A FUNCTIONAL

ARCHITECTURE

The Functional Architecture derived from the

previously presented Business Process Framework

Conceptual Structure is presented next.

In order to obtain a system that makes the

described processes operational, it will be

necessary to implement a Functional Architecture

such as the one described in Figure 3.

This architecture aggregates the processes by

functions performed using information systems. As

such, it is necessary to identify the components

that make up the whole information system.

4.1 CRM

It is a functional domain that allows the interaction

with the user from an integrated point of view,

integrating its lifecycle management. As such, it is

possible to have a holistic knowledge of the user

lifecycle in the SNS, allowing the integration of

the clinical process in the administrative process

and, in an integrated and structured approach,

support the customer in its relationship with the

SNS.

4.2 Billing

Is a functional domain that includes all the

functions that stretches from the entrance of the

service to be rated and billed to the billing and

collection of the customer and the account

management with the customer and/or business

partners.

4.3 Business Support System

Is a domain that includes all the functions required

to manage the SNS. It supports the measurement

activities of the organization against its plans and

objectives.

CRM

Customer Manager

Customer Contact

Interaction Manager

Scheduler

Clinical Process

Manager

Billing

Payment & Collection

Management

Debt Management

Business Support System

Logistics and Supplyer

Management

Account and Financial

Management

Human Resources

Management

Enterprise Information

System

Datawarehousing and

reporting

EAI Platform

Process Management

Event Transformation

and Formatting

Application

Connectivity

Communications

Middleware

Development

Architecture

Operational

Architecture

Other Systems

Proprietary Clinical

Systems

Third Party Resources

External Service

Providers

Other Systems

Interconnection

Figure 3 - Functional Architecture

A BUSINESS PROCESS MODEL FOR PUBLIC HEALTH INFORMATION SYSTEMS: A GOVERNMENTAL

PERSPECTIVE

575

Based in the defined strategy, the Key

Performance Indicators will be defined and

monitored in real time by the top level decision

makers, through the integration of the information

systems.

4.4 Enterprise Application

Integration

This platform integrates all the software that

supports all the functional areas previously

mentioned.

The Enterprise Application Integration

Platform (EAI) is a combination of technologies

and processes that enable custom-built and/or

packaged business applications to exchange

business-level information in formats and contexts

that each understands.

4.5 Interconnection

This platform will allow the interface of the system

with other external systems such as:

• Proprietary Clinical systems, owned

by third companies and in operation in

institutions of the SNS.

• External Service Providers.

• The ability to integrate resources and

services from third parties in the

planning, provisioning and activation

of workflows.

This platform is the “entry (and exit) door” to

the framework, i.e. the interconnection with the

external service providers of the SNS. It is also the

“glue” that holds together the open and proprietary

systems, namely the clinical systems, that exist

throughout the whole SNS.

4.6 Global view of the functional

architecture

Assuming that the previously presented system is

capable of performing all the operations of

information retrieval and transformation in real

time, and that all the information systems in the

different institutions are compatible among each

other, it is now possible to create a “tableau de

bord”, based in the processes and on the Critical

Success Factors indicated previously that can

respond to the need indicated in the initial

problem.

5 CONCLUSION

This paper replicates a “leading edge” process

model for the telecom industry and tries to

innovate it, adapting it to the health industry

through an “information intensive” analogy.

It develops an approach that allows the

leverage of existing assets such as the existing

telecom infrastructure of the Portuguese national

health system and the re-use of the on-going

quality accreditation efforts on its units, through

the adoption of compatible standards.

It also proposes a functional architecture that

allows the integration of the knowledge owned by

all the information systems of the national health

system and re-assembles it in a single repository,

thus providing the top-level decision makers with a

“one touch real-time application” that allows the

creation of reports with Key Performance

Indicators aligned with the management processes.

The functional architecture is also flexible

enough in order to provide the intermediate-level

decision makers with generic views of the

performance of several sub-units in what concerns

to payments and collections to partners/suppliers in

order to develop new “deal-making” strategies

and/or renegotiating contracts.

With the adoption of this functional

architecture it will be possible to respond to the

clinical, economical and political challenges that

the Portuguese national health service faces

nowadays.

REFERENCES

Law 27/2002 of November 8th, Chapter III

M. F. Collen (1999) "A Vision of Health Care and

Informatics in 2008", Journal of the American

Medical Informatics Association, 6(1): pp. 1-

C. J. McDonald (1997) "The barriers to electronic

medical record systems and how to overcome

them", Journal of American Medical

Informatics Association, 4(3): pp. 213-221.

TeleManagement Forum TM Forum Glossary

[online], available in:

http://www.tmforum.org/browse.asp?catID=8

63&sNode=863&Exp=Y&linkID=28087.

TeleManagement Forum (2002) Enhanced

Telecom Operations Map (eTOM®) - v3.0.

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