Strategic Management Systems to Increase

¶ … Strategic Management Systems to Increase healthcare performance

Results of Assessing Strategic Management Systems' Influence on Increasing Healthcare's Organizational Performance

For many healthcare providers their effectiveness is limited by the lack of system integration in their it, patient monitoring, and management systems. This lack of system integration severely limits their ability to align processes to patients' changing needs. The intent of this proposed research is to provide insights into how healthcare providers can achieve higher levels of effectiveness in diagnosing, treating and ensuring the long-term health and satisfaction of patients by researching the correlation between investments in strategic management systems and healthcare organization effectiveness and performance. Healthcare providers rely extensively on content management systems that include patient history, medical reference and treatment program success or failure. Critical to the development of strategic management systems for healthcare providers is the development of Enterprise Content Management (ECM) systems that unify all available content so it is accessible and usable by healthcare professionals. In addition, this research will evaluate how the extent of system integration increases healthcare providers' performance over the long-term. An essential aspect of any research into strategic management systems implementation is the level of adoption the system achieves. Specifically addressing how Web-based interfaces including portals increasing system adoption and lead to lasting change in healthcare organizations is also addressed.

Problem Statement

Healthcare organizations have allowed it systems to flourish without defining an enterprise-wide approach to managing the extensive data they contain. This unorganized and at times chaotic growth has led to inefficiency in patient care (Glaser, 2007). When systems are not integrated as part of a broader enterprise-wide platform strategy, critical processes, some of which are essential in saving patients' lives, are not as efficiently managed as they could potentially be (Simpson, 1995). This lack of system integration on the part of healthcare providers robs them of the ability to gain a complete perspective of their patients and the possible treatment plans to increase the likelihood of recovery (Purbey, Mukherjee, Bhar, 2007) and Noor (2007). The essence of the problem is allowing all forms of content to be fragmented throughout a healthcare organization, not defining a strategic plan for integrating it systems into a single platform that is accessible by healthcare providers contributing in various roles in the organization. The proposed research will examine the correlation between investments in creating a single management systems platform or infrastructure influences healthcare providers' efficiencies on key measures of performance. These key measures include increases in patient satisfaction, increases in preventative healthcare education and its effectiveness on the patient base of healthcare providers, and reductions in patient mortality. In addition, the efficiency of emergency room performance as a result of having an enterprise-wide availability of patient records and content will also be assessed. The efficiencies gained in emergency rooms as a result of enterprise-wide systems integration is also going to be evaluated (Athey, Stern, 2002).

Theory

The greater the integration present in any communication network, the higher the velocity of information sharing is achieved, in addition to the greater the redundancy of information sharing and potential for higher levels of data accuracy and knowledge application. The essence of collaboration within any system, whether manually or automated in implementation, is in enabling these integration points across a network. Over the long-term, the strength and predictive aspects of network-based integration points transform organizations that are operational into organizational structures that learn. The transforming of organizations from being focused only on operational efficiency to learning efficiency is the result of integrating provider or supplier, buyer or customer, and condition or market-based data together into a cohesive and well-integrated network. High levels of integration initially deliver operational benefits that over time turning into creating a network capable of learning.

Taken together, the intent of this research project and its hypotheses are designed to define the dimension between healthcare providers, patients and their needs, and the managing of the broader population. Figure 1 shows the interlocking nature of computer-based health records (C3PRs) supported by knowledge (Research & Development / Education & Training with it/informatics infrastructure), a theoretical construct defined by Berner, Detmer, Simborg (2004) that further supports the contention of integrative networks transforming from operational to learning and knowledge-based performance.

Figure 1: Interlocking Computer-Based Health Records and their use to streamline patient care

Source: (Berner, Detmer, Simborg, 2004)

Literature Review

The rapid advances made in Strategic Management Systems and Information technologies (it) is redefining how healthcare providers diagnose, treat and define long-term treatment plans for patients and how their fundamental businesses are managed. Healthcare providers have often dealt with systems that were isolated and not integrated to one another, making the task of ensuring consistency of processes difficult to accomplish. (McFadden, Stock, Gowen, Cook, 2006). This often led to multiple it systems being developed, often with overlapping requirements, with no enterprise-wide strategic management system plan in place (Stock, McFadden, Owen, 2007). Most critically, the content management systems of many healthcare providers were not integrated with one another (Klein, 2006). Empirical studies suggest that a critical part of any strategic management system is the development of an enterprise content management strategy (ECM) that equips healthcare professionals with the data they need to better serve patients (Matter, 2006). Increasing organizations' effectiveness and ability to be more responsive is directly interrelated to their ability to organize content by taxonomies (Columbus, Murphy, 2002) flexible enough to be used by healthcare professionals on the one hand and structured enough so that other systems can integrate with them (Murphy, 2005).

Studies of enterprise-wide deployments of strategic management systems that are specifically designed to support the multiple roles of healthcare professionals using these systems are orders of magnitude more effective in reducing mortality rates and increasing overall efficiency of the healthcare providers (Athey, Stern, 2002). Accuracy of healthcare records over the patient's stay in the hospital including treatment plans that have been successful, form the foundation of data models that require a high level of system integration between content and information systems throughout any healthcare organization. Healthcare providers attaining the highest levels of performance with regard to their investments in strategic management systems and it concentrate on creating enterprise-wide data and content system integration platforms that have a Web-like user interface for easier use (DeLenardo, 2004). The use of Web-based interfaces at the presentation layer of these enterprise-wide management systems, ECM and patient monitoring systems is having a significantly positive effect on their use and adoption by healthcare professionals (Win, 2006).

As resistance to change is reduced due to the design of Web-based interfaces to align with the needs of healthcare professionals higher levels of collaboration are also achieved (Lazakidou-Kafetzi, Lazakidou, Siassiakos, 2008).

Healthcare providers attaining higher levels of operating efficiencies and attaining higher levels of patient satisfaction as a result have taken the steps to create an enterprise-wide it platform that unifies previously isolated and siloed systems into a single platform. These platforms are often referred to as Service-Oriented Architectures (SOA) and are increasingly relied on by healthcare providers as the basis for their enterprise-wide it platforms or infrastructures (Klein, 2006), (Glaser, 2007). SOA architectures support applications that allow for business processes to be redefined and aligned to the changing needs of patients while also re-designing existing processes, often called Business Process Re-Engineering (BPR). Creating an enterprise-wide information systems platform that is capable of supporting process definition and if necessary, re-engineering, is also leading to greater levels of knowledge being generated in healthcare providers (Sen, Shiel, 2006). Why BPM and BPR have come so critical in healthcare strategic management systems in general and in SOA architectures specifically is due to the fact the healthcare business itself is increasingly being managed by metrics over and above just financial performance. The use of dashboards and scorecards (Slovensky, 2007) to measure the performance of healthcare providers, on everything from patient satisfaction to effectiveness of treatment programs (Conley, et.al, 2008), also favors the development of SOA architectures. Ultimately what these dashboards and scorecards are used for is defining what the existing level of quality is, both from a patient satisfaction (Vinagre, Neves, 2008) as well as an organizational perspective (Caper, 1988). Ultimately the development of an enterprise-wide SOA platform for any healthcare provider gives them the ability to be more responsive to patients, while at the same time evaluating existing processes to determine how effective they are or not. BPM and BPR techniques contribute to making healthcare organizations more effective in serving patients and operating profitably (Manos, Sattler, Alukal, 2006).

Research Design

In evaluating the impact of creating an enterprise-wide information systems architecture or Service-Oriented Architecture (SOA) as it has been described in this paper on healthcare providers' ability to better serve patients and manage their operations more efficiently the following research design will be used. First, secondary data sets that include spending on it by healthcare organizations and the rates of preventative program success and failure, success rates of treatment programs, and mortality rates of patients will all be used to construct a statistical model to evaluate the effects of it investment on these critical areas of healthcare performance. Second, the data will be analyzed using the software application, Statistical Package for the Social Sciences (SPSS) for Windows, Version 13. Statistical measures of correlation of it spending, including controlling for early adoption of SOA platforms, will be entered into the analysis. Finally, the results will be analyzed and recommendations made on specific strategies for attaining higher levels of efficiency in both patient care and operational contexts based on the analysis.

Methodology

Lacking operational system integration that ultimately leads to higher mortality rates from diseases, accidents and HIV / AIDS, hospitals and healthcare centers in counties throughout Arizona in 2000 initiated a comprehensive program to install healthcare systems in hospitals and healthcare centers in Apache, Cochise, Santa Crux, Navaho, and Yuma counties. Maricopa and Pima counties also received upgrades to existing healthcare systems in place. Forty-six hospitals and healthcare centers' five-year spending on it software, hardware, and systems, mortality rates attributable to disease, accidents, and HIV / AIDS is the data set used in the regression analysis. The three hypotheses of this project are as follows:

H1: System integration and SOA architectures have a positive influence on reduction of mortality rates

H2: Unmet needs of hospitals and healthcare providers are more process-based than cost-based

H3: Long-term investments in strategic management systems including SOA architectures are positively related to hospital financial performance

The data set is analyzed using Minitab Version 15 for completing stepwise linear regression, multiple regression and least-squares regression. Bivariate correlations, frequencies and cross-tabulations were completed using SPSS Version 13 for Windows.

Analysis of Results

The catalyst of this study is the evaluation of how processes within healthcare providers can be made more efficient from a process standpoint first, and then through the use of it, more capable of scaling to respond to a greater breadth of patients' unmet needs. The value of any it investment will only be as effective as the processes they automate. When SOA architectures serve as the foundation of BPM and ECM systems, healthcare providers have the flexibility of re-designing processes so they are more responsive and patient-centered. The intent of the three hypotheses of this study is to measure how investments in SOA architectures ultimately positively influence the development of greater treatment strategies for patients, delivering higher levels of treatment success as a result. Ultimately the more patient-centered, efficient and lean the processes are in a healthcare organization, the greater the profitability as well. The three hypotheses of this study cover these specific aspects of how investments in SOA architectures, BPM frameworks and ECM systems are transforming healthcare providers.

The intent of this section is to evaluate each of the hypotheses based on the results of the research completed. Starting with the first hypothesis of system integration and SOA architectures having a positive influence on the reduction of mortality rates due to more efficient patient-based processes being enabled through tighter process and system integration is statistically proven valid from the research completed when a longitudinal data analysis representing five years of investment in software, hardware, and services and then completing a regression analysis yielding statistically significant results. The cumulative investment in Enterprise Content Management (ECM) systems across all categories (systems software, hardware and services) showed the greatest potential to reduce fatalities caused by diseases first and accidents second. Completely unforeseen when this hypothesis was first defined was the effect of system integration and SOA architectures on increasing information and knowledge sharing outside the healthcare providers. In the sample data provided awareness of HIV / AIDS significantly increased as a result of the ECM systems within healthcare providers being more equipped to respond to patients' questions on these diseases. This finding was derived from an analysis of respondents by age groups by their use of the contents of ECM systems throughout healthcare providers. Those in the late teens and twenties were given HIV / AIDS information from their healthcare providers as preventative strategies mentioned by those interviewed during this study. The surprising finding however was the high demand placed on ECM systems by parents of these patients, often requesting the same information in their native languages and in more clinical, defined terms. The use of system integration to capture ECM system-use statistics highlighted how the content regarding HIV / AIDS was of significant interest to the parents of patients in their late teens and twenties. The unmet need of delivering this content in their specific native languages and in more clinical, less popularized or trendy in discussion, was not anticipated. As a result, healthcare providers were able to respond to this information needs of parents in their forties and fifties to educate them as to the preventative measures needed by their children to prevent HIV / AIDS occurrences. Given the data set it was not possible to measure how increasing knowledge over time had contributed to a reduction in HIV / AIDS mortality, yet the regression analyses completed of it spending relative to mortality rates did show significant statistical correlation, as is shown below.

Completing a linear regression of cumulative it spending (in total) to the dependent variable mortality rate due to disease produced the following results shown in the Model Summary table and histogram.

It is significant to point out that integrating ECM and healthcare systems within an SOA architecture does lead to greater distribution of HIV / AIDS information and an increased knowledge of the disease overall. It was unforeseen that the effects of system integration within healthcare providers would actually generate higher levels of information and knowledge demand outside the healthcare organizations as well, in the surrounding communities. The network effect (Setia, Sambamurthy, Closs, 2008) is evident in how quickly the HIV / AIDS data has permeated the community surrounding the healthcare providers who provided data as part of this research effort. The essence of the network effect is that when a greater number of users are participating and contributing and using the content, the greater the ability of the network to match their unmet needs. The following histogram illustrates how tightly the it spending levels align with the reduction in mortality from HIV / AIDS (std. deviation.986) suggesting a high clustering of data.

Further, the strength of the correlation between it spending over time and the reduction of HIV / AIDS mortality suggest that there is a lifecycle that gets created when the network effect begins to nurture information sharing both within and outside a healthcare organization. The integration of healthcare systems, development of ECM and BPM applications and their use to streamline processes within healthcare organizations, synchronized by an SOA platform creates the foundation for the network effect to bring knowledge to not only patients but also surrounding communities.

The network effect created from the integration of systems and the adoption of SOA platform over the long-term also support the second hypothesis. Health care providers are in fact much more process-based relative to cost-based, and when process improvements are found they are quickly transformed into broader network effects, as the AIDS/HIV example shows. The most complex and difficult processes to streamline within any healthcare organization is the diagnosis and treatment of disease. To first define a suitable diagnosis and treatment plan and then execute on it requires tight integration of ECM and patient monitoring systems. There is also the need of supporting non-standard processes that can be applied selectively to assist patients in getting back on their treatment plans, ensuring a high level of success with their prescribed treatments. In addition, system integration across patient monitoring and ECM systems when combined with analytics and enterprise performance management (EPM) give physicians the opportunity to monitor, over time, the progress of their treatment programs. This is a critical step forward in long-term care and alleviating mortalities related to disease. The following statistical analysis of it investment relative to mortality related to disease is shown in the Model.

Note that the correlation coefficient of.682 signifies a high level of statistical significance that over time the level of it spending does in fact drive down disease-related mortality rates. While the reduction in HIV / AIDS is more of a preventative measure of how effective systems integration is, the measure of treatment programs effectiveness is just as significant. In this scenario, the development of treatment programs requires intensively high levels of system integration, requiring the continual use of BPM and EPM-based applications to align treatment programs with the specific needs of the patients. What also emerges from this analysis is that ECM systems organized on an SOA architecture are critical for applying all available knowledge to a given disease diagnosis and treatment plan. While the HIV / AIDS finding shows the effects of system integration on preventative healthcare, the use of SOA architectures and achieving a high level of database integration specifically yields statistically significant results in defining and completing longer-term treatment programs. As a result of the amount of data that needs to be part of any successful diagnosis and treatment program, and given the fact there are many more variables to contend with, there is more dispersion of data throughout the analysis. The following histogram illustrates this point, showing the dispersion of dependent variable data (disease mortality) relative to normalized curve to illustrate the dispersion of data. This histogram also shows that the wider variation in treatment programs is made more manageable through system integration, as the data would be even more widely distributed. A topic for future research is the effect of system integration data velocity, or the speed with which data is applied to specific diagnoses and their implications on the broader effectiveness levels og successful treatment program alleviating mortalities from disease.

From a factor and correlation analysis completed of all data in the study, it was evident that the quickness or speed of response that is made possible with system integration strategies that capitalized on SOA architectures has an immediate impact on reducing accident-related mortalities. SOA architectures that nurture and enable process, then system integration while allowing emergency room technicians to gain a 360 degree view of their patients leads to an immediate reduction in mortality rates of patients. The lack of previous condition knowledge and previous treatment programs is more of a detriment to emergency room technicians and physicians than was previously thought prior to this analysis. The need for treating emergency room patients based on all previous medical history dramatically increases the chances for saving their lives after a potentially fatal accident. Of all mortality-related variables in the analysis, this specific one showed the greatest immediate gain from systems integration and the use of SOA architectures to create enterprise-wide ECM systems that in turn could give emergency room physicians greater insights into which immediate steps to take to save a patient. The following model summary shows a correlation coefficient of.776 further showing how speed of response in conjunction with real-time data on the patients' previous medical history, condition and successful treatment plans makes a significant and immediate effect for healthcare providers.

When the data from accident fatalities are graphed in a histogram relative to regression residuals the dispersion of data is not as significant as the disease-related mortality analysis. However there is still significant variation and insights into how effective systems integration to the content level through ECM apps synchronized on an SOA platform are.

Across each of the specific area of analysis (HIV / AIDS, disease and accidents) each show that lover time investments in SOA architectures when used as the foundation for creating enterprise-wide ECM systems that unify databases across healthcare providers. In addition, the use of dashboards and scorecards is also becoming more prevalent as more healthcare providers manage to a set of metrics or measures of performance. In studying the effects of system integration and SOA adoption on each of the three areas of mortality, it also has become clear that the greater the process complexity, the higher the potential reduction in mortality rates. Additional research is needed to validate an initial finding that overtly complex processes in emergency rooms for example are in fact driving up mortality rates. It is clearly evident from the findings of this study that just the integration of systems to allow for real-time access and queries of previous conditions of patients quickly and dramatically reduces mortality rates over time.

Findings and Discussion

Just as Customer Relationship Management (CRM) systems are based on the concept of ensuring a 360 degree view of customers, healthcare systems must also strive to deliver this level of information on patients to clinicians, nurses, physicians and administrators if process improvements are going to be made. The concentration needs to turn away from the view of the patients as a means for revenue generation and look more at the processes becoming more efficient so that the most important metric of all, mortality, is reduced. Savings lives and making patients' lives more enriched through effective and intelligent healthcare is the most important strategic vision for guiding the integration of healthcare systems using SOA architecture. The highly fragmented set of databases and content management systems, some including structured content, while many include unstructured content from nurse and physician entries, needs to be pulled together into a single enterprise-wide system, and this is only possible with an SOA platform.

From the results of the analysis it is clear that when investments in SOA architectures are taken from a longitudinal perspective, investing in integration does have a significant impact on the reduction in fatalities based on disease, accidents and HIV / AIDS. As the regression analyses illustrate there is a statistically significant relationship between it system integration spending when taken as a longitudinal factor, relative to mortality rates from disease, accidents and HIV / AIDS.