Enterprise Information Architecture Framework For Electronic Health Record Implementation

Importance of Electronic Health Records in Healthcare

The information system has been advanced and this enables the people to access the relevant information regarding the various services through the use of internet. The government has realized the importance of the information technology in providing the services. In order to provide better services there are certain steps like innovation of e-governance has been implemented. The information technology has also been used by the government in monitoring the system. One of those uses is the initiation of the ‘Health Information Technology for Economic and Clinical Health Act, 2009’. According to this act, all the health providers are needed to maintain the electronic heath record. Maintaining the electronic health record will provide data integration and will able to share the record among the other providers, if it is necessary (Wang et al. 2016). The goal is to implement the system within 2014. It can be said that this type of initiative will be beneficial for many people.

Enterprise Information Architecture (EIA) is a framework which will provide the systematic process to design the implementation of the Electronic Health Record (EIA). The EIA framework helps to provide the methods and the designing pattern which can be suitable for the implementation along with that , it also provides risk assessments for the design. 

There are various EIA models. Some of these ares-

• Zachman architecture model
• Federal Enterprise architecture model
• The open group model
• Department of defense architecture model.

Zachman model include six row and five columns and various ideas. It can be a solution for the elimination of interoperability problem, which is a desirable attribute of the electronic health record. The main advantage of this model is that it describes ‘enterprise business requirements’ in the field of information technology (Iyamu 2018). The main disadvantage of this model is that no procedure is followed in the case of architectural model. In case of the federal enterprise architecture model it clearly defines the organization’s mission and vision. However, this model does not provide any template for the framework. Open group model is effective for the modification of already existing model.

The main advantage of the electronic health record is that the records can be accessed from any place and the user of the record can share the details with other health providers if it is necessary (health. 2018). The main advantages of the ‘Health Information Technology’ are-

• Data integration:The main advantage of maintaining the health record system is the data integration. The health care provider records all the data regarding a patient (Nguyen, Bellucci and Nguyen 2014). In case, for further use all the past medical records of that user can be available from the health record. In case if the user forgets about some details about his or her past medical case history, those can also be retrieving from the health record. Finally, the records are stored electronically, so those records cannot be misplaced.
• Reduction of cost: Another advantage of EIA for implementation of the ‘Health Information Technology’ is the reduction of cost. The initial implementation of the electronic health record using EIA framework may take a good amount of capital (Singh 2018). However, after the implementation of the system, it will deliver its purpose in a cost effective way.
• Elimination of e-Health interoperability:Interoperabilityin general is the understanding between the two working systems. It refers that a system is performing for another system. Interoperability takes place at three different levels- process, service and data.  The adaptation of the EIA framework in developing the electronic health information system will develop a way for elimination of the e-Health interoperability. This will result better information flow in the health care sector. 

At conceptual level the electronic health record is similar to the health record. In case of health record, the details of the user are recorded manually. In case of electronic health record the user details are stored electronically in the system. There are various models for developing the EIA.  The main goal of developing the proposed framework is that it will eliminate the disadvantage of Zachman model. 

Initiatives taken by the Government for implementing Electronic Health Records

In the figure 1 the proposed framework for developing the proposed electronic health care information system has been given. The health information system has to serve covering two fields-

• Information System for the care of patient: This domain will include all the necessary information about the patients which contains the current health status of the patients and the past and present medical checkups of the patients. This section also includes other clinical details like the name of the prescribed medicines to the patient. One of the sub domain of this domain is patient management system. Patient management system keeps the important information regarding the patient, from where the record of the patients can be shared within the other health care service provider if it is needed. The clinical information system to connect to the database regarding the patient information. Relevant patient information is mapped into the electronic health record.
• Managerial information system:This domain holds the data regarding the differentmedical policies of the patient. The managerial information system can be accessed by the user and the health officials.

Data Domain is the master data storage, controlled centrally. The main aim of the framework is to provide the right information to the patient and the government bodies at right time. Information integration is achieved by ‘Service Oriented Enterprise Information Integration’. 

Information management and data integration is important for the understanding of the system. This section describes the different component of the health care information system. 

From the functionality perspective there are components of the healthcare service which serves the following purpose:

• Departmental management
• Patient management and billing
• Clinical documentation and the care delivery
• Financial support
• Resource management
• Billing and the patient management

This section generally deals with the patient management functions such as identification of the patients, keeping the record of registration, admission history and billing. The billing task was proposed to be automated. The hospitals uses ‘master patient index’ to store the information about patients and the basic data regarding the demography which are supported by the data base of health care information system. The ‘master patient index’ helps to integrate between hospital’s enterprise master patient index and the database of the healthcare information system.

Registration data serves as the basic billing information in the health care information system. In case if any other service such as – laboratory, medicine then, in that case the patient identification number serves as the reference. All the data are stored at the centralized data base and without the authorized ID the data cannot be accessed (Andersen et al. 2017). The duplicate copy of the database is created for the use for the hospital authorities. The fetching of the data regarding the registration can generate other activities such as retrieval of the medical records associated with the registration number (Vargas et al. 2016). This information also serves as a basic information during the billing system. In this way the registration data of the patient is associated with billing process.

This section of the health care information system also deals with the scheduling issues. The scheduling in the health care process is a complex function, as the functioning of the hospital can vary day by day and if a patient wants to admit in the hospital, the scheduling is needed to be done in a strategic manner. Another challenging thing is resource management. The resources in this case are the services which the patient can avail. In order to track the progress of the patient the patient tracking application is formulated in this section.

Overview of Enterprise Information Architecture Framework (EIA)

This section serves the information which is necessary for the individual clinical needs in the health care information system. This information contains the details about automatically generated pathological report, blood bank and radiology reports. There are two purpose of the section in the health care information system. Ancillary systems do many specified task which are essential for the departmental operation (Farooq et al. 2015).Secondly, the ancillary system produces the online billing and the online patient record which can be accessed by the patient. The medical report can be accessed by the health care provider online by knowing the registration ID of the patient along with the authorized access code of the hospital.

The care delivery and the clinical documentation system is the section which deals with the after service care of the patient. This section has two major functions- result reporting and the order entry. The health experts can communicate with the ancillary department through this section (Singh 2018). The automated elimination of the misplaced slips and the determination of the transcript errors can be eliminated in this section through regular update. All the information regarding the patient along with the data from the ancillary department is available in this section (Weaver et al. 2016). The data in this section of the health care information system is available online to the other health care providers and the health care experts. A detailed clinical report contains the clinical data along with the other various data which are collected by the heath experts after asking the questions to the patients.  In case, if a patient is admitted to the hospital, the clinical data can be made available from this section of the health care information system. 

This section deals with the decisions those can be taken on evaluation of the medical data of a patient. In order to give the advice and the strategic decision, clinical decision making section of the health care information system has to fetch the required data from the other sections of the health care information system (Yuehong et al. 2016). In the fetching of the data from the other section, the registration ID of the patient works as a reference. ‘Physician Order Entry’ is the sub section of this section which reminds the physicians about the drug and the food allergies of the patient (Rosenbaum et al.2017). This can help the physicians to determine the right medicine for the patient which will cause no harm.

Various EIA models for Electronic Health Record implementation

This section deals with the well processed data structure. This section is connected to the resource billing. The main purpose of this section is to inform the patient about the current balance and the status of their medical policies. Through this section the patient can pay the bills to the health care service providers through electronic data interchange (Jonkers and Quartel 2016). Some of the security measures have been taken in this in order to prevent the fraud (Degoulet,  Luna and de Quiros 2017). The transaction of the money depends on the total bill of the patient. In order to calculate the billing amount the raw data is fetched from the billing section. In this section also the registration number of the patient serves as the reference. This section also deals with the third party such as involvement and the payment made by the insurance company.

There are several challenges associated with the data management and the integration in the health care information system. Some of these challenges are-

• Security:The data processed and transferred in the health care information system is sensitive and the confidential. It is desirable that the data regarding the patient can be available particularly to the patient and the associated heath care provider. The data can be shared among the other health care provider if it is needed. In this case the sharing of the information should be done with the permission of the patient and the associated health care provider. Another security issue arises during the transaction. The transaction needs to be secured.
• Flexibility and availability: The system should be flexible enough to adopt nay change in the process and the data. The inter-functionality of the sections in the health care information system is needed to be accurate and flexible. The system needed to be available to both the health care provider and the patient.
• Managing of the data:The main purpose of the health care information system is to manage the health care related data efficiently. This purpose is needed to be served effectively.

Implementation for overcoming the challenges regarding the security has been done through the implementation of certain network and securityprotocols. All the transactions which are made in the system are needed to maintain the protocols. This will prevent the unauthorized access to the system. Moreover, the user registration number plays an important role for allowing the authorized user to use the system.In order to made the server available to the user for o all the, a dedicated server is needed to be implemented (Romero and Vernadat 2016). The system framework is designed in such a way that it can adopt ant changes in the process.In order to manage the data the SQL server is used. There are separate data bases. One is centralized data base which contains all the data. Another data base holds the data which can be accessed by the users. This helps to reduce the risk of data deletion.

Conclusion

It can be concluded from the above discussion that proper implementation of the EIA can help to develop a robust system, which will help the health care provider to record the details about the patients. There are certain models through which the EIA can be developed. However, the proposedframework has tried to reduce the drawbacks of and the models and has proposed a system that will serve the purpose of the health care information system. There are certain challenges associated with this framework. Theses challenges will be taken into concern during the development of the system. It can be said that the proposed system will be helpful for the implementation of the health care information system.

Certain recommendations can be proposed regarding system-

• The graphical user interface of the system needs to be user friendly.
• A dedicated support team should be available in case if the system does not work properly.
• The health care provider and the patient should be made aware of the importance of using this system.
• The selection of the methodology in EIA for the implementation should be done wisely.  

Andersen, S.B., Rasmussen, C.K. and Frøkjær, E., 2017, July. Bringing content understanding into usability testing in complex application domains—a case study in eHealth. In International Conference of Design, User Experience, and Usability (pp. 327-341). Springer, Cham.

Degoulet, P., Luna, D. and de Quiros, F.G.B., 2017. Clinical Information Systems. In GlobalHealth Informatics (pp. 129-151).

Farooq, F., Rosales, R.E., Yu, S., Krishnapuram, B. and Rao, B.R., Siemens Medical Solutions USA Inc, 2015. Healthcare information technology system for predicting or preventing readmissions. U.S. Patent 8,949,082.

health. (2018). Healthit.gov. Retrieved 16 April 2018, from https://www.healthit.gov/sites/default/files/hitech_act_excerpt_from_arra_with_index.pdf#%5B%7

Iyamu, T., 2018. Implementation of the enterprise architecture through the Zachman Framework. Journal of Systems and Information Technology, 20(1), pp.2-18.

Jonkers, H. and Quartel, D.A., 2016, June. Enterprise Architecture-Based Risk and Security Modelling and Analysis. In International Workshop on Graphical Models for Security(pp. 94-101). Springer, Cham.

Nguyen, L., Bellucci, E. and Nguyen, L.T., 2014. Electronic health records implementation: an evaluation of information system impact and contingency factors. International journal of medical informatics, 83(11), pp.779-796

Romero, D. and Vernadat, F., 2016. Enterprise information systems state of the art: Past, present and future trends. Computers in Industry, 79, pp.3-13.

Rosenbaum, S.E., Moberg, J., Glenton, C., Schünemann, H.J., Lewin, S., Akl, E., Mustafa, R.A., Morelli, A., Vogel, J.P., Alonso?Coello, P. and Rada, G., 2017. Developing Evidence to Decision Frameworks and an Interactive Evidence to Decision Tool for Making and Using Decisions and Recommendations in Health Care. Global Challenges

Singh, N., 2018. Strategic Operating Model for Enterprise Architecture.

Singh, N., 2018. Strategic Operating Model for Enterprise Architecture.

Vargas, A., Cuenca, L., Boza, A., Sacala, I. and Moisescu, M., 2016. Towards the development of the framework for inter sensing enterprise architecture. Journal of Intelligent Manufacturing, 27(1), pp.55-72.

Vogel, L.H., 2014. Management of information in health care organizations. In Biomedical Informatics (pp. 443-474). Springer, London.

Wang, J.W., Wang, H.F., Ding, J.L., Furuta, K., Kanno, T., Ip, W.H. and Zhang, W.J., 2016. On domain modelling of the service system with its application to enterprise information systems. Enterprise Information Systems, 10(1), pp.1-16.

Weaver, C.A., Ball, M.J., Kim, G.R. and Kiel, J.M., 2016. Healthcare information management systems. Cham: Springer International Publishing.

Yuehong, Y.I.N., Zeng, Y., Chen, X. and Fan, Y., 2016. The internet of things in healthcare: An overview. Journal of Industrial Information Integration, 1, pp.3-13.