E health system design
- 1. E-Health is the combined use of electronic communication and information technology in the health sector. Countries around the world are adopting eHealth to improve health care delivery and planning. The drivers for eHealth investments and adoption are based on providing clinical value and supporting business needs. The business strategy and a number of business objectives and initiatives which can be enabled by eHealth. The heart of all eHealth Strategies is a focus on Patient centric care, as shown in the following diagram. The following sections of this document will describe the significant benefits that will be provided to Patients, Providers (Doctors Nurses and other health care professionals), and Health System Managers. Today’s Healthcare delivery is characterized by islands of non-sharable patient data. The eHealth Strategy is designed to support making comprehensive patient management a reality in the world. A large-scale eHealth project consists of several involved institutions. Every institution included in such a project has its own agenda and goal. This goal is not necessarily
- 2. equivalent with the success of implementing a large-scale eHealth project in time and in budget. Long established institutions tend to fear that they risk losing influence and power if they are not able to increase and state their importance and needs in a large project. EHealth projects in particular contain a lot of institutions with longstanding traditions (e.g. general practitioners or hospitals) and every one of them wants their fair share of influence. influence. Even though this is hard to achieve – it might be advisable to give the institutions the impression, that their goals and requirements are the most important ones. The final system needs to combine requirements from all participating institutions. To make that happen, the project initiators need to know which institutions are involved and what their respective agenda is. You should bring their goals to the table and start a solution finding when it is defined which institutions will participate. The results of this process should give the political level the opportunity to compare the benefits and costs of the various options resulting from the institutions’ requirements/wishes/necessities. It is important to remember, that the duration of the solution finding process increases with the amount of involved institutions and the nature of their respective goals. It might be a good starting point to initially align goals between the institutions. Another issue might be the public perception on this process. Some institutions might misuse the general opinion of citizens for their agendas. e.g. a institution may spread fears among people by releasing only parts of the results of the discussion process. These may be avoided by providing transparency throughout every institution and the general population . The above stated aspects can be summarized into the following important points of the
- 3. institutional level: Identify Institutions: Which institutions are involved and what agenda or goal do they have? Describing benefit: What is the benefit for the system for the institutions? Solution process: The goals of every institution should be discussed with them. The requirements of the solution finding process should be taken into consideration by the political level. System acceptance: among the institutions there are different stages of acceptance. Some of them will like the system and some will not like it at all. You have to determine why acceptance among some groups is low and try to increase it. Usually a large-scale eHealth project consists of many stakeholders/roles from various institutions with different sights. Because of the uniqueness of every large scale eHealth project the institutions and the involved roles will not always be the same but a few of these institutions will be part of nearly every large-scale eHealth project: Primary and secondary healthcare centres: These healthcare centres represent institutions, which are responsible for delivering the initial care in most countries. They might be users or promoters of a large-scale eHealth system. The centres are essential for promoting and increasing acceptance among citizens, because they are the first or even the single point of contact in terms of healthcare. Health Insurances: depending on the national healthcare funding, public or private health insurances play major roles in budgeting and funding of healthcare services. Hospitals: hospitals consist of multiple user groups which potentially will access the final system. Pharmacies: a pharmacy is a user of a eHealth system or a promoter for it. Nursing and Nursing homes: After-hospital-care is often offered by nursing services or
- 4. nursing homes. Even if immediate patient referral is usual, data of patients are seldom taken from one institution to the other. Integrated care will have to be considered on supporting IT systems. Patients: the patient delivers data to an eHealth system or uses it. Patients are very heterogeneously distributed and therefore it is difficult to find the appropriate solution. The project maintains two levels of users:- • Administrator Level-Doctor • User Level-Data Entry Operator Main facilities available in this project are:- • Maintaining records of indoor/outdoor patients. • Maintaining patients diagnosis details, advised tests to be done. • Providing different test facilities to a doctor for diagnosis of patients. X-Ray Urine Test Stool Test Sonography Test Gastroscopy Test Colonoscopy Test Blood Test Biochemistry Test • Maintaining patient’s injection entry records. • Maintaining patient’s prescription, medicine and diet advice details. • Providing billing details for indoor/outdoor patients. • Maintaining backup of data as per user requirements (between mentioned dates). • If user forgets his/her password then it can be retrieved by hint question. • In this project collection of data is from different pathology labs. • Results of tests, prescription, precautions and diet advice will be automatically updated in the database. • Related test reports, patient details report, prescription and billing reports can be generated as per user requirements. • User or Administrator can search a patient’s record by his/her name or their registration date.
- 5. Fig : DFD (Level 0)
- 6. Fig : DFD (Level 1)
- 7. Fig : DFD (Level 2) Fig : DFD (Level 3)
- 8. Fig : Entity Relationship(ER) Diagram
- 9. There are shown 3 tables from total 17 table designs of the Entity Relation (ER) Diagram.
- 10. The introduction of large eHealth systems cannot be done in a day. Before approaching such a project, the participating parties need to define common goals and draft an approach of how they are going to achieve these goals. When this is done the planning and implementation of the project can begin. During this phase many discussions with representatives from the affected population will happen. Each of these groups will have certain reasons either for or against this project and won’t hesitate to mobilize a public movement to support their claim. Therefore it is essential that these discussions are handled correctly. Every new large eHealth project has unique problems and goals which need to be included in the design process throughout the whole process from the project start to the project end. Table 1 summarizes the aforementioned design criteria, which can be used to reduce risks, increase acceptance and give guidance from the political to the technical level of a large scale eHealth project. Naturally the mentioned design criteria can be enhanced with project specific design criteria, e.g. on the operational level rollout mechanisms, program or project management, maintenance and operation aspects and can be seen as flexible starting point to categorize typical large scale eHealth infrastructure projects.