What BPM Technology Can Do for Healthcare Process Support

Healthcare organizations are facing the challenge of delivering personalized services to their patients in a cost-effective and efficient manner. This, in turn, requires advanced IT support for healthcare processes covering both organizational procedures and knowledge-intensive, dynamic treatment processes. Nowadays, required agility is often hindered by a lack of flexibility in hospital information systems. To overcome this inflexibility a new generation of information systems, denoted as process-aware information systems (PAISs), has emerged. In contrast to data- and function-centered information systems, a PAIS separates process logic from application code and thus provides an additional architectural layer. However, the introduction of process-aware hospital information systems must neither result in rigidity nor restrict staff members in their daily work. This keynote presentation reflects on recent developments from the business process management (BPM) domain, which enable process adaptation, process flexibility, and process evolution. These key features will be illustrated along existing BPM frameworks. Altogether, emerging BPM methods, concepts and technologies will contribute to further enhance IT support for healthcare processes

Somatic surveillance: corporeal control through information networks

Somatic surveillance is the increasingly invasive technological monitoring of and intervention into body functions. Within this type of surveillance regime, bodies are recast as nodes on vast information networks, enabling corporeal control through remote network commands, automated responses, or self-management practices. In this paper, we investigate three developments in somatic surveillance: nanotechnology systems for soldiers on the battlefield, commercial body-monitoring systems for health purposes, and radio-frequency identification (RFID) implants for identification of hospital patients. The argument is that in present and projected forms, somatic surveillance systems abstract bodies and physiological systems from social contexts, facilitating hyper-individualized control and the commodification of life functions

Islamic Perspective in E-Service Quality-based Knowledge Sharing on Islamic Hospital Employee Performance Improvement

Technological developments now greatly affect the activities of health organizations and are expected to encourage better hospital performance. One of the efforts that can be made to increase employee knowledge related to technological developments is through knowledge sharing. Measuring the quality of hospital management information systems from the user’s point of view using the e-service quality method. The study aims to determine the effect of knowledge sharing and e-service quality information systems on employee performance in Islamic hospitals that have followed global budget rules in West Java. This research uses a quantitative method with a causal research type. Information is collected directly from the field to find out the opinion of the respondents on the object being studied. The researchers used judgment sampling with the number of samples obtained using the Bernoulli method with an error of 5% so that the minimum number of respondents was 128. The research data were obtained through the results of interviews and questionnaires. The data were processed, analyzed, and then conclusions were drawn using the cross-sectional method. The results of the analysis show that both knowledge sharing and e-service quality are in good category and employee performance is in the very good category. The variables of knowledge sharing and e-service quality both partially and simultaneously have a positive and significant effect on employee performance with a moderate effect. Keywords: e-service quality, employee performance, Islamic hospital, knowledge sharin

PROBLEMS AND CHANCES AT THE INTERFACE BETWEEN HOSPITAL CARE AND GERIATRIC REHABILITATION

Available statistical data offer valuable information on recent demographic changes and developments within European healthcare and welfare systems. The demographic evolution is expected to have considerable impact upon various, major aspects of the economic and social life in all European countries. The healthcare system plays an important role especially in the context of ageing societies, such as Germany. This paper focuses on the evolution of the prevention or rehabilitation service sector during the last years in Germany, analyzes the specific characteristics of the elderly patients being cared for in these facilities and underlines important aspects at the interface between (acute) hospital and geriatric rehabilitative care. Networking, integrated care services and models will be of even greater importance in the future demographic setting generating (most probably) increasing numbers and percentages of elderly, multimorbid hospitalized patients. More than this, the cooperation at regional level between acute geriatric hospital departments and geriatric rehabilitation facilities has become a mandatory quality criterion in the Free State of Bavaria. This paper presents and analyzes issues referring to a precise cooperation model (between acute and rehabilitative care) recommended for implementation even by the Free State of Bavaria while emphasizing several examples of good practice that have guaranteed the success of this cooperation model. The analysis of the main causes leading to longer length of stay (and thus "delayed discharges") for the elderly patients transferred to geriatric rehabilitation facilities within the reference model for acute-rehabilitative care provides important information and points at the existing potential for optimization in the acute hospital setting. Vicinity, tight communication and cooperation, early screening, implementation of standard procedures and case management are some of the activities that have contributed considerably to the improvement of the hospital length of stay and transfer management for elderly patients benefiting from (follow-up) inpatient geriatric rehabilitation services. The presented facts are important not only for the German health setting.acute-rehabilitative care interface, demographic impact, process optimization, care networking, geriatric patients

From embracing to managing risks

OBJECTIVE: To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services. SETTING: Four acute National Health Service hospitals in England. PARTICIPANTS: 111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff. RESULTS: There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff. CONCLUSIONS: The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices

Structuring and coding in health care records: a qualitative analysis using diabetes as a case study

Background: Globally, diabetes mellitus presents a substantial burden to individuals and healthcare systems. Structuring and/or coding of medical records underpin attempts to improve information sharing and searching, potentially bringing clinical and secondary uses benefits. Aims and objectives: We investigated if, how and why records for adults with diabetes were structured and/or coded, and explored stakeholders’ perceptions of current practice. Methods: We carried out a qualitative, theoretically-informed case study of documenting healthcare information for diabetes patients in family practice and hospital settings, using semi-structured interviews, observations, systems demonstrations and documentary data. Results: We conducted 22 interviews and four on-site observations, and reviewed 25 documents. For secondary uses – research, audit, public health and service planning – the benefits of highly structured and coded diabetes data were clearly articulated. Reported clinical benefits in terms of managing and monitoring diabetes, and perhaps encouraging patient self-management, were modest. We observed marked differences in levels of record structuring and/or coding between settings, and found little evidence that these data were being exploited to improve information sharing between them. Conclusions: Using high levels of data structuring and coding in medical records for diabetes patients has potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK

Implementing social health insurance in Ireland: Report of a meeting and workshop held in Dublin, on December 6th 2010

We considered two basic questions, 'Is it possible to implement Social Health Insurance in Ireland?', and 'How can this be done?'. Can Social Health Insurance be implemented in Ireland? Our answer is a very definite yes. Furthermore, there would be many opportunities, while working towards this end, to improve the performance of our health care system. How can it be implemented? This process will need to be actively managed. There are many difficulties in the Irish health services, but also many opportunities. The greatest strengths are the talented, well-trained and very committed staff. Getting and keeping the support of these staff, for the necessary changes in service delivery, will be critical. Ireland has the capacity to make these changes, but without high quality management, a detailed focussed plan for change, and political support, little will happen. Each step in the change needs to be planned to maintain services, improve service delivery, improve service accountability, and improve service governance. Each sector of the service will need someone to lead the change, and mind that service during the change. Primary care remains under-developed. The HSE plan to develop primary care teams (PCT) has not succeeded. There are several established PCTs which work well. In other areas there are informal arrangements for collaboration, which work well. Overall, there are many useful lessons to learn from the experience so far. Future developments will need to place general practice at the centre of primary care. The mechanisms for doing this will vary from place to place, but need to be developed urgently. Acute hospitals face a crisis of governance. Maurice Hayes' (1) recent report on Tallaght hospital gives an idea of the scale of the changes needed. Tallaght is, we believe, not atypical, and is reputed to be by no means the worst governed hospital in the system. This, alone, should provide a pressing motive for change. Redesigning Irish hospitals to a new mission of supporting primary care, of supporting care in the community where possible can, and must, be done. Long-term care for older people is also a challenge. We advise moving to an integrated needs based system with smooth transitions between different degrees of support at home, and different degrees of support in specialized housing facilities including nursing homes. A similar model should apply to other forms of long-term care, for example for people with a substantial disability. Information systems and management processes both need a major overhaul. The health service remains strikingly under-managed, and fixing this will need a substantial culture change within the services. Wide use of standardized formal project management processes will be vital. There is a separate plan being developed to improve health service IT systems, and implementing this needs to be a high priority. We have not considered other key sectors, for example mental health, disability services, and social services. This does not mean that these are unimportant, merely that we had limited time, and a great deal to cover

Developments in hospital management: a proposal for a new hospital management model for Malta

The management of hospitals has changed considerably over the last two decades. The business processes and patient treatment regimes are unrecognisable from those of ten years ago. Health care in general faces unprecedented challenges internationally as the demand for more medical treatment and services increases together with a parallel emphasis on quality and cost containment1. Furthermore external factors such as the 'greying' population and growing patients' expectations increase the burden upon hospital management and staff to provide a quality hospital service. Hospitals are expensive enterprises. Huge investments go into the construction and equipping of hospitals. In the UK the cost of building a hospital is £1000 /square metre2, whilst in Malta new construction costs around Lm430 /square metre. Medical equipment accounts for an additional 20%. Furthermore hospitals invariably take the lion's share of health care expenditure, averaging around 8% of GDP in Western Europe3 . It is therefore incumbent upon the authorities to ensure that the populace gets an appropriate return on its investment. This paper reviews developments in hospital care and management, including the increasing importance of focusing care and management decisions around the patient. It will explore the role clinicians should play in management, itself still a topic of controversy. The role of information technology and its indissoluble link with the proper administration of resources will also be critically appraised. These will be reviewed in the local context where a model for the future management of Malta's hospitals is proposed.peer-reviewe