IJN and Enterprise Architecture for better patient care

By Aaron Tan Dani

In Malaysia, not many healthcare institutions give much thought to incorporating information technology (IT) into the process of patient care.

Consultant Anaesthesiologist & the Health Information Management Committee’s Chairman at Institut Jantung Negara (IJN), Dr. Ariffin Marzuki Mokhtar, described the local healthcare IT scenario as currently being in a ‘trough of disillusionment,’ a Gartner term to describe when interest in a trend wanes as experiments and implementations fail to deliver.

Dr. Ariffin


 “Hospitals and healthcare givers would use IT for lifestyle and education. But when it comes to work, IT is too expensive and hospitals can’t get any meaningful use out of it. IT is not working,” Dr. Ariffin who is also a Certified Professional in Health Information and Management Systems (CPHIMS) further opined.

 The responsibility of providing clinical care to patients is topmost in most health professionals’ minds, but according to the good doctor, the Ministry of Health (MOH) under a new Director General, is now seriously looking at health information management (HIMS) to improve quality of care. Dr. Ariffin said, “I am really for (using HIMS to improve quality of care). I really feel IT should be incorporated and leveraged for work in patient care, and not just be a back office function. And instead of as a concept of something that you use like a tool, IT should be part of the process of taking care of the patient.

“That’s what I’m trying to do now – change mindsets that IT should be leveraged more to deliver Quality Care to our patients.”

 In fact, IJN’s previous mindset about IT had actually raised flags that something had to be done. Dr. Ariffin said, “IJN’s old medical records department (now HIMS) is separate from our old IT department (now MIS).

Each were looking for ways to use automation; HIMS wanting to automate reporting and document management while MIS wanting to automate processes. “It took a few years to sync the functions for both departments, but both their objectives actually amount to the same thing!” said Dr. Ariffin.

Quality and proof 
 IJN adheres to strict standards set by the Malaysian Society of Quality in Healthcare (MSQH) and the Joint Commission International (JCI).

 Dr. Ariffin said, “MSQH makes sure that hospitals in Malaysia proactively pursue quality in healthcare, and a patient centric approach to healthcare delivery, otherwise hospitals would not receive accreditation.” IJN also achieved JCI accreditation in 2009 and he described it as a global body that accredits health organisations, with a worldwide standard that gives a structured view of how to run a hospital.

“JCI stresses that to achieve quality you have to manage data, and make decisions based on good quality data and information. They have even dedicated one whole standard for this called the Management of Communications and Information (MCI).”

This standard looks at how IT is integrated into business or when translated to hospitals, clinical care, how to gather data from clinical care and the processes it takes to transform IT so there is meaningful information that the business can actually use to improve quality.

“If you can’t prove quality, how can you say you deliver it? Information management is the evidence for it,” stressed Dr. Ariffin. 

 No escaping enterprise architecture
“MCI is a requirement for us to satisfy. And TOGAF is the framework for how to implement Enterprise Architecture in an organisation.”

For Dr. Ariffin, what an IT architect does is see how to link business to IT, so that IT can cater for the business. When translated to hospitals, its business needs are quality of care provided to patients.

The doctor explained, “What I have done is link or extrapolate EA, TOGAF, COBIT5 (IT governance) and whatever I have learnt from IASA (IT Architect Professional Body), into clinical care. “I’m putting all standards together so we can implement enterprise architecture into this hospital to achieve quality care.”

He also opined that what IASA does is give a scope that IJN can actually use. “The scope is not tied to any industry. Banking, manufacturing and retail use it, and I see no reason why it cannot be translated to medicine.

“A hospital is run like any other business. And the core business is patient care. We can’t standardise this in Malaysia before, because every hospital in Malaysia actually have their own way of doing things.

But with the MSQH and JCI, now there is a basis for standardisation, meaning patient care can be segmented into parts that can be modeled. “TOGAF and EA are actually the foundation to manage information and satisfy quality as required by JCI,” said Dr. Ariffin.

It is difficult for healthcare professionals to think beyond treating patients and keeping them in the pink of health. But, in countries like the US and Singapore, there is a strong movement to leverage IT in hospitals.

“Unfortunately, we are lagging behind. We are not really going with the trend for the time being,” he also expressed. But this isn’t stopping Dr. Ariffin and his team of 20 HIMS, MIS and clinical care personnel, from starting to implement enterprise architecture at IJN, with target to complete by 2020.

The top management support in IJN is good as a Board-level Information System Committee has been formed and a transformation management office is also in the pipeline, by January 2014.

“The challenge would be in formalising the processes which is the basis for a Business Architecture. Then we can start the change management which is going to be a very big endeavour,” Dr. Ariffin said.

But at the end of the day, the point of all this is to deliver value, to the doctors and nurses at IJN, as well as to the thousands of patients who are under their care, at any one time.

 

 

AUTHOR BIO: Aaron Tan Dani is founder and chairman of IASA Asia Pacific, co-author of the IT Architecture Body of Knowledge (ITABoK) and chief architect of ATD Solution group of companies (Malaysia, Singapore, Hong Kong, Indonesia and Australia).

Aaron Tan Dani’s keen passion and selflessness to contribute sees him actively involved in setting up and leading IASA Chapters across the Asia Pacific countries. His close connection with industry leaders and government bodies in the respective APAC countries also gives him the edge and keeps him up to date with the latest technologies’ landscape

 




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