Affect the hospital import the key factors of data warehousing - A Case Study of a medical center The Critical Factors Affecting Hospital Data Warehouse Adoption: A
Case Study of Medical Center in Central Taiwan Happy b Zhonghui Qi Zhang c a Shih-Jung Hsiao
a China Medical University Hospital, b Peikang information management c National Chung Cheng University National Chung
Cheng University medical information management
mm.chang @ msa.hinet.net
Summary
With the development of information technology and the advent of global competition, companies have started to use data warehousing to enhance
organizational competitiveness, "Data Warehousing" by the major companies are greatly concerned about the, but the overview of data warehouse system build national key factor in the study medical institutions have not been found to import data storage of relevant studies.
In this study, a medical center as the object of case study approach, executives and IT personnel for the depth interview, the purpose of influencing the medical institutions in the data warehouse into the key factors, and understand the import of management and technical face on the issue. Study found that hospitals initially establishing the data warehouse is the main factor in order to "target management." The results summarized 11 affected hospitals to import the key factors in data warehousing, including special attention to health care institutions,
"sources of information systems quality", because its sources of information may come from HIS or other independent systems, the complexity of the usual sources of information enterprises high. Furthermore, "data privacy and security" is not there in the last study the dimensions, nothing more than explore the reasons for the medical industry, particularly the emphasis on patient privacy issues. With
results of this study can provide hospital managers as a data warehouse system planning, design and build a reference.
Keywords: data warehouse system, health care management, information technology
Abstract
More and more enterprises begin using data warehouse (DW) to promote competitive advantage.
Researchers also turn to this subject area. However, most of the studies are in manufacturing industry and service industry. None was found in healthcare industry. This study used case study to explore the critical factors of adopting DW in healthcare industry.
The subject of this research is a medical center in the central Taiwan. In-depth interviewing was used to collect the first hand information. Through interviewing with high level managers in the subject hospital, it is known that the motivation of adopting DW is to provide "Indicators management" for government policy. The results of this research generalize eleven critical factors. The quality of information resource is emphasized especially, because their resource come from HIS and other systems, that's more complex than other enterprises. "Privacy and Security" was added which is a important the concern of medical industry. The results of this research can be used as references of DW planning, designing, and building for managers in hospitals.
Keywords: Data warehouse system, health care organization administration,Information technology
1. Introduction
Gradually into the aging population, makes people growing demand for medical care; with the medical needs of the increasing force to constantly adjust NHI medical payment system, in order to finance the balance. Health care policy change resulted in tremendous cost pressure faced by hospitals, and the total budget and self-management, or even about the implementation of the hospitals under the influence of Excellence plan, making health care institutions face unprecedented challenges.
Many studies that use information technology to improve organizational
performance has a positive benefit to [Huang Shaofu, 19994, Huangsheng Chong,2001
5, Hwang et al., 2004 18], therefore, the hospital uses information technology to reduce medical costs and improve health care service quality and enhance efficiency and performance, will be without delay [Huangshao Fu, 1999] 4. As businesses began to use data warehouse to enhance organizational competitiveness, "data
warehouse" by the major companies are greatly concerned about the. Yet
looking at national data warehouse system implementation of the key factors, there are many manufacturing and service sectors [Zeng Shimin, 20033, Guo Jiawei,
20027], and medical institutions have not yet been found to affect the import of
factors of data warehousing research.
This research literature and interviews with experts in order to establish the research framework and a case study, the hospital executives and IT executives in interviews, to achieve the following four purposes: First, import the data
warehouse and medications The motive and purpose; to explore the hospital to import data warehouse, organizations face the issue of management and technical; 3, looking into medical institutions influence the key factors in data warehousing; four different industries have to import more data warehouse the key factor.
This study will examine the impact of the key factors in data warehousing conclusion, the provision of hospital managers as a data warehouse system planning, design and build a reference, Yihuo up information system of learn.
2. Literature
Data Warehousing and from the 60's, the United States to study the econometric MIT invented the multi-type module (Multidimensional Modeling) [Sudi, 1998] 9.
The father of data warehouse Inmon [1990] 19first define the data warehouse in the name of the definition of data warehouse for the collection of information, their identity as the theme-oriented (Subject oriented), integrated (Integrated),
consistency (consistent), the time variability (Time variant), data invariance (Non-volatile) to support management decision-making. Data warehouse and database query the biggest difference is merely in its raw data reorganization, value added, the information presented in the decision-making, the purpose of decision analysis in the problem-oriented, emphasizing points of view, completely and intuitively present activities of the Organization the fact that [Yu-Jen Lin, 1999] 1.
However, in establishing the data warehouse often affected at the same time, the involvement of many departments within the organization, resulting in many companies build the result of the failure of data warehousing has led many enterprises to build data warehouse hesitant [Swift, 2001 ] 24. So many experts and scholars have started to import the factors for its depth of research, Duncan [1995] 14that the construction of data warehouse project success or failure of the general system can not be the point of view; Swift [2001]that the information in the
construction of storage time, and in particular special attention to data privacy and security of such norms; Watson& Wixom [2001] 25data warehouse deployment project that contributing factors include: the full commitment of resources
(Resources), user participation (User Participation), the skills of the project development team (Team Skills), Senior management support (Management Support), the
development of technical tools used (Develop-ment Technology), sources of information system quality (Soutce Systems), with the active support of the defenders ( Champion). Paper, the use of units from the perspective of the successful interpretation of data warehouse system, that it should improve the quality of the information contained in the system to enhance the quality of the system that users feel the benefits.
The concept of critical success factors from the Commons [1934] 12proposed limiting factor (Limited Factor) concept and its application to the management and operation of the negotiations. Hofer &Schendel [1979] 17that the key success factor is the area through the activities and resources to start the decision-
making, and help enterprises develop a favorable position, through the general environment, industry environment and to analyze the three companies
themselves, linked with their overall planning; Turban & Aronson [1998] 22that the achievement of organizational objectives must be taken into account is known as critical success factors. And their characteristics were Chan [2001] 6 definitions of the various scholars and the literature summarized [Daniel, 1961 13, Rockart, 1979 21, Ferguson &Dickison, 1982 16, Boynton & Zmud, 1984 11, Aaker, 1988 10, Hofer &Schendle, 1987 17, Wu notes,1988 2],critical success factors that have changed over time, with the industry, product and market research subjects vary, with changes in the product life cycle changes should consider the characteristics of future development trends.
Critical success factors for the assessment and analysis methods, many researchers have proposed different methods. More representative of the scholars Rockart [1979] 21critical success factors put forward to confirm, by the special structure of the industry, competitive strategy, industry conditions and geographic location, environmental factors, the factors being considered to do the four sources.
Davis [2002] 13that the basis of clinical medical health care industry, the need for new information technology assistance, as the clinical decision support to help improve the clinical outcome of teaching and care systems. Hospital
management is facing the impact of the total budget, income has been the impact point value and limitations, Mr Yeung Shan, Wu Fan [2002] 8 through the data warehouse build, combined with the hospital information system (HIS), using the online analysis (OLAP), to establish self-management indicator information system to provide hospital managers in the National Health Insurance around the report data for tracking and control.
3. Research Methods
This research study under the above purpose, and information management areas for the past adoption of information technology on the organization of the literature, were compiled and analyzed, the final Canzhuo Watson & Wixom [2001]
The proposed data warehouse build and contributing factors, including: senior managers, of support, active support of advocates, the full commitment of resources, user participation, the project team's skills, the quality of sources of information systems, development tools used. And through expert interviews, we find that the medical industry, many laws and regulations prescribed factors, it also added "Government policy" factors, to construct the framework of this research prototype.
The current health care industry has to import data warehouse rate is not high, or IT director for data warehousing and application of the definition is still not familiar with, and specific success stories are still few, and the medical industry, academia, research and application of data warehousing small, and no scholar of the key success factors of its import. The purpose of this research is the
exploratory case studies, to investigate the impact of hospital data warehouse into the factors related issues, trying cases in Hospital Reality 应用 situation, identify the key Yinsubingqie Daoru explore Qi Qing Kuang development process.
Select case hospital mainly because of its medical centers and medical services for the play, clinical teaching and research and development functions, the information system and information owned equipment more complete, higher degree of information. Furthermore, cases are both Chinese and Western Medicine in a hospital, its vision of "a world-class Chinese and Western Medical Center," Taiwan's medical institutions should be representative enough. And the
case of top executives and IT director's office for the data warehouse concept is clear, for the import and build a very detailed planning process.
In this study, the general interview guide interview method is adopted, before the actual interviews, prepare interview first outline the main basis interview outline literature, secondary data and the purpose of this study been derived with the experts [Patton, 1990] 20. Interviews of this study tool, mainly based on past research literature related to the content of domestic and foreign scholars, development or questionnaire, to be made editing. After the completion of design experts to review the questions they answer, and conducted the content review to ensure that the questionnaire face validity and content validity [Straub, 1989] 23. The questionnaire is divided into eight dimensions, including:
government policy side, top managers of the support surface, with the active support of advocates face, full of resources into face, build design into the surface of resources, user participation side, the project development team skills area, the quality of surface sources of information systems, development of technical tools used in noodles. Design for all various issues, ranging from two to seven open- ended questions, on a deeper understanding of the practical implications of the various dimensions of the factors into data warehouse.
Wantonly, the results
This part is designed for research, supplemented by interviews open the results obtained.
1. Top management support surface
Hospital executives are willing to support the case establishing the data warehouse's motivation for the "target management" and "health care self- management." The main characteristics of data warehouse in real-time, will integrate different data sources, wants and hopes for rapid query response information, and can immediately grasp where the problem lies. Gu hopes the case hospital to carry out an index in this regard by the management and control, to understand the current implementation of the various indicators of the
situation, whether such abnormality occurs, in order to maintain the Yiliaofuwu provide good and operating 绩效. It should be "self-management", the hospital only to enhance cost control. Data warehousing is a multi-dimensional analysis, they were able to analyze the data to start a different time, space, science and so on for the other to compare with the management, such as medical staff
scheduling situation, the use of drugs Eisai, hospital admissions, outpatient the
number of monitoring, control of these quality indicators in real time, can effectively make cost control.
Hospital demand for data warehousing major surface sources, including law, business competition side, the hospital management of surface and four for the surface quality of medical care. Furthermore, the effectiveness of pre-
deployment assessment, the case hospital has roughly the cost of assessment methods, including face, peers, processes. The cases of hospital executives hoping to build data warehouses include: quickly build, cost should not be too high for the index appears to be able to implement the various departments, and would like to target higher accuracy, wide coverage level, we should, and be Chairman of full authorization for the deployment of data warehouse are thinking,
"must succeed" attitude.
Cases, hospitals have also set a number of indicators to measure the
effectiveness of data warehouse, including the response to aging faster or not, whether it can improve performance, whether it is able to catch problems, it can meet user needs, user satisfaction. It is worth mentioning that in the case of these indicators to measure the success of the hospital process, found that satisfaction is not high if the user does not necessarily mean a bad use of data warehousing functions, may be a violation of the original duties of the employee's professional or .
2. Advocates have actively supported
In addition to build the hospital in case the promoters, management, department heads and very concerned about the personal interests of the strong support by key deployment activities. For example: doctors For their performance, in time for physicians to know if their PPF values, they would strongly support the use of data warehousing and high loyalty.
Management support of the reasons for the hope that through this time to understand the problem; operating personnel to support the reasons for the ability to very smoothly find the necessary values. Hospital laboratory and other departments should count departments performance against them if they need performance information is very important. Furthermore the hospital needs for self-some units, set up a "cost center", they also want to be kept informed of the status of resource consumption. Especially in the hospitals under autonomous management, in particular, such a demand.
3. The full commitment of resources
Hospital for the data warehouse build the budget presentation typically includes software, hardware, training and education expenses. But the case for the data warehouse build the hospital and did not specifically budgeted, but there are set to withstand the development budget.
Deployment schedule, the general build as a data warehouse project is one to two months. In accordance with the system development process can be divided into system analysis, system writing, system testing, system on-line education and training. Systems analysis phase of a quarter of the total project time;
system accounted for two quarters writing stage; system testing and on-line about a quarter of the time. The project is about three to five individuals ranging from human.
4. User participation
Build demand for the recognition, in most cases, the hospital requested the president or vice president who serves as host to coordinate the demands made by various departments, and by the help of top executives, can make the
necessary things with people more likely to be integrated. In the system analysis and system testing phase of the final period, please be sure the user demand is correct.
Project development process, inter-and first among the members will meet to discuss, and more to maintain good communication mode, but if you encounter special situations, it will be handed over to hospital decision-making group to deal with. There in the hospital set up a decision-making group, including the
president, two vice presidents, chief secretary and other persons, dedicated to addressing the problem of the poor communication between departments.
5. Development techniques and tools used
In the choice of development technology and tools, the first should consider whether these techniques and tools with the information technologies used to produce the original hospital compatibility of the problem. The case hospital currently used by the development of technologies, including Data Cube, Cloan (to automatically copy the data), Privot, Slice; development tools, including
programming languages such as JAVA, Delphi, etc., the database as Informix, Oracle, Microsoft SQL Server.
6. Ability of professional development team
Development of data warehouse application to the necessary technology and capacity, for the cases of hospital information room staff is concerned, there is no difficulty, so in technical expertise, the IT staff of their skills is not necessary to engage consultants to carry out such assistance. Furthermore, the ad hoc staff that plan to build data warehouse is not big, so the overall budget planning, and not divided into stages.
However, progress in the project, the project development process, there is often behind schedule problems arise, hospitals often the case the way to work
overtime to catch up with the progress of the project, because the training time and convergence problem, less so with "join" in way, the pressure without a time limit, so if the project schedule or behind schedule, the applicant plans to extend the project time.
Build out of approximately 90% ofthe data warehouse functions developed in line with demand, but10% of that demand with the original difference. The main
reason for including the information is not out of grasp, there is no target value of the raw data, source data-defined, system capacity is not enough, the amount of data such as HIS very large, can not guarantee to retain complete information, or may cause slow system response time.
In case the hospital, in order to understand the data warehouse by the build accuracy of the information, there are three recognized ways: First, compared with the historical trend data; second, with the old system or manual data
matching, but if the information there is no corresponding information for the old system, will fill in the information manually compare; Third, compared with the empirical value, if the data warehouse of information and no historical trend data or manual data for comparison, the user will be the value of their experience to judge the accuracy of data warehouse data. Build effective evaluation indicators, including time spent before and after deployment compared to any increase in revenue, whether to enhance work efficiency, labor costs are lower.
7. Source system quality
In the case of the hospital's data warehouse, data used in the definition of the source system with the same sources of information may include the HIS system, blood banks, blood donation centers, dialysis centers and other independent systems. Another source of information may also be a text file, this part of the conversion of the special action needed to be done. Even some special
information needs to padded by hand, because the data warehouse is not
necessarily capture all sources of information obtained from the computer system.
But the general definition and source system data will be the same.
May encounter difficulties in the build process, including data definitions and data points, incomplete or inconsistent information on the order of the case. HIS in the hospital information system occurred in real time and stored in the system time differences, this is the medical industry data and corporate information special place. General information is incomplete or for ill-defined problems that may go back and do from the information sources, order or clarify definitions; and if the order of HIS system, the problem of inconsistent data, and information work space will be required to carry out system improvement.
8. Complementary objectives and organizational strategy
Cases, hospitals will build data warehousing and organization of the purpose of making one long-term development considerations, the current index using him to create, target tracking, target amended to implement the organization's business strategy.
9. Data privacy and security focus
Information security control part of the internal control permissions for users, so that different levels of charge to see the level, scope is different; the external use of hospital firewall, such as a closed network, limit the search machine and standard external segment was only the specific host on a particular port (service port) have access.
Part of the patient privacy, data warehouse out of data performed only statistical results, users are mostly personnel management and administrative levels, it is not particularly see the personal data or to do some personal tracking, the ad hoc members retrieve information, will remove the ID card information and medical record number to ensure privacy.
10. Future expandability
Stable operation in the data warehousing platform, the next step is to expand its planning application form and scope of the present case the hospital is evaluating the application of data warehouse to conduct analysis of a wide range of
forecasts. As predicted the rapid growth of business, scalability and stability are necessary, including the host operating environment and servo, safety control, information access, applications monitoring, and many other important
technologies, are required to confirm the timing of system expansion.
4. Conclusions and recommendations
Following on this study and summary of relevant research for comparison (as Table 1):
Table 1: Comparison of study and research
This study Watson &
Wixom [2001]
Hwang et al.
[2004]
Propert y
Industry
Medical
Manufacturin g service line number 111
Financial
Can
Can
Promote
Become
Becaus e
Su
8
1.
2.
3.
4.
5.
6.
7.
7
1.
Order Supp ort
2.
Activ e suppo rter
3.
Resou rces to
10
1.
Order Supp ort
2.
Active suppo rter
3.
Resou rces to fully
8.
fully partic ipate in the
4. User
partic ipatio n
5.
Projec t team skills
6.
Sourc e qualit y syste m
7.
Devel oper Tools
partic ipate in the
4. User
partic ipatio n
5.
Projec t team skills
6. Body
size
7.
Dome stic dema nd
8. IT
consu ltants to assist
9.
Vendo r select ion
10.
Indust ry Comp etitiv e Case Study Survey Survey
Researc h Method s
New
Increas e
1.
Consis tent with the goals and organi zation al strate gy
2.
Scalab ility
3. Data
Privac y and Securit y
No No
Tick Except
No Advocates
have actively supported
No
Commo n
With Office
Senior management support
After hospital executives and case depth interviews, found that hospitals initially establishing the data warehouse is the main factor in the hospital to do the
"target management" to enable the hospital to provide better medical service quality, and reduces the cost, immediate monitoring various indicators of whether the hospital had abnormal situation created in order to immediately make the appropriate decisions. Furthermore, the total budget for the implementation of national health insurance and self-management, in order to effectively control the amount of door emergency inpatient services, and monitoring costs have to waste any time in good condition.
Data warehouse will be used in cases of hospital medicine Eisai management and control, to see if there are unnecessary costs occurred; physician volume of real-time basis, the hospital physician services for multi-system computing began PPF (ie, service on the piece system) . Characteristics of patients to understand the sources and characteristics of hospital patients, so will be beneficial to the hospital for patients to do CRM (customer relationship management), but also to analyze the regional population in the hospital, what kind of specific diseases, both to strengthen the capacity of some departments of the medical services, and second, can be used as teaching and research purposes; non-stationary analysis of the report, in response to management decision-making needs, and data warehouse system can integrate different sources of information, which may include HIS system, and blood banks, dialysis centers, independent system, retrieve the data made special inquiries.
In medical institutions, "the quality of sources of information system" than the general enterprise data warehouse build more complexity to high, because of its main sources HIS system, handwritten records, and the blood bank, blood center, dialysis center and other independent systems, even some text files Chief
Operating systems, are subject to re-do the data definitions and conversion, so its complexity comparison to the general business to high, it is this study an
important finding, and general business Data Warehouse difference.
"The development of techniques and tools used", "consistent with the organizational strategic objectives", "Data Privacy and Security" and "future expansion of capacity," the three factors that will affect whether the medical data warehouse into a critical success factor. "Data privacy and security," this factor is not seriously in previous studies to explore the medical institutions will be special emphasis on data privacy and security issues because, in Taiwan the legal norms in the privacy of the patients in criminal law, medical law, medical law draft amendments, MD, law, nursing, psychological Learning, radiological Learning,
Computer Processed Personal Data Protection Act, file storage management for the electronics, medical institutions, the draft Guidelines for the implementation of electronic medical records, hospital computers to handle Registration of personal information management practices, etc., which shows the important privacy for patients, hospitals in establishing the data warehouse, there are special considerations information privacy and security factors.
Furthermore, "the use of technology and development tools", the case that the hospital's IT staff applied to the data warehouse technology and tools in the build during the course of their terms are not difficult, so its influence technology into Jian Purchase factors is very small. Other hospitals in the process of establishing the data warehouse will be special consideration to the organization's long-term planning strategies, etc. Therefore, its one of the key factors into the "same strategic objectives and organization." And the case hospital now hopes to use the data storage function in the forecast, the system will be considered "future expandability."
The above, developed by scholars from the impact of general business data warehouse into the critical success factors, draw over the medical field, they explore the factors that has not been removed, but due to industry factors
considered special and more reasons include the health care industry concerns, so its surface both in management and regulation should be particularly rigorous.
This study explored the impact of medical institutions into the key success factors include: government policy, top management's support, has actively supported the support of the full input of resources, user participation, the project team's skills, information sources the system of quality, development of technical tools used, in line with organizational strategic goals, future expansion capabilities, data privacy and security.
Limitations of this study, the result of data warehouse for the medical industry is still exploring the cognitive stage, the effective sample is very small, so only way to conduct case studies, quantitative research can not yet, so its external validity of the lower push .
Future research, by interviews with the hospital information department heads to explore the hospital to judge whether the data warehouse build one of the
important indicators that "the computerized index management", so future research can develop a questionnaire for national release in major hospitals to
understand the impact of hospital data warehouse into the factors, as those who wish to import the reference.
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