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Open Health: A research prospectus on HMIS research


Change management decision models based on shifts within the global economic order have forced administrators to seek new systems and relationships of oversight as organizations switch from traditional vertical work relationships to horizontal interactions. Much of the insight built into recommendations toward better change management models has been developed in scientific fields of practice. The interest in management of knowledge by science communities, and especially the integration of practice into localized IT systems has long been promoted by consultants and advisors to those fields, whom look to channels of facilitation as viable strategies toward competition in the context of change. The popularity of IT systems management as strategic model for practice field growth, as well as a core competency for institutional change, is well established. Cost cutting and innovative, IT knowledge sharing networks expand the options of institutions and professionals. Competitiveness now equates with interface with the highest calibre artificial intelligence in advancement of human potential toward global solutions that promise to enhance a new generation in oversight. Andrew Grove, former CEO of Intel once observed that “only paranoid firms survive, primarily because they continuously analyse their external environments and competition, but also because they continuously innovate” (Hitt et al. 1995). Grove's assertions are echoed by many corporate executives, whom have become sold on the constancy of research and development as the single most powerful source of competitive capital in organizations faced with ‘new market' competition. For instance, the equity of ‘value' is a price statement or ‘proposition,' as well as a method of translating brand identity within the market through illustrated performance of a product. For service organizations, structural response to delivery is still inherent to value. Practice settings are environments desire synthetic opportunities to forge alliances between internal and external forces as they navigate against risk. Value increases continuously, and incrementally as capitalization is realized in relation to those activities. Early responses to the local-global equation looked to structural articulation in what became known as ‘matrix organizations that allowed for retention of rational-analytical choice models, with modified response through process-oriented incremental decision. More recent organizational approaches, and especially in capital intensive fields such as IT, offer support for the benefit of incremental decision making with the salient distinction between the form and function of decisions. Content in both cases is driven by challenges to productivity, and executive direction is now more than before forced to consider incremental decision making as strategic option, despite the fact that rational choice inevitably overrides constant reinvention (Tiwana, A. et al. 2006). Responsive to the aforementioned challenges in the emergent healthcare environment, leaders looking to new IT HMIS operations systems are seeking change management solutions that will enable them to forge lean and agile strategic growth models in settings known for fiscal and resource waste. Six Sigma approaches to analysis have allowed businesses to streamline operations through combined methodologies of analysis (Edgeman and Dugan 2008). In the past ten years there has been increased demand for seamless service between hospitals, clinics and multidisciplinary teams concerned with the wellbeing of patients and their families. Healthcare organizations seeking competitive and more efficient options to serving patients now look to IT Healthcare Management Information Systems (HMIS) for optimizing capacity both in terms of finance and in standard of care to patients (Tan and Payton 2010). Despite the upfront costs of planning and implementation that go into introduction of new IT systems into an existing HMIS setting, integrated operations enable the advancement of fiscal and other controls not previously realized due to time lapse, as well as precision in every step of the service provision process from decoupling point between allocations to actual delivery of patient services. If efficiency in information is directly linked to ‘duty of a reasonable standard of care' within hospitals and healthcare institutions, the benefits to those organizations in terms of direction and better control of liability issues through information channels, offers new promise in terms of comprehensive patient care through “patient-centric management systems,” and ultimately sustainable organizational growth (Tan and Payton 2010). The foregoing research proposal outlines the development of HMIS in the medical field of practice in the United Kingdom.

Literature Review

The 1990s marked the dawn of knowledge sharing systems in the space science industry, and the landmark mission deployed by NASA IT engineers in the development of what would come to be known as a Competency Management System (an online system that maps individuals to their competencies). Out of that seed project, the 2005 initiation of the NASA Engineering Network (NEN) was formed under the Office of the Chief Engineer in furtherance of the space agency's knowledge-sharing capacity. Coinciding with a to benchmarked study with U.S. Navy, U.S. Army Company Command, the U.S. Department of Commerce, and Boeing Corporation, the NEN network enables “peers and experts through communities of practice, search multiple repositories from one central search engine, and find experts” (Topousis, D.E. et al. 2009). The research study follows this idea, and proposes to contribute to three (3) bodies of literature pertinent to the field of knowledge sharing: 1) General history of IT integration as change management strategy for advancement of purpose in science; 2) studies on the development of IT networks of practice within the health science community in particularly and the development of heath management information systems (HMIS); 3) literature dedicated to risk mitigation and compliance within legislative policy, and elements of security within institutional networks subject to oversight by chief information officers (CIO). Invitation of recognized Technical Fellows noted in their discipline to facilitate their respective community of practice within the network set the pace for portal integration of human resource tools, such as jSpace. The platform can be utilized as communicator/research source for professional recruitment to projects and permanent roles. Links to related associations and professional societies offer participating fellows and partners access to an integrated contact source of engineers, “while fostering an environment of sharing across geographical and cultural boundaries.” The next step in NASA NEN is incorporation into the larger NASA Enterprise Search, and potential accommodation of oft requested ITAR-restricted information. The extension of the NASA space science knowledge sharing concept has done two things: 1) further the advancement of space science objectives through KMS (Knowledge Management Systems) and PMS (Plan Management Systems) toward design and launch of multinational space missions; and 2) extend the idea of an IT integrated field of scientific practice to other scientists in distinct fields of practice throughout the scientific community (Quattrone and Hopper 2004). The emergent emphasis in organizational theory on IT Healthcare Management Information Systems (HMIS) as presented by Tan and Payton (2010), initiates query into the integration of extended practice setting networks. Interested in the advancement of IT platforms and software driven data bases as solution to change operations in global institutions, the search for approaches that succeed at meeting core competencies through risk reduction and resource maximization are the most sought after technologies for the betterment of the ‘total' organization. The new IT systems offer interconnectivity between operational units within healthcare institutions, and link human intelligence to the logistics data analysis for in-depth insight into the history of expenditures and allocation requests. Some institutions have joined supply chain cooperatives in their region to further enhance the use of network logistics and stem of the flow of fiscal waste – a persistent concern within healthcare organizations – saving literally hundreds of millions of dollars annually (Healthcare Finance News, 2010). Healthcare Management Information Systems (HMIS) offer integrated systems platforms and applications to the entire range of chain operations management activities within and between institutions that provide patient care. Consistent with the emergent interests in organizational knowledge sharing networks, healthcare institutions are looking to IT solutions for a number of reasons, and especially the growing impetus toward: 1) healthcare provider connectivity; 2) increased focus in tracking and management of chronic diseases; 3) heightened patient expectations regarding personal input in care process; 4) market pressures driving hospital-physician alignment; and 5) advances in the technological facilitation of systems operability in this area (Tan and Payton, 2010). Design of systems architecture from institution to institution still varies, as data management and interconnectivity may be distinct and also subject to existing ‘legacy systems' issues that might be incorporated in the new HMIS model. The core competency of HMIS is the more ephemeral side of systems planning which is the knowledge sharing path – where data and information become meaningful. The other key components to consideration of HMIS integration include: 1) the basic hardware, software and network schema; 2) process, task and system(s); 3) integration and inoperability aspects; and 4) user, administration and/or management inputs and oversight. For instance, IT HMIS designed to enhance the networking of financial operations in hospital institutions must be especially responsive to the growing complications in the US insurance industry as product options such as bundled claims force institutions into synchronous attention to patient' demands. Convenience and competitive pressures to supply those services supersede mere fiscal allocation in service to patients amidst conglomerate interests in the healthcare industry (Monegain, 2010). Chief Information Officers (CIO) are critical to the administration and planning of HMIS systems, and in particular, security measures and oversight of privacy protections. Unlike Chief Executive Officers (CEO) that serve as the primary responsible party for general governance, the CIO is more directly involved in the scientific praxis of organizational management; as precision in systems that retain data for record, and for analysis toward organizational growth are in their hands. CIOs are increasingly drawn into this external environment based on the nature of transactional relationships, as they are called upon to find IT systems of accountability within their own institutions (, 2010). Regulation of computer and telecommunications activities in the UK's Computer Misuse Act (CMA) of 1990 has impact in regard to the stipulations pertaining to definitions of personal and professional use of HMIS by employees, partners and clients (Crown Prosecution Service Advice on CMA 1990).

Aims and Objectives to the study

The aim of the research is to study successful approaches to knowledge sharing, risk reduction and resource maximization through HMIS IT systemization. The most sought after technologies are those that expedite a ‘total' organizational approach to information management. The goal of the research is to conduct a Six Sigma analysis of an IT based knowledge sharing infrastructure of a scientific community of practice. In spite of the nascent value of space science as a critical beginning to baseline assumptions the study proposes to survey the development of HMIS in the medical field in the United Kingdom. The three (3) core objectives to the study on healthcare IT infrastructure will be: 1) review of HMIS infrastructure as it is understood by healthcare administration in contract with systems engineers; 2) fiscal accountability is the second priority objective toward the goal of projected and actual capitalization on IT systemization in the practice setting; and 3) the significance of quality control of those systems in relation to government reporting and policy.

Methodological Consideration

Methodologies to the study will be implemented toward building a portfolio of practice on HMIS in the British healthcare industry based on data drawn from the following sources:
  • Survey of lead UK health institutions
The structured Survey instrument will be comprised of (50) questions and will be circulated in the HMIS practice community in the UK. A series of open queries at the end of the Survey will offer an opportunity to CIOs and IT administrators to contribute unique knowledge about their systems.
  • Interviews with CIO
Depth content to the research will be drawn from two (2) semi-structured Interviews with CIOs selected from information obtained from data generated in the Survey. Findings on the development of HMIS onsite in those chosen institutions will open up a new field of query into the actual challenges faced in planning, implementation and updated maintenance of architectural systems as new enterprise systems come on the market. Policy and procedure will also be discussed, as well as extended referral networks. 3. Internet Research a. Patient Research. Review of patient interface with HMIS portals at lead organizations and community healthcare providers. b. Aggregate Index. Research Data collected from healthcare industry indexes toward furtherance of trend analyses. c. Risk Management. Recommended best practices, policy and security protocol toward risk management of fiscal information, institutional and staff privacy and non-disclosure of patient record will be investigated. Review of open source software as protective measure as well as sufficient firewalls, intrusion detection, and encryption. Sources and Acquisition of Data Acquisition of data on the study will be conducted in three phases: 1) Survey; 2) Interviews; and 3) Internet. Phases 1 and 2 will focus on CIO and other lead IT staff in selected UK healthcare institutions, and incorporate information from the two instruments, as well as augmentation of the research with information on engineer consultancy relationships that they have worked with, and institutional documentation on HMIS and unit databases. Phase 3 will be conducted consecutive to the latter two phases of the research toward supplementation of policy and other details to the project. Data Analysis Examination of standardized taxonomies to open source database repositories used in HMIS will serve to further data analysis: Customer Relations Management (CRM); Electronic Health Records (EHR); Enterprise Resource Planning (ERP); Personal Health Records (PHR); and Supply Chain Management (SCM) dedicated to total operations management control, patient referral and professional knowledge sharing (Tan and Payton, 2010). Analysis of data on the project will be based on a Six Sigma solutions oriented approach. Table 1



Charter Defines the case, project goals of the organization Policy and Procedures
Drill Down Tree Process Drill Down Tree Engineering Process & Unit Oversight
FMEA Failure Modes & Effects Analysis Risk Assessment
QFD Quality Function Deployment Compliance
SWOT Strengths, Weaknesses, Opportunities, Threats Planning and Implementation (ongoing for future inputs)
Trend Analysis Aggregate Narrative HMIS industry trends
Table 1: Six Sigma methodologies for analysis of HMIS survey, interview and internet archive sources.


Computer Misuse Law, 2006. Parliament UK. Available at: Crown Prosecution Service Advice on CMA 1990. Available at: Edgeman, Rick L. and Dugan, J. P., 2008. Six Sigma for Government IT: Strategy & Tactics for Washington D.C. Available at: Hitt, Black & Porter, 1995. Management. Upper Saddle River: Pearson Education, Prentice Hall. Jones, R.E., et al., 1994. Strategic decision processes in matrix organizations. European Journal of Operational Research, 78 (2), 192-203 Monegain, B. N.C. health system to launch bundled payment pilot. Healthcare Finance News, 22 June 2010. Available at: Quattrone, Paolo and Hopper, T., 2004. A ‘time-space odyssey': management control systems in two multinational organizations. Accounting Organizations and Society 30, 735-754. The imperative to be customer-centric IT leaders (2010). Available at: Tan, J. and Payton, F.C., 2010. Adaptive Health Management Information Systems: Concepts, Cases, & Practical Applications, Third Edition. Sudbury, MA: Jones & Bartlett Learning. Tiwana, A. et al. (2006). Information Systems Project Continuation in Escalation Situations: A Real Options Model. Decision Sciences, 37 (3), 357-391. Topousis, D.E. et al., 2009. Enhancing Collaboration Among NASA Engineers through a Knowledge Sharing System. Third IEEE International Conference on Space Mission Challenges for Information Technology. Pasadena, CA: Jet Propulsion Laboratory.
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