Monday, October 12, 2009

Global Perspective on the Business Models in Medical Information Systems

Abstract
A healthy life style paves way to a successful livelihood making people utilize and expedite their natural talents and develop new skills, leading to a well-off living. Apparently, in the current global context; one has to spend a considerable amount of capital to lead a healthy life. People living in the developed country context are less fortunate in accessing specialized health services due to various reasons (e.g. financial difficulties of patients, geographical dispersion of health institutes and, etc.). Nevertheless, the increasing number of innovative technologies has started to bring the human living standards into a new sophisticated era. Consequently, many institutions and organizations prefer to exploit computing power to improve and enhance various sectors. Accordingly, health services can also be increased and enhanced to improve the living standards of the developing regions using IT. This article hence presents a comprehensive coverage of Business Models used in the field of Medical Information Systems which will sustainably stabilize the Medical Information Systems and their services.

Introduction
THE vision of the Ministry of Healthcare & Nutrition in Sri Lanka is to preserve “A healthier nation that contributes to its economic, social, mental and spiritual development” [1]. Therefore, the concept of empowering people, via healthy lifestyles should be promoted throughout the island. As a developing country it has been quite chaotic to give room to health related projects within the National Budget. Yet, the government of Sri Lanka has taken measures to increase the provisions for the health sector [2].
According to the World Health Organization (WHO), by the year 2020, 20% of Sri Lanka's population will reach 60 years of age or over [3]. Old age pave way to an array of ailments. This fact hence is a serious indicator of the number of ailing people that might exist within another decade’s time. Thus, it makes a crucial point to make necessary steps in bringing the local Hospital System to a more stable and a smoothly functioning organization before it is too late.
Application of electronic infrastructure in the face of Medical Information Systems can create dramatic changes in the health sector in both developing and developed countries. Yet, to improve the sustainability of such systems with a minimal of down-time, matured Business Models need to be incorporated.
Therefore, this paper will provide a comprehensive study of the Business Models used in the field of Medical Information Systems which will sustainably stabilize the Medical Information Systems and their services.

References
  1. Ministry of Healthcare & Nutrition Sri Lanka, Viewed on 10th October,
  2. Aussie Indo Lanka, Sri Lanka - Health status of Lankans on par with developed nations, Viewed on 10th October,
  3. World Health Organization, Sri Lanka, Viewed on 10th October,
  4. Europe’s Information Society, Business Models for eHealth, Viewed on 23rd December 2008, < item_id="4108">
  5. Stroetmann ,V.N., Jean-Pierre Thierry, Stroetmann, K. , Dobrev, A., eHealth for Safety Impact of ICT on Patient Safety and Risk Management, Viewed on 23rd December 2008,
  6. National eHealth Program, Viewed on 24th December 2008, http://www.ehealth.scot.nhs.uk/wp-content/documents/ehealth-procurement-strategy-template-v1-01.doc
  7. Encouraging Innovation-Friendly Procurement in eHealth, eHealthNews.eu, Viewed 24th December 2008, http://www.ehealthnews.eu/content/view/1097/27/
  8. An Examination of How Broadband Services Enhance Health Care In America, eHealth and America’s Broadband Networks, US Internet Industry Association, August 14, 2007, Viewed on 24th December 2008, http://www.usiia.org/pubs/eHealth.pdf
  9. eTELEMED 2009; International Conference on eHealth, Telemedicine, and Social Medicine, February 1-7, 2009 - Cancun, Mexico, Viewed on 23rd of December 2008, http://www.iaria.org/conferences2009/eTELEMED09.html
  10. Building eHealth Services in Developing Countries, Asia Pacific Telemedicine Initiative, 21st Pacific Science Congress, Okinawa Japan, 16 June 2007, Viewed on 24th of December 2008, http://www.pacificscience.org/pdf/APTdeclarationPSC21.pdf
  11. eHealth for Safety, Impact of ICT on Patient Safety and Risk Management, Viewed on 23rd December 2008, http://www.ehealth-for-safety.org/
  12. eHealth Initiative, Welcome to Initiative’s Connecting Communities Toolkit, Viewed on 23rd December 2008, http://toolkits.ehealthinitiative.org/
  13. Ognianov A., Report in the framework of the eHealth ERA project, eHealth strategy and implementation activities in Bulgaria, Bulgarian National Health Insurance Fund, 7 January 2007, eHealth ERA Towards the Establishment of a European e-Health Research Area, Viewed on 24th December 2008, http://www.ehealth-era.org/database/documents/ERA_Reports/Bulgaria_country_report_final_07-03-2007.pdf
  14. eHealth in Eastern Mediterranean, Regional Telemedicine Workshop: From Telemedicine to E-Health- Information and New Telecommunication Technologies as a Tool to Improve the Health Services in Developing Countries, (Cairo, Egypt 18-20 December 2001), http://www.emro.who.int/his/ehealth/Meetings-ITU.htm
  15. Whitten P., Steinfield C., Hellmich S., eHealth: Market Potential and Business Strategies, Department of Telecommunications, Michigan State University, USA, Viewed on 23rd December 2008, http://jcmc.indiana.edu/vol6/issue4/whitten.html
  16. ICT Results, Getting eHealth to live up to its promise, Viewed on 23rd December 2008, <>
  17. eHealth Risk, eHealth Business Risk, Viewed on 23rd December 2008,
  18. eHealth, New HER Business Model, Viewed on 23rd December 2008, <>
  19. Lin C., Wireless Differentiates eRemote Home Health Care, 2006 eHealth Forum 2006-Building a Healthy Tomorrow Using IT, Viewed on 24th December 2008, http://www.ehealth.org.hk/Speaker/Dr%20CHIH%20Lin%20I.pdf
  20. eHealth Impact, Study on Economic Impact of eHealth, Viewed on 23rd December 2008, <>
  21. Europe’s Information Society, Studies on eHealth Issues, Viewed on 23rd December 2008, http://ec.europa.eu/information_society/activities/health/studies/index_en.htm
  22. Europe’s Information Society, Ongoing Studies on eHealth Issues, Viewed on 23rd December 2008, http://ec.europa.eu/information_society/activities/health/studies/ongoing/index_en.htm
  23. eHealth Study of the Month, Legally eHealth, February, 2007, Making clear the legal and regulatory context of eHealth, viewed on 23rd December 2008
  24. Wickramasinghe Y, et al (2009) BudhuDas: An eHealth Business Model for Emerging Countries
  25. Dinusha V, et al (2009) A Mobile eHealth Solution for Patients in Emerging Countries
  26. Wijethilake D, et al (2009) A Change Management Methodology for eHealth Applications in the Developing World.


Saturday, October 10, 2009

Risk Analysis for the London Ambulance Service's Computer Aided Dispatch System (LASCAD)

Overview

By mid-morning October 27th 2002 LASCAD became the top story of BBC. The cause for this was the LASCAD failed to process the telephone calls that sought immediate ambulatory assistance to get the patients to hospitals. The reports said, many patients were in a moribund state by the time the ambulances reached them. And some even had to experience the irrecoverable loss - the unfortunate demise.

So the reason for such a disastrous situation was the authorities failed to incorporate popper Risk Management, Contingency Planning and Disaster Recovery Strategies. This, post would hence provide an overview of the LASCAD phenomena in the Risk Management Perspective.

Fundamentally, any project is recommended to consider Risks in terms of:
  • Risk Identification
  • Risk Analysis
  • Risk Planning
  • Risk Trackging
  • Control Measures
  • Communication
Let us now see how LASCAD system would have prevented such a disastrous situation being realized in terms of Risk Management, Impact Analysis and Disaster Recovery.


Risk Management

In the Risk Management the rule of thumb is to first identify the Assets, Threats and Vulnerabilities associated with the organization and its Business Processes.

A. Asset Identification
  • Information Assets - Medical Data, Caller Details, Ambulance Details, etc
  • Paper Documents - Disclaimers, etc
  • Physical Assets - Medical Equipment, Ambulances, etc
  • Software - IS
  • People- Patients, LAS Management, Headquarter Staff (esp. people in the Control Room) and Ambulance Staff
  • Reputation - Reliability of LASCAD, Medical Data Protection
B. Threat Identification
    • Technical - Hardware and Software
    • Human - Sabotage, Human Error, Hostility towards the IS, Friction between the Management and the subordinates, Vague Objectives, Personal Agendas, etc
    • Natural - Flood, Thundering, etc
    C. Vulnerability Identification
      • Absence of Medical Staff
      • Unstable Network Connectivity
      • Transmission over unprotected Communication Channels
      • Budgetary Mishaps
      • Natural Disasters
      Impact Analysis

      It is noted that when the LASCAD failed, they had a lot of trouble in switching to their backup system. There they failed to continuer their organizational operations smoothly. According to the Risk Assessment Framework by Wilcocks and Margettes 6 elements had been taken into consideration in the LASCAD failure.
      • History: Prior Organizational Developments (Prior IS Success/Failure)
      • Outer Context: Government, the Economy, Markets, etc
      • Inner Context: Characteristics of the Organization (Strategy, Structure, Reward System)
      • Content: Changes involved (Size of Project, Difficulty)
      • Processes: How things are done and possible issues (Project Management, Staffing, Change Management Practices)
      • Outcomes: Planned or unanticipated (Cost, Time, etc)

      Business Continuity Management (BCM)

      The developers of the LASCAD would have considered the following points in BC in the face of a disaster.
      • Options (Cost to Implement,MTPoD, Consequences in Interruption, etc)
      • People (Patients, LAS Staff, etc)
      • Premises (Ambulance Depot, Control Centers, etc)
      • Technology (IS, OROIN Standards over Project Management (PRINCE) )
      • Information (Call Taking, Resource Identification, Resource Mobilization, Resource Management and Management Information)
      • Supplies (multiple suppliers that can compensate amongst each other)
      • Stakeholders (Patients, Staff, Media, etc)

      Further, they would have crafted a comprehensive BCM response strategy that they should have periodically exercised and tested so as to improve their BCM response. So they would have easily switched over to their backup system when the LASCAD phenomena occurred.


      Disaster Recovery

      In conclusion they should have practiced the following strategies in quickly recovering from such a scenario:
      • Properly documented Disaster Recovery Strategy
      • Periodic Execution and Review of the Disaster Recovery Strategy
      • Monitoring and Updating the executions
      • Going up in the disaster recovery learning curve