The use of information systems to performance management: the implementation of Health Information System in Calabria s Region

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1 The use of information systems to performance management: the implementation of Health Information System in Calabria s Region Authors Marzia Ventura* Department of Law History Economics and Social Science University of Catanzaro Magna Graecia University address Viale Europa Catanzaro marziaventura@unicz.it; *Author corrispondent Rocco Reina Department of Law History Economics and Social Science University of Catanzaro Magna Graecia University address Viale Europa Catanzaro rreina@unicz.it; Concetta Cristofaro Department of Law History Economics and Social Science University of Catanzaro Magna Graecia University address Viale Europa Catanzaro cristofaro.concetta@tiscali.it; Summary: 1. Introduction & Main Objectives ; 2. Methodology; 3. Theoretical background; 4. Empirical Results; 5. First Analysis; 6. Main References. 1. Introduction & Main Objectives Over the past twenty years the deputies systems to measure performance in complex organizations was extremely interesting, so to impact on one of the complex organizational systems of national economic system, both for "contents" and for financial resources used and consumed: the National Health System. So, on these considerations and in automatic way, the information system was considered the natural and coherent support to the governance of Health System, through the introduction of instruments capable to manage the patient s information flows in order to read and help the system in the search of performance 1. On these considerations, the implementation of a Health Regional Information System tends to represent the coherent support of clinical governance processes, through the design of new application platforms and technologies, with the creation of systems for the management of longitudinal patient s data 2. For these reasons, the implementation 1 C. Caccia, M. Cucciniello, G. Nasi ( 2009), Gli impatti della CCE. Un modello di misurazione degli effetti sull azienda,mecosan n. 70; 2 C. Caccia, M. Cucciniello, G. Nasi ( 2009); 1

2 of a Regional System tends to represent the technical, conceptual and organizational effort, aimed to increase the efficiency, thus contributing to improve the quality of services provided. At present, however, the implementation of such a system in Calabria s Region, finished to discount a series of difficulties related to the completion of the final link on different organizations, although the general structure was just defined. On such evidence, the present work was focused on the implementation of a particular technical instruments of health information, the Electronic Medical Record, in its application within the Lamezia Terme Hospital in Health District of Catanzaro. 2. Methodology The research work is made with a methodology based on two steps analysis, the analysis on the desk on literature & theoretical background and then an analysis on the job. The first part focused on theoretical description - is based on the examination of the main documents in the health sector (institutional & legislative acts) and the main literature on information systems and with specific reference to the context of regional health; On this basis it is then developed the analysis on the job. The empirical analysis, firstly wanted to grasp the main aspects of the EMR with reference to the main indicators of efficiency and performance, through the administration of a questionnaire to the actual users of the instruments, medical and nursing staff. The research was developed in the Lamezia Terme Hospital in the ASP District of Catanzaro. The processing of the data collected through the questionnaires, was made by normalizing the responses obtained. Successively the answers was merged into different main areas which reflect different perceptions of stakeholders on the same subject. Following these steps, therefore, the paper represent a working paper, with respect to the issue of implementation of the Health Information System in Calabria s Region, like operational mechanism of reading, analysis and governance of organizational processes in the health region. 3. Theoretical background Health Organizations and Health Regional Systems often match with a particular situation in which an aging population, the demand for more qualified services and the technological accelerated development put seriously in trouble the economic sustainability of the systems. Therefore, decisions regarding the selection, adoption and diffusion of technology in the health sector, are increasingly sensitive because often immobilize economic and financial resources for long periods of time and simultaneously must meet the goals of appropriateness, efficiency and effectiveness requesting from multiple stakeholders 3. The basic consideration is the ability of technology to be drivers for improving the health care system, as it affects infrastructure, organizational models, 3 A. Francesconi (2007), Innovazione organizzativa e tecnologia in sanità, Franco Angeli; 2

3 work processes and skills 4, despite the dedicated costs 5. In addition, often, their spread is usually so disorganized and unplanned, thus limiting the possibility of timely and empirical assessments about their effectiveness and their impact on clinical and organizational 6. The national health system, coherent with the strategies at national and regional level in reduction of public health expenditure, has been a concern since the nineties, a major overhaul of the operating modes. These processes have helped to start a number of initiatives to organizational review in individual company, with the gradual implementation of new information systems 7. The study and approaches 8 to implementation of information systems that have occurred over time are shown in Table 1, and tend to confirm not only the need for a corporate view of information systems, but the constant research for more synergy among corporate strategy, organizational system, management processes and information systems; the presentation of different theoretical approaches can detect the strategic role assumed by the information systems, and strategic planning aspects of the new company. Table 1 Main approaches to the management information system Theories Business Administration Technological Economic Economics Authors Forrester (1961), Anthony (1967), Simon: It should be noted that organizations always use information in order to operate; Specifically, the observations undertaken by J. Forrester tend to regard information systems as an element of standardization in the detection and measurement of business phenomena affecting both individuals and groups of centres of control in a strongly hierarchical system. The increase in complexity and size of business led to the development of a second group of theories to R. Anthony and H. Simon, both authors propose a scheme of corporate structure and decision making processes within the company identifying information in the system as a prerequisite for proper functioning of the whole. McFarland, Nolan & Norton (1973), Davis: Emphasize the predominantly technical and technological information system, a particular interest has the distinction introduced by G. B Davis concerning the difference between information system and official information system suite. The creation of a private system is connected to situations in which formal systems are considered inadequate or situations in which prevails the logic of quotas satisfaction of needs through the implementation of logistics solutions. Williamson (1975), Malone: Importance of the information system as an alternative in reducing transition costs and agency costs, in particular the first approach is related to the importance of using ICT as a factor in reducing the costs of transition and the SI is considered an essential activity of production and coordination. The second one identifies as a key resource information systems for the reduction of agency costs, being the costs incurred by corporate actors, called agents, to obtain information to support the management, coordination and control. Rugiadini, Airoldi, Camussone, Saita: Tends to further reinforce a vision of 4 A.Cicchetti 2003, Traiettorie tecnologiche e routine organizzative: un approccio evolutivo, atti del convegno AIES October - Rome; 5 Altman and Blendon (1979), Medical technology: the culprit behind health care costs, Atti del Convegno 1977, Sun Valley forum on national health, Department of Health, Education, and Welfare; T. Bodenheirmer (2005), High and rising health care cost, Part.2 : Technologic Innovation, Ann Intern Med, 142; C.M. Christensen C.M. et al. (2000), Will disruptive innovations cure health care?, Harvard Business Review, 78(5); Health Care Technology Institute,1994, Decomposition of the Health Care Spending residual, Alexandria; J.P. Newhouse (1992), Medical care Costs: How Much Welfare Loss?, Journal of Economic Perspectives, 6(3); E.O Teisberg et al. (1994), Marketing competition in Health care work, Harvard Business Review, 72(4); 6 R. Grilli (2004), Governo clinico: innovazione o dejà vu?, Il pensiero Scientifico Editore; 7 C. Caccia (2008), Management dei sistemi informativi in sanità, McGraw Hill Editore; 8 C. Caccia (2008),op. ult. cit; 3

4 Enterpreneuership Structuralistic Management and Organizational the information system as an increasingly integrated and synergistic to the company's operating model as a whole; Mechanisms organizational information system plays a strategic role and is predominantly as the tool that allows you to make available to all business operators integrated information, times and methods that can support different types of decisions Giddens (1984), Crowe (1996), Lucas (1994), Ravagnani (2000): It places additional emphasis on the synergy between business processes and information system, by ensuring that integrated information with respect to corporate events are available online or on time at all levels of corporate structure in order to have extensive knowledge of organizational processes that take place in it. This research tends to emphasize that today the design of the organizational structure and business processes are essentially inseparable from the design of SI. Porter (1987): He further emphasized the interdependencies between strategy, organization and information systems, in particular the theory of "value chain" conceives the firm as a chain of interdependent activities, connected by functional links between them and affect the mutual production and value creation for its customers. Source: Adaptation by Caccia, 2008 Information system was defined as "an ordered set of elements that collect, process, store and exchange data with the aim to produce and distribute information at the time and place suitable for business people who need them; using the proper technology for the most appropriate, logical and suggested methods for different classes of business phenomena, from the disciplines of business economics 9 ". The introduction and evolution of the processes of Information & Communication Technology (ICT) in health, will inevitably lead to a change in organizational structure and management and implementation of organizational processes related, so it becomes necessary to implement a strategy for detailed planning, that takes account of the following elements (Scavuzzo, 2007): The internal processes of healthcare organizations, The external relations with patients, providers, other companies, The information flows in the overall health system as a whole. Often the adoption of these instruments took place without a clear vision of the whole system, although the awareness of the use of information technology to support the diagnostic and therapeutic patient is growing. In addition, the same situation regarding the improvement of health care through research, statistical, epidemiological studies asks for a more accurate clinical information flow management 10. One of the most innovative management and information tool in the Health System is the Electronic Medical Records, able, through the electronic management of patient data, to make internal processes more efficient while improving the actual quality of the services provided. The EMR in fact is the instrument used for data collection of the clinical history 9 P.F. Camussone (1998), Informatica aziendale, Etas Editore; 10 L. Buccoliero & G. Nasi (2004), Il sistema informatico delle aziende sanitarie: stato dell arte e prospettive evolutivo dell area clinica Rapporto OASI 2004; 4

5 of a patient and has the aim of promoting integration among professionals, information sharing, creation of new knowledge, digitization and automation of information flows. So the EMR is designed to collect all the descriptions of health events of a person, related to its interaction with a health facility 11. Very important is to able to analyse and study the aggregate impacts of its effects, in order to understand and know strength and weakness and main characteristics of governance system, both with output both with outcome, regarding typical processes of health care national system. 4. Empirical Results The analysis developed in this paper focuses on the effect of the implementation of EMR in the Hospital of Lamezia Terme; this work allowed us to recognize a lot of considerations, some already highlighted in the theory analyzed. So, very important is to evaluate the impacts of EMR in order to identify the effects that such a tool can generate in terms of outputs and outcomes with respect to the processes of care and health protection 12 ; it is evident in fact that the introduction of EMR can produce innovations both in the clinical area and in management methods, enhancing and promoting the development of inter-and intra-organizational relationship, as well as to modify the content of the professional activities of medical and nursing and the responsibilities of the individual organizational units, facilitating flexibility and operational effectiveness 13. First of all, the empirical research focused on the principles aspects of EMR, through the administration of a questionnaire regarding whom really uses the EMR, specifically medical e nursing staff; data processing was carried out by normalizing the responses obtained. The answers was organized in different sections regarding different perceptions of the actors on the same topic. So, this work represents a first step respects a general and complex process of the implementation of management information system in the health care regional system. So, in a specific way, next graphs show medical wards in which the survey was developed and different characteristic of the respondents, like professional role, etc, in order to obtain the effective participation and the possibility to compare these results with other more situations investigated. Chart.1: Medical Words 14 Chart. 2:Position Held 11 Rossi Mori A. & Maceratini R. (2009), La cartella clinica elettronica, Manuale di informatica medica; 12 C. Caccia, M. Cucciniello & G. Nasi (2009), Gli impatti della cartella clinica elettronica. Un modello di misurazione degli effetti sull azienda Mecosan, volume n. 70; 13 C. Caccia (2000), Management e information tecnology. Un possibile percorso di qualificazione del mercato tecnologico e delle aziende sanitarie, Mecosan volume n. 36; 14 Number 10 Medical words and number 34 respondents; 5

6 Source: our elaboration In addition other relevant informations, obtained through administrated questionnaires 15, regard the consideration of users respect the perceptions that they have on EMR such as operational support and its usability, operational efficiency and finally the possibilities of improving it. The E.M.R. is useful for your work For my work the E.M.R. is relevant Source: our elaboration So, the perceptions of EMR s usability for medical and nursing staff are positive; in fact the questionnaires show that the majority of answers demonstrate the great utility of EMR, but the percentage of positive answers decrease if the link is respect the importance regarding own job. The EMR is easy to use It s easy to obtain informations through EMR 15 Every information and provided datas are a direct result of on field research, carried out by the team of researchers and so they are absolutely original; 6

7 Source: Our elaboration In addition, the parameter usability of the tool used at Lamezia Terme Hospital get a positive assessment of the respondents. The use of EMR allows to perform the tasks in less time Source: Our elaboration The use of EMR facilitates the achievement of goals Source: Our elaboration If the investigated area becomes the applicability of the instrument compared with the performance of the activities planned for carrying out the tasks assigned by the organization, the values become even enthusiastic, with percentage higher than 80%, as it appears easy to observe from the graphs presented. 7

8 The use of EMR makes easy your job The EMR is flexible and adapt to your way of working Source: Our elaboration Besides, the areas linked to learning disabilities and relating the use of the EMR respect its flexibility and adaptability to the work needs reveal positive values on the implementation of the instrument at the level of health organization. It easy to learn the use of the EMR The level of detail are apt to the requirements of the job Source: Our elaboration 5. First Analysis Healthcare Organizations operating in an environment characterized by rapid technological and innovation processes with frequent changes in the institutional rules, ask for own management efforts related to high complexity that arises at the same time, both from the internal characteristics of organizations and the expectations of community served, in the constant search for appropriateness in the delivery of services. An important and increasing role in health care system has the management of clinical data, in order to combine in a consistent way technological innovation and organizational innovation. Several authors in fact point out that the joint adoption of several innovative practices can lead to significant higher performance than the adoption of the same practices differently in distinctive wards and in disorganic way. So to the Health Management is required to understand the strategic importance of information systems in order to support organizational performance and organizational change. Accordingly, the results obtained reveal that 8

9 the users of the EMR have a positive perceptions about the use of technical and information instruments in its application in health organization. This may represent a good descriptor of the successful implementation of integrated information systems in regional health system. But, the reflections produced represent only a first step, respect the goal to obtain a broaden perspective of use of electronic medical records as a symbol of innovation in health information systems. So, in addition, next steps regard the possibility to analyze the relations between EMR and other technological system of specific health organization and the Health Information Regional System as a whole (Calabria Region). Main References: - Alvesson M., Bridgman T., Wilmott H. (2009) The Oxford Handbook of Critical Management Studies, Oxford University Press; - Barki H./Hartwick J. (1994) Explaining the role of user participation in information system use, Management Science; - Brynjolfsson E. (1993) The productivity paradox of IT: review and assessment, Communications of the ACM; - Burns T & Stalker G.M. ( 1961) Direzione aziendale ed innovazione, Franco Angeli. - Buccoliero, L. & G. Nasi. (2004). Il sistema informatico delle aziende sanitarie: stato dell arte e prospettive evolutivo dell area clinica. Rapporto OASI. - Caccia, C.( 2008). Management dei sistemi informativi in sanità. Mc Graw Hill. - Camussone P.F. (1998) Informatica aziendale, Etas Editore; - Costa G. & Nacamulli C.D. (1996) Manuale di Organizzazione Aziendale, UTET, Volume 1; - Daft R.L. (2007) Organizzazione aziendale, Apogeo; - Davis G.B. (1974) Management information system: conceptual, foundations, structure and development, McGraw-Hill; - Etheredge L.M. (2007) Technologies of health policy, Health Affairs 26; - Francesconi A. (2007) Innovazione organizzativa e tecnologia in sanità, Franco Angeli. - Hatch M.J. (2009) Teoria dell organizzazione, Il Mulino; - Howcroft D. (2009) The Oxford Handbook of Critical Management Studies, Oxford University Press; - Joos et al.,(2006).an Electronic Medical Record in Primary Care: Impact on Satisfaction, Work Efficiency and Clinic Processes. AMIA Annu Symp Proc. - Knights D. & Willmott H. (2007) Comportamento Organizzativo, Isedi; - Lucas H. et al. (1994) The role of information technology in organization design, Journal of Management Information Systems; - McFarland W.F/Nolan D./Norton R. (1973) Information system administration, Holt Rinehart and Winston; - Merlyn, V.& Parkinson, J.,(2007).Il cambiamento organizzativo nell information Tecnology. FrancoAngeli. - Mintzberg H.(1982) La progettazione dell organizzazione aziendale, Il Mulino.; - Nonis, M./Braga M./Guzzanti E. (1998) Cartella clinica e qualità dell assistenza: passato, presente e futuro, Il pensiero Scientifico; - Pontiggia A. (1997) Organizzazione dei sistemi informative: modelli per l analisi e la progettazione, Etas Libri; - Pontiggia A. (2001) L impiego efficiente delle tecnologie d informazione, Egea; - Ravagnani R. (2000) Information Technology e gestione del cambiamento organizzativo, Egea; - Reina R. et. al, (2012) A healthcare project: managing knowledge trough electronic medical record: empirical cases, International Journal of information Systems in the Service Sector, Vol. 4 number 4; - Reina R. et. al, (2012) Managing the knowledge interdependence with the E.M.R, Measuring Business Excellence, The journal of organizational performance management, Vol. 16 number 4; - Rossi Mori A. Maceratini R. (2009) Manuale informatica medica: la cartella clinica elettronica; - Vurdubakis T. (2007) La tecnologia, in Knights D. & Willmott H. (2007) Comportamento Organizzativo, Isedi; - Woodward J. (1965) Organizzazione industriale: teoria e pratica, Rosenberg & Sellier. 9