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Abstract
Information management in hospitals is a complex task. In order to reduce complexity, we distinguish strategic,
tactical, and operational information management. This is essential, because each of these information management
levels views hospital information systems from different perspectives, and therefore uses other methods and tools.
Since all these management activities deal only in part with computers, but mainly with human beings and their social
behavior, we define a hospital information system as a sociotechnical subsystem of a hospital. Without proper
strategic planning it would be a matter of chance, if a hospital information system would fulfil the information
strategies goals. In order to support strategic planning and to reduce efforts for creating strategic plans, we propose
a practicable structure. © 2001 Published by Elsevier Science Ireland Ltd.
Keywords: Hospital information system; Hospital information system management; Information management; Organizational issues;
Strategic plan
* Corresponding author.
E-mail address: winter@imise.uni-leipzig.de (A.F. Winter).
1386-5056/01/$ - see front matter © 2001 Published by Elsevier Science Ireland Ltd.
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100 A.F. Winter et al. / International Journal of Medical Informatics 64 (2001) 99–109
must not question whether a hospital should formation management plan [16]. The plan
be equipped with a hospital information sys- includes the direction and strategy of infor-
tem or not. The question of information mation management and gives directives for
management rather focuses on the issue, the construction and development of the hos-
whether the performance should be en- pital information system by describing its
hanced, for example by using computer-sup- intended architecture. A proposal for the
ported information processing tools. structure and content of strategic information
Accordingly, information management en- management plans will be presented in Sec-
gages in the following objects ([15], p. 1): tion 3.
information,
The strategic plan is the basis for strategic
application systems,
project portfolios. They contain concrete
computer-supported and non-computer-
projects, which implement the objectives of
supported information and communica-
the strategy, and shall be revised regularly.
tion techniques.
Directing a hospital information system as
The general tasks of management are plan-
part of strategic information management
ning, directing, and monitoring [11]. For in-
formation management in hospitals this means to transform the strategic plan into
means action, i.e. to systematically manipulate the
planning the hospital information system, hospital information system in order to make
respectively its architecture, it conform to the strategic plan. The system’s
directing its establishment and its opera- manipulation is done by the initiation of the
tion, and projects of the strategic project portfolio. The
monitoring its development and operation projects deal with the construction or further
with respect to the planned objectives. development and the maintenance of compo-
With respect to its scope information man- nents of the hospital information system.
agement can be differentiated into strategic,
tactical, and operational management [11].
The corresponding activities will be specified
in the next sections.
In summary, activities of information man-
agement can be classified by a three dimen-
sional classification as depicted in Fig. 1.
Planning, directing and monitoring these tactical information management are based
projects are the tasks of tactical information on the strategic plan they need a specific i.e.
management. Operational management will tactical project plan. This plan has to de-
be responsible for the proper operation of the scribe the project’s subject and motivation,
components. the problems to be solved, the aims to be
Monitoring a hospital information system achieved, the tasks to be performed, and the
as part of the strategic information manage- activities to be undertaken to reach the aims
ment means continuously auditing its quality [8]. Based on that directing in tactical man-
as defined by means of its strategic plan’s agement means the execution of such projects
directives and goals. It should be audited, of tactical information management in hospi-
whether the hospital information system is tals. Therefore, it includes typical tasks of
able to fulfill its tasks. In order to be able to project management like resource allocation
audit the information system’s quality the and coordination, motivation and training of
management task is to install ‘sensors’. They the personnel etc. Monitoring means continu-
have to receive information from the projects ously checking, whether the initiated projects
running, from operational management, from are running as planned and whether they will
users and from the various stakeholders. Ad- still produce the expected results.
ditional information can be gained by evalua-
tion projects (e.g. [17]). 2.6. Operational information management in
Strategic information management and in hospitals
result the strategic plan are the vital require-
ment for tactical and operational information Operational information management is
management in a hospital. responsible for maintaining the installed hos-
pital information system and its components.
2.5. Tactical information management in It has to care for its operation in accordance
hospitals with the strategic plan.
Planning in operational information man-
Tactical management deals with certain en- agement means planning of all resources like
terprise functions [18], i.e. with hospital func- organizational structures, finance, personnel,
tions as for example the planning and rooms, buildings that are necessary to ensure
documentation of operations. It aims to con- the faultless operation of all components of
struct or to maintain components of the hos- the hospital information system. These re-
pital information system. According to the sources need to be available for a longer
example above, this could be an application period of time. Therefore, they should be
system for planning and documentation of allocated as part of a strategic plan. More-
operations. Related activities are usually exe- over, planning in this context concerns the
cuted as projects; they have to be initiated as allocation of personnel resources on a day-to-
part of an information strategy, which is day basis (e.g. planning of shifts).
formulated in the project portfolio of a Directing means the sum of all manage-
strategic plan as drawn up by the information ment activities, which are necessary to ensure
management. proper reactions to operating faults of com-
Planning in tactical information manage- ponents of the hospital information system
ment means planning of projects and all re- i.e. to provide back-up facilities, to operate a
sources needed. Even though projects of helpdesk, to maintain servers, to keep ready
104 A.F. Winter et al. / International Journal of Medical Informatics 64 (2001) 99–109
task forces for repairing of network compo- 3.1. Stakeholders and their concerns
nents, servers, personal computers, printers
etc. Directing in this context deals with en- There are various stakeholders5 involved in
gaging the resources planned by the strategic the creation, updating, approval, and use of
plan in such a way that faultless operation of strategic plans:
the hospital information system is ensured. top management,
Monitoring deals with verifying the proper funding institutions,
working and effectiveness of all components employees, e.g. physicians, nurses, admin-
of the hospital information system. For ex- istrative staff,
ample, a messaging infrastructure must be clinical, administrative, and service
installed, which enables a quick transmission departments,
of users’ error notes to the responsible information management department (IM
services. department),
consultants,
hardware and software vendors.
3. Strategic information management plans in It has also been suggested to involve pa-
hospitals tients or patient organizations as stakehold-
ers [19]. These stakeholders may have
A strategic information management plan different expectations from a strategic plan
documents, how the goals of a particular and are involved in different life-cycle phases
hospital shall be supported by information of strategic plans:
technology. Therefore, it describes how infor- Creation, i.e. writing a first plan,
mation management will be organized, what Appro6al, i.e. making some kind of con-
the different working groups have to do and tract among the stakeholders,
how the various stakeholders are concerned Deployment, i.e. asserting that the plan is
(Fig. 2). The strategic plan defines direction put into practice,
and schedule for all tactical and operational Use, i.e. the involved stakeholders refer to
information management activities in the the plan whenever needed,
hospital. Updating when a new version is required
As a result of our experiences in drawing (because of new requirements, new avail-
up strategic information management plans able technologies, failure to achieve indi-
for a municipal hospital in Bremerhaven and vidual tasks, or adjusting the time frame of
for university hospitals in Utrecht (Nether- the plan). After the first version, the cre-
lands) [19], Heidelberg,2 Homburg,3 and ation and update phases merge into a
Leipzig4 we want to make some recommen- cyclic, evolutionary development of the
dations concerning structure and content of plan.
such plans [20].
Top management is interested in seamless
and cost-effective operation of the hospital.
They approve the plans, probably together
2
with the funding institutions, which are pri-
http://www.med.uni-heidelberg.de/mi/department/service/
rahmenko.zip
3 5
http://www.med-rz.uni-sb.de/zik/rahmenkonzept2000.pdf The term stakeholder is used to refer to everyone who may
4
http://www.imise.uni-leipzig.de/ gabi/KAS/Ueber have some direct or indirect influence on the system require-
sichten/rahmenkonzept.html ments [21] (p. 80).
A.F. Winter et al. / International Journal of Medical Informatics 64 (2001) 99–109 105
marily interested in the financial conse- reflecting tactical management issues. Addi-
quences. Employees as well as the different tionally the IM department usually has to
hospital departments should be involved in deploy the plan, which cannot be done with-
eliciting the requirements, since they will use out effective backing from the top manage-
the resulting information systems. IM depart- ment. Due to technological and market
ments will usually create and maintain pro- changes and the development of the hospital
posals for the plans. They are interested in over time, the validity of a strategic plan is
clearly defined requirements for their work, temporal limited. Therefore, after a period of
106 A.F. Winter et al. / International Journal of Medical Informatics 64 (2001) 99–109
3 – 5 years the IM department will initiate the Strategic goals of the hospital and of the
update of the plan. External consultants may information management
help creating or updating plans, but can also Description of the current state of the
be effective in negotiations for the approval. hospital information system
The actual strategic plans will be used by the Assessment of the current state of the hos-
IM departments as well as by software or pital information system
hardware vendors when constructing or Description of the planned state of the
maintaining components of hospital informa- hospital information system
tion systems. Path from the current to the planned state
This is only a basic structure that may be
3.2. Structure and content of strategic adapted to the specific requirements of indi-
information management plans vidual hospitals. Particularly, a short man-
agement summary and appendices describing
The most essential purpose of a strategic the organizational structure, personnel re-
plan is to improve a hospital’s information sources, the building structure, the network
system in a way it better contributes to the architecture, etc. are likely to complement a
hospital’s goals. This purpose determines its strategic plan.
structure, i.e. it should show a path from the
current situation to an improved situation, in 3.2.1. Strategic goals of the hospital and of
which the hospital’s goals are achieved as far the information management
as possible and reasonable. Hospitals aim at providing health care.
A strategic plan should encompass the hos- However, these goals may be further refined.
pital business strategy or strategic goals, For instance, specific goals could be to in-
the resulting information management strate- crease the number of outpatients, to decrease
gies, the current state of the hospital in- the average duration of inpatient stays, to
formation system, and an assessment perform best quality patient treatment, to
on how far the current information system improve collaboration with healthcare insti-
fits to the strategies. The planned architecture tutions in the nearer region, to be more com-
should be derived as a conclusion of this petitive by an image of being a modern
assessment. hospital with all the latest technical means, to
The strategic plan also has to deal with the offer wholesome patient care by less technical
resources needed to realize the planned archi- but more personal engagement, to increase
tecture, and has to include a strategy for the profit, and so on. Obviously, such very differ-
operation of the resulting hospital informa- ent and partly conflicting goals can result in
tion system and a description of appropriate different and conflicting information manage-
long term organizational structures. Exam- ment strategies and different architectures of
ples for resources are money, personnel, soft- hospital information systems.
and hardware, energy, rooms for servers and
(paper-based) archives, and for training. The 3.2.2. Description of the current state of the
resources should fit to the architecture and hospital information system
vice versa. Before any planning is commenced, the
The general structure of strategic plans for hospital information system’s current state
information management in hospitals can be should be described. This may require some
summarized as follows: discipline, because some stakeholders may be
A.F. Winter et al. / International Journal of Medical Informatics 64 (2001) 99–109 107
more interested in the planned (new) state achieves the goals better, provided that the
than in the current (obsolete) state. current state does not already achieve the
The description of the current state will be hospital’s goals. Note that beside of technical
the basis for identifying those functions [18] aspects also organizational aspects have
of the hospital that are supported well—e.g. to be discussed. In many cases this is an
by information technology— and those func- opportunity for introducing a chief informa-
tions that are not (yet) well supported. Thus, tion officer (CIO) or to clarify its role respec-
application systems as well as existing infor- tively.
mation and communication technology have
to be described including their contribution 3.2.5. Path from the current to the planned
to the overall performance of the hospital’s state
functions. The functions having to be consid- This section should describe a project port-
ered here can be derived from the goals of the folio as a step-by-step path from the current
hospital. to the planned state. It should include as-
Problems in information processing do not signed resources, i.e. personnel, estimated in-
always have technical reasons only, but may vestment costs as well as future operation
also be caused by shortcomings in organizing cost, etc. and concrete deadlines for partial
information management [6]. Thus, the de- results of the portfolio’s projects. This path
scription of the current state should be com- could also assign priorities to individual
pleted by the description of the current projects as well as dependencies between
organizational structure of information projects.
management.
mainly with human beings and their social ‘bad’ information system is. But what are
behavior. As a consequence we proposed to criteria for ‘good’ hospital information sys-
define a hospital information system as a tems? So future work has to define such
sociotechnical subsystem of a hospital. criteria, which enable us to compare
We showed, that without a strategic infor- ‘chaotically’ developed hospital information
mation management plan, neither tactical nor systems with systematically developed hospi-
operational management would work appro- tal information systems based on strategic
priately. A strategic information management plans.
plan is the ‘plot’ for planning, directing, and
monitoring the hospital information system.
It should be written and approved by the References
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