Chapter 36 & 37 - Desiderio, Gomez, Limcangco (BSN2B)

BATAAN PENINSULA STATE UNIVERSITY
MAIN CAMPUS www.bpsu.edu.ph

College of Nursing and Midwifery bpsu.cnm.2018@gmail.com
City of Balanga, 2100 Bataan
HEALTHCARE ANALYTICS
Nursing Level 2
2nd Semester 2021
SUBMITTED BY:
DESIDERIO, JOZZLYN MARIE B.
GOMEZ, CARREL DANE D.
LIMCANGCO, ANGELA MAREE D.
BSN 2-B
SUBMITTED TO:
Ma’am Charlene Joy Gallos
April 24, 2021
Our Vision Our Mission
A leading university in the Philippines recognized for its To develop competitive graduates and empowered community members by providing relevant,
Proactive contribution to Sustainable Development Innovative and transformative knowledge, research, extension and production programs and services
through progressive enhancement of its human resource capabilities and institutional mechanisms
Through equitable and inclusive programs and services by 2030
Outline of Topics
 Definition
 The Triple Aim
 Terms Associated with Healthcare Analytics
 Common Middleware Tools
 Decision Support System
 Difference of Reports and Analytics
 Major Systems in Hospitals
 Rapid Cycle Improvement Processes
 Steps in Performance Management
 DEFINITION
Prepared by: DESIDERIO, Jozzlyn Marie B.
A. Healthcare
 Definition
- The prevention, treatment, and management of illness and the preservation of mental and
physical well-being through the services offered by the medical and allied health
professions.
B. Analytics
 Definition
- The scientific process of discovering and communicating the meaningful patterns which
can be found in data.
- Concerned with turning raw data into insight for making better decisions
- Relies on the application of statistics, computer programming, and operations research in
order to quantify and gain insight to the meanings of data
- Especially useful in areas which record a lot of data or information
C. Healthcare Analytics
 Definition
- The technology and processes that calculate, track, and analyze healthcare data are
the subject of healthcare analytics
- Helps healthcare providers to arrive to more accurate and reliable tactical and clinical
decisions, when used correctly.
- Insights can help you better understand the drivers of organizational and clinical
performance, patient outcomes, distribution costs, and which elements of those
outcomes you can change for better results
D. Benefits
- Enables companies to analyze data more efficiently and effectively, resulting in improved
decision-making across the board
- Improves focus on resources to have the greatest effect on enhancing operating practices,
processes, and patient care
 Improve Patient Experience
- Helps to concentrate attention on improving the quality of treatment
- Transforms data into actionable knowledge that aids in making the best decisions
possible about the patient experience.
 Gain market share
- Assists providers in determining where to grow, what specialized programs to invest
in, and how to improve existing services.
 Cost optimization
- Helps to streamline supply chains by providing data on inventory, supply costs, and
suppliers, as well as insights that increase supply chain performance
 Improve Billing Efficiency
- Gives a lot of information about procedures and results through different facilities or
providers.
- Loss is reduced when irregularities are identified such as false statements, redundant
billing, or duplicated supply orders
 THE TRIPLE AIM

Prepared by: GOMEZ, Carrel Dane G.
A. Definition
 Driver of Governmental Healthcare Policy and Funding
 Framework developed by the Institute for Healthcare Improvement that describes an approach to
optimizing health system performance.
B. Approach in line with the IHI Triple Aim - IHI believes that to do Triple Aim effectively, it’s
important to harness a range of:
1. Community determinants of health
2. Empower individuals and families
3. Substantially broaden the role and impact of primary care and other community based
services, and
4. Assure a seamless journey through the whole system of care throughout a person’s life
C. Concept Design of the Triple Aim - IHI’s innovation team developed a concept design and
described an initial set of components of a system that would fulfill the IHI Triple Aim. The five
components are listed below:
1. Focus on individuals and families
2. Redesign of primary care services and structures
3. Population health management
4. Cost control platform
5. System Integration and Execution
D. Three Components of Triple Aim (Berwick et al., 2008; IHI, n.d.)
 Improve the experience of care
- Providers can use real-time data to help clinicians make decisions about patient care, as
well as improve future patient care through the capture and analysis of patient satisfaction
surveys.
 Improve the health of populations
- Hospitals can identify opportunities for clinical and financial improvement in the
management of specific patient populations.
 Reduce the per capita costs of healthcare
- Whether for identifying clinical variance, streamlining supply chain management or
using real-time data to predict staffing needs, data can be used in a number of ways to
reduce waste and cost for a hospital.
E. Healthcare Reform and the Triple Aim
Selected access and delivery reforms and potential effects on the Triple Aim
Reform Population Quality Costs

Health
Basic Health Preventive care Comprehensive benefits Cost sharing based on income;
Coverage without cost Provider risk payment
sharing
ACOs and medical  Improve care  Provider risk payments;

homes coordination  Reduce duplication and
and; waste;
 Patient  Reduce use of inpatient
experience with services by coordinating
care outpatient care
Inpatient care for  Improve  Lower hospital

Medicare patients in inpatient readmissions;
fee-for-service health experience and;  Acquired hospital
plans.  Quality of care infection rates
 TERMS ASSOCIATED WITH HEALTHCARE ANALYTICS

Prepared by: LIMCANGCO, Angela Maree D.
A. Data
 Definition
- Raw facts
- Meaningless by themselves
- Require context to be interpreted
 Big Data
- Defined in 3Vs: volume, high-velocity and high-variety information
- Assets that demand cost-effective, innovative forms of information processing for enhanced
insight and decision making
 Massive volumes of information created by the adoption of digital technologies that
collect patients' records and help in managing hospital performance, otherwise too
large and complex for traditional technologies
 Applied to healthcare, it will use specific health data of a population (or of a
particular individual) and potentially help to prevent epidemics, cure disease, cut
down costs, etc.
B. Information
 Definition
- Data are in a contextually organized state
- A collection of data or facts


Health Information System
- A system designed to manage healthcare data through processes like collecting, storing,
managing and transmitting
 The healthcare industry constantly produces data. Health information systems help
gather, compile and analyze health data to help manage population health and reduce
healthcare costs. Then the healthcare data analysis can improve patient care
C. Knowledge
 Definition
- Information that can be used to make decisions
- Understanding of the information that is discovered and can be put to use
 Knowledge Management
- The process of capturing, developing, sharing, and effectively using knowledge
- Focuses on strategic objectives such as improved performance, competitive advantage,
innovation, the sharing of lessons learned, integration, and continuous improvement.
D. Wisdom
 Definition
- The application of data, information, and knowledge to make appropriate decisions
 Practical Wisdom
- Characterized by its fusion of practical, theoretical and interpersonal considerations and by its
substantive guide to the workings of judgment.
- A theoretical virtue of human reason, manifesting itself in a multiplicity of different kinds of
intellectual activities and knowledge
 COMMON MIDDLEWARE TOOLS

 Definition
- Software that provides common services and capabilities to applications outside of
what’s offered by the operating system.
- Helps developers build applications more efficiently.
- Acts like the connective tissue between applications, data, and users.
- Data management, application services, messaging, authentication, and API management
are all commonly handled by middleware.
 Some Common Middleware Tools in Hospitals
1. Crystal reports
- Is a popular Windows-based report writer solution that allows a developer to create
reports and dashboards from a variety of data sources with a minimum of code to write
- Owned and developed by SAP.

- Designed to produce reports from virtually any data source.
- Formulas, cross-tabs, sub-reports and conditional formatting help make sense of data and
uncover important relationships that might otherwise be hidden.
- Data visualization tools such as geographic maps and graphs communicate information
visually to help in understanding data analysis.
2. Business Objects
- Business objects can be any type of entity for which you store information, such as
patients, doctors, hospitals, medications, and so on.
3. Excel
- Used for analysis, reporting, and manual integration of data
4. SSRS
- SQL Server Reporting Services is used as way of extracting and manipulating data
- A reporting software that allows you to produce formatted reports with tables in the form
of data, graph, images, and charts
- Reports are hosted on a server that can be executed any time using parameters defined by
the users. It is part of Microsoft SQL Server Services suite.
5. SPSS
- Acronym for Statistical Package for the Social Sciences, and it’s used by various kinds of
researchers for complex statistical data analysis.
- Used for statistical analysis in social science
- Provides solutions for data management, which allow researchers to perform case
selection, create derived data, and perform file reshaping.
6. R
- A free software programming language and software environment for statistical
computing and graphics.
- Used in many academic medical centers
7. RDL
- Report Definition Language used for data reporting.
- An XML representation of a SQL Server Reporting Services report definition. A report
definition contains data retrieval and layout information for a report. RDL is composed of
XML elements that match an XML grammar created for Reporting Services.
8. Microsoft—Access Database
- Used for storing and manipulating data obtained from other systems
9. PORG
- Personal Option Report Generator used by some financial and payroll systems for
reporting and data extraction
10. SQL
- Stands for Structured Query Language. SQL is used to communicate with a database.
According to ANSI (American National Standards Institute), it is the standard language
for relational database management systems.
- Standard Query Language is used to run reports and extract data from relational
databases.
11. Promodel
- Tool for data simulation
- A Windows based system with an intuitive graphical interface and object-oriented
modeling constructs that eliminate the need for programming
- Combines the flexibility of a general purpose simulation language with the convenience
of a data-driven simulator.
 DECISION SUPPORT SYSTEM

 Definition
- A conceptual framework for decision-making
- Applies quantitative models, and simulation models which impact strategy and performance.
- Enhances medical decisions with targeted clinical knowledge, patient information, and other
health information.
 Traditional CDSS
- Comprised of software designed to be a direct aid to clinical-decision making, in which the
characteristics of an individual patient are matched to a computerized clinical knowledge

base and patient-specific assessments or recommendations are then presented to
the clinician for a decision
 Modern CDSS
- Primarily used at the point-of-care, for the clinician to combine their knowledge with
information or suggestions provided by the CDSS and continuous development of those with
the capability to leverage data and observations otherwise unobtainable or uninterpretable by
humans.
 Subsystems
1. Business Intelligence
- Any computerized applications that apply analytical tools, applications, and
methodologies
- The process is based on the process of transforming data to information.
- Formerly known as Executive information systems (EIS): was used as senior
business leaders used multi-dimensional data in either ad hoc or routinely scheduled
runs for reporting, forecasting, status against key performance indicators (KPIs).
- Examples: Data warehouses, data marts, online analytical processing (OLAP),
dashboards, and scorecards with drill down capabilities.
2. Knowledge Management System
- Computerized applications to identify, collect, capture, store, manage, and
disseminate useful knowledge to workers to support individual or group decision-
making.
- An applied business practice that uses technology.
- Includes data, information, knowledge, action, and results (DIKAR).
- Bring together culture, process and decrease variation in practice.
- Supported by artificial intelligence (AI), intelligent agents (AIs), knowledge
management in databases (KMDBs), extensible markup language (XML), Web 2.0,
electronic document management systems (EDM), enterprise knowledge portals
(EKPs), collaborative computing and groupware tools, knowledge serves, knowledge
harvesting tools, search engines, and content management systems (CMS).
3. Business Performance Management
- A subset of Business Intelligence
- Used to change behaviors related to achieving results.
- Uses analytical visual applications
- Relates to various rapid-cycle improvement processes
4. Predictive Analytics
- Uses forecasting and simulation models to predict occurrences, trends, or
outcomes.
- Examples:
- LACE model for predicting patients who are at a high risk for a hospital
readmission in relation to these four predictive factors:
•• L = length of stay
•• A = acute admission through the emergency department (ED)
•• C = co-morbidities
•• E = ED visits within the past six months (RWJF)
- CURB-65 criteria for predicting mortality for Community Acquired Pneumonia
in patients 65 or older.
•• C = Confusion of recent onset
•• U = Urea (BUN > 7)
•• R = Respiratory rate > 30 breaths per minute
•• B = Blood Pressure (Systolic < 90 mmHg and Diastolic < 60 mmHg)
•• 65 = Age 65 or older
 REPORTS vs. ANALYTICS

 Similarities
- Both are considered Business Intelligences
- Fields of Application

1. Quality of care - The degree to which health services for individuals and
populations increase the likelihood of desired health outcomes, based on evidence-based
professional knowledge
2. Service Line analysis – Analysis of demand factors within a particular healthcare service
line in order to identify areas of strong and poor consumer opportunity.
3. Clinical effectiveness - Doing the right thing at the right time for the right patient by
applying the best knowledge, derived from research, clinical experience and patient
preferences
4. Variation in practice (cost, quality, length of stay, and post-operative complications)
5. Operational effectiveness - Maximizing the efficient use of resources in their business
operations and to improve quality, productivity, or competitive positioning in markets in
which they participate.
6. Improve financial performance
 Differences
1. Reports
- A static view of data at a point in time that shows what happened
- One data source, one view that shows one aspect of the problem or situation
- Validity and reliability issues as each separate analytical system has its own
terminology and description of values
2. Analytics
- A malleable view that can drilldown to indicate why it is happening, and can assist
with determining the root cause
- Multi-phasic views that incorporate data and information from other electronic
systems, such as clinical information from an EHR and financial systems
- One version of the truth” where standardized terminology is used and the process for
producing the analytics is tracked
 MAJOR HOSPITAL SYSTEMS

 Definition
- A hospital information system (HIS) is an element of health informatics that focuses mainly
on the administrational needs of hospitals.
- In many implementations, it is a comprehensive, integrated information system designed to
manage all the aspects of a hospital's operation, such as medical, administrative, financial,
and legal issues and the corresponding processing of services.
- Hospital information systems are also known as hospital management software (HMS) or
hospital management system.
- An information system that facilitates the activities of a hospital takes into consideration:
 the functions of a healthcare facility
 the capability of information technology
 The Major Systems Used In Hospitals
1. Transactional processing systems (TPS)
- A TPS is used for operational management. They tend to be real-time systems, such
as ADT.
- For example, a transactional system would have minute-to-minute census
information. They are used for operations management.
2. Decision Support Systems
- These systems are not transactional, which means that they are not real time. These
systems are used for tactical or strategic management decision.
- Data marts and data warehouses receive data feeds from transactional systems or
operational data stores (ODS) at pre-defined intervals.
- The frequency of data feeds to a data warehouse or a data mart often depends on the
decisions that are being made and how current the data need to be (data latency).
3. Management Information Systems (MIS)
- A MIS consists of transactional data that process patient data.
- It includes document management software, health information management systems
(HIS), microfiche viewing systems, and telephone systems.
4. Data Visualization Tools

- Dashboards and scorecards are examples of how data and information can
be displayed.
- It is important to determine the type of dashboard, such as financial, clinical
outcomes, departmental specific, patient flow, service line, etc.
- Clinical informatics professionals often need to counsel and discuss with end users
which visual application viewing format would work best.
-
Presenting several prototypes and discussing the advantages and disadvantages of
each prototype can be valuable. Some BI experts dislike using pie charts because of
the limitations associated.
5. Rapid-cycle improvement processes
- Combined with visual analytical tools, such as dashboards to allow the teams to track
progress toward the goals over time. Dashboards are an easy means to determine if
the action is working or not and to spark additional questions, which the team can
respond to as they work toward achieving the KPIs
 RAPID CYCLE IMPROVEMENT PROCESSES

 Definition
- Mechanism to promote rapid behavioral changes leading to cultural changes
- Tools used to aid in the goal of Business Project Management, which is to change
behavior through strategies and objectives
- Tests changes over periods of three or months or less, rather than the standard eight to
twelve months
 Rapid Cycle Change
- A systematic problem-solving approach to understand client needs, restructure processes,
and make the most efficient use of available resources
 Processes
1. Plan-Do-Check Act (PDCA)
- A repeated cycle that is used to carry out change
- Used when:
 Starting a new improvement project
 Developing a new or improved design of a process, product, or service
 Defining a repetitive work process
 Planning data collection and analysis in order to verify and prioritize
problems or root causes
 Implementing any change
 Working toward continuous improvement
- Steps:
a. Plan: Recognize an opportunity and plan a change.
b. Do: Test the change. Carry out a small-scale study.
c. Check: Review the test, analyze the results, and identify what you’ve
learned.
d. Act: Take action based on what you learned in the study step. If the
change did not work, go through the cycle again with a different plan. If
you were successful, incorporate what you learned from the test into
wider changes. Use what you learned to plan new improvements,
beginning the cycle again.
2. Six Sigma (Define, Measure, Analyze, Improve, and Control)
- Data-driven quality strategy used to improve processes that focuses on the
development of new products or services compared to existing ones
- Phases:
a. Define the problem, improvement activity, opportunity for improvement,
the project goals, and customer (internal and external) requirements.
b. Measure process performance.
c. Analyze the process to determine root causes of variation and poor
performance (defects).
d. Improve process performance by addressing and eliminating the root
causes
e. Control the improved process and future process performance.

3. Lean
- A system for developing process improvement that is continuous and has a focus
on reducing and eliminating waste
- Benefits:
 Minimize waste
 Reduce inventory

Increase productivity

Improve quality

Increase customer satisfaction

Reduce costs

Increase profits
- Basic techniques:
 Look at the overall flow of products and services
 Do not focus only on separate technologies and departments but look at
the big picture
 Look at all assets, technologies, and departments involved
 Eliminate waste along the entire process not just separate points
 (Voice of the customer, value stream mapping, determination of the
value-added and non-value-added steps, create or revise processes)
4. Root Cause Analysis (RCA)
- Retrospective analysis of a problem or event—asks a series of why questions to
determine the root cause
- Core Principles:
 Focus on correcting and remedying root causes rather than just
symptoms.
 Don’t ignore the importance of treating symptoms for short term relief.
 Realize there can be, and often are, multiple root causes.
 Focus on HOW and WHY something happened, not WHO was
responsible.
 Be methodical and find concrete cause-effect evidence to back up root
cause claims.
 Provide enough information to inform a corrective course of action.
 Consider how a root cause can be prevented (or replicated) in the future.
- RCA Process
a. Define the Problem
b. Collect Data
c. Identify Possible Causal Factors
d. Identify the Root Cause(s)
e. Recommend and Implement Solutions
5. Failure Mode Effects Analysis (FMEA)
- A tool for identifying potential problems and their impact
- Failure modes: the ways, or modes, in which something might fail, and can be
potential or actual.
- Effects analysis: refers to studying the consequences of failures
- Used when:
 Designing a new product, process or service
 Planning on performing an existing process in a different way
 Having a quality improvement goal for a specific process
 Trying to understand and improve the failures of a process
- Process:
a. Define the topic
b. Assemble the Team
c. Graphically Describe the Process
d. Conduct the Analysis
e. Identify Actions and Outcome Measures
 (Process maps current state, identify process failures, estimate effect
of identified failures, identify top reasons for failure, and take risk
mitigation steps)
 STEPS IN PERFORMANCE MANAGEMENT

Prepared by: GOMEZ, Carrel Dane G.
A. Definition
- It is a strategic process that is intended to achieve results, produce outcomes, and change
behavior.
- Synonymous with “performance appraisal” which requires more than an annual
performance, and is in fact an ongoing and rewarding process.
- ‘Action, based on the performance measures and reporting, which is directed to improving
behavior, motivation and processes’ (Radnor & Barnes, 2007: 393).
B. Steps in Performance Management

1. Planning
- The first step of the performance management process
- The groundwork for success is laid down, this involves the overall strategy for the
business.
a. The defining stage - HR and management need to define the job itself, including
a comprehensive description, long and short term goals, identify key objectives
and develop a clear metric for how those objectives and goals will be assessed.
b. The feedback stage - once management completed the defining stage,
employees should have the opportunity to give input on this material.
c. The approval stage - management and employees both agree to the definition of
the role, goals and objectives.
2. Monitoring
- Key function in achieving the goals set out in the planning stage.
a. Organize meetings on a timely, regular basis - the monitoring process is
extremely important and must be done on a regular basis. Meetings should be at
least quarterly, although monthly meetings are the ideal.
b. Provide necessary training, coaching and solutions - should focus on solutions
and coaching opportunities, rather than punitive measures for lackluster
performance.
c. Solicit feedback on both sides - management should be able to give - and -
receive honest feedback and work with employees rather than adopting a
combative stance.
d. Revisit objectives as necessary - this step involves reviewing the overall
performance of the employee, and how well the process itself worked.
3. Reviewing
- Chance of management and employees to evaluate both the final result and the process
itself.
a. Reviewing employee performance - held to look at how well the employee
performed over the span of time. There should be a clear record from previous
check-ins to show the employee’s progress throughout the year.
b. Reviewing the performance management process - it is important for both
management and employees to look over the previous year and see how well the
performance management process worked.
c. Reviewing overall goal completion - it is important to look at both smaller and
larger goals, as this can give an indication to problem areas where training or
interventions can be applied.
d. Giving actionable feedback - key part of the review - to give and receive
feedback.
4. Rewarding
- The last step in performance management process
- A step that cannot be overlooked, as it is the one that is the most important for employee
motivation.
a. Reward and recognition - absolutely key - employees will not stay motivated if
they are given no reason to. This does not necessarily have to be monetary,
although it likely will include monetary compensation.
b. Setting the stage for next year’s performance management cycle - the end of
the performance management cycle where management and employees are given
one last chance to offer feedback on the process as a whole and asks for thoughts
and feedback for the planning stage for the next year’s cycle.

C. Coherent Programs in line with Performance Management Approach
1. Goal Setting
 Evaluations of goal setting have shown that if an employee believes that their goals are
important, they become the standard against which their performance will be measured,
and if they receive regular feedback, their performance will improve (Locke et. al 1981;
Bandura & Locke 2003).

The evidence is clear that the goals need to be “SMARTT”. Performance goals need to be
Specific, Measurable, Attainable but challenging, Relevant and recorded, and have a
Timeframe for achievement, and be Trackable or easily monitored (Mealiea & Latham,
1996: 35).
2. Performance Measurement and Reporting
 The intent of the balanced scorecard (BSC) was to provide a ‘balanced’ picture of
performance which contains balance of indicators focusing in different content areas, as
well as balance between short-term and long-term indicators. Balanced scorecards have
been enhanced to incorporate strategy maps that illustrate the link between key
performance indicators and their impact on the achievement of the organizational strategy
(Kaplan & Norton, 2000).
3. Performance Feedback
 Suggests that managers need to conscientiously avoid a win-lose mindset, and focus on
the desired behavior, providing examples and detailing how to improve (DeNisi &
Pritchard 2006), rather than emphasizing the person or the undesired behavior (Latham et
al., 2005).
 It is clear that feedback is more readily accepted if it is delivered by someone whom the
recipient trusts and believes has good intentions (Manzoni, 2002).
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Decision Support Systems – Limcangco, Angela Maree D.
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Performance Management – Gomez, Carrel Dane D.

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[04.21.2021]
PLANNING, DESIGN, AND

IMPLEMENTATION OF
INFORMATION TECHNOLOGY
IN COMPLEX HEALTHCARE
SYSTEMS
Nursing Level 2
2 Semester 2021
nd
SUBMITTED BY:
DESIDERIO, JOZZLYN MARIE B.
GOMEZ, CARREL DANE D.
LIMCANGCO, ANGELA MAREE D.
BSN 2-B
SUBMITTED TO:
Ma’am Charlene Joy Gallos
April 24, 2021
Outline of Topics
 Definition of Complex Healthcare Systems through the Systems Theory

 System Flow
 Information System Planning
 Information System Design
 System Analyst Toolbox
 Organizational Fragility
 DEFINITION OF COMPLEX HEALTHCARE SYSTEMS THROUGH THE SYSTEMS

THEORY
Prepared by: GOMEZ, Carrel Dane D.
A. General Systems Theory
- A system can be defined as a set of interacting units or elements that form an integrated whole
intended to perform some function (Skyttner, 2001).
- Provides a general language which ties together various areas in interdisciplinary communication.
B. Types of General Systems Theory
 Open Systems
- Goal seeking
- As simple systems interact, they are synthesized into a hierarchy of increasingly complex
systems, from subatomic particles to entire civilizations (Skyttner, 2001).
 Complex Systems
- Way of information flows through a web of channels that depends on the technology used,
organizational design, and the nature of tasks and relationships (Clancy & Delaney, 2005).
 Complex Adaptive Systems (CAS)
- Exhibit specific characteristics that are different from simple systems and the terminology
used to define them may be unfamiliar to healthcare providers.
- Special cases of complex systems; the key difference being that a CAS can learn and adapt
over time (Clancy, Effken & Pursuit, 2008).
C. Principles of General System Theory and its Application in Nursing
 The principle of wholeness
- Provides guidance or methodology to us in order that we can study all kinds of objects
effectively
 The principle of optimization
- To achieve an optimal state in certain condition and to perform its best function by
organization and coordination
 Local effect must obey whole effect
 Insisting multipolar optimization
 To combine the Absoluteness and relatively of optimization
 The principle of modeling
- To design a model similar to a real system first, then to describe and understand the
characterization and level of the real system by studying the model.
 Concrete Model
 Abstract Model
 Structural Model
 Functional Model
 SYSTEM FLOW

 Definition
- The complex system interactions, branching, activities and decisions that systems execute
- Without flow, a system cannot exist and to survive, it must evolve in a direction that
improves its access to designs that improve the flow of currents through them
 Long and fast flows

- Movement of information flow at a faster rate and through longer distances in wider or
larger channels
 Short and slow flows
- Branching out and creating smaller channels causes the movement of information flow to
slow down and travel shorter distances
 Development of queues
- Delayed information flow as a result of:
 Poorly designed systems
 Burdensome processes and policies
 Mismatch between “short and slow” and “fast and long” information flow
 INFORMATION SYSTEM PLANNING

 Definition
- The process of determining and analysing information requirements and integrating those
requirements with overall organizational objectives
 Information System (IS)
- Interrelated components working together to collect, process, store, and disseminate
information to support decision making, coordination, control, analysis, and visualization
in an organization
 Information System Plan
- Guide organizational activities, and serve as a means for evaluating results using the
rapidly advancing information technology
- Takes into account both the short and the long term views in order to properly allocate
resources as well as support the information needs of an organization
 Levels of Information System Planning Process
1. Strategic Planning
- Establishing the relationship between the overall organizational plan and the IS
plan
IS Planning Activity Related Operations
Assess organizational characteristics  Review the organizational strategic plan
 Identify the organizational objectives and strategy
 Assess the organizational environment
Assess IS environment  Assess the current IS capabilities
 Assess the current application portfolio
 Application Portfolio: refers to an
organization's collection of software
applications and software-based services
 Evaluate the stage of IS maturity in the
organization.
Identify IS strategic opportunities  Identify the role and importance of IS in the
organization
 Identify the applications with strategic relevance.
Set IS strategy  Set the IS objectives, set the IS mission and
strategy
 Set the IS charter
2. Organizational Information Requirements Analysis (Tactical Planning)

- Identifying broad, organizational information requirements to establish a strategic
information architecture that can be used to direct specific system development
project.
Determine information requirements  Define the current and projected information
needs.
Assemble application portfolio  Evaluate the organizational needs, and identify
relevant IS project
Formulate IS architecture  Identify the resources needed, and formulate the
overall architecture (hardware, software,
communications, facilities, etc.).
Rank projects  Rank the IS projects according to relevant criteria
3. Resource Allocation (Operational Planning)
- Allocating both IS application development resources and operational resources
Evaluate anticipated results  Assess benefits for each project.
Assign development priorities  Review the potential benefits, estimate the time
needs
 Develop a priority scheme for IS projects based on
projected results.
Plan for resource allocation  Develop the IS plan (hardware, software,
personnel and facilities)
 Develop the annual financial plan
 Develop the specific time tables for various
activities.
 Wicked Problems
- Problems encountered that are difficult or impossible to solve because of incomplete,
contradictory, and changing requirements
- Characteristics:
 Very difficult to define or formulate
 Not described as true or false, but as better or worse
 Have an enumerable or exhaustive set of alternative solutions
 Inaccessible to trial and error; solutions are a “one shot” deal
 Unique and often a symptom of another problem
- Exists because practice patterns vary, each provider wants the system customized to their
workflow, thus imposing an enumerable number of alternative solutions
- Solution: Engage all stakeholders, find those who are most affected, and formulate a
common agreed approach
 INFORMATION SYSTEM DESIGN

 Definition
- The designer takes the system-requirements document created in the analysis phase and
develops the specific technical details required for the system.
- Business requirements are translated into specific technical requirements
- Develops design for the user interface, database, data inputs and outputs, and reporting
- End Product: System-design document that contains everything a programmer will need to
actually create the system
 Types of System Design

1. Structured Design
- A set of prearranged procedures performed to convert the logical specification into
a design that can be implemented on the organization’s computer system
- Also known as detailed design or internal design
- Goals:
 Convert the structured specification into a reliable, maintainable design. This is
similar to the process of converting a building model into a blueprint.
 Develop a plan and budget that will ensure an orderly and controlled
implementation of the new system. Procedures must be devised to get the
hardware in place, the programming completed, the training conducted, and the
new system operating.
 Develop an implementation test plan that ensures that the system is reliable,
complete, and accurate. A plan must be developed to test the system to ensure
that it does what the user wants it to do.
 Develop a user manual that facilitates efficient and effective use of the new
system by operations and management personnel. Personnel must know how to
use the new system effectively, and the information processing staff must know
how to operate the system.
 Develop a program that ensures that users and support personnel are
adequately trained.
2. Agile Design
- An iterative process, which starts from the first stage and moves towards the last
stage.
- The goal is not to create a deliverable, but to improve the design in each iteration
- The stages run in parallel as the functionality is divided into small parts that can be
delivered independently and are worked on simultaneously
- Practices:
 Architecture envisioning - Light-weight modelling at the beginning of a
project to identify and think through critical architecture-level issues.
 Iteration modelling - Light-weight modelling for a few minutes at the
beginning of an iteration/sprint to help identify your team's strategy for that
iteration. Part of your iteration/sprint planning effort.
 Model storming - Light-weight modelling for a few minutes on a just-in-time
(JIT) basis to think through an aspect of your solution.
 Test-first design (TFD) - Write a single test before writing enough
production code to fulfil that test.
 Refactoring - Make small changes to a part of your solution which improves
the quality without changing the semantics of that part.
 Continuous integration - Automatically compile, test, and validate the
components of your solution whenever one of those components changes.
 SYSTEM ANALYST TOOLBOX

A. Flowcharts
 Definition
- One of the most basic tools used by system analysts to describe the flow of entities
(information, patients, and providers) in a process.
- Flowcharting software can be found as a stand-alone commercial product or as a feature in
word processing, spreadsheet, and project management software
B. Computer-Aided Software Engineering (CASE) Tools
 Definition
- A suite of software applications used for systems design and analysis.
- Improve communication, integrate life cycle activities, and are used extensively in the design
and implementation of new applications
C. Discrete Event Simulation
 Definition

-
Utilizes mathematical formulas to show how model inputs change as a process
evolves over time
- Typically built visually using standard flowchart symbols
- Simulated entities (people, patients, information) as they move through individual steps
- Allows analyst to quickly communicate the flow of entities within a process and compare
differences in workflow after the introduction of new technology
- Ideal for agile design projects because processes can be quickly modelled and analyzed prior
to testing
D. Network Analysis
 Definition
- Network analysis combines theories from sociology and information science (network
theory).
- The unit of measure is the pattern of relationships that exist between entities and the
information that flows between them
- The field characterizes entities as “nodes” and the relationship or link between them as “ties.”
- The pattern and strength of ties between nodes is then plotted on a graph where the flow of
information can be analysed
- These tools measure information centrality, density, speed, and connectedness and can
provide an overall method for measuring the accessibility of information to provider
 ORGANIZATIONAL FRAGILITY
 Definition
- The effect of organizational complexity when it decreases both the quality and financial
performance of a health system, thus, creating an exponentially negative impact when
unexpected events take place
 Definitions in Fragility:
1. Fragile
- Does not like volatility
- Essentially everything in the modern economy
- Tend to break ruinously when subjected to just a bit too much stress, which is a
highly nonlinear response, because up to the point of breaking there is often little
indication of a problem
2. Antifragile
- Likes and requires volatility (randomness, stress, etc.) to stay healthy or to get
stronger
- Uses stressors in the environment as fundamental information that allow the
organization to make minor adjustments
- Combats black swan events
3. Robust/Resilient
- Resistant to volatility but not Antifragile because this does not improve or grow
because of stress
4. Black Swan event
- A low probability, but high impact event that cannot be predicted, but they can be
anticipated
- Mitigated by prediction, prognostication, and risk management
 Characteristics of Antifragile Organizations
 Systems thinking
- Everybody in the organization knows the goals of the organization and makes
sure their work is directly contributing towards these goals
 Theory Y Management
- Management needs to assume employees are anti-fragile, self-motivated and will
be able to learn how to solve problems themselves
- Give employees autonomy, purpose, and the opportunity to learn and master new
skills

 Continuous experimentation
- Good management knows that the best solutions come from the workers
- Create an environment in which practitioners are able to research ways to deliver
services more efficient and effectively, and learn as rapidly as possible
References:
Definition of Complex Healthcare Systems through the Systems Theory
Professional.
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System Flow – Limcangco, Angela Maree D.

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Information System Planning – Limcangco, Angela Maree D.

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Chapter 36 & 37 - Desiderio, Gomez, Limcangco (BSN2B)

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BATAAN PENINSULA STATE UNIVERSITY

MAIN CAMPUS www.bpsu.edu.ph

City of Balanga, 2100 Bataan

April 24, 2021

Our Vision Our Mission

City of Balanga, 2100 Bataan

Our Vision Our Mission

City of Balanga, 2100 Bataan

 THE TRIPLE AIM

Reform Population Quality Costs

ACOs and medical  Improve care  Provider risk payments;

Inpatient care for  Improve  Lower hospital

Our Vision Our Mission

City of Balanga, 2100 Bataan

 TERMS ASSOCIATED WITH HEALTHCARE ANALYTICS

- A collection of data or facts

 COMMON MIDDLEWARE TOOLS

Our Vision Our Mission

City of Balanga, 2100 Bataan

 DECISION SUPPORT SYSTEM

Our Vision Our Mission

City of Balanga, 2100 Bataan

 REPORTS vs. ANALYTICS

Our Vision Our Mission

City of Balanga, 2100 Bataan

 MAJOR HOSPITAL SYSTEMS

Our Vision Our Mission

City of Balanga, 2100 Bataan

 RAPID CYCLE IMPROVEMENT PROCESSES

Our Vision Our Mission

City of Balanga, 2100 Bataan

 STEPS IN PERFORMANCE MANAGEMENT

Our Vision Our Mission

City of Balanga, 2100 Bataan

B. Steps in Performance Management

Our Vision Our Mission

City of Balanga, 2100 Bataan

Our Vision Our Mission

City of Balanga, 2100 Bataan

The Triple Aim – Gomez, Carrel Dane D.

Terms Associated With Healthcare Analytics – Limcangco, Angela Maree D.

Common Middleware Tools – Desiderio, Jozzlyn Marie B.

Our Vision Our Mission

City of Balanga, 2100 Bataan

Major Systems in the Hospital – Desiderio, Jozzlyn Marie B.

Rapid Cycle Improvement Processes – Limcangco, Angela Maree D.

Our Vision Our Mission

City of Balanga, 2100 Bataan

Performance Management – Gomez, Carrel Dane D.

Our Vision Our Mission

City of Balanga, 2100 Bataan

PLANNING, DESIGN, AND

Our Vision Our Mission

City of Balanga, 2100 Bataan

April 24, 2021

 Definition of Complex Healthcare Systems through the Systems Theory

 DEFINITION OF COMPLEX HEALTHCARE SYSTEMS THROUGH THE SYSTEMS

Our Vision Our Mission

City of Balanga, 2100 Bataan