Enterprise Architecture Design for a Multi-Center Anesthesia Liver Transplant Clinical Decision Support System Open Access

Cogdill, Lisa (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/pk02c975z?locale=en



Executive Summary Due to the low number of liver transplants per center, clinicians are limited in their ability to analyze and trend outcomes in their population. A solution to this problem could be a system that aggregates data among centers. This could create a significant sample size for proposing clinical practice modifications, and create an opportunity for real-time alerting and predictive analyses to support clinical decision making during intraoperative care. Currently, this functionality does not exist for this population, creating a void in clinical care and an opportunity for clinical improvement using informatics.

The idea of this system raised many questions and concerns about sharing protected health information (PHI), and whether a centralized versus decentralized approach was best, considering the need to maintain commitment from collaborating centers. Therefore, the creation of this system was studied and a preliminary enterprise architecture (EA) design was created for an Anesthesia Liver Transplant Clinical Decision System (ALTCDSS) that collects, shares, and analyzes information across multiple transplant institutions. By overlapping an Architectural Development Method (ADM) from The Open Group Architecture Framework (TOGAF) with the main components of EA: Business, Information, Application and Technology Architecture, we identified the key processes, risks, IT models, constraints, and complexities that the system would work within.

Project Aims ●    Aim 1: Determine a high-level technological approach of managing a collaborative ALTCDSS both internally and externally. ●    Aim 2: Determine the business rules of a collaborative ALTCDSS. ●    Aim 3: Design a model that could support, promote, and foster the sharing of information among healthcare centers.

Conclusion The EA analysis created a balance between determining and meeting the needs of the organization and formulating an IT approach. We concluded that the combination of a centralized model, and iterative development (starting with a pilot, to a registry, then to a matured system) would be the best way to circumvent wasted time, effort and resources. This iterative development will set the stage for a matured system by allowing us to evaluate methods and measure success quickly in small phases.

A comprehensive strategy for sharing PHI between centers and data governance was developed to support sustainability. These attributes address data accuracy and security while creating a process to manage modifications and development over-time. Well-defined principles were outlined for the system to follow from a business and technical standpoint. The project team can now move forward with the EA design and the key processes we identified to obtain consensus in the proposed models with collaborating centers, create work-breakdown structures and secure funding to initiate the pilot.

Public Health Impact    The development of any large-scale solution needs to be built with sustainability and future-use in mind. By using population-based statistics, a matured ALTCDSS could provide predictive measures to healthcare organizations to improve public health. The system can be purposed beyond liver transplant and serve the full range of organ transplantation (e.g. Kidney, Heart, Lung, Pancreas, etc.). In the future, this solution could help guide public health action at the federal, state, and local levels in producing guidelines for care, while serving as a model in sharing granular intraoperative data for other surgical specialties.


Table of Contents

TABLE OF CONTENTS Executive Summary    4

1    CHAPTER 1: Introduction    6 1.1    Background    6

1.2    The Open Group Architecture Framework    6

1.3    The Importance of Enterprise Architecture    7

1.4    The Liver Transplant Population    8

1.5    MPOG - The Comparable Effort    9

1.6    Other Registries and Reporting    11

1.7    Public Health and Business Impact    12

1.8    Related Use of Health Information Technology    13

1.9    Problem Statement    14

1.10  Research Question    15

1.11  Purpose    15

2    CHAPTER 2: Methodology    16 2.1    Introduction    16

2.2    Project Design    17

2.3    Data Type(s) and Description    17

2.4    Electronic Medical Record Systems    19

2.5    IRB Approval    19

2.6    Analysis    19

3    CHAPTER 3: Results    21 3.1    Introduction    21

3.2    Business Architecture    22

3.2.1    Guiding Principles    22 3.2.2    Facts, Assumptions, and Requirements    23 3.2.3    Business Goals    24 3.2.4    Key Business Processes of the System    24 3.2.5    Access and Engagement    25

3.3    Information Systems Architecture  (Information & Application Architecture)    26

3.3.1    Information Architecture    26 3.3.2    Application Architecture    30

3.4    Technology Architecture    32

3.4.1    Technical Principles of ALTCDSS    32

3.5    Roadmap Planning    33

3.5.1    Key Performance Indicators/ Evaluation Criteria    33 3.5.2    Risk Management    33

3.6    Governance    34

3.6.1    Data Governance Strategy    34 3.6.2    Implementation of Data Governance    36 3.6.3    Change Management    36

3.7    Summary    37

4    CHAPTER 4: Discussion    41 4.1    Summary of Project    41

4.2    Limitations    42

4.3    Future Use    43

4.4    In Summary    44

5    Appendix A    45 5.1    Sample Business Associate Agreement    45

5.2    Sample Data Use Agreement Template    45

References    53

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