Enterprise Architecture Design for a Multi-Center Anesthesia Liver Transplant Clinical Decision Support System Público
Cogdill, Lisa (Spring 2018)
Published
Abstract
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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