Hospital Information Systems Outsourcing - A Regional Hospital
The research of the hospital information system outsourcing - The example of region hospitals
Zhang Huijuan a Xing Jin b LI Xing Qiu c
a Nguyen General Hospital b National Chung Cheng University Information management c National Chengchi
University Information management kakumimi@ksts.seed.net.tw
Summary
Information Systems Outsourcing (IS Outsourcing) has become a business to improve return on IT investment, reduce manpower, reduce capital investment, to enhance the business environment changes in response to an important method, the medical industry as industry specialty, so the information systems outsourcing decision-making is the same general industry, of great worth. Regional hospitals in the medical classification on both the economies of scale and the
characteristics of a high degree of information, this research information system for regional hospitals the key factors in outsourcing decision-making two-case study, research framework and literature review and interviews with experts, rests with the questionnaire meeting from, divided into hospital, outsourcing firms and the environment to be explored three dimensions. The subjects were two regional teaching hospital executives. The results showed: in hospitals, in addition to senior management, culture, strategic management, IT department capabilities, the system development time, system, system development techniques with the degree of IT budgets, organization size and the impact of conflicting considerations are outsourcing decision-making factors; The
companies, in addition to technical skills software, hardware, technical ability, reputation and word of mouth, project management, product performance, quality and reliability, and price, its suppliers and outsourcing partnerships between the also factors affecting the outsourcing decision-making; in the environment than the industry in terms of competition, government policies and
national health care system, there was also demand for hospital accreditation and management factors.
Key words: health care industry, information systems outsourcing, information systems outsourcing decision-making, hospital information system
Abstract
Information system outsourcing (IS Outsourcing) now has become the significant way of promoting the enterprises' capabilities to fit the environmental change for them to improve the investment reward rate of information technology, decrease the capitalinvestment andthe medical industry is also not exceptional. In recent years, many scholars noted the importance of the information technology to apply to the medical industry, the idea increased day by day; however, the medical and the general industries are quite different. Less scholars to discuss the issue of the hospital information system ( HIS) outsourcing thoroughly from the academic aspect and the most of the research for the past are emphatically explain the IS Outsourcing by economic theory; fewer person engaged in the practical operation and the elementary demonstration. This research is aimed to the region hospital to carry on the deeply interview of the semi-construction to collect the key factors for the decision of the HIS outsourcing. It is divided into three parts which are hospital, outsourcing firm and environment, the consequence reveals: In hospital, except the high rank supervisor, culture , strategy
management, and the capability of the information section; The system developing time, the system development technology, information budget matching, the size of the organization and conflict consideration are the decision effecting factors of the IS Outsourcing. In firm, the partnership amount the suppliers is the decision effecting factors of the IS Outsourcing as well except the software technical capability, hardware technical capability, reputation and tradition, project management capability, products performance, quality, reliability and price; to environment, there are still have the factors of hospital evaluation and management requirement except the craft competition, government policy and health insurance system.
Keywords: Medical industry, IS Outsourcing, IS Outsourcing decision, hospital information systems I. Preface
The rapid development of information technology, information systems, increasing functionality, but also with the rising complexity of the enterprise for economic and strategic considerations, as well as Government is actively promoting, making the hospital information system outsourcing trend gradually enhanced. The so-called information systems outsourcing represents an organization of information system functions such as application development,
equipment management, information systems planning, part or all of the
information service provider by the completion of [6], and the present is not only small businesses, even with a mature information systems departments of large enterprises have the information systems outsourcing practice.
The past, information management or business management scholars who are against the process of enterprise development, a series of information technology research, and get very fruitful results. In recent years, with the rapid
development of information technology and medical industry business environment changes, prompted a hospital to re-think how to improve their efficiency and effectiveness, including the use of information technology to assist people who work the traditional hospital has become a modern twenty-first century hospital important indicator. However, the particularity of the business environment in hospitals, making information technology applications in health care industry will be different from the general information technology enterprises in the processing speed, large storage capacity, rapid communication capacities, will be able to improve the traditional manual operation, accelerate the job Liucheng to enhance the overall effectiveness and efficiency. On hospitals, assisted by information technology, will be able to simplify the previous manual operation complicated procedures, shortening the waiting time for patients, to enhance the overall quality of medical care services within the hospital
administration and flow of information.
Current medical environment, based on economic, operational, management considerations, before seeking outsourcing vendors to build hospital information system, its past, information systems outsourcing in general is facing serious problems: first, the lack of professional IT personnel and a system integration experienced person to be responsible, resulting from system planning, bidding to complete the system build process takes too long; Secondly, the applications available on the functional aspects of the case, can not demonstrate its effectiveness, if the surface of some transaction in demand, and no more stringent constraints outsourcing contracts to vendors, resulting in the implementation of the surface can not protect the interests of customers, or changes in demand led to the contract transaction and the required
supplementary budget, the overall service quality, the owners can not have a good satisfactory degree. Therefore, the hospital information system in addition to problems faced on the outside, the hospital complex molecular composition, different health care professionals, lack of user information literacy, information
inequality and professional staff changing and diverse needs of users are all appointed hospital information system outside considerations and risks.
Two, the literature
1. Special health care industry
Unlike the hospital industry, the manufacturing sector, its management is people, the stress management, which will manage the ideas and methods used in hospitals [4]. And health care services are different from general services, in addition to other services as well as emphasize the importance of services to win the competitive process, but also the lives of countless mouths involved in health behavior; therefore the importance of quality of medical care can not only
increase competitiveness, and to provide characterization of the human rights and life, [3].
Special health care industry: 1. Organization of complex division of labor and fine; 2by various professionals, each dedicated personnel laws and regulations; 3.
Highly specialized, hard work uniform; 4complex process not easily simplified; 5 status of each patient are different processes can not be unified; 6. transactions in different ways, not have the opportunity to return, often an emergency situation;
7. Professional high degree of autonomy coupled with strong quality ideas than medical personnel lacking, resulting in the hospital more difficult to carry out, [10].
Jinnian Lai,快速, as the technology of business development and medical Chan Ye Huan Jing of change, facilitated the hospital need to re-think Ruhetisheng its efficiency and 效能, and the use of information technology Laifu Zhu 传统 hospital who Gongzuoyeyi into the twenty-first century in a modern hospital in the important indicator.
2. Definition of information systems outsourcing
Information resources from the point of view, Richmond & Seidmann that outsourcing is the business of technology and the appropriate allocation of resources to generate maximum benefit, the specific approach is to focus corporate resources on the core business, outsourcing is not the importance of strategies to demand [ 9]. Thus, information systems outsourcing is defined as
"the organization any information processing activity in whole or in part by outside service providers to provide the information" [2, 6]. This definition does
not talk about information systems outsourcing by the interaction between the two sides with the contractor. So join the contractual relationship, which is defined as "the form of contracts, the contractor responsible for any information processing within the organization all or part of the activities" [10].
3. Advantages and disadvantages of outsourcing IT system
Information systems outsourcing success will bring substantial business
interests, that the information system for business benefits of outsourcing are: 1.'s Focus on core competencies, 2. The formation of economies of scale, 3. To
enhance the quality of IS, 4 .low investment risk, 5. generate awareness of conservation, 6. to resolve the problem of insufficient resources,7. reduce the long-term capital investment [8].
However, information systems outsourcing has its shortcomings. Outsourcing may also bring strategic benefits (benefits) and risks (risks). Well-known large companies such as Kodak, Dupont company's outsourcing experience, may not be ported to other interested companies on the adoption of outsourcing. They cited outsourcing concerns in the three-point strategy: 1. Loss of key technical skills (critical skills) or the wrong technology developed; 2. Loss of cross-functional technical skills (cross-functional skills);3. Loss of information system control[9].
Tsai Hsin-Yi has put together six of the shortcomings of outsourcing: (1) lost control of the system; (2) a dependency mentality; (3) the outflow of trade secrets; (4) want to change the future of switching costs when the contractor; (5) overall outsourcing, companies lack a strategic planning capacity; (6) unless there is profit, or the lack of updated technology outsourcing contractor motivation [5].
4. Information Systems Outsourcing Decision
Information system outsourcing is the business use of information technology strategy, and many scholars have proposed different information systems outsourcing decision model for information system outsourcing of establishing conceptual framework. From the organizational environment to explore the decision to outsource or self-made, it has two aspects, one is the degree of
internal human resources (hiring the extent of information systems) and the other to the extent of the internal organization of technical resources (with the degree of information assets ). When the degree of internal human resources and internal organization of the high level of technical resources, it is recommended to
consider self-made [8]. Another scholar from the organizational point of view
considering the overall environment proposed outsourcing mode, the industry and competitors and other factors into account. Welch & Nayak source model proposed strategy(Strategic Sourcing Model), from the "competitive technological edge,"
"science and technology in the industry matures," and "compared with competitors technical level" enterprise information system in three areas to consider outsourcing decision [ 11].
Triple, research methods
First, the composition of architecture elements
This study used a case study (Case study) to carry out, the main research questions is to explore dimensions of affect hospitals, manufacturers and environmental dimensions dimensions of how to influence (How) and hospital information systems outsourcing decision-making between the various dimensions factors influence how (How), and what factors affect the hospital information systems outsourcing decision (Why) and completion factors, but this research is based on hospital information systems outsourcing decision making of dimensions, factors and medical institutes discuss the current situation.
In the course of the study, the first on the literature and existing data to collect and organize data, and to consider relevant literature to conduct the data analysis, information management scholars and academics invited practitioners Hospital executives are meeting to discuss this study, we want to analysis baseline dimensions and the design of its relevant variables. For the regional hospital executives in-depth semi-structured interviews, interview based study architecture interview questions. Conceptual research framework of this study are shown in Figure 1.
The subjects, scope and process
Select the southern region of this study is quite well known and has a long history of the two regional teaching hospital for the scope of the study (the Case A and Case Bin the table), the number of cases of Ahospital-wide staff of about 760 people, the total number of 534 beds, The daily outpatient visits of about 1,800 people, the occupancy rate of about 75%. In the Republic of China on August 79 set up an information department, IT department staff now number 6. The total
number of cases of B 1, more than one thousand employees, the total number of beds is about 654, its about 45 000 outpatient visits per month around, the
occupancy rate of about 80%. Seven years in the Republic of China set up
computer rooms in September, now called Information room, while the present IT department employees to 13.
Interviewed for the management of the main hospital executives, and these executives are actually involved in the information systems outsourcing decision making personnel. Interview panel composed by two researchers, the two researchers are all school teachers and have many years of practical experience related medical information. Interviews, the researchers first interviewed, please e-mail sent to pre-examine its content and for content to be clearly explained doubts Department, followed by the date agreed to go interview the respondents.
The interview process by a senior researcher in chief, and the other researchers recorded the process, the consent of the respondents were able to get the whole recording. Interviews came back, the researchers immediately for interviews and analysis from the whole, and repeatedly broadcast audio content to determine content.
Figure 1: The structure of the content Wantonly, the results
1, describes the statistical analysis
In this study, information systems outsourcing decision for key factors, in three dimensions, using a semi structured questionnaire in-depth interviews, to
facilitate the respondents expressed the view extent, every five items were tailor Likert scale to measure the degree of difference, a point that is very important,
otherwise, a fifth was very important. In addition, the interview questions and join the many open questions to aid in the depth of the research topic. The case
for the importance of the factors interview average scores, "very important" a score of 5.00, "important" to 4.00 "ordinary" 3.00, "not important" to 2.00 "very important" to 1.00. Interviews, respondents were of the view of the importance of each factor against the average score statistics are as follows Table 1:
Table 1: Distribution of respondents overall table of cases
Case A
Case B
Dimension
Factor name
Hospital Executives 4.11 4.00
Culture 4.47 4.10
And strategic management 4.33 3.89
IT sector capacity 4.58 3.88
Company Software technological capabilities
4.67 4.67
Technical capacity of the hardware
4.78 4.50
Reputation and word of mouth 4.67 4.00
Project management 4.75 4.00
Product performance, quality and reliability
4.80 3.70
Price 4.67 4.00
Environmen t
Industry competition 4.33 4.00
Government policy 3.56 4.00
Health care system 5.00 5.00
Records from the above data and interviews show, the case of hospital
executives surveyed dimensions of h ave that hospital executives, cultural, and strategic management capabilities and information sector are significant factors
in information systems outsourcing decision should be considered an important factor; The technical capacity of the software, hardware, technical skills,
reputation and word of mouth, project management, product performance, quality and reliability and price are affecting the respondents case decision-making in information systems outsourcing, the supplier should consider the dimensions important factor; Finally, the intra-industry competition, government policies and national health care system in Beijing and Taipei is the impact of hospital
information systems outsourcing decision should consider the important environmental dimension factors.
Second, the case dimensions of
CasesA, B are all the private non-profit medical institutions, but at history, the number of beds and the organization of the background there is still difference.
Found in the case interview, hospitals, manufacturers, environmental three dimensions is to determine the hospital information systems outsourcing decision- making was the norm, but the effect among the factors, because the background of the opposite sex medical institutions vary. Therefore, the dimensions for the case study of factors analyzed as follows:
(A) The Hospital Management side:
Case Aand Case Bof the respondents (president, vice president, information consultants, information director) executives are considered, culture, strategic management and IT sector are affecting the ability of the hospital information systems outsourcing decision making in the hospital dimensions of important factors should be considered. However, the general director A case that the cultural factors, for the outsourcing of information systems, the hospital's attitude and preferences of users are not affected in the hospital information system outsourcing considerations; other in strategic management, improve the hospital professional image does not affect the hospital information system outsourcing considerations.
This study suggest that, as the case A related needs for information systems, must be done through hospital Fang own assessment of the Commission, and the respondents in order to function-oriented cases that provide patients with good service strategies and meet the accreditation standards that can improve hospital reputation, to enhance the professional image of the hospital. The case Bfor the information system related needs, in addition to the Committee by the hospital
own assessment, but need professional IT consultants from the hospital a detailed review before enacting the relevant policy information. Moreover, in addition to senior management, culture, strategic management, IT departments the ability and other factors, the study found two cases of all respondents believe that outsourcing the system development time, system, system development techniques with the degree of IT budgets, organization size and conflicting considerations also affect the decision-making factors.
(B) the vendor area dimensions:
CasesA and B of the respondents generally hold that the ability of software technology, hardware, technical ability, reputation and word of mouth, project management, product performance, quality and reliability, and prices are affecting the hospital information systems outsourcing decision on when
Manufacturers dimensions are important factors to be considered. In addition to these important considerations, the suppliers and the outsourcing of partnership is also a hospital information systems outsourcing decision on the consideration factors. Other suppliers, such as where the location, the timeliness in terms of system maintenance is also one of the factor.
(C) Environmental Management side:
From case A, B that, regardless of industry competition, government policies and national health care system are affecting the hospital information systems
outsourcing decision on when should be considered important factors.
Furthermore, interviews revealed that the two cases, depending on the hospital evaluation and management needs for information systems outsourcing decision of the main concerns. In addition, government policies, the case A president and general director of the Government subsidies that build some of the cost (for example:IC card) is not a hospital information system outsourcing decisions in consideration of the factors; Similarly, the extent of government support on the outsourcing decision made is not big.
III Summary
This research interview is to understand the present dilemma facing health care institutions, first of all for the part of IT department, most of the common ground is the information sector faces increasing all the different needs of both user requirements and constantly modify the existing information systems to meet
hospital side business data analysis and introduce new requirements of National Health Insurance Bureau, the new department from the operation of the user level, management reports can not refuse. Therefore, if the medical institutions for the development of the system can not keep up the speed and ability to demand from users, and users of its software R & D gap may be growing demand to expand. Therefore, backlog information needs, users complained about the increase in response to the current situation required, and should not change in information architecture of choice, all medical institutions have become common problems IT departments.
With the popularity of ready-made software packages, more and more users learn to use information technology to master the use of information, so more and more information needs. Hospital information system developed by considering the purchase of ready-made software or outsourcing the development of problem- solving, this study suggests that in addition to consider the size of the hospital, made or benefits advantages and disadvantages of outsourcing, but also must recognize that the level of information system performance not just the
responsibility of IT departments, more importantly, the key factor is "the attitude of executives and support" effect. As for the domestic hospital information system development, the proportion of home-made or outsourcing, research data, the medical center to develop their own mainly indirect use of ready-made
software package to complement it; Hospital, lower level, the lower the proportion of self-development, outsourcing The higher the ratio. The main reason is self- developed system of investment is very large, the size of the hospital, if not big enough, not cost-effective [1].
Wu, discussion and conclusions First, the dimensions of factors
1. Hospital dimensions
Interview cases found, the system development time and technology is the impact of hospital information systems outsourcing decision making
considerations. Most hospital IT departments are deeply committed to
information technology hardware and software maintenance, development, health care related professional only been in system development, maintenance access, lack of medical care and medical expertise is not in-depth understanding of operational procedures, and the medical profession general lack of information
literacy personnel, followed by the senior medical director for information systems planning and design is not the concept, could easily lead to misunderstanding of both parties to each other, so conflicting considerations are also factors affecting the outsourcing decision.
Recommendations to enhance the medical information professional IT staff in the development system can not only medical personnel described the scene in person to the medical care process, the actual process involved in the planning, inter-departmental communication and coordination are necessary conditions for continued consultations minimize the conflict, so as not to cause unnecessary distress; other medical personnel to enhance the information literacy, information education and training held regularly, to avoid the existence of disparity
information asymmetry between the two sides to reach consensus and realize.
As the health care industry has its own specialty, compared with those in the industry, it will even take into account information technology and life in the accuracy and timeliness of information requirements, as for the rigor of new technology also has considerable gap.
2. Manufacturers dimensions
IT personnel can understand the management of various medical personnel clearer perspective and management requirements. Development system more in line with each other's needs and he will not have too much deviation, will be more need be amended frequently.
Therefore, information systems outsourcing vendor needs to know more about the environment, and management decision-making focus of attention in order to provide effective systems and information.
Study found that hospitals and medical institutions with the purpose of
computers, are designed to save human resources and improve the efficiency of its systems development approach to outsourcing for some; many medical institutions in the process of developing information systems, due to design, and outsourcing company itself does not take into account future integration,
manageability and scalability problems, so each separate information system development, often causing difficulties in data conversion and sharing. Also
recommended for system development outsourcing company, to conduct a systematic way, for the maintenance of software systems need to leave more
detailed planning and related system files, to facilitate the information after the hospital staff took over the maintenance and smooth.
Therefore, partnerships become the medical institutions to manufacturers dimensions important factors, in-depth understanding of each other and trust, in addition to information sharing between the two, but also to establish good communication channels.
3. Environmental dimension
The results also confirmed that changes in government policy will also affect the hospital information systems outsourcing decision factors. With the
advancement in information technology, with the advent of competitive pressures, hospitals, driven by competitive pressure, hoping that through managed care information system functions, from support for administrative processes and daily trading operations, developed to provide the information required for management control, even to support the application of advanced decision-making functions, of medical information systems through the provision of information, be flexible enough to cope with changes in policy or insurance requirements.
Health care system and government policy requirements and changes, and in response to new health care payment system, hospitals are facing an
unprecedented pressure on the operation; and health care increasingly intense competitive environment, hospitals and units of the rapid increase in demand, but also makes the IT departments of all hospitals units of demand accumulation, and therefore indirectly affect the hospital for the IT outsourcing decision-making.
Second, limitations and future research directions
This study aims to establish a business model to help hospitals in the hospital information system outsourcing issue when 可能 facing difficulties, as the health information system into the Shenkao Chan Ye, Gu through Zhuanjiahuiyi, Li Yong Fang Tan Ou-depth case study method alkali hospital to hospital information systems outsourcing decision summarized the key factors, as a contribution to this study.
However, there are still relevant in this study limits, first of all, because this study focuses on two regional hospitals in depth interviews, however, the hospital
hierarchy in Taiwan there are "medical center", "District Hospital", and even clinics, these organizations still have different levels of demand for IT outsourcing, the results of this study failed to generalize.
Second, the research model in this thesis Despite the cover of "hospital",
"vendor" and "environment" three dimensions, but with the development trend of domestic and foreign health care environment of rapid change and whether there are other policy factors should be considered fear needs further in depth.
Therefore, in future cases in the literature and the choice if it can be diverse and extensive, the research results obtained by the growth of the space should be there.
Therefore, this study on the findings and limitations, suggested that future researchers can address the above limitations more in-depth and extensive study, supported by questionnaire survey to validate this study, a hospital information systems outsourcing decision making models They can also compare the
similarities and differences, and to be compiled by an integrated empirical model.
3, Conclusion
In general, hospitals for the implementation and the implementation of
information technology than other industries are more "conservative." Medical
staff are facing irreversible character of the life and health, so the introduction of new technology assessment also very strict. Health professionals of information literacy and IT staff less than the medical profession's poor, is a common medical phenomenon, is also anxious to improve the direction of the hospital. By
outsourcing the information professional and blue-chip companies to help
establish good partnership with the manufacturers, is believed to be the hospital strengthen its core capabilities and improve the overall operating efficiency of hospital information important strategy, in particular, policies to promote electronic medical records and the implementation of the total budget, the hospital The implementation of a comprehensive information technology is to improve health care quality and business performance requirement.
Medical information is very professional information industries, firms often need to put a very high professional training of personnel and system development costs, can have a stable development and planning capacity of medical information, from the high successful or failed cases of hospital information systems outsourcing have to go the hospital operating the lack of standards and
information needs of the difficult integration, IT outsourcing are causing failure is the main reason. Only close cooperation between hospitals and manufacturers, support each other in order to minimize the obstacles to mutual cooperation, but also the opportunity to enhance outsourcing success, which the hospital decision- makers, must bear in mind the concept.
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