Security is about the protection of information. It deals with the protection of information in a given domain. In this context, protection is expanded in three different directions: (1) Confidentiality, assurance in the accessibility of particular information by the authorized personnel only; (2) Integrity, assurance that no unauthorized changes of information is made during the processing; (3) Availability, assurance that the information is usable at will (, 2000, )
Database security is an area of substantial interest in information system security. From the security view point, this system may be viewed as an application requiring protected subsystems and trusted processes. It ensures that the security is enforces at a record or at the data item level. Thus, the security of a single element may be different from the security of other elements of the same record. That is, the security of one element is different from other elements of the same database row or column. Security interest can also reduce the ability of the system to provide data to the users by restricting some queries (, 2002, ). Also, the health care organization must develop its own policies that will guide and manage support to the members of the personnel involved in the processing of health information. The level of the security included in the information system must involve certain judgments about the dangers associated with the system and the means of avoiding such dangers.Initial Stages of SSM
The Soft Systems Methodology (SSM) is an approach that is based on the belief that the complex problems can be resolved on the innate subjective view of the participants. The main principle behind this method is to engage the participants in changing the operation and to improve commitment to outcomes. The SSM will enable the elaboration of view points by the management allowing them to make informed choices for the future. The approach breaks down into a seven stage process of inquiry that will lead to changes in three dimensions: in attitudes, structure and procedures.
- Stage 1 Finding out
- Stage 2 Rich picture
- Stage 3 Root definitions
- Stage 4 Redesign
- Stage 5 Real-world comparison
- Stage 6 Debate and decision
- Stage 7 Taking action
Figure1. Seven Stages of SSMStage 1
The first stage will consist of exploring the problems situation and gathering information about it through formal data and interviews. One of the identified problems at Curbishley Royal Hospital is the improvement of quality health care delivery. Due to the conventional process, the initial contact of the patients is rather slow. Another is the reduction of patient visits to the hospital through tele-home care. The Hospital management can acquire a clearer view of the problem situation by consulting with the hospital employees regarding their perceived problems. For example, the difficulties in accessing patient related health information, scheduling of medical visits and consultations.Stage 2
Having identified the problem situation the second stage can be expressed in the form of cartoon called the 'rich picture' which represents the problem situation as experienced by the hospital employees. The manual system implemented by the hospital makes it difficult for hospital employees to access health care information. Also, a minimum number of patients can be accommodated at a time, thus reducing the health care delivered. From these two stages, it can be argued that the hospital needs to implement an information system and develop a technology to encourage the patients to receive treatment at the comfort of their homes.Stage 3
The third and fourth stages are abstract processes designed to discover how things could be as compared to how they are as perceived by the hospital employees. This concerns what is called as the 'idealized design'. The third stage develops brief statements of the various systems or processes called the 'root definitions'. The root definition presents an ideal view of what the relevant system ought to achieve. Based on the problem situation presented, the management and the employees will develop their idealized design of what out to be changed. The automation of the tele-home health care and the development of either a stand alone or integrated hospital information systems are some of the identified changes. The tele-home health care aims to reduce the number of patient visits by providing them an alternative treatment that can be delivered on their homes. On the other hand, the development of an information system will provide a means for easier access and fast transmission of information.Stage 4
The fourth stage uses the validated root definition to redesign the activities or transform the process. A conceptual model that has been developed will identify the minimum set of activities necessary to ensure that the transformation achieves its purpose. From the design, the management shall alter its activities so that the transformation is accommodated. For instance, identifying which activities will be supported by the system such as administrative and clinical processes.Stage 5
The fifth stage is concerned in comparing the models constructed in the real world understanding of the participants. This will enable them to emphasize the possible changes in the actual situation to bring it closer to the idealized system that has been developed. Forming the comparison may involve the highlighting the areas of differences, evaluating options and generating the projections of possible futures. At this stage, the management determines the changes in the present situation so that they can be aligned with the system to be implemented.Stage 6
At the sixth stage, the comparison drawn from the previous stage are discussed and debated. This leads to the selection of feasible changes to the actual situation. That is whether the changes are systematically desirable and are achievable considering the structure of the organization. The final outcome should be the set of changes that are willing to adopt and commit to by the participants. The various stakeholders will discuss the differences from the previous situation to the proposed change. This will include the debate whether the automation is desirable for those whose jobs will be affected by it. It must also be discussed whether such systems are feasible based on the structure of the hospital. For instance, evaluating whether the hospital can efficiently implement the tele-home health care and its implications on the quality of care provided.Stage 7
In the final stage, the changes are taken into action. That is, implementing the proposed changes within the real world situation. These actions may affect the totality of the organization including its structure (organization design and job design), attitudes (culture and values) and procedures (actual operations of the organization). After the series of discussion and evaluation, the management will have to decide the systems to be adopted. Thereafter the changes are implemented in accordance to their identified purpose.Overview of Key Issues
- Area for systems development
One of the central issues in the system development is the identification of the areas to be affected and changed. This can be done by exploring the current situation and the problematic areas. The management must collaborate with the hospital employees and other stake holders in assessing the problem situation
- Systems Design
Upon the identification of the problem, the changes that ought to resolve and improve the current situation must be laid out. Stake holders must participate in formulating the idealized design and the necessary changes to be implemented
Before the actual implementation, the management must ensure a sound transformation. At this stage, the management should provide guidelines and policies to assist the personnel involved in the processing of the system. This is to ensure that the system is carried out properly. The management must also implement change management since the new system is likely to affect the totality of the organization.
The effectiveness of the new system is evaluated through its impact in the quality of health care. The management will have to monitor whether or not the implementation has achieved its purpose.
The adoption of an IT system can provide a foundation for major transformation in the healthcare delivery system. If the implementation of such system is to be successful, the needs of the various stake holders and the types of applications should be match to produce benefits. The management and delivery of such benefits requires the understanding of the interest and the implementation of applications that are suitable for those interests.
The management's plan of adopting an information system and the automation of its tele-home health care will meet the need to improve the quality of health care delivered. First, the information system will provide a better means for acquiring, organizing, storing and accessing health information in user friendly interfaces. With such system, the administrative process is simplified and done faster thus allocating more contact time with the patient. Electronic medical records also changed the availability of information from various locations. Other stake holders can be provided access on selected areas. Most importantly, the information system enables the physician and health care practitioners to make better medical judgments and treatment.
On the other hand, the automation of the tele-home health care will help achieve the hospital's goal of reducing its patient visits. With the aging of the population in most developing countries, the tele home care has a great potential for rapid growth. In addition to his, the changing tradition in caring for the elders at home creates challenges and unique opportunities for implementing tele-home care. Indeed, the promise of telemedicine provides improved and cost effective access to quality health care. Telemedicine helps to transform the delivery of health care and improve the lives of many people.
The pressures on health care organizations to reduce costs and improve the quality of care have been the primary drivers for embracing information technology. The quality of heath care delivered is evaluated through the impact of information technology in improving health services and the heath status of the patients. In this respect, IT can contribute in the fast and accurate information about the patient and immediate treatment for them.
The plans of the Curbishley Royal Hospital to develop an information system and automate its tele-home heath care manifest the benefits of information technology. Such developments will assist the hospital in achieving its goals. However, it must be noted that the success of such systems depends on the appropriate implementation. Adopting a system does not readily guarantee advantages. The process must involve the involvement of various stake holders in formulation, design, implementation and monitoring of the new systems. Ultimately, the success of the system will be evaluated based on its impact on the patient, the staff and the structure of the organization.