Health Care Information Systems

Module 8: Systems Analysis

The following objectives should be met by the end of this module:

1. Determine which system should be used in a healthcare organization
2. Determine how and where the system will be constructed
3. Decide how to design the optimal system
4. Describe the data collection, data organization and data analysis system design tools
5. List and understand the guidelines for questionnaire development in system analysis
6. Describe and list the uses for upper and lower CASE tools in systems analysis and design
7. List pros and cons for the four types of systems design

These notes are intended only to supplement your readings. The best way to ensure each module is absorbed is to complete all the readings prior to reviewing these lecture notes. I will try to highlight what I believe to be the most important topics from your module readings. If you have any questions or concerns or there is something you do not understand, please ask me. You can either post on the webboard the question you have (that way others can benefit from the response), or you can e-mail me if you want a more private response. Either way it is extremely important that you have a complete and thorough understanding of the material for the module.

Critical success factors (CSF) have been identified (Tan, p. 371) which are necessary for a successful final implementation of a new IS to an organization. Careful attention to these CSF in the early planning stages of IS development will enhance the success of implementation. The CSF identified are listed below, we will only discuss a few in detail during this module.

• Staffing Issues - Does the organization have the adequate resources and expertise to carry out a successful implementation of the IS?
• Project Management - Are the leaders who are developing the IS good project managers? Project scheduling and program coding are two skills that are essential. These will be discussed in more detail in this module.
• Process Reengineering Considerations - This must involve more than simply mechanizing existing procedures through technology.
• End-User Involvement - this must involve empowerment of end-users through their involvement in systems planning and design.
• Vendor Involvement - If vendors are used, they should be seen not only as providing a product but as providing a service. They can (and should) be involved through the development and implementation stage. They have expertise that is vital to success.
• Top down management involvement and full dedication to IS development and success.

In your future roles in healthcare you may take on positions that involve project management. These postitions will vary in degree and subject, but will have similar characteristics. This is true for information systems as well. In fact, one could argue that a IS manager is nothing more than a full-time project manager. One of the most vital characteristics of a good project manager is ensuring the project is completed on time. To do this you must rely on accurate and reliable project scheduling. The critical path method (CPM) is a technique that can assist you in project scheduling. The CPM is a graphical representation of the tasks involved as well as the sequence of these tasks needed for project success. The following is an example of a CPM.

In the figure above, the numbers in the circles represent different stages of development and implementation. The letters represent different tasks required to progress from one stage to another. The numbers next to the letter represent the days needed to complete the task. From this CPM, we can determine the critical path, or the sequence of activities, that will take the longest period to complete. The time needed to complete all the activities on this path is the minimum period required to complete the entire project. In other words, the project cannot be completed in an amount of time less than that dictated by the critical path. The chart below lists all of the possible pathways with the number of days needed for each path. The critical path is highlighted in red.

Program coding is another facet of program management in information systems that is needed for successful implementation. This refers to the process of writing instructions that the computer can execute. This is very labor intensive and requires coordination from all programmers working on the system. A data dictionary (DD) is a technique that can prove to ease program coding. A DD is a list of entities with the proper definitions that can be used for data entry by all of the users in the system. It should also list the identities of all the database programs used, the names of all the data fields found in the database, the names of the programmers that use them, the description of the data and the personnel responsible for that data for the entire organization. DDs are useful in program coding coordination as they act as a ready references for users.

The following is a link that discusses the use of data dictionaries in health care organizations. http://www.ahima.org/publications/2f/duffy.feb.97.focus.html

In a systems analysis, the strategic IS plan is reviewed to determine the rationale for the system along with the detailed requirements needed. Based on this information, a design approach can then be determined. The "life cycle" of IS development can be described in seven steps.

The analysis is the process of collecting, organizing, and evaluating facts about specific requirements and the environment the IS will be operating in. Based upon this information a design approach will be selected. These include either "packaged" software from commercial vendors, a "designed to fit" approach specific to the organization, or a combination of these approaches. Once the design has been selected, specific system requirements must be developed and put out to vendors for bid or acquired through contractual basis. Once the system has been purchased, the system must be put into place in the organization. This involves not only the "actual" wiring of the system, but also developing organizational policies and procedures for the new system. The next step is implementation which must include user training for success. In the implementation stage, employees must be trained to use the new system, files must be converted from old to new, and the system must be tested before it goes "live". Operation, maintenance and evaluation are the final steps in the development life cycle. These steps are permanent and must be reviewed on a regular basis to ensure the system is dynamic and operating at full efficiency (as planned). This chapter and these notes will highlight the first two steps in the cycle; system analysis and selection of a design approach.

The systems analysis should by guided by the same principles and framework discussed in the last module (Strategic IS Planning). The following questions should be answered by a thorough systems analysis:

1. What are the weaknesses of the present system? What are its strengths?
2. Why is a new system needed?
3. What specific kinds of information should the system generate?
4. When does this information need to be available? Who will use it?
5. In what ways will the information be used?
6. Where does the needed data originate?

The table below lists the six main steps required for an information systems analysis.

System analysis tools have been developed to assist in this process. They fall into three categories of system analysis tools, either data collection, data organization, or data analysis. Data collection tools are just that, aides in collecting the data needed for analysis. These consist of interviews (of key IS participants), questionnaires, and observation. Observation can be done on a continual basis or through a work sampling process. Data organization tools include summary tables and statistics, interview summaries, flowcharts, and narrative reports. They are designed to help in analyzing the data that was collected by organizing the material in a standard fashion. The most useful of these tools is the flowchart. A flowchart is a graphical representation of the "relationships among various organizational functions as far as information interchange is concerned". This is critical to understand in the analysis stage because the identification of this "information flow" will help to achieve system integration. An example of this type of flowchart is shown on page 204-205 as applied to a clinical laboratory. The flowcharts follows a top-down format, this means information flows from the top to the bottom. Rectangular boxes represent individual processing steps and diamond shaped boxes indicate decision making points. At these decision making points alternative paths can be selected depending on the results of the decision.

Data analysis tools provide a complete examination of the data that was collected and organized as well as documenting requirements of the new system. Tools include:

• Workload analysis
• Output utilization analysis
• Input and data collection analysis
• Code analysis
• Database analysis
• Procedures and information flow analysis
• Cost analysis

Computer-aided systems engineering (CASE) is a technology that is used in software to aid the systems analysis process. they are used not only for analysis but also for design, and implementation. The two major categories of CASE tools are "upper CASE" and "lower CASE". This type of technology is expensive and involves a large learning curve although there are also many benefits to their use.

In selecting a type of design approach for the system, once analysis is complete, care must be given to weight the pros and cons for each design. Prepackaged systems are generally less expensive than having a unique system designed for a specific organization. This may not be true if the prepackaged system needs many modifications to fit the organization. A detailed cost-analysis should be done comparing both types of design.

That is it for notes for module #8! Let me know if you have any questions.

Tan, JKH. Health Management Information Systems: Theories, Methods, and Applications. Aspen Publishers, Gaithersburg, Maryland. 1995