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Modelos de Madurez para Gestión de Sistemas de Información en Hospitales

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Modelos de Estadios de Crecimiento para la Gestión de Sistemas de Información en La Salud

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Modelos de Madurez para Gestión de Sistemas de Información en Hospitales

  1. 1. Modelos de Madurez para GSI en Hospitales 1 Modelos de Madurez para Gestión de Sistemas de Información en Hospitales Álvaro Rocha AISTI & Universidade de Coimbra Portugal amrrocha@gmail.com
  2. 2. Modelos de Madurez para GSI en Hospitales 2 Teoria de Estadios deTeoria de Estadios de CrecimientoCrecimiento • Las entidades evolucionan con el tiempo. • La Teoria de Estadios de Crecimiento asume que patrones predicables, conceptualizados en términos de estadios, existen en el desarrollo de las entidades. • Los estadios son: – (1) Secuenciales por naturaleza – (2) Acumulativos • Los Modelos de Madurez son basados en la Teoria de Estadios de Crecimiento
  3. 3. Modelos de Madurez para GSI en Hospitales Estructura de un Modelo de MadurezEstructura de un Modelo de Madurez 3
  4. 4. Modelos de Madurez para GSI en Hospitales 4 Introducción de los Modelos de Madurez en las Organizaciones Modelo de Greiner (1972, 1998) • Las organizaciones pasan por cinco (seis) estadios a lo largo de su existencia • Cada estadio termina en una crisis • Para avanzar a lo siguiente estadio, una organización debe gestionar y resolver con éxito el problema asociado con cada crisis
  5. 5. Modelos de Madurez para GSI en Hospitales 5 Modelo de Greiner (1972, 1998)Modelo de Greiner (1972, 1998) Rede ? VIGrande Estadio I II III IV V Colaboración Coordinación Delegación Dirección Creatividad Liderato Autonomía Controle Burocracia Complejidad Evolución: Estadios de crecimiento Revolución: Estadios de crisis Edad de las organizaciones MaduraJoven Pequeña Industria com Alta tasa de crecimiento Industria com Media tasa de crecimiento Industria com Baja tasa de crecimiento
  6. 6. Modelos de Madurez para GSI en Hospitales 6 Prácticas organizacionales en los cincoPrácticas organizacionales en los cinco estadios de crecimientoestadios de crecimiento [Greiner 1972][Greiner 1972] Factores de Infuencia Estádio I Creatividad Estádio II Dirección Estádio III Delegación Estádio IV Coordenación Estádio V Colaboración Enfoque de la Gestión Producir y vender rápidamente Eficiencia de las operaciones Expansión del mercado Consolidación de la organización Resolver problemas de forma rápida; Innovación Estructura Organizacional Informal Centralizada y funcional Descentralizada Por grupos de productos Matriz de equipos Estilo del Top de la Gestiíon Individualista y empreendedor Directivo Delegar Atento Participativo Sistema de Control Cuota de mercado Normas de trabajo; Centros de costo Centros de beneficio Centros de planos Objetivos comunes Gestión de la Recompensa Salarios modestos; Possibilidade de ser dueño Incrementos salariales Incrementos iondividuals Compartir lucro y acciones de la empresa Bónus por equipo
  7. 7. Modelos de Madurez para GSI en Hospitales 7 Modelos de Estadios para laModelos de Estadios para la Planificación y Gestíon de SIPlanificación y Gestíon de SI • En gran parte el resultado de esfuerzos a nivel de personas individuales; • Primeros a aparecer en el área de SI (años 70); • Modelos rudimentares. Pocos detalles; • Se centran principalmente en cuestiones políticas y estratégicas.
  8. 8. Modelos de Madurez para GSI en Hospitales 8 Modelo de 4 Estádios de Nolan (1973)Modelo de 4 Estádios de Nolan (1973) MadurezControleContagioIniciación Tiempo P r e s u p u e s t o y T e c n o l o g í a
  9. 9. Modelos de Madurez para GSI en Hospitales 9 Modelo de 6 Estádios de Nolan (1979)Modelo de 6 Estádios de Nolan (1979) Foco de la Gestíon Punto de Cambio Gestíon de Tecnologia Gestión del Recurso Información Portfolio de Aplicaciones Estructura del DPD Planificación y Control del DPD Postura de los Usuarios Madurez Gestión de DatosIntegraciónControlContagioIniciación Presupuesto y Tecnología1ºs 2ºs
  10. 10. Modelos de Madurez para GSI en Hospitales 10 Criticas al Modelo de NolanCriticas al Modelo de Nolan • Es poco probable que el presupuesto y la tecnología son los factores o indicadores clave en el crecimiento de la madurez; • Es poco probable que el gasto en SI siga una curva en "S"; • Es poco probable que cualquier organización es enteramente en la misma etapa de madurez para todos los factores de SI evaluados; • Es poco probable que todas las organizaciones comienzan a partir del primero estadio; • Es poco probable que la secuencia hasta la madurez no tiene a veces retrocesos, sobre todo en estadios avanzados (por ejemplo, debido a un cambio de personal o de la actitud de gestión); • También es poco probable que no pueda saltar estadios (por ejemplo, mediante la adquisición de empresas más maduras); • Presta una atención insuficiente a la gestión ambiental, social y organizacional;
  11. 11. Modelos de Madurez para GSI en Hospitales 11 Factores Estádio I Iniciação Estádio II Contágio Estádio III Controlo Estádio IV Integração Estádio V Gestão de Dados Estádio VI Maturidade Critérios de 1ª Nível: Orçamento para PD Igual à taxa de crescimento das vendas Exceda a taxa de crescimento das vendas Menor que a taxa de crescimento das vendas Excede a taxa de crescimento das vendas Menor que a taxa de crescimento das vendas Igual à taxa de crescimento das vendas Suporte Tecnológico 100% batch 70% batch 20% on-line 70% batch 15% bases de dados (BD) 10% inquiry processing 5% time-sharing 50% batch e on- line 40% BD e comunicações 5% informática pessoal 5% mini e micro- computadores 20% batch e on- line 60% BD e comunicações 5% informática pessoal 15% mini e micro- computadores 10% batch e on- line 60% BD e comunicações 5% informática pessoal 25% mini e micro- computadores Critérios 2º Nível: Carteira de Aplicações Aplicações funcionais de custos reduzidos Proliferação de aplicações Actualização da documentação e reestruturação das aplicações existentes Reajustamento das aplicações existentes utilizando tecnologia de bases de dados Organização e integração das aplicações Integração de aplicações espelhando os fluxos de informação de toda a organização Organização do Departamento de PD Fechado e especializado em tecnologia Programadores orientados ao utilizador Gestor médio Estabelecimento da utilidade dos computadores e de equipas de avaliação de utilizadores Gestão de dados Gestão do recurso informação Planeamento e Controlo do Departamento de PD Descuidado Menos descuidado Planeamento e Controlo formalizado Planeamento à medida e Controlo de sistemas Partilha de dados e de sistemas comuns Planeamento estratégico do recurso informação Postura dos Utilizadores Desinteressado Superficialment e entusiasmado Por vezes responsável Aprendendo a responsabilidade Efectivamente responsável Parceria
  12. 12. Modelos de Madurez para GSI en Hospitales 12 Modelo de las múltiples curvas de aprendizajeModelo de las múltiples curvas de aprendizaje de McFarlan et al. (1982)de McFarlan et al. (1982) Procesamiento por Lotes Tiempo $ Desarrollo y Mantenimiento Tecnologías Futuras Automatización de Oficinas Sistemas on-line IV- Difusión de la Tecnología III- Controle II- Experimentación y aprendizaje I- Inversión Inicial
  13. 13. Modelos de Madurez para GSI en Hospitales 13 Modelo Revisado de los Estadios deModelo Revisado de los Estadios de Crecimiento de Galliers y Sutherland (1991)Crecimiento de Galliers y Sutherland (1991) • Probablemente el modelo de estadios más completo para planificación e gestión de SI • Basado en 7 curvas de crecimiento en "S": Strategy; Structure; Systems; Staff; Style; Skills; Shared values • 6 estadios: –Adhocracy; –Foundations; –Centralized; –Cooperation; –Entrepreneurial; –Harmonious. • Proporciona Cuestionario de Medida [Galliers 1995]
  14. 14. Modelos de Madurez para GSI en Hospitales 14 Modelo Revisado de los Estadios deModelo Revisado de los Estadios de Crecimiento de Galliers y Sutherland (1991)Crecimiento de Galliers y Sutherland (1991)
  15. 15. Modelos de Madurez para GSI en Hospitales 15 Modelo Revisado de los Estadios deModelo Revisado de los Estadios de Crecimiento de Galliers y Sutherland (1991)Crecimiento de Galliers y Sutherland (1991)
  16. 16. Modelos de Madurez para GSI en Hospitales Instrumento de Medida del Modelo Revisado de losInstrumento de Medida del Modelo Revisado de los Estadios de Crecimiento [Galliers 1995]Estadios de Crecimiento [Galliers 1995] Factor de influência APTIDÕES DO PESSOAL Discorda Concorda em Pouco Sem Opinião Concorda em Muito Concorda Não é empreendido treino/formação em SI/TI na organização      Aptidões técnicas de instalação muito limitadas      Aptidões de programação muito limitadas      As habilidades são guardadas individual e secretamente      Poucas aptidões técnicas de instalação dentro da organização      Aumentam as aptidões de programação e análise, apesar de ainda serem limitadas      Aptidões de gestão de projecto limitadas      Quase nenhum treino/formação é empreendido em SI/TI      Competência técnica considerável      Aptidões dos analistas e programadores bem desenvolvidas      Aptidões de gestão de projecto bem desenvolvidas      Faltam ao Gestor de SI aptidões interpessoais      16
  17. 17. Modelos de Madurez para GSI en Hospitales Varios otros modelos han sido introducidos,Varios otros modelos han sido introducidos, incluyendo en dominios específicos…incluyendo en dominios específicos… 17 Field Name Autor Year Intranet implementation Damsgaard, J., & Scheepers, R. 2000 ERP systems Holland, C., & Light, B. 2001 Software development process SEI Software Engineering Institute 2010 Software maintenance April, A., Abran, A. & Dumke, R. 2004 Business Management Levin G. & Nutt, H. 2005 Project Management Brookes, N. & Clark, R. 2009 Project Portfolio and Program Management Murray, A. 2006 Information Management Venkatesh V., Morris M., Davis G., Davis F 2003 IS/ ICT Management Renken, J. 2004 e-Business Earl, M. J. 2000 e-Learning Marshall, S. 2007 Knowledge Management Berztiss, A.T. 2002 BPM – Business Process Management Rosemann, M. & deBruin, T. 2005 Enterprise Architecture Nascio 2003
  18. 18. Modelos de Madurez para GSI en Hospitales Modelos de Madurez para GestiónModelos de Madurez para Gestión de SI en Hospitalesde SI en Hospitales • Revisión Sistemática de Literatura • Bases de Datos consultadas: - AIS Electronic Library, SpringerLink, ScienceDirect, IEEE Xplore, Google Scholar, Google • Resultó en 14 modelos • Mayoría oriunda de empresas, entidades gubernamentales o sociedades 18
  19. 19. Modelos de Madurez para GSI en Hospitales Stage 1 Basic HIS • Patient Registration / Inpatient Admission Discharge & Transfer • Patient Billing and Accounts Receivable • HRIS / Payroll • General Ledger / Financial Reporting • Purchasing / Accounts Payable Stage 2 Advanced HIS • Electronic Claims Submission • Electronic Payment Processing • Inventory, Supply Requisitioning and Distribution • Basic Order Communications • Email • Internet Access • Intranet Stage 3 Advanced HIS Core Clinicals • Laboratory Information System • RIS/Radiology Results Reporting • PACS • Pharmacy • Operating Room Scheduling and Management Stage 4 Digital Hospital • Patient Appointment Scheduling • Computerized Physician Order Entry • Nursing Documentation • Emergency Department Management • Physician Portal • Patient Portal • Wireless Infrastructure • Inpatient Electronic Medical Record (EMR) • Ambulatory EMR • Enterprise Master Patient Index • Location-based services Stage 5 Digital Virtual Enterprise • Secure Email (Provider-Provider/ Provider-Patient) • Clinical Data Repository/ Data Warehouse • Participation in Regionalized Patient CDR • Home Health Case Management • Remote Patient Monitoring/ Telemedicine Fonte: IDC Health Industry Insights 2007 19 IDC Healthcare IT Maturity ModelIDC Healthcare IT Maturity Model
  20. 20. Modelos de Madurez para GSI en Hospitales NHS EPR Maturity ModelNHS EPR Maturity Model 20
  21. 21. Modelos de Madurez para GSI en Hospitales EMR Maturity Model from HIMSSEMR Maturity Model from HIMSS 21
  22. 22. Modelos de Madurez para GSI en Hospitales Resultados de los USA basado en elResultados de los USA basado en el EMR Adoption ModelEMR Adoption Model 22
  23. 23. Modelos de Madurez para GSI en Hospitales Modelos de Madurez para GSI enModelos de Madurez para GSI en Hopitales (1)Hopitales (1) Designation Health Field Stages Research Method Influencing factors / Dimensions Assessment Tool Reference Model Author / Year Quintegra Maturity Model for electronic Healthcare (eHMM) General 7 n/d Entities; Department; Infrastructure n/d n/d (Sharma, 2008) IDC Healthcare IT (HIT) Maturity Model General 5 n/d Types of IS n/d n/d IDC Health Industry Insights, 2008 IDC's mobility maturity model for healthcare Mobility 5 Survey, Case study Intent; Technology; People; Processes IDC's Mobility Maturity Model Guidance CMM IDC Health Industry Insights, 2013 HIMSS Maturity Model for Electronic Medical Record (EMRAM) EMR 8 n/d Types of IS EMR Penetration Assessment Tool n/d HIMSS Analytics, 2006 HIMSS Continuity of Care Maturity Model (CCMM) General 8 n/d Types of IS n/d EMRAM HIMSS Analytics,2014 Patient records/content management maturity model (Forrester Model) EPR 3 Interviews with US healthcare providers Access; Interoperability; Content Features; Planning & strategy Guidance To Get To The Next Phase n/d (Clair, 2010) Maturity Model for Electronic Patient Record (EPRMM) EPR 6 n/d EPR System n/d n/d (Priestman, 2007 ) 23
  24. 24. Modelos de Madurez para GSI en Hospitales 24 Designation Health Field Stages Research Method Influencing factors / Dimensions Assessment Tool Reference Model Author / Year NEHTA Interoperability Maturity Model (IMM) Interoperability 5 ODP standards (open distributed processing) Organisation; Information; Technical Sim IMM / CMMI (NEHTA, 2007) NHS Infrastructure Maturity Model (NIMM) Infrastructure IT 5 n/d Process; People & Organisation; Technology; Security & Information Governance; Strategy Alignment & Business Value Key Capabilities Self-Assessment Tool CMM (NHS, 2011) Healthcare Analytics Adoption Model (HAAM) Data Warehouse & Analysis 9 Data gathered by observation and learned in a structured educational curriculum, experts opinions New Data Sources; Complexity; Data Literacy; Data Timeliness Healthcare Analytics Adoption Model Self Inspection Guide EMRAM ( Sanders et al., 201 ) Hospital Cooperation Maturity Model (HCMM) Networking / Collaboration 4 Interviews, Focus Group, prototype Strategic; organizational; Information HCMM Instantiation CMM ( Mettler & Blondiau, ) PACS Maturity Model (PMM) PACS 5 Literature review, qualitative meta- analysis approach Strategy and policy; Organization & Processes; Monitoring and Control; Information Technology; People & culture Sim CMMI ( Rogier Wetering & ) Telemedicine Service Maturity Model (TMSMM) Telemedicine 5 Literature review, workshop with health and IT professionals, case study Man; Machine; Material; Method; Money Sim CMM ( Van Dyk & Schutte ) Healthcare Usability Maturity Model (UMM) Usability 5 Literature review, case study Focus on users; Management; Process & Infrastructure; Resources; Education Sim Schaffer UM, Nielsen UM, Earthy UM (HIMSS, 2011)
  25. 25. Modelos de Madurez para GSI en Hospitales Discusión (1)Discusión (1) • Desarrollados por diferentes tipos de entidades • Enfocados en sub-áreas específicas o mas amplios • La mayoría no divulga su proceso de concepción y que opciones de investigación fueran adoptadas para su desarrollo e validación 25
  26. 26. Modelos de Madurez para GSI en Hospitales Discusión (2)Discusión (2) • Principal modelo de referencia/inspiración: CMM/CMMI • 6 de los modelos desarrollados ha basado su estructura en este modelo • Los estadios oscilan entre 3 y 9 • Los factores de influencia oscilan entre 1 y 5 26
  27. 27. Modelos de Madurez para GSI en Hospitales Discusión (3)Discusión (3) • Las características de los estadios oscilan entre 1 y 4 • Los factores de influencia tienen todos los mismo peso • No indican como las organizaciones pueden avanzar para estadios superiores • Pocos ofrecen instrumento de medición de la madurez 27
  28. 28. Modelos de Madurez para GSI en Hospitales Discusión (4)Discusión (4) • Pocos ofrecen una herramienta para suportar el proceso de medición de la madurez • Mayoría publicada en documentos de trabajo (White Papers), no en revistas científicas 28
  29. 29. Modelos de Madurez para GSI en Hospitales Modelo a Desarrollar (1)Modelo a Desarrollar (1) • Un modelo amplio, que cubra las principales áreas de la GSI en hospitales • Desarrollado en un proceso científico • Factores de influencia basados na literatura y en expertos • Factores de influencia con pesos diferentes atribuidos por expertos en un Proceso Delphi 29
  30. 30. Modelos de Madurez para GSI en Hospitales Modelo a Desarrollar (2)Modelo a Desarrollar (2) • Instrumento de medición de la madurez y herramienta de suporte de este proceso • Validación en hospitales • Publicación en Revista Científica 30
  31. 31. Modelos de Madurez para GSI en Hospitales 31 Gracias por suGracias por su atención!atención! Álvaro Rocha AISTI & Universidade de Coimbra Portugal amrrocha@gmail.com ?

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