Williams Patricia Ah, Lovelock Brendan, Cabarrus Tony, Harvey Marlon
Flinders Digital Health Research Centre, College of Science and Engineering, Flinders University, Adelaide, Australia.
Cisco Systems Australia, Melbourne, Victoria, Australia.
JMIR Med Inform. 2019 Jan 11;7(1):e12465. doi: 10.2196/12465.
Digital transformation in health care is being driven by the need to improve quality, reduce costs, and enhance the patient experience of health care delivery. It does this through both the direct intervention of technology to create new diagnostic and treatment opportunities and also through the improved use of information to create more engaging and efficient care processes.
In a modern digital hospital, improved clinical and business processes are often driven through enhancing the information flows that support them. To understand an organization's ability to transform their information flows requires a clear understanding of the capabilities of an organization's information technology infrastructure. To date, hospital facilities have been challenged by the absence of uniform ways of describing this infrastructure that would enable them to benchmark where they are and create a vision of where they would like to be. While there is an industry assessment measure for electronic medical record (EMR) adoption using the Healthcare Information and Management Systems Society Analytics EMR Adoption Model, there is no equivalent for assessing the infrastructure and associated technology capabilities for digital hospitals. Our aim is to fill this gap, as hospital administrators and clinicians need to know how and why to invest in information infrastructure to support health information technology that benefits patient safety and care.
Based on an operational framework for the Capability Maturity Model, devised specifically for health care, we applied information use characteristics to define eight information systems maturity levels and associated technology infrastructure capabilities. These levels are mapped to user experiences to create a linkage between technology infrastructure and experience outcomes. Subsequently, specific technology capabilities are deconstructed to identify the technology features required to meet each maturity level.
The resulting assessment framework clearly defines 164 individual capabilities across the five technology domains and eight maturity levels for hospital infrastructure. These level-dependent capabilities characterize the ability of the hospital's information infrastructure to support the business of digital hospitals including clinical and administrative requirements. Further, it allows the addition of a scoring calculation for each capability, domain, and the overall infrastructure, and it identifies critical requirements to meet each of the maturity levels.
This new Infrastructure Maturity Assessment framework will allow digital hospitals to assess the maturity of their infrastructure in terms of their digital transformation aligning to business outcomes and supporting the desired level of clinical and operational competency. It provides the ability to establish an international benchmark of hospital infrastructure performance, while identifying weaknesses in current infrastructure capability. Further, it provides a business case justification through increased functionality and a roadmap for subsequent digital transformation while moving from one maturity level to the next. As such, this framework will encourage and guide information-driven, digital transformation in health care.
医疗保健领域的数字化转型是由提高质量、降低成本以及提升医疗服务患者体验的需求所推动的。这一转型通过技术的直接干预创造新的诊断和治疗机会，以及通过更好地利用信息来创建更具吸引力和效率的护理流程来实现。
在现代数字化医院中，改进的临床和业务流程通常是通过增强支持这些流程的信息流来推动的。要了解一个组织改变其信息流的能力，需要清楚地了解该组织信息技术基础设施的能力。迄今为止，医院设施一直面临挑战，因为缺乏统一的方式来描述这种基础设施，而这种方式能够使它们对标自身现状并构想未来愿景。虽然存在一种使用医疗保健信息与管理系统协会分析电子病历采用模型对电子病历（EMR）采用情况进行行业评估的方法，但对于评估数字化医院的基础设施及相关技术能力却没有类似方法。我们的目标是填补这一空白，因为医院管理人员和临床医生需要知道如何以及为何投资于信息基础设施，以支持有益于患者安全和护理的健康信息技术。
基于专门为医疗保健设计的能力成熟度模型的运营框架，我们应用信息使用特征来定义八个信息系统成熟度级别以及相关的技术基础设施能力。这些级别与用户体验相对应，以建立技术基础设施与体验结果之间的联系。随后，对特定技术能力进行解构，以确定达到每个成熟度级别所需的技术特征。
由此产生的评估框架明确界定了医院基础设施五个技术领域和八个成熟度级别的164项个体能力。这些与级别相关的能力表征了医院信息基础设施支持数字化医院业务（包括临床和行政要求）的能力。此外，它允许为每个能力、领域和整体基础设施添加评分计算，并确定达到每个成熟度级别所需满足的关键要求。
这个新的基础设施成熟度评估框架将使数字化医院能够根据其与业务成果的一致性以及对所需临床和运营能力水平的支持，来评估其基础设施的成熟度。它能够建立医院基础设施性能的国际基准，同时识别当前基础设施能力的弱点。此外，它通过增加功能提供了商业案例依据，并为从一个成熟度级别提升到下一个级别提供了后续数字化转型的路线图。因此，该框架将鼓励和指导医疗保健领域中由信息驱动的数字化转型。
