Rogier van de Wetering

A PACS maturity model: A systematic meta-analytic review on maturation and evolvability of PACS in the hospital enterprise

INTRODUCTION With PACS and medical imaging technology maturing, the importance of organizational maturity and effective deployment of PACS in the hospital enterprise are becoming significant. OBJECTIVE The objective of this paper is twofold. Firstly, PACS literature on maturity and evolvability in the hospital enterprise is analyzed, resulting in an overview of the relevant developments concerning maturity of PACS. Secondly, this paper looks at the development of a maturity model for PACS technology. METHODS AND RESULTS Using structured search queries, we identified 34 papers reporting relevant aspects of maturity and evolvability of PACS. From the results of a meta-analytic review on PACS maturity and evolvability, we propose a model--the PACS maturity model (PMM)--that describes five levels of PACS maturity and the corresponding process focus. CONCLUSION We argue that this model can help hospitals to gain insights into their (strategic) objectives for growth and maturity with regard to PACS, the electronic patient record (EPR) and other health information systems. Moreover, the proposed model can be applied as a valuable tool for organizational assessments, monitoring and benchmarking purposes. Hence, the PMM contributes to an integral alignment model for PACS technology.

A balanced evaluation perspective: picture archiving and communication system impacts on hospital workflow.

Around the world, hospitals are faced with both budget and regulatory pressures, forcing them to re-examine the way clinical practice is carried out. Proposed technologies that provide workflow enhancements include Picture Archiving and Communications Systems (PACS); however, is PACS really effective in improving hospital workflow and the flow onto patient care, and how should this be evaluated? An acknowledged and successful approach for organizational evaluation is the Balanced Scorecard (BSC), providing the fundamental features for assessing organizations from various perspectives. In this research, the impact of PACS on the workflow of a large public hospital in Melbourne, Australia, is examined using an adapted version of the BSC. Empirically, this model was applied as an evaluation instrument through a series of in-depth interviews with PACS users. Results show that PACS did improve hospital workflow considerably and that the organizational alignment of PACS in hospitals is an important critical success factor.

Purchasing alignment under multiple contingencies: a configuration theory approach

Purpose – Strategic alignment is a theory-based state that is considered as crucial for organizations in order to realize performance gains from information technology (IT) investments and deployments. Within the domain of purchasing and supply chain management there has been a growing interest on how purchasing strategy can be effectively aligned with IT and what conditions facilitate this state. The purpose of this paper is to investigate complex causal relationships of contingency elements that are key in enabling the “fit” between purchasing strategy and IT. Design/methodology/approach – The paper employs a configuration theory approach and propose that purchasing alignment is dependent upon patterns of multiple contingencies. In adherence with contingency theory, the authors group these elements as relating to strategic orientation, organizational factors, and purchasing decisions. On a sample of 172 international companies the authors then apply the novel methodology of fuzzy set qualitative compara...

Evolutionistic or revolutionary paths? A PACS maturity model for strategic situational planning.

PurposeWhile many hospitals are re-evaluating their current Picture Archiving and Communication System (PACS), few have a mature strategy for PACS deployment. Furthermore, strategies for implementation, strategic and situational planning methods for the evolution of PACS maturity are scarce in the scientific literature. Consequently, in this paper we propose a strategic planning method for PACS deployment. This method builds upon a PACS maturity model (PMM), based on the elaboration of the strategic alignment concept and the maturity growth path concept previously developed in the PACS domain.MethodsFirst, we review the literature on strategic planning for information systems and information technology and PACS maturity. Secondly, the PMM is extended by applying four different strategic perspectives of the Strategic Alignment Framework whereupon two types of growth paths (evolutionistic and revolutionary) are applied that focus on a roadmap for PMM. This roadmap builds a path to get from one level of maturity and evolve to the next.ResultsAn extended method for PACS strategic planning is developed. This method defines eight distinctive strategies for PACS strategic situational planning that allow decision-makers in hospitals to decide which approach best suits their hospitals’ current situation and future ambition and what in principle is needed to evolve through the different maturity levels.ConclusionsThe proposed method allows hospitals to strategically plan for PACS maturation. It is situational in that the required investments and activities depend on the alignment between the hospital strategy and the selected growth path. The inclusion of both strategic alignment and maturity growth path concepts make the planning method rigorous, and provide a framework for further empirical research and clinical practice.

A situational alignment framework for PACS.

This paper reports the outcomes of a study on an integrated situational alignment framework for picture archiving and communication systems (PACS) labeled as PISA. Following the design research cycle, complementary validation methods and pilot cases were used to assess the proposed framework and its operationalized survey. In this paper, the authors outline (a) the process of the framework’ development, (b) the validation process with its underlying iterative steps, (c) the outcomes of pilot cases, and (d) improvement opportunities to refine and further validate the PISA framework. Results of this study support empirical application of the framework to hospital enterprises in order to gain insights into their PACS maturity and alignment. We argue that the framework can be applied as a valuable tool for assessments, monitoring and benchmarking purposes and strategic PACS planning.

Modeling Alignment as a Higher Order Nomological Framework

Achieving Business/IT-alignment (BITA) and pursuing intended goals within organizations seems an intricate and poorly examined process. We argue that without proper theories concerning BITA, the ‘mapping’ of theoretical constructs onto empirical phenomena, is ambiguous. In this paper we synthesize a higher order nomological framework for BITA with a considerable degree of complexity, coherence and causality. We aim to extend and generalize previous work on BITA within the healthcare domain, drawing on principles of complexity science. Our framework explains how BITA is related to firm performance. Using this knowledge, organizations can define improvement activities that can be executed along five organizational dimensions that best meets a organizations’ current and future needs; done simultaneously and hence by an integrated management perspective. This work contributes to academia by using a modeling approach that overcomes acknowledged limitations of existing approaches. Doing so, the outcomes of this study also offer many opportunities for future research.

A Meta-Framework for Efficacious Adaptive Enterprise Architectures

Tuning enterprise architectures to stay competitive and fit is an enduring challenge for organizations. This study postulates a meta-framework for Efficacious Adaptive Enterprise Architectures (EA), the 2EA framework. We use fundamental long-standing principles found in complex adaptive systems. These principles explain adaptive success. Also, we set forward managerial implications about the dynamics of EA to function effectively on four architectural levels, i.e. enterprise environment, enterprise, enterprise systems and infrastructure. Principles of efficacious adaptation have not been incorporated into current EA frameworks and methods underlining an improvement area. Subsequently, we extend baseline work into a meta-framework and evaluate it accordingly following the design science method. Our meta-framework supports organizations to assess and adapt EA capabilities – modular units of functionality within the organization – to the continuously changing environment, stakeholder interests and internal organizational dynamics. Our research contributes to foundational work on EA and can be used for strategic EA development and maturation.

Big Data Enabled Organizational Transformation: The Effect of Inertia in Adoption and Diffusion.

Big data and analytics have been credited with being a revolution that will radically transform the way firms operate and conduct business. Nevertheless, the process of adopting and diffusing big data analytics, as well as actions taken in response to generated insight, necessitate organizational transformation. Nevertheless, as with any form of organizational transformation, there are multiple inhibiting factors that threaten successful change. The purpose of this study is to examine the inertial forces that can hamper the value of big data analytics throughout this process. We draw on a multiple case study approach of 27 firms to examine this question. Our findings suggest that inertia is present in different forms, including economic, political, socio-cognitive, negative psychology, and socio-technical. The ways in which firms attempt to mitigate these forces of inertia is elaborated on, and best practices are presented. We conclude the paper by discussing the implications that these findings have for both research and practice.

A classification framework for clinical information system implementation in hospitals

In the last decade, many information system (IS) implementations took place in the healthcare organisations. Mainstream reasons for this evolvement are the increase of quality and safety of care, and reducing costs. As in many other sectors IS implementations in healthcare are complex, and confronted with many types of difficulties that significantly hinder achieving the objected benefits. So far, a number of systematic overviews and classifications of critical success factors (CSFs) have been available for IS implementation in healthcare, but a CSF framework specifically for clinical information systems (CISs) in hospitals does not exist. This paper provides such a framework, validates it, and translates it into a practical contribution for IT project managers in hospitals. The framework is based on a systematic literature review that has been performed to extract relevant SCFs from recent academic publications. After a filtering process, 58 publications have been selected from which 248 success factors have been extracted. Building upon seven existing classifications, the classification framework for CSFs in CIS implementations was build. Expert interviews were conducted to validate the framework and the relative weights of eight CSF categories.

Reflections on Using an Architecture Model for Matching Existing Applications to a Radical Business Requirements Change: A Case Study

In this practice paper, we report the outcomes of a case study in a new Dutch hospital, where enterprise architects are working toward a ‘lean’ and ‘simplified’ EA model to align existing IT systems to new requirements. The objective of the case study was to examine if the developed EA model could support architects in selecting components of an existing IT infrastructure for re-use, with regard to radically new requirements. We have developed an EA model in close collaboration with enterprise architects. This study reflects on the use of this model in the hospital. The approach combines analysis of the content in the model, a study of documents in the organization, and communication with the architects. We signal that the existence of an integrated suite for an Electronic Health Record system largely determined how the model was used. Reflection disclosed that a lack of information on requirements and applications, as well as low adaptability of existing systems, negatively affected the flexibility of IT in the organization.