Transcript Z.Sabic. eHealth Architectures eng_123x

UKRAINE eHealth Strategy
- “Strategic and Architectural Options for Effective
Implementation and Integration Zlatan Šabić
Kiev, Ukraine, April, 2016
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Options for…
Objectives/Value
Architectures
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2.
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Implementation
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Implementation Strategy
Planning Strategy and Indicators of Progress
Funding
Investment Plan
Governance
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Overall Conceptual Architecture
Functional Architecture
Technical Architecture
Leadership and Implementing Structures
Regulations, Standards and Interoperability
Legislation, policy and compliance
1. Objectives/Value
WHY are we doing this?
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Defining objectives
What is the purpose of eHealth systems to be introduced and
how is that related to the overall development objectives?
Considering the overall development objectives and strategies,
are there opportunities to use the eHealth as an innovation
that can critically influence them?
Define value that eHealth brings, e.g.
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Better/new service delivery models
Supported financing models
Improved information for policy/decision making
Administrative efficiency and productivity of the public health system
…
Relationship to other development plans/strategies
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Objectives can come from challenges
Typical eHealth Challenges
Support clinical and administrative
processes to:
• strengthen primary care to be first point of
contact and gatekeeper for patient navigation of
delivery system
• facilitate inter-provider communication
(hospital-to-hospital; hospital-to-primary care)
to provide technical assistance, supervision and
training
• support doctors’ multi-sited practice and
remote medical treatment
• improve provider-patient relations and benefit
people by reducing information asymmetry
• allow results based payment models, such as
paying integrated care networks (e.g.,
capitation), or paying for a package of services
(e.g., bundled payments)
…
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Integrate data flows to support:
• balanced service delivery model through levels of care
• effective management of medical alliances or networks
• horizontal integration of individual preventive and
curative care services
• vertical integration of care
• expansion of cost effective “intermediate” facilities
• provide flexible clinical and administrative data
analytics to make delivery system accountable for
population health
• provide flexible clinical and administrative data
analytics to allow measurement and feedback on
outcomes, costs and quality processes to strengthen
performance evaluation and assessment and make
delivery system accountable for population health
• access to accurate and timely information to
strengthen integrated planning and coordination of
medical reform
…
Objectives - other considerations
The IT value does not appear instantly; it grows as the
utilization of IT evolves from using the IT as a tool for
efficiency improvement to the business integrator and
enabler.
IT can be the decisive factor in achieving the reforms’
goals, and considering wider context, it can become the
enabler of the reforms in sector’s that would otherwise
be limited or even not possible.
Think of priorities and feasibility
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2. Architectures
WHAT needs to be developed
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Architectures – Conceptual Architecture
Agree on Conceptual System Architecture (CSA) before
moving to functional requirements, to be able to make
decisions on various implementation time-frames,
implementation strategies and investments.
The CSA defines functional separation of systems,
services and applications to be implemented.
It implicitly defines possible implementation options.
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CSA
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Identification of
building blocks
No details
Central Reference
Registries
Web interface for
manual access to
central systems
MPI
health data
dictionary
providers
professionals
health services
ICD-xx
…
Shared EHR
Common Application
Systems
Health Data
Exchange
Platform
Tools and
services for
data exchange
based on
minimal
standards.
Grassroots/Regional
Systems in Health
Facilities (EMRs)
PHC
Hospitals
Laboratories
Emergency
Regional EHR?
…
Two way referral
ePrescription
central appointments
common payment
…
Public health &
Vertical Registries
Pharmacies
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Central Systems
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Other Systems
Social protection
…
Conceptual Architecture – it can be one scheme, but
needs to answer key design questions
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The set of potentially large number of options shall be reduced by
deciding on key design dilemmas, for example:
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Centralized vs. distributed EMR?
Functional separation per level of health care (primary, secondary) and
per business functions (outpatient, inpatient, laboratory, radiology,
emergency, …)
Do Primary Health Care (PHC) and Specialist/Secondary Health Care
(SHC) use separated Electronic Medical Records (EMR)?
How is data exchange provided between systems using a standard
messaging?
Are data from EMR’s (PHC and SHC) aggregated into some sort of
Central EHR (Central Electronic Patient Registry – CEPR; or Central
EHR), providing subset of data for policy making, and also allowing data
exchange between PHC and SHC systems?
If there is one, centralized EMR, how are PHC, SHC and CEPR systems
are built around it?
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DESIGN
Data collection vs. process oriented
design
Top
management
Middle
management
Higly-synthetic data,
oriented to future and
support to strategic
planning
Summary, synthetic data,
but with enough details to
effectively support tactical
managerial control
Operational, daily
data with high level
of details
Operational
management
Data collection
Zlatan Šabić, 2012.
Daily operations,
generating data
Data collection vs. process oriented
design
DESIGN
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Data collecting will not be very useful for daily
business processes and will never collect accurate
data that we can trust. Data produced as a result of
“data collection process” are:
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not accurate,
not timely reported,
not useful for support of daily business processes, and
generating more workload
Data collection vs. process oriented
design
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DESIGN
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The IT system must be implemented into the heart of the health system to
directly support its business processes and thus operate on real, operational,
transaction data
Collecting and extracting information from these databases is a trivial task
then. Generated data are “by-product” of real business processes – they can
be trusted as it has been aggregated from operational data generated by real
people in real business processes.
HEEALTH SYSTEM
POLICY MAKING
Business processes
PHC
Hospitals
Pharmacies
Databases
- EMR
- referrals
- provided services
MANAGEMENT
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CSA – example, Kazakhstan
Pati ent’s Personal
Cabi net
Personal heal th professi onal ’s
cabi net
BI and Anal yti cal tool s
e-Governm ent
servi ces
Cl assi fi ers and Nom encl atures
M anagem ent
Exi sti ng Inform ati on system s
RAP
OPC
M SQM S
RM S
DPM S
RPWFA
ERHP
ACPCT
M EM S
ERDP
HB
DIS
NRD
ERCP
Si ngl e data reposi tory
EHR Reposi tory
Anal yti cal warehouse
M aster pati ent i ndex,
heal thcare faci l i ti es
i ndex, heal thcare
professi onal s i ndex
Cl assi fi ers and
nom encl atures
e-Governm ent Gate
Integrati on bus
Integrati on bus
External Inform ati on system s
Health facility level modules (within this contr act)
Di stri ct doctor
Adm i ssi on
M eal s
Pharm acy
Hum an Resources
Hospi tal Doctor
Day-hospi tal
Hospi tal
adm i ni strator
Profi l e speci al i st
Procedures and
m ani pul ati ons
Hospi tal nurse
Di agnosti c studi es
Prophyl acti c exam s
Lab IS
PACS (Pi cture
Archi vi ng and
Com m uni cati on
System )
M edi cal stati sti cs of
pol i cl i ni c
Head of Pol i cl i ni c
departm ent
Head of hospi tal
departm ent
Legend
Exi sti ng i nform ati on system s
Pl atform com ponents
e-Governm ent Gate and servi ces
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Heal th faci l i ty l evel m odul es
Recepti on
Adm i n
M edi cal Stati sti cs
for Hospi tal
Functional Architecture
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After deciding on CSA, general functional description
of key components of CSA shall be described – systems
and services.
It is NOT making specifications for procurement, it is
defining the conceptual structure to be foundation for
functional standards and recommendations for the
implementers to follow
The functional descriptions shall not be detailed, but it
must be clear what each of components is consisting of.
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Functional Architecture
WHAT exactly needs to be implemented
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Service Delivery
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Primary Health Care ISs
Hospital ISs
Pharmacy ISs
Patient Portal
ePrescription
eReferrals
LIS
RIS
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Admitting
Billing
Medical Records
Ward
Medicine
Operating room
Inpatient
Pediatric
Pharmacy
Radiology
Emergency Room
Laboratory
Dietary
Ob/Gyne
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Functional Architecture
WHAT exactly needs to be implemented
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Public Health
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Public Health Statistics
Epidemiological Surveillance
International Health
Surveillance
Quarantine Services
Management
Epidemic Containment
Monitoring
Health Education
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Disease Management
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Cancer Registry
Diabetes Registry
Hypertension Registry
Coronary Arterial
Disease Registry
HIV Registry
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Functional Architecture
WHAT exactly needs to be implemented
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Resources and Regulation
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Health Facilities & Services
Licensing/Accreditation
Health Devices & Technologies
Registration
Drugs registration and
management
Central Reference Registries
Health Data Dictionary
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Payment Systems
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Administration
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Health Insurance Funds ISs
Payment and budgeting
mechanisms
…
Human resources
Management
Financial management
Supply Chain management
Fixed Assets Management
Information Assets
management
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Functional Architecture
WHAT exactly needs to be implemented
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Governance and
Management
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Annual Budgeting & Planning
Budget Utilization Monitoring
Fixed assets Accounting &
Control
Procurement Monitoring
Suppliers Performance
Monitoring
HHR Deployment Monitoring
Contracts Management
Retail Drug Price Monitoring
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Adverse Drug Reaction
Monitoring
Licensing & Accreditation
Compliance Monitoring
Health laws/standards
compliance Monitoring
Health Programs Development
Service Quality and Monitoring
Emergencies Response
Monitoring
International Health
Cooperation
Functional Description
Example: What do you mean by PHC System?
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Support for outpatient business flow (registration, scheduling/appointment, initial
consultation, examinations, examination review and additional consultations,
treatment session, drug prescription and administration, hospitalization
instruction,…)
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Access to and update of EMR
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Health risk appraisal (integrating data about the patient’s condition obtained from
laboratory, radiology/imaging, or other equipment or technology-related tests
and/or procedures, capturing and monitoring patient health risk factors, capturing
and monitoring vital signs data, such as height, weight, pulse, respiratory rate, blood
pressure, … )
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Progress notes (performed/planned (Laboratory) procedures, diagnosis, goals
(provider’s and patient’s) and follow-up plans, medications prescribed, education
materials, consultation/referrals, patient condition or status, …)
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Problem list (problem status, problem summary list, monitoring of health risk
factors, link problems with orders and results, link problems to clinical practice
guidelines, …)
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Architecture – centralized vs. regional?
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Functional Description (cont.)
Example: What do you mean by PHC System?
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Orders
Referrals
ePrescription
Integrated Clinical Practice Guidelines (CPG) - import/create/edit the CPG
guidelines, (re)configure business flow according to CPGs, documentation
management following CPG, …
Clinical decision support
Multidisciplinary care plans
Prevention
Access to health insurance data
…
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Functional Description
Example: What do you mean by Hospital IS?
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Support for inpatient business flow (registration,
hospitalization instruction, hospitalization procedure,
consultations, examinations, inpatient treatment, nurse
assignment, surgery, drug management, …)
Registration and scheduling
Access to and update of EMR
Problem list (problem status, problem summary list,
monitoring of health risk factors, link problems with orders
and results, link problems to clinical practice guidelines, …)
Laboratory Information System (LIS)
Radiology Information System (RIS)
Referrals
Orders
ePrescription
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Functional Description (cont.)
Example: What do you mean by Hospital IS?
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Disease Management
Integrated Clinical Practice Guidelines (CPG) import/create/edit the CPG guidelines, (re)configure business
flow according to CPGs, documentation management following
CPG, …
Care plan
Alerts
Internal pharmacy management
Service/Cost administration (may include DRG)
Quality assurance
Access to health insurance data
…
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No need to define everything…
Source:
“Overview of IT Adoption Status in Peking University People’s Hospital”, LIU FAN, Assistant
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President of Peking University People’s Hospital, 2014
High
uncertainty
How?
High
uncertainty
What?
How?
Low
uncertainty
Low
uncertainty
What?
High
uncertainty
High
uncertainty
Low
uncertainty
Defining everything?
“Analysis-Paralysis”
(c)
(b)
(a)
Low
uncertainty
Architectures – Functional Architecture
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The point of describing functional architecture is not to
design everything to be implemented by the government.
The purpose is to define on conceptual level the
structure that will allow creation of functional standards
and recommendations.
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Architectures – Technical Architecture
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Conceptual technical architecture – how are databases and
systems hosted, client/server architecture vs. web based SOA,
how are systems connected, what are the basic communication
protocols, …
End-user computing facilities (computers, printers, scanners, …)
Local area networks in health facilities
Last-mile communication infrastructure (who, how, …)
National (WAN) communication infrastructure
Systems and applications hosting environments – central data
center(s) based on cloud computing (who, how, relationship with
other national platforms, …)
…
Technical Architecture - example
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2011
EMERGENCY MEDICAL SERVICE
2010 september
SCHOOL NURSES
2010 january
PHARMACIS
2009
FAMILY DOCTORS
2009
HOSPITALS
BUSINESS REGISTER
POPULATION REGISTER
- Health care providers
- Health professionals
- Dispensing chemists
HEALTH CARE BOARD
- Coding Centre
- Handlers of medicines
STATE AGENCY OF MEDICINES
Example: Technical architecture based on
national eGov infrastructure (Estonia X-Road)
X-Roads, ID-card, State IS Service Register
PATIENT
PORTAL 2009
HCP PORTAL
2011
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XROADS
GATEWAY
SERVICE
2009
PHARMACIS
AND FAMILY
DOCTORS
2009
eHealth Foundation
NATIONAL
HEALTH
INFORMATION
SYSTEM
2009
Health Insurance
INSURANCE REGISTER
CLAIMS & REIMBURSMENT
PRESCRIPTION
CENTRE
2010 january
Architectures – Technical Architecture
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Again, the point of describing technical architecture is not
to design everything to be implemented by the
government. The purpose is to define on conceptual level
the structure that will allow creation of technical
standards and recommendations.
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3. Implementation
Nice architecture, but
HOW will it be developed?
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Implementation Strategy
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For each of identified component:
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What is the basic implementation strategy, for example, open market
model vs. centralized one solution for all?
How many separated systems will be actually implemented for the
component to be implemented?
Who will implement it? Who is responsible for the functioning of it?
Who is responsible for the content of databases?
What is the transition strategy ?
What is the plan of gradual introduction of regulations and standards?
Who is responsible? How are stakeholders and users involved?
What is the plan for establishing needed structures for governance,
their re-structuring, capacity building, establishing of stable funding
mechanisms, etc. ?
Change management strategy?
Basic implementation model
Many IT
service
providers
IT governance monopoly
liberalized market
One IT service
provider
monopoly
not likely to happen
One organization
implements IT services for
the whole sector
Many organizations are
implementing different
systems that cooperate
You can have different model for different systems, for example:
 PHC, policlinics, municipality hospitals – IT governance monopoly
 Regional hospitals – liberalized market
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Implementation – critical decision
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What will be implemented directly by the government, and
what will be implemented locally, by regions and/or facilities?
Possible implementation strategy:
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Government will define and enforce the standards and regulations
for that implementation.
Government will implement some central functions (which ones?), to
ensure implementation of conceptual functional and technical
architectures, to ease data exchange, and to stimulate more
development on local level.
Most of the implementation will be done by regions and medical
facilities. They will purchase solutions available on ICT market, but
only those which are certified by the government to be compliant to
regulations and standards.
Actually, the government is not physically implementing eHealth
(except some central systems), it creates the stimulating and
encouraging environment for the organized and regulated eHealth
development in Moldova.
Implementation Strategy A, example
GOVERNMENT
G AT EW AY
eHealth Regulations and
Standards enforce the use of
service
For example, “all implemented
PHC systems must have interface
to CEHR, using XY standard)”
CEHR
(web based communication services)
This model might make sense for central
electronic health record (CEHR - the subset of
electronic medical record used for the purposes
of data exchange and statistical/policy reporting)
Hospital
Information
System
HEALTH
FACILITIES
EMR
Emergency
Information System
EMR
Primary Health Care
Information System
EMR
Implementation Strategy B, example
GOVERNMENT
Government implements central PHC system.
Facilities can use it, or they can chose to use
other solutions. If they use it, they use common
EMR (that is not the same as CEHR)
G AT EW AY
EMR
CEHR
(web based communication services)
Centrally developed and
hosted Primary Health
Care Information System
This facility uses centrally
developed and hosted
Primary Health Care
Information System
HEALTH
FACILITIES
EMR
EMR
This facility uses it’s own
Primary Health Care
Information System
This facility uses it’s own
Primary Health Care
Information System
GOVERNMENT
Implementation Strategy, example: How
to regulate liberalized market option?
eHealth Regulation and
Standardization
- Components of CSA
- Functional requirements
-Technical standards
- Data exchange standards
- Data structures standards
-…
Feedback
Certification
ICT INDUSTRY
Monitoring of
compliance and
conformance
Procurement and
implementation of
only certified
solutions
HEALTH FACILITIES
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Implementation strategy – balancing
systems and integration efforts
Implement Grassroots Systems
Integrate Data Flows
- Basic PHC EMR systems
- Central Reference Registries
- Basic hospital EMR systems
- MPI
- Tele-consultations
- Shared EHR
- Clinical decision support systems
- Health Data Exchange Platform
- Post-treatment e-consultations
- Common Cluster Systems (two-way
referrals, ePrescription, central
appointment, common payment, …)
- Off-line consultations
- Post-discharge patient management
- …
- …
Improve Enabling Environment
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IT Service Delivery Options
Delivery Strategy Characteristics
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Advantages
Disadvantages
in-sourcing
Direct control
Internal capacities are
Freedom of choice
used for the design,
development,
Familiarity with
internal procedures
maintenance, execution,
and/or offer of support for
the service.
Cost and time for
delivering services
Dependence on
internal resources
and competencies
outsourcing
Focus on core
Engaging an external
competencies
organization for the
Reducing long-term
design, development,
costs
maintenance, execution,
and/or offering of support
of the service.
Less direct control
Unfamiliarity with the
skills of supplier
co-sourcing
A combination of in- and
outsourcing in which
various outsourcing
organizations work
cooperatively throughout
the lifecycle.
Time to deliver services Complexity of projects
Better control
Intellectual property
and copyright
protection
IT Service Delivery Options (cont.)
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Delivery Strategy
Characteristics
Advantages
Disadvantages
Complexity of projects
“Culture clash”
multi-sourcing
Multiple organizations Expanded market
opportunities
make formal
Competitive response
agreements with the
opportunities
focus on strategic
partnerships (creating
new market
opportunities).
business process
outsourcing (BPO)
One-counter
An external
organization takes over functionality
a business process, or Access to specialized
skills
part of one, at a
cheaper location (for
example, call center).
Loss of knowledge
Loss of relationship
with the business
application service
provision
Computer-based
services are offered to
the customer over a
network.
Access to complex and Access only to
expensive solutions
facilities, not
knowledge
Support and upgrades
included
“Culture clash”
Implementation – Planning Strategy
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Define planning horizons. Try to be comprehensive in
defining architectures and governance, but do not plan
everything immediately. Rather, make detailed plans for 3
years period, and more strategic plan for 5-10 years, but
with less details, …
Define Progress Indicators
Define planning documents, for example:
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“eHealth Strategy” (policy and strategy paper with
simplified details on implementation)
“eHealth Implementation Plan/Road Map” with more
details on functional architecture, business models, technical
architecture, legal and standardization issues, programs/projects
to be implemented, budget, timeframe, responsibilities,, etc.
Define re-planning dynamics
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Implementation - Funding
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Funding business models that enhance incentives for
implementation.
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Funding structure that follows the decision making structure (“who gets
the money for something, that one is making decision about it, but is also
responsible for that”).
For example, is central implementing agency 100% on budget, or it needs
to be partially financed by IS users (polyclinics, hospitals)? Also, is
everything implemented/financed by that central unit? If not, does it mean
polyclinics and hospitals have budget for eHealth? These are all different
models of funding that will require some decisions and institutional/legal
changes – and that needs to be clearly stated and planned in the
Strategy, so the government can approve it.
Who decides on investments?
Funding of national, regional and local level? Substitutes, cofinancing, …
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…
Implementation – Investment Plan
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It shall not be too detailed, but must cover the
implementation of crucial components. It must be clear
how will it be implemented, in which timeframe and how
will it be financed.
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Implementation Matrix (Component, Time-frame, Estimated
Investment)
Investment Matrix (Component, Project/Program/Activity,
Investment Source)
Implementation - Funding
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Funding business models that enhance incentives for
implementation.
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Funding structure that follows the decision making structure (“who gets
the money for something, that one is making decision about it, but is also
responsible for that”).
For example, is central implementing agency 100% on budget, or it needs
to be partially financed by IS users (polyclinics, hospitals)? Also, is
everything implemented/financed by that central unit? If not, does it mean
polyclinics and hospitals have budget for eHealth? These are all different
models of funding that will require some decisions and institutional/legal
changes – and that needs to be clearly stated and planned in the
Strategy, so the government can approve it.
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Who decides on investments?
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Funding of national, regional and local level
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…
Stimulation mechanisms
Ministry of Health
Health Facilities (HF), or regions?
Project proposals
HF1
HF2
Stimulation/
Innovation Fund
HF2
($$$)
Stimulation
fund
+
HF Budget
HF3
Tender
Software Solutions
SP1
SP2
SP3
Certification
according to
functional and
technical
standards
HF contracts
SP
SP1
SP3
45 of Kazakhstan, 2013
Source: Ministry of Health of the Republic
4. Governance
Nice plan, but
WHO will run it?
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Governance – Leadership and Implementing
Structures
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Who will lead the implementation of the Strategy on 4 levels? Be
very clear and specific in defining structures for:
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Policy. What is the long term responsibility of the policy level? Who is
doing it? What is the revised organizational structure needed, ….
Regulation and standardization.What is the long term responsibility
of the regulation and standardization level? Who is doing it? What is the
revised organizational structure needed, ….
Implementation Management. What is the long term responsibility
of the implementation management level? Who is doing it (some sort of
central institution only, or hospitals/PHC, or, groups of hospitals/PHC are
also managing the part of it?), what is the revised organizational structure
needed, what additional capacity is needed, ….?
Operations. What is the long term responsibility of the operations
level? Who is doing it? What additional capacity is needed? How to do it
on national, regional and local levels? Who is responsible for operations
in health facilities? How are implementation management and operations
separated? Data management and data quality assurance issues?
Separation of governance, implementation and
operations is important
Governance
Governance &
Regulation
Information
Analytics &
Management
Implementation
Management &
Quality Mgmt.
Implementation
Support
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Business
processes
-
Policy
Standards
Regulations
Main implementation
body/bodies:
- Information Analytics & Mgmt.
- Coordination of Implementation
- Data Quality Mgmt.
- Contracting the implementation
- Operations
HC Facility
HC Facility
IT Industry – Solutions/Operations
Identify needed Regulations, Standards and
Interoperability requirements
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Terminology/Health Data Dictionary
Codes and directories
Business Processes/Functional Standards
Basic data semantics/structures standards (e.g. EMR,
referrals, prescriptions, orders, imaging).
Identification and authentication services
Messaging standards
Software certification standards (important for all
implementation models, but very important in case of open
market implementation model)
…
Identify legislation, policies and compliance
requirements







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Changes of laws and internal rules/rulebooks needed for the
implementation
Privacy policy
Compliance to other privacy policies (national, international)
Access and consent policy
Audit policy
Software certification and licensing policy
…
Main implementation body/bodies








One or more (eHealth Center? eGov?)
Legal status – controllable, but agile (agency, public
enterprise, foundation, …)
Ownership
Business model
Key organizational units/staffing
Responsibilities/Technical processes
Knowledge/capacity needs
…
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Look for examples from other
sectors/countries

Estonia e-Health foundation






Founded by 7 main stakeholders (Ministry of Social Affairs of
Estonia, North Estonia Medical Centre, Tartu University
Hospital Foundation, East Tallinn Central Hospital, Estonian
Hospitals Association, The Estonian Society of Family Doctors,
Union of Estonian Emergency Medical Services)
Founders are Board members
Ministry has policy unit, participating in e-HF Board
Has basic budget + charges for services + fights for external
financing (EU funds, global funds, international projects,
consulting, …)
No developers, all project managers
Runs infrastructure
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Source:
http://www.e-tervis.ee/index.php/en/
Look for examples from other
sectors/countries

Many (blended) options







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HIF “runs the show” (Croatia, Slovenia)
Health Information Center as the part of Strategic
development Unit of the MoH; no HIF (Kazakhstan)
Public enterprise strongly connected to HIF and Pension Fund;
HIF strictly limited to HIF systems (Sarajevo Canton, Bosnia)
Department in MoH+strong HIF (Macedonia)
Very strong directorate in MoH; health insurance not involved
(Turkey)
eGovernment Center implementing integrated PHC+SHC
solution (Armenia)
Small unit in MoH (Kosovo)
Critical Questions
C A P A C ITY





Under what conditions the introduced IT systems will be
sustainable in long term?
What are the institutional and individual responsibilities for the
system development and implementation? What organizational
arrangements are needed for the system implementation,
maintenance and future improvements (development teams,
implementation teams, system support and maintenance units,
…)?
What managerial capacities are needed for the management of
the process?
What managerial and technical processes need to be
established in order to facilitate and control the
implementation process?
What body of knowledge is needed for the teams to run the
processes well? What knowledge will be needed for system
users to use the system on daily basis?
Critical Questions (cont.)
C A P A C ITY




What information will be needed for the system
implementation? Who will provide that information?
As a result of the system implementation, what software
packages will be considered as organizational resource for
goods and services delivery, and what packages will be
needed as resources for the system development and
implementation?
How will the infrastructure for the future system be
implemented and maintained? Who will be institutionally
responsible for that?
What budget will be needed for the system
implementation, maintenance and future improvements?
What are rough estimates of investment and recurring
costs?
High
Expected maturity of IT Governance function
Enabling
business
Process
Integration
Service
Provision
Low
C A P A C ITY
Capacity for IT governance grows in time
Low
Expected role of IT in overall organizational performance
High
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UKRAINE eHealth Strategy
- “Strategic and Architectural Options for Effective
Implementation and Integration Zlatan Šabić
Kiev, Ukraine, April, 2016
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