The software development process has advanced at a tre- mendous rate and ... for Implementing Healthcare Enterprise Information. Systems. P. H. Cheng1,2 ...
A Collaborative Knowledge Management Process for Implementing Healthcare Enterprise Information Systems P. H. Cheng1,2, T. H. Yang1,4, C. H. Yang3, G. H. Lin2, F. Lai1,6, C. L. Chen1,6, H. H. Lee1,6, Y. S. Sun4, J. S. Lai5, S. J. Chen2 1
Information Systems Office, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 2 Graduate Institute of Electronics Engineering and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan 3 Department of Computer Science, Stanford University, California, USA 4 Department of Information Management, National Taiwan University, Taipei, Taiwan 5 Department of Physical Medicine and Rehabilitation and Department of Medical Informatics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 6 Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan process [4]. A vision of democracy and an understanding of the type of knowledge process can facilitate organizational constancy [5]. Appropriate process management is becoming increasingly important in improving software development performance. There can be no doubt about the value of understanding the antecedents of software process capability [6][7].
Abstract—This paper illustrates a feasible health informatics domain knowledge management process which helps gather useful technology information and reduce many knowledge misunderstandings among engineers who have participated in the IBM mainframe rightsizing project at National Taiwan University Hospital (NTUH). Our health informatics domain knowledge management process can be used to publish and retrieve documents dynamically. It effectively creates an acceptable discussion environment and even lessens the traditional meeting burden among development engineers. An overall description on the current system development status is presented. Then, the knowledge management implementation of hospital information systems is proposed. Its related effects on the environment pressure, user requirements and project management are also discussed.
II. HYPOTHESIS DEVELOPMENT Learning organizations are organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are natured, where collective aspiration is set free, and where people are continually learning to see the whole together [8]. The choice of the appropriate knowledge processing strategy is a complex issue [9]. This paper only considered four parts: the network utilization, the relationship between technology and knowledge, knowledge sharing, and e-learning mechanism.
Keywords—knowledge management, environment design, project management
I. INTRODUCTION
A. Power of Networks
The software development process has advanced at a tremendous rate and seems to be accelerating, as computers become faster and more powerful [1]. Traditional approaches in knowledge management are focused on the storage and retrieval of knowledge, but they do not address the tacit dimension of knowledge process [2]. Furthermore, the process of the virtual agency concept is attempting to balance formal process controls with the agility to adapt rapidly to new research opportunities. The virtual agency can be used to improve organizational efficiency, improve knowledge transfer, increase interoperability through standards, provide better alignment of agency missions with national policy, and introduce increased flexibility into the R&D process [3]. Reisman analyzed seven kinds of the management processes: ripple process, embedding process, bridging process, transfer of technology process, creative application process, structuring process, and empirical validation
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The death of distance shift in the goals of internetworking toward universal access not only mobilized more people and organizations to get connected but also generated a discourse that assumes that societal and global transformation will follow [10]. For example, the knowledge network concept as a means of establishing an integrated approach to knowledge management and will highlight it using observations made during system implementation in SMEs [11]. Expertise-sharing network systems differ from library-like repositories that collect explicit knowledge in forms such as databases, reports, presentations, and documents. Contemporary knowledge management initiatives increasingly include expertise-sharing networks that help answer questions about who knows what [12]. Furthermore, the idea of a distributed network of repositories each exchanging partial, specific
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knowledge giving and gaining value when distributed in the network is substituted for a common organization-wide knowledge repository [13]. Danskin et al. illustrated the process of acquisition, retention, maintenance, and retrieval of knowledge within a firm by improving organizational memory and across the value chain through knowledge management systems to gain competitive advantage [14]. Meanwhile, trouble management is the handling of problems that require exploratory, yet routine problem-solving practice [2][15]. In summary, it is our expectation that the appropriate using of networking will attract most of the engineers. Most of the engineers eagerly obtain the latest system development information through networks. If possible, they also want to enhance their capabilities simultaneously. B. From Technology to Knowledge Originally, technology not only consists of machines and mechanical equipment but also comprises technical knowledge and participant skills. Some contend that technology is a form of knowledge. Knowledge is like pollen; it creates new knowledge by interacting with other knowledge vectors acting as stamen [16]. As a simplest, technology is more about knowing how things are done while knowledge is more about knowing why things occur. That is, knowledge is much broader than a particular technology [17]. Moreover, knowledge captures the underlying cause and effect relationships on which a technology is constructed and embedded [18]. Current Web service standards are not sufficient for automatic composition. However, the Semantic Web can reduce manual discovery and usage of Web resources and allow software agents to automatically identify, integrate and execute them for achieving the intended goals of the user [19]. The efficient forum will gradually become an information pool which serves from technology transfer to knowledge exchange.
role of the knowledge users and let the process be created within positive effect circle. D. E-Learning Mechanism Organizational learning has been generally measured in aggregate. In such a way that it is difficult to determine a single individual’s contribution or how the individual improves over time. Individual-based is an alternate theoretical view of learning in organizations whereby performance is a unique attribute of each individual within the organization [24]. The results of Nord et al. help identify the educational and training requirements for future system analysts that need to be in place for both academic and corporate instructional programs [25]. Thus the system analysts have to study the contents from the knowledge pool, in order to learn a wide range of skills. On the other hand, the result of Lang et al. indicates that novices were variable in performance not because of differences in declarative knowledge (on which they were trained) but because of these differences in procedural knowledge (on which no training was given) [26]. The novices have to browse the procedural contents from the knowledge pool just after they enter the development team and try to learn the development knowledge as soon as they could. III. METHODOLOGY Fundamentally, the System Design II division of NTUH transplanted a forum template from phpBB and utilized it as a discussion forum to share the view of points of engineers inside the development team [27][28]. This forum is opened on December 5th, 2003. Fig. 1 and Fig. 2 illustrated the portal screen snapshot of the research and development forum the system development environment at NTUH, respectively. The phpBB is an open source free community solution. We install several phpBB v.2.0.6 modules which include forum statistics, document upload, and document management. The forum statistics module supports content statistical functionality. The document upload module provides functionality to let system analysts and system designers upload every document and to use Project Manager to track the schedule.
C. Knowledge Sharing Documentation of project information, storage and retrieval systems for project information, information reviewing practices, vision clarity, vision stability, and management support of the project impact a team’s ability to acquire and use knowledge to reduce cycle time and improve their probability of success [20]. As the engineers face an increasing load of other tasks which also demand time and effort, the decision to adopt the innovation or not seems to depend more on the effort required to adapt the innovation for local use than other factors [23]. An efficient multifunctional team is welcome because every team member will be capable of communicating to each other within the team due to their multifunctional knowledge, team-work skills, as well as an established good working relationship [21]. Moreover, the soft dimension assists in better understanding the process of organizational knowledge transfer [22]. It is necessary for the managers to clearly divide the
Fig. 1. Portal of the system R&D forum at NTUH.
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TABLE I ROLE OF THE R&D FORUM USERS
Division Manager System design I System design II
System engineering
Training & research Others
Fig. 2. System development environment at NTUH.
Amount 7 9 16 1 9 4 5 6 1 4 1 2 3 7 5 8 6 5
Gradually, this R&D forum becomes a public discussion center of the development team. Most of the mangers and engineers posted their information on the forum and share others view of points from the same forum. In summary, it is our expectation that the R&D forum will attract most of the engineers in the system development team.
This forum uses password to manage the entry privilege and let right person to login the related web pages of the development environment. The web pages include documents, programs, and shared files (such as CVS Web and system binary release), and quality assurance status report. This forum server owns a Pentium IV 2.0GHz CPU, 1GB memory, and an 80GB hard disk. It installed the FreeBSD 4.10-STABLE operating system. Actually, the development team also installed Apache HTTP Server, CVS server, FTP server, rsync server, phpBB forum, CVSweb, Bugzilla, and MySQL database server at this machine. These services provide the whole system development team members to negotiate, coordinate, and share resources among the rightsizing project. There are 99 users who had registered and shared their opinions in this forum until June 2005. They can post their experiences and opinions for further discussion. Every log of the discussion is automatically controlled by the forum system and the related statistical reports are easy for reviewing.
B. Information Pool
A. Role of the Forum Users Everyone who wants to enter this forum should be granted by the managers of the development team and the forum system administrator will physically grant privilege to a specific user. The roles of the users include the chief information officer (CIO), chief of information systems office, system analysts, system designers, system programmers, quality assurance team members, part-time engineers, system engineers, database administrators, system consultants, and the representatives of end users. Table I illustrates role of the R&D forum users. Note that the end users of others in Table I were transferred from R&D forum to another public forum for security reason.
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Role Category Management System analysis System maintenance System analysis System design Programmer (full-time) Programmer (part-time) Quality assurance Database administrator System consultant System administrator Database administrator Network administrator System operator Training Clinical doctor Nurse Clinical clerk
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The crucial challenge in achieving effective control of the knowledge management process rests not in strategies for collecting and classifying relevant problem/solution information [2]. Originally, our forum only includes the kernel developers who attend the hospital system rightsizing project. Most of them are in favor of the new information techniques. Furthermore, they ask for the managers to invite all of the related colleagues to use this forum to discuss the issues of the project. Sequentially, mangers accept their requests and announce this forum to most of the attending colleagues. The R&D forum includes four categories: new outpatient system, NTUH system R&D, R&D technology, and general discussion. The new outpatient system category includes 15 folders: registration, blood bank, laboratory and pathology, medical image and nuclear medicine, pharmacy, observation, clinical room and diagnosis, treatment and scheduling, billing, insurance, credit, disease surveillance, patient record management, and data exchange. The NTUH system R&D category include five folders: programming guidelines, HL7 protocols, Web service, emergency system, and IBM data transformation. The R&D technology category includes six folders: programming frequently asked questions, .Net framework, Oracle database, user interface, quality assurance, and printing. The general discussion category includes four folders: system announcement, general comments, minutes, and travel. The characteristic of the forum information exchange is asynchronous. The question posters and repliers can post their information and browse the related information in the forum any time. The more information the engineers post on the R&D forum, the more feedback will reply from the others.
C. Dilemma of User Privileges After one year of R&D forum opening, the knowledge sharing speed and power are beyond the original estimations of most of the managers. For example, the end users who post their requests at this forum will know the detailed system development status and spread the estimated development status to the other end users. There are two kinds view of points: positive and negative. If the development status is on schedule, then the spread information is a good advertisement for the development team. Meanwhile, it will cheer up the development team members. If the development status is not on schedule, then the rumor will spread around the whole organization and development team should feedback the actual fact which already posted on the R&D forum. Basically, most of the end users lack of fundamental information technology knowledge, but abound of domain know-how. If we could not guarantee our development team can achieve the project on schedule, it is better for us to let end users to browse the well completion information of the project. Otherwise, it is necessary for the development team to explain why they should need more development time to solve some information technology questions. In order to avoid the trouble that is illustrated as above. The development team moved its R&D forum from an Internet environment to an intranet environment. In the mean time, we screen all of the user accounts and only let development team members to register the R&D forum. The end users being kicked out of the R&D forum are reallocated at the organization forum for general development status discussions. D. Self-Training Center In order to speedup the learning status of the novices and decrease the occasional disturb from novices to professionals, the project manager selects the relative important contents and integrates them in a brand new web page. For example, the novices can learn the coding style from the forum by themselves. Furthermore, the project manager defined an orientation course to let all of the novices learn the necessary guidelines of project team by themselves. Most of the professionals favor this change, which lets them evaluate the learning status from their successor’s questions. The R&D forum is focused on both of the technology transfer and knowledge transfer. That is, the forum supports fundamental technology knowledge and an environment for engineers to share some of their experiences, which will let their followers absorb knowledge quickly. For example, the user interface coding style had a well conclusion and followers can learn it by themselves in the forum.
Rank Top 10 Reply Topics 1 HL7: subsystem 2 User interface 3 Quality assurance 4 Blood bank system 5 Pharmacy system: SD 6 Patient record management 7 Oracle Database 8 Travel Information 9 General suggestions 10 HL7: standard 1 SD: system design 2 TS: table schema
Top 10 Browsing Topics HL7: subsystem User interface Oracle Database Pharmacy system: SD1 Travel Information Quality assurance HL7: e-learning courses How to start your working? Conformance statements Pharmacy system: TS2
Especially, pharmacy system is complex and most of the engineers like to browse the system design documents, table schema, and related explanations from the forum. Moreover, the novices of this team prefer to browse the “how to start your working and conformance statement” topics. At last, quality assurance and database topics are also popular in this forum. V. DISCUSSION Novices learn the orientation course through the project web site in the project team. However, the web site does not record the learning track and evaluation. Furthermore, the project materials do not manage with appropriate standards. For example, the related materials should follow the SCORM standard and implement some efficient mechanism to evaluate the engineer learning status. It will be another knowledge management factor for mangers to evaluate the project engineers. Some figures from the Internet service provider America Online (AOL) support the survey’s findings that elderly in the United States are not the most frequent Internet users. Only 5% of AOL members are aged 65 years old or older [29]. This evidence might warn us that the senior manager might be afraid of using computerized knowledge management and transfer mechanism. On the other hand, they might be in favor of the statistical reports and paper documents. However, the acceptance rate of the computerized knowledge management for senior managers will be increased gradually by time passing. VI. CONCLUSION The key contribution of this study is the development of a R&D forum for sharing information asynchronous among all of the project colleagues. No matter how many goals we achieved, the managers should remember the tale which illustrated in the Hutchen’s book [30]. If a learning organization wants to achieve many higher goals, we should utilize the organizational knowledge and illuminate the beliefs that limit our organization.
IV. RESULTS Table II illustrates part of the statistical data of the R&D forum at NTUH. Obviously, most of the engineers are eager to share the HL7 subsystem and user interface knowledge. Meanwhile, the system analysts prefer to browse most of the topics in this forum frequently.
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TABLE II PART OF THE STATISTICAL DATA OF THE R&D FORUM
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ACKNOWLEDGMENT The authors would like to acknowledge the implementation engineers of rightsizing project, System Design II Division, Information Systems Office, National Taiwan University Hospital. The authors also want to thanks for the collaboration from the colleagues, K. P. Hsu, C. H. Chen, S. M. Chu, et al., at Computer and Information Networking Center, National Taiwan University. REFERENCES [1] A. H. Rubenstein, “50 years of engineering and technology management,” IEEE Trans. Eng. Manage., vol. 51, no. 4, pp. 407-408, 2004. [2] J. Kim and J. King, “Managing knowledge work: specialization and collaboration of engineering problem-solving,” J. of Knowledge Management, vol. 8, no. 2, pp. 53-63, 2004. [3] M. Castro, R. S. Foster, K. Gunn, and E. B. Roberts, “Managing R&D alliances within government: the ‘virtual agency’ concept,” IEEE Trans. Eng. Manage., vol. 50, no. 3, pp. 297-306, 2003. [4] A. Reisman, “On alternative strategies for doing research in the management and social sciences,” IEEE Trans. Eng. Manage., vol. 35, no. 4, pp. 215-220, 1988. [5] D. Mercer, T. Leschine, C. H. Drew, W. Griffith, and T. Nyerges, “Public agencies and environment risk,” J. of Knowledge Management, vol. 9, no. 2, pp. 129-147, 2005. [6] T. Ravichandran and A. Rai, “Structural analysis of the impact of knowledge creation and knowledge embedding on software process capability,” IEEE Trans. Eng. Manage., vol. 50, no. 3, pp. 270-284, 2003. [7] R. Rada and J. S. Craparo, "Standardizing management of software engineering projects," Knowledge Technology, and Policy, vol. 14, no. 2, pp. 67-77, 2001. [8] P. M. Senge, The fifth discipline, New York: Currency, 1994. [9] S. Dutta, “Strategies for implementing knowledge-based systems,” IEEE Trans. Eng. Manage., vol. 44, no. 1, pp. 79-90, 1997. [10] S. Iacono and R. Kling, Computerization Movement: the rise of the Internet and distant forms of work, Information Technology and Organizational Transformation: History, Rhetoric, and Practice, Sage Publications, Thousand Oaks, CA, USA, pp. 93-135, 2001. [11] E. Scherer, “The knowledge network: knowledge generation during implementation of application software packages,” Logistics Information Management, vol. 13, no. 4, pp. 210-217, 2000. [12] A. Tiwana and A. A. Bush, “Continuance in expertise-sharing networks: a social perspective,” IEEE Trans. Eng. Manage., vol. 52, no. 1, pp. 85101, 2005. [13] M. H. Larsen and M. K. Pedersen, “Distributed knowledge management in health care administration,” in Proc. 34th Hawaii Int’l Conf. on System Science, pp. 1-10, Hawaii, USA, 2001.
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