1.
Designing Distributed Electronic
Patient File System Integration
Framework for Ethiopian Hospitals
By: Eid Ahmed
Advisor: Nune Sreenivas (PHD)

2.
Outlines Of The Thesis
• 1. Introduction
• 2. Statement of the problem
• 3. Research questions
• 4. Objective of the study
• 5. Review of related literature
• 6. Research Model framework
• 7. Methodology
• 8. Result
• 9. Conclusion and recommendation

3.
1. INTRODUCTION
• Health information system integration is
bringing together different systems into one so
that the system is able to deliver the overarching
functionality and ensuring that the different
systems function together as a system.
• According to (WHO, 2008) report Health
information system provides the underpinnings
for decision-making and has four key functions:
data generation, compilation, analysis and
synthesis, and communication.
• In recent years enterprise architecture is
gaining growing importance in Integrating various
HIS into several health services that gives value
through new approaches to the system.

4.
---cont
• many scholars articulate the need for
health care system integration
framework, emphasized on patient
information system integration.
• All healthcare organizations strive to
provide cost-effective, high-quality,
shared, and seamless healthcare delivery
while reducing medical errors,
safeguarding patients' data, and
streamlining clinical and administrative

5.
2. Statement of the problem
• Sabian General Hospital & Dilchora
General Hospital are health care that are
found in Dire Dawa .
• Both of the hospitals have employed
Health information system.
• As observed by the researcher of this
study, their is lack of an integrated HIS,
notably the lack of an integrated patient
medical record.
• public health information from one
hospital may not be used in another place

6.
---cont
• Generally, previous studies haven’t been
made on integrating patient record in our
country .
• As such, studies carried out in other
countries their was different kind of HIS
integration within gap that have been
found.
• Thus, this research will fill the identified
knowledge gap in the current literature.
• This study will also investigate what
factors is blocking HIS of hospitals from

7.
3. Research questions
• Therefore, the study will address the
following research questions:
1. How the existing patient records in HIS
of different hospitals in Dire Dawa are
characterized?
2. What are the basic need and
requirement to be incorporated in the
design of integrated patient record
framework among hospitals in Dire Dawa?
3. Which enterprise architecture is better
in designing a framework for an
integrated patient record system?
4. What kind of patient record systems
integration framework can be designed

8.
4. Objective of the study
• The General objective of this study is to design
patient information record system integration
framework of health information system for Dire
Dawa public hospitals.
• Specific objectives
1. To examine the existing HIS of different hospitals
2. To set the architecture vision and business
architecture of hospitals based on the existing
system of hospitals information system
3. To design and organize data architecture by
defining data entity catalog
4. To integrate the patient record system
5. To categorize opportunities and Solutions that
identify and scope change initiatives
6. To suggest Requirement management that the
hospitals need to do to meet the architecture
vision

9.
5. Review of Related Literature
 Bobarshad, Rezaei, Saghafi, and Bagherzadeh (2018)
They designed hospital enterprise architecture
framework on their article.
– A exploratory research approach was taken as a
methodology.
– The study discovered that “the process of creating a TOGAF
Enterprise architecture framework, for hospital starts with
recognizing the present original situation of the hospital,
and it all continues with designing a long-term plan in
which there is a way to achieving all the objectives of a
Hospital.
– In addition, the result of the study argued that, TOGAF
defines a hospital as a set of units which have common
aims, and it also creates a logical structure for
classifying and organizing complicated information and it
also explains different perspectives.
– The study, therefore, recommended the findings of this
research was introducing TOGAF as a framework with the
highest appropriateness with hospital’s procedures in mind.

10.
Cont---
• 1. Chaczko, chiu, and Kohli (2010)
– They studied an approach in architecting
solutions which can be utilized as framework
to address common issues in integration of
enterprise level solutions.
– The TOGAF version was used as methodology.
– The finding of the study is that TOGAF based
Integration Framework enables several
hospitals and mobile units to operate
concurrently in various parts of the nation
(Austria).
– This finding concentrated on integrating the
data architectures of several institutions.
However, it will be possible if businesses are

11.
Cont---
• Azanfack and Soriyan (2011)
– Conducted study on Integration of Patient Information
System with Picture Archiving and Communication System
through Radiology Information System platform: case of
OAUTHC”.
– The study ” used an interview to identify the basic
requirements for designing the integrated system. then
After identifying the requirement for the designing the
integrated system, they classified the integration process
in to four steps.
– By following those four steps they propose the integration
framework they developed.
– Based on result of their integration framework they were
able to conclude that, the system allows the user to work
in a consistent environment without switching between
applications and also the system will respond quickly to
the needs of imaging specialties and help clinicians in
their decision process
– The paper presented an integration framework that can

12.
5. Research Model framework
• In the design of organizational enterprise architecture, several
frameworks are employed, however the two most widely used and
acknowledged enterprise architectures TOGAF and ZEAF was
compared in this study.
• In their study of selecting better enterprise architecture for
knowledge based medical diagnosis system, Sajid and Ahsan (2016)
compare TOGAF and ZEAF based on different criteria’s. The first
criteria contain nine points as shown in table 1.
Table 1 The TOGAF and ZEAF comparison Sajid and Ahsan (2016)
Criteria TOGAF ZEAF
Methodology to categorize the different architectural
artifacts
Poor Good
Methodology to guide a step-by-step process for
designing EA
Good Poor
Instructions for building a set of reference models Good Poor
Focus on a technology that reduced expenses and
increased income
Good Poor
Practice guidance Good Poor
Governance guidance Good Poor
Guidance on effective autonomous separate sections of
the organization which is used for managing complexity
Good Poor
Catalogue management about architectural assets that
can be reused in future
Good Poor
Information availability Good Poor

13.
--cont
• The additional comparison criteria included eight points
as well, and they are presented below according to
Sajid and Ahsan (2016).
• Table 2 The TOGAF and ZEAF comparison Sajid and
Ahsan (2016)
Criteria TOGAF ZEAF
Definition of Architecture and
Understanding
Fully supports Partially support
Process of Architecture Fully supports No support
Evolution of Architecture
Support
Fully supports No support
Standardization Fully supports No support
Knowledge-Based
Architecture
Fully supports No support
Drivers of Business Fully supports Partially support
Model of Business Fully supports Fully supports
Visualization tool Fully supports Fully supports

14.
--cont
• From these two comparisons, it is clear that
TOGAF is the greatest enterprise architecture
for constructing an integration prototype for
the case of Dire Dawa administration hospital
by allowing researchers to design the best
architecture by implementing the TOGAF
lifecycle.

15.
7. Methodology
• This study followed a qualitative research
approach.
• This study was intended to collect primary
data from the sample two hospital using
observation and interview and secondary
data from literature.
• The open group Architectural development
method is chosen because it is practical,
cost-effective, and less rework on the
current system, and offers flatter transition
of system.
• Related studies have used the open group

16.
7.1 Sampling Technique and
Sample Size
• Purposive sampling was used since the
main objective of hospital is delivering
health care to the patient.
• Two hospital from Dire Dawa were used
as sample .
• 8 people were used as a sample size in
the analysis so generalizations can be
made justifiably to represent the two
hospital integration framework.

17.
7.2 Procedures of Data Collection
• The process of data collection is self-
administered.
• The researcher visited the two hospitals
several times and inform them about the
aim of the research and asked their
willingness to participate in the interview.
• Their positive response helped to be
interviewed by the researcher , 2
administrative staff and two ICT staff were
the respondent of the interview.
• By designing an observation & interview
checklist the data was gathered.
• But due to the presence of COVID 19 the
process didn’t go as expected.
• The data was collected from 03 May to 30

18.
7.3 Methods of Data Analysis
• The collected data is then analyzed by
using TOGAF data analysis tools.
• The Architectural vision and business
architecture of the two hospital were
used to describe the data collected.
• All qualitative data were analyzed using
ArchiMate modeling tools.

19.
8. Result
• The report of the result has been organized by
following TOGAF approach. The existing enterprise has
been discussed, the architecture vision and principle has
been set, the business architecture, data architecture,
application architecture, technology architecture of the
hospitals has been described for both the baseline and
target. The opportunities and solutions with the
requirements management has been presented for the
target architectures and the summary have been done
depending on the gap analysis done between the baseline
architecture and the target architecture. A diagram

20.
---cont
8.1 Analyzing business activity
• Using value chain diagram presents the
architectural vision as a value chain
diagram in figure 1 where the Primary
activities and supportive activity
identified.

21.
---cont
8.2 solution concept diagram
• Solution concept diagram represents a pencil sketch of
the expected solution at the outset of the engagement
• The purpose of this diagram is to quickly onboard and
align stakeholders for a particular change initiative.

22.
8.3 boundary context model

23.
8.4 business service diagram of
integrated system
to make high quality business service

24.
8.5 data references model Cont--
-
• is used from the architecture continuum to enable
information sharing and reuse across the integrated
patient record system. It provides a standard means by
which data may be described, categorized, and shared.

25.
8.6 Data architecture building
blocks of the target architecture
• There are among eight building blocks for the integrated HIS.
These building blocks are: Patients, Information, Service delivery,
Human resource, Medicine and technologies, Financing and
Leadership and governance.
• The capability of this architecture building block is to meet the
business need across the integrated patient record system

26.
8.7 Database architecture of
integrated HIS
The integrated HIS database share data from the
legacy application databases by a data
transmitter

27.
8.8 Model of the target
application architecture
• The application architecture of the target integrated
HIS is shown below by using a diagram that relates the
users of the system the application and the technology
aspects such as the HIS database, the server and the
hardware devices to be used in the integrated HIS.

28.
8.9 Platform decomposition
diagram
• The Platform Decomposition diagram shows the
technology platform that supports the
operations of the Information Systems
Architecture.

29.
8.1.0 Integrated HIS environment
benefit

30.
8.1.1 Integrated patient record
system framework

31.
9. CONCLUSION
• The study was evaluated based on outcome impact
evaluation which assesses the changes that can be
recognized to a particular intervention, such as a
project, program or policy, both the intended ones,
as well as ideally the unintended ones.
• An impact evaluation has also been done to show
weather the open group architecture framework can
be used to integrate the health information system of
the selected hospitals. The system administrators of
both Sabian General Hospital and Dilchora General
Hospital have an idea that the open group
architecture framework can be employed to integrate
Health information system of their hospitals and the
data has been properly used in the study.

32.
--cont
• The data architecture was also established and
opportunities & Solutions that identify and scope
change initiatives have been identified. The
requirement management that the hospitals should
follow was presented and the open group
architecture framework methodology is proposed as a
systematic approach to implement integrated patient
information record.
• Though the research has the above outcome it only
focuses on showing how the open group architecture
framework phases can be used in integrating health
information system of hospitals. The implementation
has not been done which has to be explored further
the way it has to be implemented

33.
9.1 Recommendation
• 1. Hospitals with computerized health
information should implement the
integrated HIS framework proposed
with trainings.
• 2. Hospital Governance, leadership
should set clear business strategy as
they are a starting point for reflection
in the planning and practices of
organizations
• 3. TOGAF based change management
should be performed in hospitals

34.
9.2 Limitations of the study
• Several limitations were drawn from this
research study. Because most of Ethiopian
hospital are not yet employing HIS the
study was limited by only two hospital
from insufficient sampling.
• Second, the lack of previous research
studies on health information integration
utilizing the open group architectural
framework (TOGAF).

35.
9.3. Future research outcome
• The study presents an integrated HIS
framework as an output, the framework is
evaluated thus it can become useful if
implemented and become real work. So, it can
be used as a base for implementation of
hospital system integration in future studies.
Everything that is necessary for implementing
the integrated HIS framework is identified and
set on the opportunities and the requirement
management phase of TOGAF so depending on
this outcome future studies can be done on
implementing the integrated HIS framework.
• Future studies can also be done on the idea of
integrating HIS system of public hospitals and
even different health centers found in Ethiopia
so that the work environment for health

36.
Thank you!