Rational Systems Design for Health Information Systems in Low-income Countries: An Enterprise Architecture Approach

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Henry Mwanyika, David Lubinski, Richard Anderson, Kelley Chester, Mohamed Makame, Matt Steele, and Don de Savigny


Low-income countries with their funding and implementing partners are increasingly recognizing health information systems (HIS) as an essential way to strengthen and support health systems. There is tremendous potential for innovations in information and communication technologies to assist health managers, health workers, and patients. Yet individual technologies and software applications are often developed without specifying how they will interact and communicate with existing and future information systems. Furthermore, they are developed without giving adequate attention to the needs the information system is supposed to address, resulting in software applications that do not effectively meet user needs. There is a lack of documented systematic methodology for gathering and documenting requirements for developing HIS. This article introduces a systematic, architected, and rational approach (SARA) for the design and development of health information systems. SARA, based on an Enterprise Architecture (EA) approach, represents a portfolio of practices, tools, and methods that can be easily and appropriately adapted and applied in the design phase of health information system development. This article will present early efforts to develop this portfolio including lessons learned from applying SARA in Tanzania.

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Braa, J., Hansthen, O., Heywood, A., Mohamed, W., and Shaw, V.: Developing Health Information Systems in Developing Countries: The Flexible Standards Strategy, Management Information Systems Quarterly (31:2), pp381-404 (2007).

Brooks, T.: Serivce-Oriented Enterprise Architecture: A Conceptual Design through Data Architecture, Journal of Enterprise Architecture (5:4), pp16-26 (2009).

Chandrasekhar, C.P. and Ghosh, J.: Information and Communication Technologies and Health in Low Income Countries: The Potential and the Constraints, Bull. World Health Organization (79:9), pp850-855 (2001).

de Savigny, D. and Adam, T.: Systems Thinking for Health Systems Strengthening, Alliance for Health Policy and Systems Research, WHO (2009).

ETR .Net: ETR .Net – Background (2007); available at: www.etrnet.info/Background.aspx.

Gartner Group: The First Key to Project Success is Collaborative Requirements Definition and Management, Gartner (August 2008).

Harmon, P.: Developing an Enterprise Architecture Whitepaper, Business Process Trends (2003).

Harrison, D. and Varveris, L.: TOGAF Establishing itself as the Definitive Method for Building Enterprise Architectures in the Commercial World (June 2004).

Heeks, R.: Health Information Systems: Failure, Success, and Improvisation, Int.J.Med Inform. (75:2), pp125-137 (2006).

HMN: The Health Metrics Network Framework, 2nd Edition (2008).

Kimaro, H. and Tollman, S.M.: Challenges of User Participation in the Design of a Computer-based System: The Possibility of Participatory Customization in Low Income Countries, Journal of Health Informatics in Developing Countries (2:1), pp1-9 (2008).

Krickeberg, K.: Principles of Health Information Systems in Developing Countries, Health Management Information Journal (36:3), pp8-20 (2007).

Kuldeep, K. and Niels, B.: A Cross-cultural Comparison of IS Designer Values, Commun.ACM (33:5), pp528-538 (1990).

Kuziemsky, C. and Lau, F.: A Four-stage Approach for Ontology-based Health Information System Design, Artif Intell Med. (2010).

Lucas, H.: Information and Communications Technology for Future Health Systems in Developing Countries, Soc.Sci.Med. (66:10), pp2122-2132 (2008).

Parnas, D.L.: Document-based Rational Software Development, Knowledge-Based Systems (22:3), pp132-141 (2009).

PATH: Proceedings of HMN Consultation Meeting held at PATH in Seattle, Washington (September 11-12, 2009).

Rees, A.: Establishing Enterprise Architecture at WA Police, Journal of Enterprise Architecture (7:3), pp49-56 (2011).

Ross, J., Weill, P., and Robertson, D.: Enterprise Architecture as Strategy: Creating a Foundation for Execution, Harvard Business School Press, Boston, MA (2006).

Saha, P.: Architecting for Business Insight and Strategic Foresight: A Systems Approach to Management of Chronic Diseases in Singapore, National University of Singapore, Institute of Systems Science (2011).

Sahay, S., Monteiro, E., and Aanestad, M.: Towards a Political Perspective of Integration in IS Research: The Case of Health Information Systems in India.

Schlotzer, A. and Madsen, M.: Health Information Systems: Requirements and Characteristics, Stud.Health Technol.Inform. (151, pp156-166 (2010).

Smith, S., Lai, L., and Khedri, R.: Requirements Analysis for Engineering Computation: A Systematic Approach for Improving Reliability, Reliable Computing (13:1), pp83-107 (2007).

Spewak, S.: Enterprise Architecture Planning: Developing a Blueprint for Data, Applications, and Technology, John Wiley & Sons (1993).

Stansfield, S., Orobaton, N., Lubinski, D., Uggowitzer, S., and Mwanyika, H.: The Case for National Health Information Systems Architecture: A Missing Link to Guiding National Development and Implementation (2008).

The Open Group: TOGAF Version 9, Enterprise Edition (2010).

The Standish Group: CHAOS Report (1995).

Tyre, M., Eppinger, S., and Csizinsky, E.: Systematic versus Intuitive Problem Solving on the Shop Floor: Does it Matter?, Massachusetts Institute of Technology, Sloan School of Management, Working Paper (1995).

WHO: Issues in Health Information: National and Subnational Health Information Systems (2005).

WHO: Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes, WHO’s Framework for Action (2007).

World Bank: The World Bank Webcast on Enterprise Architecture as an Enabler of Public Sector Reform (April, 2008); available at: http://go.worldbank.org/WIL3R3XTV0.

World Bank: How we Clasify Countries (2011); available at: http://data.worldbank.org/about/country-classifications.

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