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In times of the ongoing digitalization, enterprises face challenges in terms of
flexibilization and consequently new phenomena emerge continuously, e.g. methods for
process improvement or decision models for working activities. One approved method to
handle these challenges and to structure digitalization efforts is the Enterprise
Architecture Management, as it provides “methods and tools to establish a more holistic
perspective on enterprises which includes systematically capturing and developing the
different architectural layer of an enterprise (e.g. business, application and technology
architecture)” [
18
]. However, especially the healthcare sector still lacks digitalization
efforts [
4, 5
]. According to digitization indexes, such as the McKinsey Global Institute
industry digitization index [
23
] or the DIGITAL Economy Monitoring Report [
24
], the
healthcare branch is one of the least digitized. In terms of the digital usage that is
specifically relevant for this research and contains transactions, customer and supplier
interactions as well as internal business processes, only the construction as well as the
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agriculture & hunting branch perform worse [
23
]. Thus, the healthcare sector is in need
of smart and appropriate services to improve the digital usage, whereas Enterprise
Architecture Management is a suitable concept for the development [
1, 2
]. In connection,
cost-related and time-consuming activities to improve the digitalization efforts are the
most critical barriers that inhibit digitalization [
6
]. The improvement of customer
communication using digital channels, the enhancement in the quality of services or the
range of services and the reduction of costs through the digitalization of internal
processes, workflows and resources could provide huge advantages for the sector’s
enterprises [
6
]. In connection to the aforementioned most critical barriers, it is necessary to
design an initiative plan for the implementation, adaption and removal of digital entities
that integrates all relevant stakeholders, as this approach is considered to be the most
promising one [
21, 22
]. To further define the digital entities, the term digital building
block is used, as it helps teams to deliver services faster and to comply with regulation.
Digital building blocks offer well-defined capabilities that can be used in digitalization
of internal operations and delivery of patient-oriented services in hospitals. They
encompass organizational, technical and economic aspects adaptable to individual
hospitals. Furthermore, some of the basic capabilities of those blocks can be reused in any
other project to facilitate the delivery of digital services across the stakeholders [
12
].
Therefore, this research investigates a possible solution for managing the digitalization
in hospitals by designing a reference architecture that is dedicated to seamlessly
implement, adapt or remove digital building blocks as the assumption is that such a reference
architecture could gain the aforementioned advantages for a hospital. Furthermore, this
research should answer the main research question:
RQ: How could a hospital benefit from a reference architecture that is dedicated to
seamlessly implement, adapt or remove digital building blocks?
2
Problem Investigation & Research Progress
This section provides a detailed explanation of the individual steps of the research
as well as the definition of sub research questions that are necessary to answer the main
research question. As the first step of the research, an overview about the current
approaches for digitalization in hospitals and their repercussions on the respective
enterprise architectures is necessary. Furthermore, limitations are important and have to be
documented as they could function as provider for ideas. Consequently, the first sub
research question is:
S-RQ1: What is the current state of the art concerning enterprise architecture modeling
in hospitals and what are the main difficulties to be resolved by implementing
new digital building blocks?
The S-RQ1 seeks to define the research problem and to justify the value of a solution.
The problem shall be atomized to gain information and to determine if the problem is
of special or general interest. The latter is necessary, so that the reader is able to validate
the research’s finding, to accept the results and to understand the reasoning, which is
associated with the researcher’s understanding of the problem [
3
]. To realize this
purpose, a systematic literature review shall be conducted.
As the second activity, the research’s scope has to be sharpened. Since several
stakeholders in terms of digitalization of hospitals exist, the first step is to predefine the
target group for the research. Whereas the definition of internal and external
stakeholders in hospitals depends on certain views, such as the key output [
10
], the research
would become too complex by considering external stakeholders, as they vary from
country to country, e.g. the Medicaid [
8
] program in the USA or the Medical Advisory
Service of the German Association of Statutory Health Insurance Funds [
9
] in
Germany. Since it is possible that patients are determined as external stakeholders due to
that fact that they do not operate in hospitals and by contrast are the necessity that a
hospital can function [
11
], this research intends to investigate the physical actors within
a hospital, which includes the patient as an internal stakeholder. Thereby, different and
very important needs emerge, as it is conceivable that the alteration of a digital building
block could affect several actors in a hospital, regardless of whether they operate in a
hospital (e.g. physicians, nurses) or not (patients, relatives). Therefore, a determination
of the actor group is essential, which leads to the second sub research question that is
divided in three parts each concerning one of the aforementioned aspects:
S-RQ2.1: Who are the physical actors in a hospital?
S-RQ2.2: What are their needs? S-RQ2.3: How do they interact with the corresponding enterprise architecture and the digital building block(s)?
By answering those questions, the objectives for the solution shall be gathered and
determined, by what is possible and feasible. As a new artifact shall be developed that
is a desirable solution, which is better than the current one, there should be qualitative
and quantitative goals. Additionally, the solution should fulfill the actors’ needs [
3
]. To
assure that, the necessities have to be ascertained, which could be realized by the Digital
Innovation and Transformation Process [
13
]. This process is particularly well-suited
for the present research as it supports the digital architect to moderate modeling
sessions, regardless of the level of knowledge the local experts in the hospital exhibit
concerning enterprise architecture modeling.
The first phase of this process is called Focus Your Intention as presented in figure
1. It is dedicated to collect information about the actors’ needs as it asks for: What has
to be digitalized?, How does it have to be realized?, Who is involved? and What is the
value of the solution? [
13
].
Consequently, those information as well as the information gathered by S-RQ1 and
the qualitative and quantitative goals lead to the third phase of the research – the
creation of the artifact. Typically, such artifacts are models, methods, constructs or
instantiations [
3
]. For this research, a reference architecture is envisaged that satisfies the
actors’ needs and enables IT specialists within the hospitals to implement, adapt or
remove digital building blocks in the respective enterprise architecture with seamlessly
conditions. Therefore, the third sub research question reads as follows:
S-RQ3: How is it possible to seamlessly implement, adapt or remove digital building
blocks into the enterprise architecture of hospitals?
The next step of the research requires the demonstration of the developed artifact.
This could be an experiment, simulation, case study, proof of concept or other
appropriate activities [
3
]. By now, a conceivable case study could be the implementation of
sensor-based indoor positioning [
14
] into the enterprise architecture of a hospital, as
called the CliNav project. It would provide a digital mobility solution to navigate people
through the hospital buildings to their destinations. Therefore, CliNav transforms
loudspeakers into indoor GPS satellites. The project explores a web-based positioning
solution on non-audible ultrasonic tones so that the clinic’s website can navigate every
webpage visitor to the desired space. Concerning this research, the actors’ needs for
indoor positioning are interesting and have to be ascertained as well as investigated in
terms of potential outcomes concerning the reference architecture. Additionally, data
from other use cases already exist [
15
] and could lead to further improvements by
comparison. Further, the outcomes regarding the enterprise architecture of the hospital (e.g.
advantages, risks, complications, procedure of integration) will be captured and
evaluated in order to improve the intended reference architecture, which leads to the fourth
sub research question:
S-RQ4: How could the artifact be further developed to better fulfill the existing or
newemerged needs of the actors?
To gain the information needed, several approaches are conceivable and the
selection will depend on the progress of the case study. A possible attempt could be the
comparison between the situations before and after conducting the case study. For
example, error-proneness’s regarding the hospital’s architecture as well as time savings
or expenditures due to the navigation system could be measured. Furthermore,
satisfaction surveys, client feedback or simulations are possible [
3
].
As the sixth and last step of the research, the overall process, which includes the
problem and its importance to handle it, the artifact including its utility and novelty
(and possible improvements) as well as its effectiveness to researchers and other
audiences will be communicated [
3
]. Concerning this research process, the summarizing
communication should be a publication, which comprises the whole research work and
is the doctoral thesis.
3
Methodology
As the methodology for this research, the design science approach by Peffers et al. [
3
]
is used. It provides the following six steps to carry out the research process:
1. Prolem identification and motivation,
2. Define the objectives for a solution,
3. Design and development,
4. Demonstration,
5. Evaluation and
6. Communication.
These six steps are presented below in figure 2 and adapted to this research.
Additionally, several factors [
20
] influence the process steps. First, the column research
methods describes the approaches that are relevant for the progress. Second, the
columns below the research methods describe the data collection and data analysis and
respectively the tools applied. Third, on the bottom of the figure, are the databases
relevant for the research. They are separated in knowledge base (light green), e.g. research
publications within the area and environment (dark green) with data derived from use
cases, e.g. information from expert interviews.
In relation to the first step of this research, possibilities and interests in terms of indoor
location-based services were gathered. Qualitative interviews with domain experts in
several sectors were conducted [
15
] to determine, if those services trigger a general
interest and if they could be implemented in several branches. Additionally, the Digital
Innovation and Transformation Process has to be verified, improved and tested
concerning the suitability in hospitals. Therefore, implementations in different contexts
took place, such as zoo gardening facilities [
17
]. By considering the S-RQ1, a
systematic literature review has been conducted [
7, 16
]. SpringerLink, AISeL, IEEE and
Scopus have been selected as the relevant databases and it was ascertained, that efforts
concerning digitalization and new approaches for enterprise architecture management
exists and that the number of researches within the area is rising (figure 3). In order to
gain a holistic view, the outcomes of the systematic literature review were categorized
in sub-groups by a similarity approach according to Palinkas et al. [
19
]. As the most
important topics, the 405 relevant were sorted as:
1. Clinical Process Management, including Lean Management (132 paper),
2. Business or Enterprise Architecture Management (69),
3. Platform Development & Management (40),
4. Process Mining, including Data Management (38),
5. Decision Management (35),
6. Conformance Management (16),
7. Simulation Management (16),
8. Quality Management (9),
9. Knowledge Management (8) and
10. Petri Net Models (6) [
16
].
The next steps of the research process will be to determine actor-based digital
building blocks in hospitals and the respective state of research as well as to prepare
qualitative studies in terms of expert interviews. Therefore, research questions have to be
considered that trigger the actors’ needs for the artifact.