The Architecture of an Inter-organizational Healthcare IT Infrastructure in the Netherlands.

By nature, the organizational structure of healthcare is distributed, being geographically spread and consisting of centers at different levels of complexity: from general hospitals down to individual general practitioners. The demands as well as the costs for healthcare are rising and productivity in the sector is declining. Patients are becoming more and more well informed and will demand higher quality healthcare and more control over their own health. Thus more efficient healthcare of a higher quality is needed demanded by market and politics.

Preserving individual specialties and autonomies, the various healthcare providers must be able to cooperate, with the aim of increasing the overall effectiveness of the activities carried out, in terms of prevention, caring and costs. The most promising applications in cross-organizational healthcare are the integrated Electronic Health Record (EHR) and Clinical Pathway support. The integration and electronic exchange of health information and the integration of healthcare processes across healthcare organizations will help to increase the overall quality of healthcare. The inter-organizational healthcare infrastructure lies at the basis of this and provides the functionality necessary to support applications such as the EHR and Clinical Pathway support.

In this research an architecture for an inter-organizational healthcare infrastructure is proposed based upon a standardized architecture framework. The architecture framework used in this research is a standard for architecture frameworks developed in the Netherlands named ArchiMate. The framework is generally comparable with other existing architecture frameworks but has never been used to develop architectures for inter-organizational healthcare infrastructures. This gives us the opportunity to compare the results of the infrastructure architecture developed in this research with the results of other inter-organizational healthcare infrastructure initiatives currently under development in the Netherlands. Compared to ArchiMate, other modeling languages ArchiMate offers important extra coverage for developing architectures.

The comparison of the developed reference architecture is done on two other inter-organizational healthcare infrastructures, the project for a national infrastructure, AORTA, and a regional healthcare infrastructure project called IZIT, which is one of the frontrunners in regional healthcare infrastructures.

The result of this comparison is that the architecture built with the ArchiMate framework has the basic functionality need to be used for both a national as well as a regional infrastructure. Furthermore, the need of regional infrastructures is certainly present, both on the field of data integration and in the field of interoperability between healthcare organizations. Many healthcare providers are not able to change their information systems so that they adhere to the requirements of AORTA. A regional healthcare infrastructure can help to do so by offering additional services such as data structure translation and new applications in the Shared Service Center model. On the field of interoperability is it is questionable if the national AORTA infrastructure is suitable for more advanced healthcare applications that make use of Service Oriented principles. At this moment the national infrastructure can be categorized as a Message Oriented architecture which lacks certain important properties that are found in pure Service Oriented Architectures.

This research contributes an alternative way of filling in the Dutch infrastructure for inter-organizational integration in Dutch healthcare with the use of the ArchiMate language. At the same time this is a test on the usefulness of ArchiMate in developing inter-organizational information systems. The experience with Archimate was gennerally positively. Visualizing different architecture viewpoints and their relationships with each other due to the use of the ArchiMate language is an important advantage over other architecture frameworks, although it is recommended to also use elements of other architecture frameworks as ArchiMate only covers a very narrow phase of the whole architecture design process.