The sustainability of the Dutch healthcare system is under severe pressure with increasing expenditure, more demand for care and a shortage of healthcare professionals. In the current healthcare system, providers are rewarded for increasing volume, but not for adding value, which only exacerbates the situation. Value-based healthcare (VBHC) is a candidate framework to reform the current healthcare system into an outcome-based system. Information systems are essential for the implementation of VBHC to execute outcome and cost measurements and collaborate across the care cycle. A literature review shows that there is a knowledge gap in the scientific literature to the architectures and components for such value-enabling information systems. This thesis aims to fill that gap by identifying and designing the essential components for a value-enabling IT architecture for the Dutch healthcare system.
The Information Systems (IS) research framework of Hevner et al. (2004) is adopted to guide the research. The environmental analysis shows several deficiencies in the as-is architecture for VBHC including a lack of patient-centredness, inaccessible or unavailable data, and complex to extract and integrate data. Preliminary semi-structured interviews reveal that, besides IT barriers, there is a deeply rooted trust issue among stakeholders which hampers successful implementation of VBHC. It is found that trust is often related to transparency and can be managed. Increasing transparency in the healthcare architecture would allow for (i) continuous quality improvements, (ii) improved decision-making, (iii) positive financial stimulus and (iv) patient empowerment. The design activities aim to facilitate VBHC through integrating components that reduce or eliminate the IT barriers and increase transparency. Another round of semi-structured interviews is carried out to find the principles, requirements and components for the design. The overall design developed uses three types of environment: a Healthcare Information System (HIS) used by caregivers, a Personal Healthcare Environment (PHE) used by patients and a Quality Registration System, available to all stakeholders. The design and components are evaluated with an expert panel. The most essential components are: PHE, HIS, Quality Registry system, Clinical building blocks (Zibs), terminology standards, a data integration centre, logging and monitoring services, measurements and evaluations, auditing IT and care processes and an intermediary that stimulates improvement and collaboration. The expert panel reached a consensus that transparency in healthcare would contribute to solving some of the problems, but it will not solve the core problems that lie within the healthcare structure. There are several areas recommended for future research. First, the components should be evaluated with a broader expert panel to increase the validity. Second, the PHE is an essential component, but still in its infancy. It is recommended to further evaluate the utility for VBHC. Third, blockchain technology might enhance the design due to its inherent characteristics that offer transparency. Fourth, further research on the privacy-utility trade-off in the context of VBHC is recommended. Finally, interoperable systems rely on a shared and uniform language. It is recommended to research which standards have the highest potential to facilitate the architecture components.