Nictiz builds a reference architecture for hospitals with Enterprise Architect

Nictiz is the Dutch competence centre for e-health. With the help of Enterprise Architect, the hospital reference architecture ZiRA was created there, which is attracting great interest not only in the Netherlands. The framework serves to facilitate the inventory, development and innovation of hospital IT. Particularly interesting examples are now presented in a practical handbook to support the dissemination of the reference architecture.

Vienna/The Hague – ZiRA (Ziekenhuis Reference Architecture) was born out of the realisation that, although Dutch hospitals are dealing with similar problems, there was no framework for cooperation in the area of IT. Ten IT specialists from various hospitals in the Netherlands joined forces and developed ZiRA with Enterprise Architect on the basis of information requirements and best practice examples.

ZiRA is part of the iZiekenhuis community, in which hospitals share their knowledge and experience with regard to providing information. ZiRA also provides a digital platform for sharing knowledge, information and best practices. In addition, regular workshops are organised with and for information architects.

ZiRA manual with hands-on examples

The ZiRA reference architecture is the replacement for the ‘Domain Reference Model for Hospitals’ (RDZ), which has been used for many years for the development of various applications in Dutch hospitals. A separate practical handbook now explains the general principles of ZiRA and provides practical examples.

It states that ZiRA provides a reference framework and helps to develop the organisation and provision of information in hospitals. The reference architecture is intended to support day-to-day work, but does not claim to be complete or absolutely correct. The initiators of ZiRA invite all interested parties to use ZiRA to their advantage and adapt it to their own purposes and contexts. Using concrete examples, the practical handbook is intended to encourage people to join the growing ZiRA community and make their work easier through modelling.

ZiRA is aimed at a large group of employees in hospitals: Enterprise and Information Architects, Information Managers, Solution Architects, Functional and Technical Designers, Functional Administrators, Policy Officers, Consultants and others involved in organisational and process change. The examples in the handbook clearly show how diverse the possible applications of the reference architecture are and how they can contribute to the benefit of hospitals.

Hans Bartmann, Sales Manager of SparxSystems Europe

Some implementations of the Dutch hospital reference architecture ZiRA:

• Mapping the value proposition of hospital, project and service
• Reference list for architectural principles
• Determine distinguishable and indistinguishable core competences
• Insight and overview of costs, benefits, risks and bottlenecks in the business function model
• Basis for capacity and volume management
• Basis for process design
• CIA classification
• Application mapping for e.g. mergers
• Definition of people
• Development of an enterprise architecture
• Modelling of information
• Tool for the future description of the application architecture

Karolinska Institute developed a capability model

Shortly after the ZiRA reference model was published, the world-famous Karolinska Institute in Sweden took an interest in it. They used the ZiRA business function model to derive a capability model. This describes what the County of Stockholm needs in order to fulfil its mission to support and ensure continuity of healthcare in the future.

The capability model has already been used in specific bids. The operational vision in the model describes what an organisation must be capable of in order to fulfil its mission in accordance with the Health and Medical Services Act. Incidentally, the Karolinska Institute is also where the Nobel Prize for Medicine is awarded each year.

Erasmus MC: Enterprise Architecture Repository

As in many organisations, hospitals also like to use models to map their existing IT. This provides an overview of hardware and software and their interdependencies, which helps with the replacement of outdated items as well as with the further development of the system.

The Erasmus University Medical Centre in Rotterdam is one of the most important university hospitals in Europe and has used ZiRA as the basis for its own Enterprise Architecture Repository (EAR). An EAR is ideal for describing the actual and target IT status mentioned above. Regardless of the architecture framework chosen, Enterprise Architect is a fully-fledged EAR that can store and manage all architecture content. In Erasmus MC, we added our own organisation-specific concepts: organisations, subsidiaries, topics, pillars, departments, etc. The applications were read from the CMDB (Configuration Management Database) and linked to the application functions.

In addition, the own architecture principles and the data centres, servers, networks and nodes from the infrastructure layer were added. This EAR serves as a starting point and basis in various projects and is supplemented with project-dependent elements and views in each case.

This process is illustrated in the diagram using the example of ‘medical history collection’. Erasmus MC therefore used the metamodel, structure and concepts of ZiRA as the basis for setting up the repository, but enriched these with its own organisation-specific elements.

AVL uses ZiRA for maintenance and capacity management

The Antoni van Leeuwenhoek (AVL) Hospital in Amsterdam is a leader in cancer research and treatment. It is named after the Dutch natural scientist of the same name (1632 – 1723) and the most important microscopist of the 17th and early 18th century, often referred to as the ‘father of bacteriology’.

With the help of the consulting firm Logiqol, AVL launched the ‘Integrated Capacity Management’ programme in 2017 to optimise logistics processes in the healthcare sector, enabling it to better manage throughput and access times. ZiRA made it possible to provide the necessary control information. Based on the ZiRA process reference model, the process flow for the largest patient group was described down to the level of work processes.

It was found that the ZiRA model was well understood and at the same time well suited as a uniform language for the other tumour groups. A printed manual of the ZiRA work processes was therefore produced, which is available to all those involved in the process. The process description was used to identify time points and patient flows, which are used to visualise the care process in five phases in a dashboard.

This provides the tumour working group with an up-to-date overview of the scope of activities in their patient flow in a given week.

The Gelre hospitals used the ZiRA process model to gain an insight into their own risk management. (Graphic: ZiRA Practice book)

At the same time, the ZiRA process model was used to gain an insight into the company’s own risk management. For each process area, it was determined who is responsible for identifying, assessing and managing risks. As no suitable reference model for comprehensive risk management could be found, the Gelre clinics began to develop their own model, using the ZiRA process model as a starting point. It was found that the existing processes almost corresponded to the ZiRA model, as this provides a good overview of the generic processes in the hospital.

At the Antoni van Leeuwenhoek (AVL) hospital, a printed manual of the ZiRA work processes was created. The process description was used to identify time points and patient flows, which are used to visualize the care process in five phases in a dashboard. (Graphic: ZiRA Practice book)