Hospital Reference Architecture Guide: The Complete and Expanded English translation of the Dutch ZiRA E-Book

The Open Group

• Herausgeber: Van Haren Publishing
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 189

Veröffentlichungsjahr: 2023

Beschreibung

Dive into a groundbreaking resource that equips healthcare professionals, Enterprise Architects, and IT decision-makers with the essential tools to enhance patient care and streamline operations within hospitals of all sizes and locales. In an era of Digital Transformation, this guide is your compass. Introducing the ZiRA Hospital Reference Architecture in English, a pioneering open-source solution developed by healthcare experts, for healthcare experts. Building upon the foundation of the renowned Dutch ZiRA and our collaboration with Nictiz, the Center of Excellence for Health IT in The Netherlands, this guide offers an accessible translation, clear insights, and essential updates. Discover why the ZiRA in English Guide by The Open Group fills a critical void, providing a trusted, internationally relevant reference architecture tailored to the unique needs of hospitals worldwide. Hospitals are the backbone of healthcare, accounting for a substantial portion of spending in the US and EU, yet they grapple with the challenges of a digital era. This guide empowers hospitals to thrive in today’s evolving healthcare landscape.

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Title:

Hospital Reference Architecture Guide:

The Complete and Expanded English translation of the Dutch ZiRA

Subtitle:

Prepared by Members of The Open Group Healthcare Forum, in Collaboration

with: Nictiz and the ZiRA Governance Board

Series:

The Open Group Series

A Publication of:

The Open Group

Publisher:

Van Haren Publishing, ’s-Hertogenbosch, www.vanharen.net

ISBN Hard copy:

978 94 018 1104 0

ISBN eBook (pdf):

978 94 018 1105 7

ISBN ePub:

978 94 018 1106 4

Edition:

First edition, first impression, December 2023

Layout:

The Open Group

Copyright:

© 2023, The Open Group. All rights reserved.

This work is based on the Dutch Ziekenhuis Referentie Architectuur (ZiRA) developed by Nictiz.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the copyright owner.

Document Number: G23A

Published by The Open Group, September 2023.

Comments relating to the material contained in this document may be submitted to:

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Forbury Road

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United Kingdom

or by electronic mail to: [email protected]

Contents

1 Introduction

1.1 What is the ZiRA?

1.2 Audience

1.3 Objective

1.4 Assumptions

1.5 ZiRA Construction

1.6 The ZiRA Metamodel

1.7 Metamodel Example

1.8 Clarification of Concepts

1.9 Derivations/Specializations

1.10 Parts of the ZiRA

1.11 The Common Structure of ZiRA Reference Models

2 Architecture Principles

2.1 What are Architecture Principles?

2.2 Purpose and Application of Architecture Principles

2.3 ZiRA Architecture Principles

2.4 ZiRA Basic Principles

2.5 Basic Principle 1: The Patient Comes First

2.5.1 Motivation

2.5.2 Rationale

2.5.3 Implications

2.6 Basic Principle 2: The Hospital Function in a Network of Care Providers

2.6.1 Motivation

2.6.2 Rationale

2.6.3 Implications

2.7 Basic Principle 3: Clear and Unambiguous Data Capture at the Point of Care

2.7.1 Motivation

2.7.2 Rationale

2.7.3 Implications

2.8 Basic Principle 4: Information Provision is Flexible, Secure, and Sustainable

2.8.1 Motivation

2.8.2 Rationale

2.8.3 Implications

2.9 Basic Principle 5: Quality can be Deduced from the Care Process

2.9.1 Motivation

2.9.2 Rationale

2.9.3 Implications

2.10 Knowledge Model and ZiRA Principles

3 Hospital Business Model Canvas

3.1 Application

3.2 Additional Resources

4 Business Function Model

4.1 Introduction

4.2 What is a Business Function?

4.3 The ZiRA Business Function Model

4.3.1 Subdividing the Healthcare Domain

4.3.2 Specializations

4.4 Purpose and Application of the Business Function Model

5 Service Model

5.1 Introduction

5.2 Service Model

5.3 Service Characteristics

5.4 Application

5.5 Service Catalog

5.6 Explanation

6 Process Model

6.1 Introduction

6.2 Process Model

6.3 Explanation

6.4 Process Model Principles

6.5 Process Model Structure

6.6 Application

6.7 Decomposing (Specifying) Business Processes

6.7.1 Business Process Diagrams

7 Information Model

7.1 Introduction

7.2 Healthcare Information Model

7.2.1 Purpose

7.2.2 Application

7.2.3 Basic Design Pattern (BDP)

7.2.4 Types of Information Objects

7.3 Information Domain Model

7.3.1 Information Domain versus Business Function

7.3.2 Coherence of Information Objects and Business Activities in Healthcare

7.4 Information Objects in the Care Processes

7.4.1 Application

7.5 Relationship of Information Objects to Healthcare Information Building Blocks (ZIBs)

7.5.1 Healthcare Information Building Blocks

8 Application Function Model

8.1 Overview of Features

8.2 Applications

8.3 Further Explanation

8.3.1 Features versus Services

8.3.2 IT Change and Service Management versus Generic IT Functions

8.3.3 Generic IT Functions, Not the Infrastructure Itself

8.3.4 Granularity

A Consensus Statement of the FHIM Transition Council

B Nictiz Interoperability Model and the TOGAF ADM

C Derived Principles

D Business Functions and Business Activities

Preface

The Open Group

The Open Group is a global consortium that enables the achievement of business objectives through technology standards. Our diverse membership of more than 900 organizations includes customers, systems and solutions suppliers, tool vendors, integrators, academics, and consultants across multiple industries.

The mission of The Open Group is to drive the creation of Boundaryless Information Flow™ achieved by:

• Working with customers to capture, understand, and address current and emerging requirements, establish policies, and share best practices

• Working with suppliers, consortia, and standards bodies to develop consensus and facilitate interoperability, to evolve and integrate specifications and open source technologies

• Offering a comprehensive set of services to enhance the operational efficiency of consortia

• Developing and operating the industry’s premier certification service and encouraging procurement of certified products

Further information on The Open Group is available at www.opengroup.org.

The Open Group publishes a wide range of technical documentation, most of which is focused on development of Standards and Guides, but which also includes white papers, technical studies, certification and testing documentation, and business titles. Full details are available at www.opengroup.org/library.

The Healthcare Forum

The Open Group Healthcare Forum (HCF) provides a vendor-neutral environment where members from diverse organizations in the global healthcare sector share experiences, gain insights, strengthen professional networks, and collaborate to produce useful products for their organizations.

Members have defined the Forum’s mission and vision as follows:

• Mission: Imagine a world in which protected health information is available when and where you need it

• Vision: The Forum is grounded in the conviction that health information should follow the person in a timely, accurate, and secure manner

When healthcare systems interoperate, they achieve a higher degree of efficiency and create value by providing better care to patients and enhanced revenue to stakeholders.

Membership is open and encouraged across the vast healthcare sector, including healthcare IT, hospitals and healthcare services, health insurance, biotechnology, pharmaceuticals, and medical devices. Forum participants apply system-wide perspectives and adaptable approaches to better understand and communicate the needs, requirements, and interdependence of key stakeholders.

The HCF aims to develop, test, and implement tools that foster Digital Transformation, agility, risk management, and improved quality and efficiency in healthcare enterprises. Through weekly meetings and quarterly events, members gain skills they can use to help their employers (and the membership of The Open Group in general) avoid fragmented, short-sighted, or needlessly expensive solutions to business problems.

Nictiz

Nictiz is the competence center for digital information management in healthcare in the Netherlands. Committed to developing a vision for the healthcare information system and the architecture supporting that system, Nictiz develops and maintains standards for digital information management, ensuring that healthcare information can be recorded and exchanged in an unambiguous manner. In addition, Nictiz has an advisory function and shares knowledge about digital information management in healthcare, focusing not only on the Netherlands, but also on international developments. Nictiz is an independent knowledge organization supported by the Dutch Ministry of Health, Welfare and Sport with the mission: Better health through better information.

For more information, refer to: https://nictiz.nl/about-nictiz/.

This Document

The main body of this document, Chapters 1 to 8, contains the full English translation of the Dutch Ziekenhuis Referentie Architectuur (ZiRA). The ZiRA is a hospital reference architecture used to streamline and optimize the design and implementation of systems, applications, and technology solutions in hospitals. It includes customizable templates and models that provide guidelines, best practices, and a set of design principles for making hospitals more effective and efficient. It includes links to configuration files for modeling and documentation using a standard application, such as the ArchiMate® modeling language.1

The Open Group produced this translation in close collaboration with Nictiz, which manages the ZiRA. The ZiRA is “from, for, and developed by hospitals”. Its value has been widely demonstrated in The Netherlands and parts of Scandinavia; however, it is largely unknown elsewhere. The objective of this document is to fill this significant gap by expanding awareness and understanding of the ZiRA and establishing its relevance to thousands of hospitals worldwide.

Two terms in the subtitle of this document, “The Complete and Extended English Translation of the Dutch ZiRA”, call for elaboration. First, this translation is “complete” in the sense that it faithfully conveys the content, meaning, and style of the source text, which is contained in a series of webpages available at: www.ziraonline.nl. Where possible, it is a verbatim rendering of the original language. But when preserving the ZiRA’s exact wording and structure produced awkward or unnatural phrasing, the source text was modified to foster clarity and understanding.

Second, this translation is “extended” in the following ways:

• It fills intermittent gaps in the original content2

• It uses source material, including information referenced in hyperlinks in the original text, to weave a compelling narrative or “story” about the Dutch ZiRA3

• It clarifies, elaborates, or otherwise explains elements in the original text that The Open Group and Nictiz collaborators agreed were unclear, vague, ambiguous, or obscure

This document is The Open Group Guide to Hospital Reference Architecture. It has been developed and approved by The Open Group.

Who is this Document for?

This document is for healthcare IT and healthcare systems professionals who combine their knowledge of operations and expertise in technology to drive improvements and optimize systems within hospitals and related healthcare organizations.

At the operational level, the ZiRA is useful for enterprise and information architects, information managers, solution architects, functional and technical designers, and functional managers. These roles primarily deal with practical implementation and maintenance of systems to ensure smooth and efficient operations.

At the strategic level, the ZiRA is useful for policy officers, Chief Medical Information Officers (CMIOs), consultants and others who are involved in organizational and process changes. These roles often have a broader perspective and include responsibilities for driving strategic initiatives, aligning technology with business goals, and overseeing transformational projects.

__________

1 A configuration file, also called a modeling tool file, serves as a container for various elements of an Enterprise Architecture reference model, such as diagrams, objects, relationships, attributes, and documentation. There are other modeling tools. The ArchiMate modeling language is mentioned here for two main reasons. One, because the Dutch ZiRA was created using the ArchiMate Specification (which is not surprising given that ArchiMate modeling language was initially developed in The Netherlands, and at about the same time.) Two, because it is managed and maintained by The Open Group. It bears noting that Enterprise Architecture modeling tools enable users to organize, visualize, and document complex information about an organization. This is the key benefit, or one of the key benefits of using Enterprise Architecture; the structures, processes, systems, and resources of an organization can be viewed together and in relation to one another, as its architecture.

2 Indeed, the Nictiz and The Open Group collaborators are using this translation- especially its figures and tables- to update the Dutch online version of the ZiRA.

3 A substantial number of references point to projects undertaken in The Netherlands that contribute valuable insights to, and serve as cornerstones for, the ZiRA. Informed Dutch readers may know about such work, but most English readers will not be familiar with it. One example is the National Reference Architecture (NORA) for the Dutch Government.

Trademarks

ArchiMate, FACE logo, Making Standards Work, Open O logo, Open O and Check certification logo, OSDU, Platform 3.0, The Open Group, TOGAF, UNIX, UNIXWARE, and X logo are registered trademarks and Boundaryless Information Flow, Build with Integrity Buy with Confidence, Commercial Aviation Reference Architecture, Dependability Through Assuredness, Digital Practitioner Body of Knowledge, DPBoK, EMMM, FACE, FHIM Profile Builder, FHIM logo, FPB, Future Airborne Capability Environment, IT4IT, IT4IT logo, O-AA, O-DEF, O-HERA, O-PAS, Open Agile Architecture, Open FAIR, Open Footprint, Open Process Automation, Open Subsurface Data Universe, Open Trusted Technology Provider, Sensor Integration Simplified, SOSA, and SOSA logo are trademarks of The Open Group.

Archi is a registered trademark of Phillip Beauvoir.

Business Model Canvas is a trademark of Alexander Osterwalder.

CDA, FHIR, and HL7 are registered trademarks of Health Level Seven International.

DICOM is a registered trademark of the National Electrical Manufacturers Association (NEMA).

Google Translate and YouTube are trademarks of GOOGLE LLC.

Microsoft and Excel are a registered trademarks of Microsoft.

LOINC is a registered trademark of Regenstrief Institute, Inc.

RxNorm is a registered trademark of the National Library of Medicine.

SNOMED CT is a registered trademark of the International Health Terminology Standards Development Organisation (IHTSDO).

All other brands, company, and product names are used for identification purposes only and may be trademarks that are the sole property of their respective owners.

Acknowledgements

(Please note affiliations were current at the time of approval.)

The Open Group gratefully acknowledges the contributions of the following people in the development of this document:

• Chimeless Baltcha, Gainwell Technologies

• Peter Beijer, Digital Architects NetWork, formerly DXC

• Laura Hugill Belken, Belken Consulting, formerly Mayo

• Tony Black – Kyndryl

• Alec Blair, Alberta Health Services

• Antje Derksen, Nictiz

• David Gordon, NHS, University Hospitals of Leicester, formerly Leeds Teaching Hospitals

• Jim Griffith, NTT Data Services

• Jan-Joost van Walsum, University Medical Center Groningen

• Oliver Kipf, Boehringer Ingelheim, formerly Philips

• Alvin Marcello, MD, UP Manila National Telehealth Center and AeHIN

• Gerda Meijboom, Nictiz

• Oscar Miranda, Trace3, formerly with Armis

• Kishore Ravilla, OhioHealth

• Padma Roy, DXC

• Scott Sloan, Kyndryl

• Ashley van der Toom, Philips

• Danny Williams, IBM

• Michael van der Zel, University Medical Center Groningen

The Open Group gratefully acknowledges the following members of the ZiRA Governance Board

who participated in the review of this document:

• Daniel Woning, Isala

• Dennis Groen, Elisabeth-TweeSteden Ziekenhuis

• Erik Bosgra, Medisch Centrum Leeuwarden

• Koos Folkersma, Ziekenhuis Gelderse Vallei

• Michael van der Zel, University Medical Center Groningen

• Mikis van Dijk, Haaglanden MC

• Thiemo Steen, OLVG

• Niek Poppe, Nictiz

Referenced Documents

The following documents are referenced in this guide.

(Please note that the links below are good at the time of writing but cannot be guaranteed for the future.)

Adams

Bringing the Fourth Industrial Revolution to Healthcare, by Helen Sydney Adams, published by Healthcare, December 2022; refer to: https://healthcare-digital.com/technology-and-ai/bringing-the-fourth-industrial-revolution-to-healthcare

Agarwal et al.

Using a Plan-Build-Run Organizational Model to Drive IT Infrastructure Objectives, by Himanshu Agarwal, Nagendra Bommadevara, and Allen Weinberg, McKinsey Digital, December 2013; refer to: https://www.mckinsey.com/capabilities/mckinsey-digital/our-insights/using-a-plan-build-run-organizational-model-to-drive-it-infrastructure-objectives

Bizzdesign

Annual Report: State of Enterprise Architecture 2023, published by Bizzdesign, 2023; refer to: https://content.bizzdesign.com/lp-state-of-enterprise-architecture-2023/p/1?utm_source=google&utm_medium=cpc&utm_term=enterprise%20architecture&utm_content=651365874436&utm_campaign=Search-Non_Brand-Collateral&gclid=Cj0KCQjw1_SkBhDwARIsANbGpFtGFBBMI9S8v3mF5jNkvGqzAbCvOSGN4-dAvDUo7t4pnbTS393QZ0EaAv0HEALw_wcB

Bossert and Van der Wildt

How Enterprise Architects Need to Evolve to Survive in a Digital World, Oliver Bossert, Niels Van der Wildt, McKinsey Digital, July 2021; refer to: https://www.mckinsey.com/capabilities/mckinsey-digital/our-insights/how-enterprise-architects-need-to-evolve-to-survive-in-a-digital-world (accessed July 2023)

C220

The TOGAF® Standard, 10th Edition, a standard of The Open Group (C220), published by The Open Group, April 2022; refer to: www.opengroup.org/library/c220

C226

ArchiMate® 3.2 Specification (C226), published by The Open Group, October 2022; refer to: www.opengroup.org/library/c226

CMS

National Health Expenditure Data, published by Centers for Medicare & Medicaid Services (CMS), refer to: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData (accessed August 2023)

CMS

NHE Fact Sheet, published by Centers for Medicare & Medicaid Services (CMS), June 2023; refer to: https://www.cms.gov/Research-StationalHealthExpendData/NHE-Faatistics-Data-and-Systems/Statistics-Trends-and-Reports/Nct-Sheet (accessed July 2023)

FAIR

FAIR Principles, published by GO FAIR; refer to: https://www.go-fair.org/fair-principles/ (accessed August 2023)

Glaser and Shaw

Digital Transformation Success: What Can Health Care Providers Learn from Other Industries, by John Glaser and Stanley Shaw, published by NEJM Catalyst, March 2022; refer to: https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0434

I127

The Open Group Standards Process (I127), published by The Open Group, April 2022; refer to: www.opengroup.org/library/i127

ICT & health

Nictiz Collects Practical Examples of ZiRA, published by ICT & health, February 2019; refer to: https://icthealth.nl/nieuws/nictiz-bundelt-praktijkvoorbeelden-zira

ISO 13972

Health Informatics – Clinical Information Models – Characteristics, Structures, and Requirements (ISO 13972), February 2022; refer to: https://www.iso.org/standard/79498.html

Kane et al.

Strategy, not Technology, Drives Digital Transformation, by Gerald C. Kane, Doug Palmer, Anh Nguyen Phillips, David Kiron, and Natasha Buckley, published by MIT Sloan Management Review, 2015; refer to: https://www2.deloitte.com/content/dam/Deloitte/fr/Documents/strategy/dup_strategy-not-technology-drives-digital-transformation.pdf

Kim and Song

How Digital Transformation Can Improve Hospitals’ Operational Decisions, by Song-Hee Kim and Hummy Song, published by Harvard Business Review, January 2022; refer to: https://hbr.org/2022/01/how-digital-transformation-can-improve-hospitals-operational-decisions

Kipf

Reference Architecture for Healthcare (RA4H) – Core Capabilities, by Oliver Matthias Kipf, published by The Open Group, December 2020; refer to: https://blog.opengroup.org/2020/12/29/reference-architecture-for-healthcare-ra4h-core-capabilities/

Lee

The Impact of the Fourth Industrial Revolution on the Healthcare Industry, by Jason Lee, published by Health Tech World, June 2023; refer to: https://www.htworld.co.uk/leadership/opinion/the-impact-of-the-fourth-industrial-revolution-on-the-healthcare-industry-digi23/

Nictiz

Facilitating Clinical Documentation at the Point of Care: Sharing and Optimizing Healthcare Information [Video], published by Nictiz; refer to: https://amigo.nictiz.nl/het-totale-programma-in-zes-minuten

NIH

Serendipity and the Prepared Mind: An NHLBI Intramural Researcher’s Breakthrough Observations, published by The National Heart, Lung, and Blood Institute (NIH), December 2013; refer to: https://www.nhlbi.nih.gov/directors-messages/serendipity-and-the-prepared-mind

MSD Manual

Common Medical Tests, by The Manual’s Editorial Staff, published by MSD Manual, May 2023; refer to: https://www.msdmanuals.com/home/resources/common-medical-tests/common-medical-tests

NORA

NORA’s Strategy Supplement, published by e-overheid, 2010; refer to: https://www.noraonline.nl/images/noraonline/1/18/NORA_3.0_Strategy_Supplement.pdf

Palmgren

The Enterprise Architects Dilemma: Deliver Business Value with IT! - Build: - Set IT Processes and Key Performance Indicators, by Martin Palmgren, published by Communicate Publications, October 2013.

S182

Healthcare Enterprise Reference Architecture (HERA) (S182), published by The Open Group, April 2018; refer to: www.opengroup.org/library/s182

Shudes et al.

Digital Transformation: From a Buzzword to an Imperative for Health Systems, by Chris Shudes, Maulesh Shukla, Christine Chang, Chuck Appleby, John Hendricks, and Janice Wurz, published by Deloitte Insights, October 2021; refer to: https://www2.deloitte.com/us/en/insights/industry/health-care/digital-transformation-in-healthcare.html

Simon

Models of Bounded Rationality: Empirically Grounded Economic Reason, Volume 3, by Herbert A. Simon, published by MIT Press Direct, 1997; refer to: https://direct.mit.edu/books/book/4286/Models-of-Bounded-RationalityEmpirically-Grounded

Sprenger

Electronic Information for Health and Care Services: Are We Getting Better?, by Michiel Sprenger, published by Nictiz, 2019; refer to: https://nictiz.nl/app/uploads/2022/08/Paper_electronic_information_for_health_and_care_services.pdf

W153

Enhancing Health Information Exchange within the FHIM (W153), published by The Open Group, April 2015; refer to: www.opengroup.org/library/w153

WHO 2018

First-Ever WHO List of Essential Diagnostic Tests to Improve Diagnosis and Treatment Outcomes, by World Health Organization (WHO), published by WHO, May 2018; refer to: https://www.who.int/news/item/15-05-2018-first-ever-who-list-of-essential-diagnostic-tests-to-improve-diagnosis-and-treatment-outcomes

WHO 2020

Global Spending on Health: Weathering the Storm, published by the World Health Organization (WHO), December 2020; refer to: https://www.who.int/publications/i/item/9789240017788

Foreword

It is a self-evident truth that people care deeply about their health and healthcare. There is a fundamental human desire to preserve wellbeing and seek medical attention when needed. People value health – they consider it a “blessing” to be in good health, that they are “fortunate”, “privileged”, and “grateful” to be in good health. Inversely, people go to “great lengths” and take “extreme measures” to avoid, repair, and cure a state of poor health.

Economically, healthcare has immense ramifications. On average, one out of every ten dollars of global GDP is spent on healthcare.4 Socially, politically, and culturally, healthcare pervades each aspect of life. From the highest echelons of power to the grassroots, from local markets to global marketplaces, healthcare matters.

Challenges to Improving Healthcare

Over time, healthcare has evolved from the use of primitive and rudimentary healing practices to modern means of diagnosis, treatment, and disease prevention. Beyond a doubt, this has led to greatly improved health outcomes and life quality for all of humanity. In today’s modern era, progress continues, sometimes with lightning speed. And yet, despite rapid modern advancements in knowledge and technology – and often because of them – today’s healthcare systems can be frustratingly resistant to improvement. This applies equally to organizations (or parts of organizations) involved in providing non-clinical supporting services as well as those directly engaged in patient care. Either way, The Open Group is committed to helping them succeed by using Enterprise Architecture frameworks, methods, and tools to do what they do even better, more effectively, and more efficiently.

The improvement journey, in any economic sector, begins by understanding how to promote safe and secure information flow and better align business strategies with technology infrastructure. In the healthcare sector, two of the most intransigent challenges to improvement must be addressed:

1. Difficulties related to Digital Transformation.

2. Cognitive biases that obstruct holistic thinking

Digital Transformation

The expanded use of digital technologies can enhance a data-rich healthcare organizations’ ability to extract meaningful information to inform clinical practice and improve healthcare management. Yet, Digital Transformation has posed greater challenges for healthcare organizations than for organizations in virtually every other industry.5 There are several reasons for this:

1. Poor interoperability.

Healthcare organizations have characteristically complex data systems. Healthcare data is often siloed, fragmented, and spread across multiple systems, making it difficult to share, integrate, and analyze. It has proven very difficult to develop agreed code sets using common semantics and syntax. In addition, some medical conditions are highly nuanced and therefore difficult to express in a fully standardized manner. As a result, automation can be cumbersome and restrictive compared to traditional analog methods of data capture. But innovative healthcare organizations have shown this need not be the case.6

2. Legacy systems.

Many healthcare organizations are at least somewhat encumbered with legacy systems. They use outdated technologies that are not interoperable, making it difficult to share data (even within the same system). This creates significant barriers to innovation and improvement, as healthcare organizations struggle to integrate new technologies and processes with their existing infrastructure.

3. Privacy and security.

The healthcare industry is rife with challenging privacy and security concerns. Healthcare data are highly sensitive and must be protected, which can create challenges in sharing and accessing data for analysis, treatment, and improvement.

4. Resistance to change.