Data Flow Diagrams in Health Care

Knowledge management in health care refers to the organization of and easy access to important know-how, whenever and wherever it is required. Whether it is patient data or information about medicines that is required by a health care professional at any given time, the help that information technology can provide in accessing required information, cannot be discounted. No longer does the health care professional have to flip through book after book to find needed information at a time of emergency.

No longer does he or she have to go searching for doctors when electronic communication is ready to ease the functioning of healthcare facilities. Information systems allow teachers of health care to impart education more effectively to their juniors. It is a fact, after all, that information technology allows for accurate information to be stored and retrieved. What is more, as the present discussion reveals, the models used to understand information systems today may also be applied in other important areas. This is the reason why data flow diagrams of information technology are nowadays being used to impart health care information.

Given the above advantages, all information technologies that ease the functioning of health care facilities have been greeted with great enthusiasm because of their ability to simplify complex data. No wonder, the health care industry has emerged as a leader in adopting various information systems, that is, systems based on latest computer technologies to store pertinent information about patients, various diseases, medications, etc. Health care professionals have had to learn to use the new technologies to make their jobs easier than before.

Additionally, they have had to learn the use of latest technologies by employing a variety of tools that attempt to simplify the technology lessons for health care experts. One method of simplifying the data that goes through an information system is by way of a data flow diagram (DFD), which, in its most basic form, simply shows the source of the data that the information system uses as an input, and the channel through which the data must move through the system to reach the ultimate users of the data output (See Appendix).

The information system which processes the data that enters it as an input, is held responsible for delivering the data to its ultimate users in a form that makes it easy for the users of data to understand the information thus delivered unto them. By making it simple for the users of technology to understand the information system, the data flow diagram turns itself into an essential tool for health care administrators who must understand the basic processes surrounding a newly implemented technology before they can employ the technology appropriately.

The data flow diagram thus becomes one of the most commonly used systems-modeling tools today, particularly for operational systems in which the functions of the system are of paramount importance and more complex than the data that the system manipulates (Yourdon). In order to simplify complex data, DFDs were first used in the software engineering field as a notation for studying systems design issues. The notation had been borrowed from earlier papers on graph theory, and it continues to be used as a convenient technique by software engineers concerned with direct implementation of models of user requirements (Yourdon).

Technology experts who design innovative health care information systems may similarly find it convenient to use DFDs while designing new systems for health care facilities to benefit from. Through the use of a DFD, it is easy for a designer of an information system to understand the processes that information must go through in the system, to break down the processes and study them in depth, and to change the processes in the flow diagram when and if necessary. The DFD method is an element of “object-oriented analysis” and is widely used in all fields concerned with the design and use of information systems (Le Vie).

According to Donald Le Vie, the advantages of a data flow diagram are the following: (1) Use of DFDs promotes quick and relatively easy project code development; (2) DFDs are easy to learn with their few-and-simple-to-understand symbols; (3) The syntax used for DFDs is simple, employing English nouns, or noun-adjective-verb constructs; and (4) DFDs are good for functional decomposition. While the data flow diagram makes it simple also for people that are not technology experts to understand the principal processes involved in an information system, the model suffers from several disadvantages too.

Le Vie describes the disadvantages as the following: (1) DFDs for large systems can be cumbersome, difficult to translate, and read, and be time-consuming in their construction; (2) Data flow can be confusing to programmers; (3) DFDs are useless without the prerequisite detail; (4) Different DFD models employ different symbols (circles and rectangles, for example, for entities); and (5) The model fails to distinguish data and control signals.

From a theoretical standpoint, the data flow diagram has the power to show an information system at a glance. Nevertheless, information systems involve processes within processes. To put it another way, even technology experts may have a problem understanding DFDs unless these diagrams elaborate on the processes revealed through the diagrams. Furthermore, it is impossible for people that are not technology experts to understand an information system via DFDs beyond the basic processes that are shown in these diagrams.

The inputs and outputs mean nothing, in other words, to those that seek knowledge beyond the obvious. All the same, DFDs are highly popular among the designers of health care information systems, as well as the administrators of health care facilities that need to understand the information systems at work. At present, DFDs are being used by the health care system in processes from prescription up to and including the administration of chemotherapy (vincristine) in the pediatric oncology inpatient setting.

As a matter of fact, DFDs are capable of embracing all sorts of processes in the health care system. Partly due to their ease of use, the Healthcare Failure Mode and Effect Analysis (HFMEA) was developed with DFDs playing an important part in the design of the project. The HFMEA, the purpose of which is to improve health care by way of reducing errors, has been described as “a systematic approach to identify and prevent product and process problems before they occur.”

There are five key steps involved in conducting an HFMEA analysis: (1) Define the HFMEA topic: This should include a clear definition of the process to be studied; (2) Assemble the HFMEA team: The personnel should be multidisciplinary and include subject matter experts and an adviser; (3) Graphically describe the process: Develop a flow diagram; number each process step; identify the area of the process to focus on; identify all sub-processes; create a flow diagram of the sub-process;

(4) Conduct a failure analysis: List all possible failure modes under the key sub-process; determine the severity and probability of each potential failure mode; use a Decision Tree to determine if the failure mode warrants further action; list all failure mode causes where the decision has been made to proceed; and (5) Evaluate actions and outcome measures: Determine if you want to eliminate, control, or accept each failure mode cause; identify a description of action for each failure mode to be controlled or eliminated; identify outcome measures to test the redesigned process; identify an individual responsible for completing the action; and indicate whether top management concurs with the recommended action (van Tilberg).

Although the processes involved in HFMEA are complex, the DFD has the power to simplify them for those studying the processes. DFDs are nowadays being used for the proper management of diseases to boot. As an example, the Michigan Department of Community Health is launching a project called, Implementation of a Statewide Information System for Sickle Cell Disease in Michigan using data flow diagrams to assist in the planning and use of the new system. The purpose of the project is to develop a state-wide information system for the early detection, proper management and treatment of sickle cell disease and other complications of sickle cell disease.

The first year of the project would involve meeting with the project advisory committee, hiring a change management specialist, verifying detailed flow charts of data flows to and from each partner, purchasing necessary hardware, and programming software. The directors of the partner organizations would identify follow-up protocols for sickle cell disease to be programmed into the DocSite program. The interest and willingness of physicians to utilize the DocSite program would be assessed by survey (Miller). During the second year of Implementation of a Statewide Information System, DFDs would remain in use when the partner organizations would begin pilot testing the DocSite software. MDCH staff would then modify the program and develop user manuals – all with the use of DFDs.

MDCH staff would also begin disseminating information about the information system to other programs and physicians, through internal meetings with Children with Special Health Care Services, and professional meetings in Michigan (Miller). The DFD would, of course, continue to remain as a valuable tool through the entire process by also helping the MDCH staff to demonstrate the information system to others in a flash. The advantages of DFDs to modern health care processes do not end here. The data flow diagram happens to be a very important tool also for the cloning of health care information systems. By making it easy to explain an information system, the DFD allows for easy replication of the system in various health care facilities.

Krol M. and Reich D. L. have created an object-oriented analysis and design of a Health Care Management Information System. This system happens to be a a prototype for a “universal object-oriented model” of a health care system. A set of three models has been developed: (1) The Object Model describes the hierarchical structure of objects in a system—their identity, relationships, attributes, and operations; (2) The Dynamic Model represents the sequence of operations in time as a collection of state diagrams for object classes in the system; and (3) A Functional Diagram represents the transformation of data within a system by means of data flow diagrams.

All of these models define the major processes and sub-processes of information systems that any health care facility administrator would find easy to understand. The DFD is, after all, a master of communication. Data flow diagrams have further assisted health care administrators in the creation of scenarios for the effective management of disease outbreaks. Whereas DFDs are generally associated with information systems, a flow design can describe the complex stages of a smallpox outbreak, for example, by broadly dividing its stages into pre-event and post-event scenarios. DFDs are similarly being used to facilitate the patient flow into the health care facilities (Hupert).

What is more, these basic diagrams of information flow may be used in health care trials where complex information must be reduced to the fundamentals in order for the general public to understand the processes involved in a case (Egger). No doubt, DFDs are indispensable in the world of technology. These tools are not only used by experts of information systems, but also by health care professionals who need to understand the new systems at a glance. DFDs are a powerful training tool for the ultimate users of information systems. In addition, these diagrams may be used outside the rubric of information technology to aid people in understanding processes in the health care system. Seeing the value of ‘information’ in the health care profession, DFDs are expected to continue being used in future.

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