G een Tu ning B own – Domain Enginee ing o Social and Heal h Se ices in Finland
Reima Suomi
a, Pi kko Nykänena,b, Tapio Vepsäläinena, Riina Hil unena
a
Depa men o Managemen and En ep eneu ship, Uni e si y o Tu ku, Finland
b
Facul y o Na u al Sciences, Uni e si y o Tampe e, Finland
Abs ac
Being able o design in o ma ion sys ems o an un ouched
domain, wi hou he bu den o exis ing in o ma ion sys ems,
especially legacy sys ems, is o en seen as a d eam o mos
in o ma ion sys em p o essionals. Uncha ed domains a e
anyway sca ce, and o en such g een ield p ojec s u n in o
b own ield p ojec s, also o p ojec s whe e exis ing s uc u es
se e ely cons ain he de elopmen o new sys ems. In his
a icle we discuss he concep s o g een ield and b own ield
domain enginee ing and so wa e de elopmen , and e lec
hei possible messages o he e-enginee ing o he Finnish
heal h- and social ca e ecosys em cu en ly unde way. In ou
ieldwo k we could iden i y a lo o need and wish o
g een ield domain enginee ing in he Finnish heal h and
social se ices deli e y. As well we ound a lo o b own ield
elemen s inhibi ing change. Ou p oposal o he u u e is a
ecosys em app oach, whe e new and es ablished elemen s
could li e oge he in a sel -go e ned balance.
Keywo ds:
Knowledge Managemen ; In o ma ion Sys ems; Decision
Making
In oduc ion
Heal h and social ca e a e unde es uc u ing in many
coun ies [1], including well-known p og ams like Obamaca e
in he US [2] and e o m o Na ional Heal h Se ice in UK [3]
and Sweden [4]. In Finland, he enewal o heal h and social
se ices ( he Finnish SOTE- e o m) is cu en ly unde way,
and i will demand a lo o new go e nance s uc u es,
p ocesses and suppo ing ICT in as uc u e o become a
eali y, he whole heal h and social ca e ecosys em will deeply
ein en i sel in Finland. This pu s hea y p essu es on many
domains, including, and no o he leas , in o ma ion sys ems
in he indus y. Whe eas all would like o see his new
ecosys em as a g een ield design, also a design wi hou
es ic ions om he pas , in eali y we alk o a b own ield
design: old s uc u es mus be aken in o accoun , and hey
o en inhibi he implemen a ion o he bes a ailable
solu ions. G een ield and b own ield e minology is eage ly
used in land usage planning [5; 6], bu he me apho s o
g een ield and b own ield ha e also ound hei way o he
ield o o ganiza ional con ex [7; 8] and in o ma ion sys ems
[9].
In his a icle, we e iew based on academic li e a u e wha
b own ield and g een ield de elopmen means in
o ganiza ional and indus y con ex , and wha i speci ically
means in he design o in o ma ion sys ems. We look o
insigh s ha could be used when edesigning in o ma ion
sys ems in heal h and social ca e domain.
To al ewo k o a la ge en i y can be called domain
enginee ing. Domain enginee ing is o en seen as ocusing on
so wa e. Domain enginee ing is ele an o he wo k equi ed
o es ablish a se o so wa e a i ac s ha can be eused by he
so wa e enginee . The pu pose o domain enginee ing is o
iden i y, model, cons uc , ca alog and dissemina e a se o
so wa e a i ac s ha can be applied o exis ing and u u e
so wa e in a pa icula applica ion domain [10]. The e is
anyway e idence ha domain enginee ing is mo e han jus
so wa e wo k: Domain enginee ing aims o suppo
sys ema ic euse, ocusing on modeling common knowledge
in a p oblem domain [11].
The majo al e na i es o domain enginee ing a e g een ield
and b own ield enginee ing.
Mos o he sys em and so wa e equi emen s li e a u e
assume de elopmen o sys em om sc a ch i.e. G een Field
Sys ems [12]. New p oduc de elopmen o g een ield p ocess
(which does no include cons ain s o de elopmen wo k like
b own ield p ocess) has highe isks. Ma ke s usually ha e
dominan designs, which a ec he cus ome beha iou . When
a new p oduc has been de eloped, he e is a isk ha he
cus ome s do no accep i . In es men s o in as uc u e o he
o ganiza ion and exis ing esou ces ha e an e ec on he
selec ion o whe he o de elop cu en p oduc s o highe
le el o o de elop comple ely new p oduc s [13].
Leh onen e al. [13] de ine ha he b own ield (p ocess) s ands
o he eusing o a ailable asse s and i includes no ions ha
he e a e limi a ions o designing and solu ions because o
exis ing s uc u es. Old p oduc solu ions, p oduc s uc u es
o cus ome equi emen s limi designing o new p oduc s.
Because o his, he b own ield p ocess is no he p e e ed
solu ion om he designe poin o iew. Mos o ganiza ions
in his e a ha e exis ing la ge-scale o medium-scale
ope a ional sys ems. Wi h he e ol emen o new business
equi emen s a ise o change in exis ing sys ems o mee
e ol ing business demands and needs. In gene al, he
challenges aced by indus ies a e mainly he cap u e o
equi emen s o changes and e-enginee ing in ope a ional
sys ems. Un o una ely, he e a e e y limi ed app oaches
de ined o e-enginee ing and changes in exis ing B own ield
ope a ional sys ems because mos o he sys em & so wa e
equi emen s in he li e a u e assume he de elopmen o
sys em om sc a ch i.e. G een Field Sys ems [12].
In as uc u e building is a key ask in domain enginee ing: a
domain enginee ing p ocess should encompasses a leas h ee
main ac i i ies: domain analysis, in as uc u e speci ica ion
and in as uc u e implemen a ion [14].
MEDINFO 2017: P ecision Heal hca e h ough In o ma ics
A.V. Gundlapalli e al. (Eds.)
© 2017 In e na ional Medical In o ma ics Associa ion (IMIA) and IOS P ess.
This a icle is published online wi h Open Access by IOS P ess and dis ibu ed unde he e ms
o he C ea i e Commons A ibu ion Non-Comme cial License 4.0 (CC BY-NC 4.0).
doi:10.3233/978-1-61499-830-3-803
803
A common scena io o b own ield sys em de elopmen can
be a majo upg ade in cu en ope a ional sys em in e ms o
he ollowing equi emen s [12]:
• Inco po a ion o new business ules in exis ing sys em
• Adding up new ea u e in exis ing sys em
• Up-g ada ion o exis ing ea u e
• Adop ion o new echnology
• Legaliza ion/Ce i ica ion o p oduc o speci ic
ea u e
Today and inc easingly in he u u e, mos la ge so wa e-
in ensi e sys em (SIS) de elopmen s will be cons ained by
he need o p o ide con inui y o se ice while mig a ing hei
se ices away om poo ly s uc u ed and documen ed legacy
so wa e applica ions. Ye mos SIS p ocess models con ain
unde lying assump ions ha an applica ion p ojec s a s om
sc a ch in an uncons ained G een ield app oach [15]. We eel
ha his is a mo e han co e desc ip ion o heal h and social
ca e p ojec s in mos coun ies – including Finland.
A heal h and social ca e sys em e o m has been on he agenda
o se e al Finnish go e nmen s. P ime Minis e Sipilä´s
cu en go e nmen has a plan o pu he new heal h and social
ca e sys em in o ope a ion by 2019. One o he main a ge s o
he ongoing heal hca e sys em e o m is o eo ganize se ice
p o ide s in o la ge uni s called heal h and social ca e
p o ide egions. The aim is a ull ho izon al and e ical
in eg a ion o heal h and social ca e and he p ima y and
seconda y le els o se ices. [16]
New key ac o s in he new ecosys em will be egions, ha will
o de he heal h and social ca e se ices om he ma ke s,
whe e public, p i a e and hi d sec o se ice p o ide s
compe e in equal e ms as much as possible. These new
egions a e ye inexis en , and so a e hei in o ma ion
sys ems. They need a o ally new ICT in as uc u e ha is
ela ed o and buil on he cu en ly a ailable one, bu
especially sys ems o manage con ac s wi h se ice p o ide s,
and sys ems o o esee and plan o se ice demands, so ha
hey can pu chase he igh amoun and quali y o se ices
om he ma ke s. Simila sys ems a e a he unseen in he
Finnish con ex a leas ; he e we a e no speaking o o dina y
p ocu emen sys ems [17]. One o he domains whe e public
au ho i ies ha e mos expe ience o pu chasing se ices migh
be logis ics [18; 19].
Messages om B own/G een ield de elopmen o heal h-
and social ca e wo k
The p oblem a ea o B own ield sys em de elopmen seems o
be a he spa sely unde s ood in heal h and social ca e
in o ma ion sys ems ield. Much mo e unde s anding needs o
be gained on how exis ing s uc u es inhibi he
implemen a ion o bes new p ac ices. In heal hca e,
especially he ponde ous pa ien eco ds sys ems a e a co e
elemen , o which all new sys ems mus adjus . As well
di e en o he sys ems, such as di e en coding sys ems and
e minologies inhibi change. On op o e e y hing else, he
indus y is hea ily egula ed.
As said, domain enginee ing is abou modelling common
knowledge in a domain. Knowledge in he a ea o medicine
especially is ex emely ex ensi e, and he e is e y li le oom
o g een ield enginee ing o modelling. Ye new ecosys em
unc ions migh necessi a e a esh iew on knowledge oo.
As a ep ie e o he p oblems, IS p ojec s mee wi h
b own ield elemen s Boehm [15] p oposes inc emen al
commi men building. All decisions conce ning he new
sys ems a e no done a once, and hey a e no done by jus
one pa y. In o de o apidly and success ully adap o he
inc easing a es o change, p ojec s need o be able o
concu en ly, a he han sequen ially, assess and manage (1)
oppo uni ies and isks; (2) equi emen s, solu ions, plans, and
business cases; and (3) ha dwa e, so wa e and human ac o s
[15]. This kind o app oach is clea ly needed and o a g ea
ex end also isible in he Finnish enewal o heal h and social
ca e.
B own ield de elopmen means ha he e a e es ablished
s uc u es, expe s and solid knowledge o he domain a ea
al eady a ailable. Ca e ul lis ening o expe s and aking hei
ideas in o a en ion and p oduc ion is a key success ac o o
b own ield p ojec s. I is impo an o emembe ha
cus ome s and o dina y s a membe s a e o en he bes
expe s in de ails, e en when hey a e no always able o
s uc u e he o al pic u e. The chance o success o
B own ield domain enginee ing is g ea ly enhanced i he
people wo king oge he a e e ec i e communica o s, like
wo king in eams, a e humble, and enjoy lea ning om o he s.
All o hese a e impo an o help c ea e a “no blame” cul u e,
whe e people a en’ a aid o help one ano he and do wha is
igh o he p ojec [9].
In as uc u e de elopmen is a key ac ion in domain
enginee ing. Again, in as uc u e in heal h and social ca e
migh in many cases no be he mos sophis ica ed one, bu i
is usually deeply oo ed and di icul o change. Di e en
s anda ds o heal hca e message exchange a e a he co e o
in as uc u e de elopmen in heal h and social se ices [20].
Table 1 summa izes ou main indings om he li e a u e on
b own/g een ield enginee ing.
Table 1- Main indings om he li e a u e on
b own/g een ield enginee ing
• G een ield domain enginee ing is always mo e
isky han b own ield domain enginee ing
• In as uc u e planning (a chi ec u e) and
implemen a ion a e a he co e o domain
enginee ing
• Con uini y o se ice is a majo goal
• Re-use o cu en esou ces and asse s is a goal o
b own ield domain enginee ing
• Lis en o expe s o he old sys em
• In IS, g een ield enginee ing aims mig a ing
se ices away om poo ly s uc u ed and
documen ed legacy so wa e applica ions
• Inc emen al commi men building is impo an in
b
own ield domain en
g
inee in
g
Me hods
Ou ieldwo k ook ou mon hs in Decembe 2016 - Ma ch
2017 in Sou hwes Finland. Du ing ha ime we held 12
expe in e iews wi h Finnish expe s in social and heal hca e
in o ma ion sys ems, and one wo kshop. The heo e ical
backg ound o g een o b own ield domain enginee ing was
no p esen in he empi ical discussions. Ou s udy app oach
was explo a i e [21].
R. Suomi e al. / G een Tu ning B own – Domain Enginee ing o Social and Heal h Se ices in Finland804
Resul s
In ou ieldwo k we could iden i y a lo o p essu es and
change in agen s o he cu en si ua ion. Genuine in e es o
design he whole in o ma ion go e nance in Finnish heal h-
and social ca e clea ly exis s. The main iden i ied ac o s a e
summa ized in Table 1.
The mos clea b own ield elemen in Finnish heal h and
social ca e domain o heal h and social ca e in o ma ion
go e nance is he es ablished po olio o many clinical
heal hca e in o ma ion sys ems. While he amoun o di e en
sys em b ands can be coun ed in housands, a ew main
sys ems – especially pa ien eco d sys ems – accoun o he
main pa o cu en sys em po olio. The new and cen al
Finnish main da abase o heal h and social ca e cus ome
in o ma ion Kan a is on he edge – i can be in e p e ed as a
new building block in an old b own ield landscape.
The cu en si ua ion in heal h and social ca e IS can be
desc ibed in Finland as wai ing. A lo o planning wo k goes
on, bu eal in es men s in o new sys ems a e ew, because o
he unclea si ua ion o he upcoming new heal h and social
ca e go e nance. I is s ill widely unclea , wha kind o
o ganiza ions will ope a e in he new domain, and wi h which
kind o p ocesses and business models, and which kind o
incen i es a e gi en o di e en playe s by go e nmen and
ma ke o ces.
In Finland, he e is al eady a lo o he y discussion on he
u u e o he ixed p ope y, which will be mos likey dese ed
in he new ma ke en i onmen – especially acili ies in u al
a eas a e in dange . Less discussion has been on he same
possible a e o hea y in es men s in cu en in o ma ion
sys ems and in as uc u e.
Finally, making G een ield domain enginee ing is made
di icul because o e y adi ional easons: lack o inance,
lack o ision and di ec ion, and lack o ma ke o o he new
al e na i es ha would eally look like supe io ones as
compa ed o cu en s a us.
Table 2 - Main eeze s and change agen s o in o ma ion
go e nance in Finnish heal h- and social ca e enewal
Main eeze s – b own ield elemen s
• Es ablished pa ien eco d sys ems wi h high
ma ke sha e
• Unclea go e nance
• Unclea p ocesses
• Unclea incen i e sys ems and business models
• Hea y in es men s in cu en sys em po olio and
in as uc u e
• Lack o inance
• Lack o ision and di ec ion
• Lack o su
p
e io ma ke o e in
g
s
Main change agen s – g een ield elemen s
• Ambi ious poli ical goals
• Ambi ious a chi ec u e plans
• New egions as ac o s
• Need o decision suppo
• Need o seconda y da a use
• New pa ien eco d ini ia i es
• A i icial in elli
g
ence, IBM and Wa son
Poli ical agenda se ing in Finnish heal h and social ca e ield
has been ambi ious. Howe e he si ua ion ha he e would be
a lo o esh esou ces and a eas o un ap, which is a key idea
in g een ield domain enginee ing, is missing.
The e also seems o be going on some ich and ambi ious
wo k on new IS a chi ec u es o he heal h and social ca e
domain. Un o una ely, howe e , he wo k seems o o m an
a chipelago; he b idges joining he wo k i ems a e ew and
a .
The new egions should ac as main change agen s. Thei
capaci y and capabili y o do so is s ill unde specula ion, as
hey a e no es ablished ye . The goal is o ha e s ong and
wisely led egions as a majo change agen s o Finnish heal h
and social ca e domain and i s in o ma ion sys ems.
The e seems o be a s ong consensus ha especially decision
making in he new heal h and social ca e domain needs
s eng hening. Decision make s a all le els should be ed
wi h ele an and esh in o ma ion. The same holds ue o
seconda y use o in o ma ion in esea ch and de elopmen
domains.
We can also see some new ini ia i es in he main sys em
po olio. The na ion-wide Kan a-se ice was al eady
men ioned. In addi ion, some egions plan o ambi ious esh
pa ien eco ds sys ems and ela ed unc ionali ies. IBM
seems o en e he ield s ongly wi h i s a i icial in elligence
Wa son concep s, ha i seems o u ilize as a T ojan Ho se o
mo e s ongly access he Finnish heal h and social ca e IS
ma ke .
Discussion
A p omising app oach o go e nance and managemen o he
complexi y, wide scope and b own/g een ield de elopmen o
he social and heal hca e sys em is he ecosys em app oach.
An eHeal h ecosys em is composed o heal hca e
o ganiza ions, bo h public and p i a e, se ice p o ide
p o essionals, cus ome s, ci izens and pa ien s, indus ial
companies p o iding hei p oduc s and se ices, and
echnology-media ed communica ion and in as uc u es ha
in collabo a ion p o ide add-on alue o bo h se ice
consume s and o he se ice p o ide s. In as uc u es and
ne wo ks a e needed bo h o knowledge sha ing and
managemen , and o exchanging and communica ing
in o ma ion and da a. In an ecosys em, se ices and p oduc s
a e de eloped and deli e ed o ul ill he cus ome s’ needs, o
egula ion-s a ed needs, and he ole o ma ke ing and
comme cializa ion is mino [22]. Cus ome s a e bo h heal h
p o essionals and pa ien s, ci izens, and se ice p o ide s a e
heal hca e o ganiza ions and a ious supplie s and indus ial
companies o o e sys ems and se ices o be used by
heal hca e o ganiza ions and pa ien s. This app oach suppo s
e y well he egional model o he Finnish social and
heal hca e e o m. Good examples o ecosys em applica ions
and se ices a e elec onic heal h eco ds, pe sonal heal h
eco ds, pa ien po als and heal h in o ma ion sys ems
including heal h knowledge managemen and e-lea ning o
heal hca e p o essionals. Fu he , hese sys ems include
clinical decision suppo sys ems and emo e pa ien
moni o ing and managemen applica ions o be used a home
and on-mo e by pa ien s and ci izens. Wellnes and i ness
applica ions should also be men ioned.
An eHeal h ecosys em is e y dynamic sys em ha
inco po a es a a ying numbe o s akeholde s. Ecosys em
equi es enabling in o ma ion, communica ion, and
empowe men mechanisms, which make i possible o
in o ma ion and expe ise o be accessed quickly and
R. Suomi e al. / G een Tu ning B own – Domain Enginee ing o Social and Heal h Se ices in Finland 805
accu a ely o in o m and guide he ecosys em ac i i ies and
pe o mance. An eHeal h ecosys em is e y speci ic in he
sense ha poli ical decision making has s ong e ec s on how
he heal hca e se ices a e o ganized and unded, and also,
he e is s ong legal and no ma i e egula ion on how he
se ices can be deli e ed, accessed, disclosed, cha ged and
unded [23]. Typical o an eHeal h ecosys em oday is ha
he se ices, e.g. elec onic heal h eco ds, need o be
deli e ed online, ac oss dis inc o ganiza ional, egional o
e en na ional bo de s. This equi es ha an ecosys em is
composed o in e connec ed s akeholde s, each one wi h a
mission o imp o e he quali y o ca e. In his si ua ion, in
o de o ensu e he pa ien sa e y and quali y ca e, he
s akeholde s build new ela ionships, o en ou side he
heal hca e o ganiza ion, e.g. de elop new ypes o public-
p i a e pa ne ships [24].
The ecosys em app oach on eHeal h sys ems and applica ions,
especially in his new na ion-wide social and heal hca e
e o m con ex , helps heal hca e o ganiza ions and e-heal h
s akeholde s o c ea e business models based on collabo a i e
se ice p oduc ion and hus imp o e collabo a ion and
communica ion be ween he s akeholde s. The ac o s, pa ne s
o he ecosys em need o sha e he common objec i es o he
sys em and bene i om collabo a ion, c ea e sha ed alue,
and when hey ha e adequa e ools and means o
communica ion, collabo a ion will be ac i e and suppo he
ecosys em sus ainabili y.
eHeal h ecosys em can p o ide many po en ial bene i s o he
heal hca e p o essionals and o ganiza ions and pa ien s and
ci izens and o indus ial supplie s. Howe e , c ea ing
sus ainable eHeal h ecosys ems equi es ha all s akeholde s’
opinions and needs a e aken in o accoun o ecosys em
success and sus ainabili y. Sus ainabili y is impo an because
he bene i s o en can be achie ed only o e a pe iod o ime.
This kind o app oach is e y ele an , essen ial, and
necessa y o he success ul go e nance and managemen o
ou planned social and heal hca e e o m.
Conclusions
Ou explo a i e jou ney con i med ha e minology and
hinking on g een ield and b own ield domain enginee ing i s
well e en o he social and heal hca e domain in o ma ion
sys ems de elopmen . This o a g ea amoun in heal h and
social ca e, IS de elopmen un apped heo e ical cons uc ion,
and s eam o li e a u e and esea ch o e s new a enues and
insigh s o esea ch in heal h and social ca e IS.
In eali y heal hca e is plagued wi h b own ield elemen s ha
hampe new openings o IS in he domain. Social ca e is
ha ing less pas bu den, especially in IS go e nance, bu e en
he e old adi ions migh hea ily hampe new de elopmen
ideas.
A lo o long- e m IS planning in he o m o a chi ec u es is
aking place in he Finnish heal h- and social ca e domain.
We can easily see ha he de elopmen ini ia i es a e o ming
an a chipelago, wi h ew b idges be ween he di e en plans
and a lo o o e lapping wo k.
Inc emen al commi men building is a key o success in
b own ield domain enginee ing p ojec s. Lis ening o di e en
s akeholde s and allowing hem o make hei eal inpu o he
u u e IS go e nance a angemen s is an enable o success,
bu o cou se no ye a sil e bulle . The cos o his app oach
is mos likely a lo o supe imposed wo k, bu his is he cos
ha has o be paid o consensus. Allowing wide g oups o
s akeholde s o co-p oduce he plans also se es educa ional
and lea ning pu poses.
Ou p oposal o a esh app oach is mo e unde lining he
na u e o an ecosys ems o he heal h and social ca e domain.
Ra ional op-down planning will ne e ha ness he eali ies o
he domain – e en no in a small coun y like Finland. Ra he
we need mo e ocus on he unde s anding on how he heal h
and social ca e ecosys em wo ks, and how IS as a sub-
ecosys em in he a ea wo ks.
Re e ences
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Nu sing Managemen 4 (1997), 26-30.
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means o pa ien s and physicians, B i ish Medical Jou nal 349 (2014),
5376-5376.
[3] S.P. Ba e and G. Robe , Knowledge managemen and communi ies o
p ac ice in he p i a e sec o : lessons o mode nizing he Na ional
Heal h Se ice in England and Wales, Public Adminis a ion 80 (2002),
643-663.
[4] H. Hasselbladh and E. Beje o , Pe o ma i e policy: he case o Swedish
heal hca e e o ms, C i ical Policy S udies (2016), 1-20.
[5] D. Lange and S. McNeil, Clean i and hey will come? De ining
success ul b own ield de elopmen , Jou nal o u ban planning and
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Add ess o co espondence
P o esso Reima Suomi
Uni e si y o Tu ku, Finland
Email: [email p o ec ed]
R. Suomi e al. / G een Tu ning B own – Domain Enginee ing o Social and Heal h Se ices in Finland 807