International Journal of Medical Informatics 114 (2018) 88–100

Contents lists available at ScienceDirect

International Journal of Medical Informatics

journal homepage: www.elsevier.com/locate/ijmedinf

Hospital enterprise Architecture Framework (Study of Iranian University T

Hospital Organization)
⁎
Atefehsadat Haghighathoseinia, Hossein Bobarshada, , Fatehmeh Saghafib,
Mohammad Sadegh Rezaeia, Nader Bagherzadehc
a
Faculty of New Sciences and Technologies, University of Tehran, Iran
b
Faculty of Management, University of Tehran, Iran
c
Department of Electrical Engineering and Computer Science, University of California, Irvine, United States

A R T I C LE I N FO A B S T R A C T

Keywords: Backgrounds: Nowadays developing smart and fast services for patients and transforming hospitals to modern
Hospital organization hospitals is considered a necessity. Living in the world inundated with information systems, designing services
Information system architecture based on information technology entails a suitable architecture framework.
TOGAF architecture Objectives: This paper aims to present a localized enterprise architecture framework for the Iranian university
Enterprise architecture
hospital.
Methods and results: Using two dimensions of implementation and having appropriate characteristics, the best 17
enterprises frameworks were chosen. As part of this effort, five criteria were selected according to experts’
inputs. According to these criteria, five frameworks which had the highest rank were chosen. Then 44 general
characteristics were extracted from the existing 17 frameworks after careful studying. Then a questionnaire was
written accordingly to distinguish the necessity of those characteristics using expert’s opinions and Delphi
method. The result showed eight important criteria. In the next step, using AHP method, TOGAF was chosen
regarding having appropriate characteristics and the ability to be implemented among reference formats. In the
next step, enterprise architecture framework was designed by TOGAF in a conceptual model and its layers. For
determining architecture framework parts, a questionnaire with 145 questions was written based on literature
review and expert’s opinions. The results showed during localization of TOGAF for Iran, 111 of 145 parts were
chosen and certified to be used in the hospital.
Conclusion: The results showed that TOGAF could be suitable for use in the hospital. So, a localized Hospital
Enterprise Architecture Modelling is developed by customizing TOGAF for an Iranian hospital at eight levels and
11 parts. This new model could be used to be performed in other Iranian hospitals.

1. Introduction systems in hospitals [2]. On the other hand, due to the rapid pro-
liferation of wearable devices and smartphone, the IoT enabled tech-
The new emerging technology will consist of big data, Internet of nology is used in healthcare and other hospital’s business process [3]. In
things (IoT) and cloud computing. As a result, all parts of the hospital such a situation a hospital, without infrastructure and suitable archi-
including patient’s information, machines, and patient’s rooms are tectural features is not able to use this information technology [4].
identified through an ID number and special sensors. For maintaining Nowadays, unstable and changing settings of enterprise framework are
this great amount of information, Big Data technology is used [1]. Many the result of a wondrous increase in the use of information interchange
applications are developed for exchanging electronic medical records and creating informatory society. In such a situation a careful percep-
(EMRs) among hospital organization, in the form of outpatient records, tion of different enterprise parts based on a system is necessary for
medical imaging reports, discharge summaries, laboratory test reports, adapting enterprise settings with these unstable and changing settings
and outpatient medical records. For this reason, the digital information [5].
flow in hospital organizations increases day by day. It is necessary to Lack of enterprise architecture framework equals lack of official
use cloud computing platform for appropriate managing information procedures and as a result lack of official organization. The absence of

⁎
Corresponding author.
E-mail addresses: atefeh.hoseini@alumni.ut.ac.ir (A. Haghighathoseini), hossein.bobarshad@ut.ac.ir (H. Bobarshad), fsaghafi@ut.ac.ir (F. Saghafi), ms.rezaei@ut.ac.ir (M.S. Rezaei),
nader@uci.edu (N. Bagherzadeh).

https://doi.org/10.1016/j.ijmedinf.2018.03.009
Received 13 February 2017; Received in revised form 16 March 2018; Accepted 19 March 2018
1386-5056/ © 2018 Elsevier B.V. All rights reserved.
A. Haghighathoseini et al. International Journal of Medical Informatics 114 (2018) 88–100

access to an official organization will create an essential challenge in Rijo and others [17] presented a conceptual model for providing the
effective managing of the enterprise. Hence an architecture framework needs of a hospital with 700 beds for having the managing attitude for
which presents a logical structure for ranking, organizing and pre- using complex modern information technology. Four Zachman, TOGAF,
senting a description of enterprise, is considered important [7]. A fra- FEDERAL and DODAF frameworks, were the frameworks which were
mework presents a specific definition of different aspects and attitudes referred in this paper. First, three frameworks were not considered
of an enterprise and suggests necessary descriptions [8]. appropriate for the hospital, and 4th framework was considered in-
Hospitals and Health enterprises are very complex organizations. appropriate, and it was only considered a good model for being op-
They have a high degree of specialization and a heterogeneous com- erational. Then a framework was presented in which the steps of en-
bination of actors and interests. Hospitals and Health enterprises have terprise architecture framework’s concepts and not architecture
very complex ICT infrastructures. So it is necessary to create customized framework by itself were presented.
enterprise architectures that can accommodate agile changes in ser- According to Walsh and others [18], the keywords architecture and
vices, processes, and systems [4]. hospital were found, but this essay is not about Enterprise architecture
Zachman presented a framework for an architecture of systems or model but about the architecture of leadership models for enabling
information [9], some other enterprise architecture frameworks were medical systems.
presented to use this framework. Federal Enterprise Architecture fra- Searching on Google only one article was found. In that article, Lu
mework [10], The Open Group Architecture Framework (TOGAF) [11] and others [15] have worked on hospital enterprise architecture fra-
and Command, Control, Communication, Computers, Intelligence, mework but their work focuses on a strategy for purchasing hospital
Surveillance, and Reconnaissance (C41SR) [12] are those Frameworks equipment different from suitable standards from different sellers, and
extracted from the Zachman. their work is not Enterprise architecture, but it is a strategy which is
A hospital is a very complicated and critical organization regarding done using a neural network. The 4th International Conference will be
structure, responsibilities, rules, and procedures. Therefore, im- held by Medical Informatics World Conference in April 2016 meetings
plementing Information Technology entails an appropriate archi- and conferences will give information about Enterprise architecture
tecture. So, researchers try to define an appropriate framework for the framework strategy [19].
description of the hospital organization. This framework helps man- The main aim of this article is to present a model of Enterprise ar-
agers to arrange information technology for health services and goals. chitecture for enabling hospitals in Iran, with the support of
Authors in [9], introduced a hospital as a complicated system with lots Information Technology for providing the patient’s needs and giving
of beneficiaries, needs, and disharmonious aims. These authors also them satisfaction. As it was mentioned before using Hospital Enterprise
considered a hospital as a system with capabilities to deliver suitable architecture framework is important for Enterprise architecture as well
healthcare services in suitable time, suitable place and with appropriate as its products. On the other hand, implementing the framework de-
costs. The main challenge though was lacking systematic and compre- pends on every country's native condition. So, we try to modify current
hensive attitude in outside as well as inside the Enterprise [13]. enterprise architecture models by choosing appropriate enterprise ele-
In another article which, authors wrote about one of the hospitals in ments for modeling hospitals’ organization in Iran.
Japan, they analyzed the architecture framework of this hospital for In the remainder of this paper, we first describe the objective and
planning electronic medical care and designing enterprise; then it was method of research and process of performing it, followed by a de-
designed according to the hospital aims. Then an implementation map scription of questionnaires and experts that were used in the study. We
was designed for creating necessary changes for accessing to suitable next present the results of the study in choosing the best frameworks
enterprise framework [14]. In another research in China doing Medical and recognizing the best features for appropriate enterprise archi-
Services is considered a challenge because of variety and disharmony of tecture frameworks. Then we customize the proposed model for Iranian
Hospital Systems. Then with redesigning systems and enterprise struc- hospital. In Sections 5 and 6, we conclude the paper with an analysis of
tures, a harmonious structure of the various medical system was de- our results in the context of previously reported literature.
signed [15].
In another research in England, a medical care modeling was per- 2. Objective
formed considering the complexity of designing medical care system
because of the complexity of activities which is the result of challenges This research seeks to present an appropriate architecture frame-
of resource management and improving services. The results of this work for enterprise information system. It is a framework for designing
research showed that enterprise architecture could help in a worthy a suitable system in hospitals, to deal with the possible challenges in the
way for converging medical care processes and information technology medical arena. There are main and secondary questions.
and developing medical care management. It's also explained that Main question: what is a suitable hospital enterprise architecture
Enterprise architecture is a leading activity and a tool for Enterprise framework [HEAF] for Iran’s hospitals?
designing in which decision making is done easily, and it causes the Sub-question 1: What is the most appropriate framework regarding
presence of the ability of conceptual attitude to an enterprise from implementation in the hospitals of Iran?
different aspects and it causes efficient development [16]. Sub-question 2: What are elements and components of Enterprise
Olsen [4] reviews implementation enterprise architecture in Nor- architecture framework?
wegian health sector and founds some challenges that impeded the
process toward a common enterprise architecture(EA). These chal- 3. Method
lenges include unclear enterprise architecture roles, ineffective com-
munication, low EA maturity and commitment, and complicated EA The approach of the research is to use details and observations for a
tools. He reported the ambiguity of the EA concept, difficult EA ter- case study. The strategy of this research is a survey in a case. The aims
minology, and the complexity of EA frameworks as three causes of the and choices of methods are exploratory-descriptive.
challenges. Lack of appropriate EA framework for hospitals and health The horizontal time of research is from July 2015 to Aug. 2016. The
organizations is the main reason for this challenge in implementation collecting information tools are interviews, expert panels, and ques-
EA. An appropriate EA framework must be clear and simple in health tionnaires. The process of research in five steps for performing the
sector organization. Enterprise architecture framework is shown in Fig. 1.
Searching in Elsevier essay database, using two keywords hospital The aim of the preliminary step is studying the literature of the
and architecture, showed that there are only 22 essays about having subject. In the first step, 17 existing Enterprise architecture frameworks
those keywords in the summary or introduction. were studied, and 44 characteristics were extracted. Moreover, the

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Fig. 1. The process of performing the research.

ways of frameworks implementation and necessary characteristics for Table 1

an appropriate framework with existing literature was studied. Demographic information of experts.
In the first step, the framework was chosen according to im- The demographic characteristics Frequency
plementation capability. First, five indicators for the frameworks ability
to be implemented by experts’ ideas, and its importance was de- Age 20–30 7
termined, after that, a questionnaire was written which determines the 30–40 5
40–50 3
presence of these indicators among 17 Frameworks with expert’s opi-
50+ 2
nions. In the following after considering the importance and calculating Total 17
a weighted average, five frameworks with the highest priority were Education PhD 9
recognized. Master 8
In the second step, the best characteristics of enterprise architecture Work experience 10–15 years 3
15–25 years 10
framework were considered. For doing this, first,44 characteristics were 25 years or more 4
extracted considering an Enterprise framework and the needs and its Job Position The staff of IT department 2
proportion for hospital and then it was ranked. Delphi method [20] is Deputy of Informatics Dept. 5
used for this step according to a panel of experts and with using a Head of Informatics Dept. 6
CEO and Policymaker 4
questionnaire as a data collector tool.
Kendall’s W [20] was used to converge expert opinions. Eight
characteristics were recognized as important and necessary character-
Organizational architecture), for example Prof. Fereioon Shams (Head
istics in this step. The experts were people who had researched and
of Service-oriented Enterprise Architecture Lab, Director of Information
taught enterprise architecture at least for ten years.
Research Architecture, Associated Professor in IT Dept. of Shahid Be-
In the 3rd step for choosing the best enterprise architecture fra-
heshti University), Mr. Mahdi Zargarnataj (Director of Health Network
mework for a hospital, the Analytical Hierarchy Process (AHP) was
Project at Sina Andishan Green Company, Project Manager for Servi-
used. For doing this, five frameworks were recognized among nine
cing Architecture and Blood Automation in Royan Technology Co.), Mr.
characteristics, and then these five frameworks were analyzed with
Amir Mahjourian (Technical Director of Service Architectural Lab, Ex-
AHP method, and finally, the best framework was determined.
pert in the field of service-oriented enterprise architecture), Dr. Siamak
In the 4th step, elements and components of Enterprise architecture
Kargar (Independent IT Consultant in Hospital & healthcare Organiza-
framework (which were in 3rd step) were accessed as a conceptual
tion). Then The measure of extracted Criterion was determined ac-
model which was determined using questionnaire method, binomial
cording to interviewing with three experts and rank between 0–10 was
test and One-way Analysis Of Variance (ANOVA).
determined (Tables 2 and 3). Multiplying the measure of every Cri-
terion to its rank and calculating total numbers relating to every
4. Results
Table 2
4.1. Choosing the best frameworks according to the capability of Ranking frameworks according to choosing criteria.
implementation in Iran Row The criteria for evaluating hospital Rank (0–10) Weight (0–1)
framework
Five criteria were chosen according to Table 1 for choosing en-
1 Covering the hospital activities and 10 0.250
terprise architecture framework with expert’s opinion. processes
The experts were five people who had taught or researched about 2 Up to date frameworks 6 0.150
enterprise architecture at least for ten years as shown their demo- 3 Access to the information and details of the 8 0.200
graphic information in Table 1. The occupations of our experts were framework
4 Customized framework and using in the 9 0.225
Health Policy maker, Vice president of IT Management, Project Man-
hospital field
agers, Technical and consultants team (PhD and Master of Science in 5 Support through enterprise modeling tools 7 0.175
Software Engineering and Information Technology specialist in

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Table 3 time, and there has been agreement on eight cases, so the first and
Weighted ranks of all frameworks. second time ideas are the same. Therefore, Delphi method using has
Row The frameworks name Criterion Weighted been stopped. According to this, Delphi panel experts’ agreement on
ranks “Definition and clear understanding of architecture”, “Supporting and
1 2 3 4 5 developing architecture”, “Considering entrepreneurs”, “Considering
existing architecture framework”, “Presenting business model”,
0.25 0.15 0.2 0.225 0.175
“Presenting systems model”, “Transmission project”, and “Ability to run
1 C4ISR 0 0 10 0 10 3.75 supported by components”. Therefore, these criteria were considered
2 CIMOSA 0 0 3 0 0 0.6 important for hospitals.
3 DODAF 0 9 10 0 10 5.10
4 E2AF 0 6 10 5 3 4.55
5 MODAF 0 8 5 0 7 3.425
4.3. Choosing the most appropriate hospital enterprise architecture
6 TOGAF 0 10 10 10 10 7.50 framework
7 Zachman framework 0 0 10 10 10 6.00
8 ISE Enterprise 0 8 10 5 0 4.33 After recognizing evaluation criteria, and considered options in
Architecture framework
choosing appropriate Enterprise architecture framework an appropriate
9 Prado Enterprise 0 0 3 0 0 0.6
Architecture framework for Hospital was chosen through group decision making by
10 Treasury Enterprise 0 0 10 3 0 2.67 implying and Analytical Hierarchy Process which is listed below:
Architecture framework
11 Denmark’s state 0 9 3 0 0 1.95 1. – Building decision-making hierarchy
Enterprise Architecture
2. – Group decision-making information collection
framework
12 Pragmatic Enterprise 0 10 3 0 0 2.1 3. – Calculations with (expert Choice software)
Architecture framework 4. – Examining rate of adjustments
13 Federal Enterprise 0 0 10 3 3 3.2
Architecture framework
4.4. Choosing the most appropriate hospital enterprise architecture
14 The Netherlands 0 7 3 0 0 1.65
Enterprise Architecture framework
framework
15 NATO Enterprise 0 7 3 0 0 1.65 After recognizing evaluation criteria, and considered options in
Architecture framework choosing appropriate Enterprise architecture framework an appropriate
16 Gartner Enterprise 0 5 3 3 0 2.02
framework for Hospital was chosen through group decision making by
Architecture framework
17 Integrated Architectural 0 10 10 2 0 3.95 implying and Analytical Hierarchy Process which is listed below:
process
1. – Building decision-making hierarchy
2. – Group decision-making information collection
framework, five Frameworks had the highest rank (Table 3). As it is 3. – Calculations with (expert Choice software)
shown in Table 3 that TOGAF framework, ZACHMAN framework, 4. – Examining rate of adjustments
DODAF, and E2AF and Enterprise architecture framework ISE have the
highest rank, respectively. Also, none of those Enterprise architecture Step 1: Building decision-making hierarchy: in performing the first
frameworks could fulfill the hospital relating activities and goals of the step of hierarchy analysis process, the hierarchy was depicted according
process as mentioned in the literature previously. to aim, criteria, and decision-making options. Five frameworks,
DODAF, E2AF, OGAF, Zachman and ISE EAF, have all eight experts’
4.2. Recognizing the best features for appropriate enterprise architecture considered options in choosing appropriate Enterprise architecture
frameworks for a hospital framework (mentioned in Section 4.2).
The objectives: Choosing an appropriate Enterprise architecture
44 criteria were extracted for finding the most appropriate en- framework. The criterion of decision-making was recognized through
terprise architecture frameworks. These criterions were based on ex- Delphi and decision-making options involved five selected Frameworks
perts opinion and reviewing the researches done on enterprise archi- in previous parts.
tecture frameworks, specially Teng and co-workers [21,22]. As it is Steps 2: Group decision-making, data collection: The questionnaires
listed in Table 4. of pairwise comparisons for the AHB analysis was composed and
Among criteria in Table 4, ten criteria were chosen according to completed in a meeting with the presence of Information Technology
expert’s opinions with Delphi method. For doing this a questionnaire managers in the field of hospital and enterprise architecture
with the 5-points, the Likert scale was designed for the survey of ex- Frameworks Consultants, through an interview.
perts. The outcome of opinions reached an agreement in the 2nd round Step 3: Calculations using expert Choice software: The results were
of Delphi. Kendall's Concordance (W) Coefficient was used for evalu- analyzed through this software, and relative weight of criteria of esti-
ating agreements among experts. Considering the calculations done by mation was calculated. These criteria and their relative weights are:
SPSS software, statistics of Kendall’s W equals 0.242. Zero probability “Definition and clear understanding of architecture (0.153)”,
of Kendall’s W can be examined. The statistics equal 1666.72792 and p- “Architecture support and development (0.066)”, “Considering en-
value equal 0.000. According to the p-value, it could be concluded that trepreneurs (0.142)”, “Considering existing architecture (0.153)”,
the zero probability of Kendall’s W is rejected, it means that expert’s “Presenting business model (0.153)”, “Presenting system model
opinion about the importance or lack of importance of criteria is con- (0.153)”, “Presenting transmission project (0.094)”, and “The cap-
vergent. ability of being performed and supported through tools (0.085)”. In the
After collecting questionnaires and analyzing information, Delphi meantime, the options of relative weight connected to each criterion
stop conditions should be examined and in the case of lack of Delphi were calculated for selected five enterprise architecture framework.
stop conditions, the second time of sending questionnaires and col- The final consequence of options’ absolute weight shows that
lecting information is done. Because, the aim of using Delphi method is TOGAF framework has the highest absolute weight among decision-
extracting important criteria regarding Enterprise architecture frame- making options and as a result has the highest rank (Table 5).
work choice, and because the aim mentioned is fulfilled in the first After TOGAF, DODAF and then ZEKMAN, after that E2AF and

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Table 4
characteristics and criteria for an appropriate enterprise architecture framework for hospital selection.
Row Criteria and characteristics

1 Definition and clear understanding of architecture frameworks: using standard phrases, principles, and guidelines for correct usage of Frameworks and transforming
Enterprise architectural information.
2 A process-dependent architecture: Using processes which are defined accurately and are the instructions for building and architecture.
3 Supporting and development of architecture: Using processes and setups in the system which supports systems development.
4 Architectural analysis: Providing a collection of attitudes for analyzing and collecting the information guidance for creating the architecture.
5 Design tradeoffs: The possibility of choosing one design among many designed options by deciding on multi-dimensional contradictory needs.
6 The comprehensiveness of architectural models: providing logical standards for architectural characteristics documentation for, planning, communication management
and performing relative activities for adapting to other systems and present situation in enterprises.
7 Design rationale: the reasons design decisions documentations base on the analysis of different dimension of inputs for confirming the decision.
8 Standardizing: Providing a standard for keeping standard qualification for ensuring architectural development and designing standards.
9 Architecture based on knowledge: providing a logical collection of the content and the reasons are reviewing designing and architecture.
10 Architectural verifiability: Given enough information or explanation of architecture for measurements and studying architectural verifiability.
11 Entrepreneurs important: Businesses aims, orientations, principles, strategies and priorities.
12 Considering inputs of Technology: Architectural strategic orientation consisting of platforms, future architecture interoperability and the standards of emerging
technologies.
13 Considering needs of business: Considering the user's needs, functional requirements, data needs, and other business-related needs.
14 Considering environment of information system: Budget, schedule, technical limitations, sources and expert knowledge, enterprise structure and knowledge and
limitations.
15 Considering existing architecture Frameworks: Considering existing standards and infrastructure.
16 Presenting business model: Describing business models, business needs, business processes, and determining the policy and enterprise rules.
17 Presenting a system model: Presenting modeling of an original component of the system, for the achieving system architectural model, in which future should be
considered, and the main decision should be taken, and substitute designs should be chosen.
18 Presenting information model: Including data model and data interface.
19 Non-functional requirements of design: Modeling the system’s structure for reflection of non-functional requirements. These needs refer to the Quality of attributes or
quality of services. It also involved access, credibility, Scalability, Security, generalizability, modifiability, and tenability. Integration: Providing methods for business
rules, stability and performing the system inside the Enterprise.
20 Presenting computation model: Including functional system description, system processing progress, system operation, software component and interactions
21 Presenting software configuration model: describing software development, saving, management, and sharing.
22 Presenting software processing model: describing the ways of software designing and its runtime.
23 Executive software environment: describing some cases for performing software like operating systems, hardware and a network component, protocols and standards.
24 Presenting transmission projects: providing designs and maps for supporting development and development of the systems.
25 Component interactivity: providing information and guidance for facilitating communication and using information among users and systems.
26 Complexity: providing information and guidance for helping enterprise incompatibility or changes according to the inside or outside needs.
27 Reusability: providing solutions for the possibilities of using the systems and architectural products in more than one system.
28 Presenting implementation model: physical construction description like operating environment and hardware and network components of the system. Implementation
process including installation and running, development, configuration, and management.
29 Scalability: guiding helping to create effective changes for system development.
30 Portability: providing a method for facilitating movement of the systems or components to another place.
31 Alignment: providing solutions for aligning management aims with the system technology, aligning business stimulants with system development and aligning enterprise
and aligning intended system to the enterprise with the intended system to the project.
32 Integration: providing methods for business rules, stability and performing the system inside the enterprise.
33 Communication: Providing information for developing business organized communication and information technology at the Enterprise level.
34 Sharing and quality of information: Providing methods for developing quality and sharing information throughout Enterprise in an effective way; like timelines and
consistency of information.
35 Customizable framework: It examines the framework flexibility to match the special needs of an Enterprise.
36 Information redundancies decrease Providing information about redundancy in the existing system.
37 Creativity, change management, survival, success, and compatibility with enterprise: Providing businesses favorable positions for the designer for enterprises survival and
success.
38 Decision making, and planning investing in information technology, information system managing, supplies, distinguishing opportunities and decreasing risk: Providing
information about the existing situation and favorable situation of Enterprise and new technologies for managers and people who make decisions for business and
information technology for defining key subjects.
39 Reducing time of Supply to Market maximizing return on investment better and faster Services, Effectiveness: Communications Management in system’s lifetime recycled
and Enterprise architectural models for increasing Effectiveness in Enterprise.
40 Fitting the environment and Enterprises Mission: Presenting an appropriate Enterprise architecture framework for a specific environment and organizations.
41 the presence of technical support knowledge, and expert knowledge: the amount of the access to sources, Instruments and experts and their technical knowledge about the
framework
42 The performance and support of tools: The possibility of Performing and implementing Enterprise architecture framework and fulfilling enterprises aims using appropriate
tools for management and production.
43 Expenses: the required expenses fiscal and human expenses for implying the Frameworks.
44 The Simplicity of concepts: a simple statement of Concepts, principles, considered methods in an architecture framework for education and easier usage on understanding
the framework.

Table 5 finally, ISER ranked. Considering this fact, one can conclude that
Frameworks absolute weight relating to the aim. TOGAF is the most appropriate framework for hospitals in this research.
Rank Item Absolute weight
Step 4: Checking inconsistency rate: Inconsistency rate of de-
scribing decision-making system in previous parts equals 0.01, con-
1 TOGAF 0.318 sidering that this amount should be between 0–0.1, one can conclude
2 DODAF 0.219 that systems inconsistency is an appropriate limit. For assigning credit
3 Zachman enterprise 0.187
4 E2AF 0.144
to choose Enterprise architecture frameworks, all the results were given
5 ISE enterprise architecture framework 0.132 to 5 experts involving decision-making experts who were not an em-
ployer and then the results were admitted. Therefore, TOGAF was
chosen as the most appropriate framework for hospitals. This

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framework has been created by open Group in eight years. TOGAF’s in the country. The center has about 600 active beds, 32 hospital beds,
first version was created in 1995 according to TAFIM, and it was sup- 34 para clinic units, which provide various types of specialized and
ported by America's Department of Defense (DOD). The open group was specialized services to visitors from all over the country and even
given authority by DOD to create TOGAF on the according to TAFIM neighboring countries.
which was the results of years of trying and spending a lot of money by The hospital provides over 190,000 outpatient careers per year,
America's government. Indeed, TOGAF is an Enterprise framework more than 305,000 outpatient para-clinics, and about 1800 emergency
which enables Enterprise to design, estimate an appropriate archi- services annually. So, for managing this hospital using EA is a necessity.
tecture, it also decreases planning expenses, design, and implementa- Enterprise architecture describes Enterprises with such a layer [27], on
tion and it is also supported by the best scientific approach and a col- the other hand, TOGAF covers four main layers of Enterprise archi-
lection of architecture components. tecture Like Below [28]:

1. – Business architectural layer: it is considered the highest level of

4.5. Conceptual model of TOGAF for hospital an architect Enterprise. The aim of this architecture is recognizing
and describing operational areas, operational lines, and Enterprise's
The process of creating a TOGAF Enterprise architecture framework, responsibilities.
for hospital starts with recognizing the present original situation of the 2. – The layer of application of information system: it involves job
hospital, and it all continues with designing a long-term plan in which processes, Information Systems, applications and system’s interac-
there is a way to achieving all the objectives of a Hospital. tion methods.
The aim of implementing Enterprise architecture in the hospital is 3. – Information system (data) architectural layer: it is responsible
developing the present situation of hospital. TOGAF defines a hospital for describing information headlines, data’s logical models, and
as a set of units which have common aims, and it also creates a logical physical models.
structure for classifying and organizing complicated information, and it 4. – The technological infrastructure of the architectural layer:
also explains different perspectives. In the present article, the con- technical reference and Technical standards of models which should
ceptual model of TOGAF for hospitals (Fig. 2) was calculated by be considered in Enterprise
studying TOGAF 9.1 [23] content and its Conformity with architectural
development methods [24]. It should be considered that TOGAF has four inputs and internal
In this conceptual model, a hospital has its perspective, driver, a layers it should be eight parts. In the meantime, every layer has some
strategy, standards, and capabilities. These factors are TOGAF inputs. sub-layers. For determining necessary factors in every layer, the ex-
The essential components for every input in this model extracted from pressed component Enterprise architecture documented inside, and
Dr. Shariati hospital and desirable situation analysis of other hospitals outside Iran was used, and then a questionnaire with 145 questions was
in other countries examining observation on the steady existing situa- designed. The findings and their results of the questionnaires analysis
tion [25,26] and then it was customized by existing situations of Dr. will be presented in the analysis separately for every eight parts.
Shariati hospital. Dr. Shariati Hospital has officially begun in December Shariati hospital is a first class and public Hospital which was es-
1974 in a total area of 72,000 m2, 110 scientific and about 500 nursing tablished in Tehran – Iran 1970.
staff member care for 140,000 inpatients and outpatients every year. It The substructure of the hospital is 33,247 m. The hospital has a
is one of the most reputable medical, research and educational centers

Fig. 2. The General content of TOGAF conceptual model in the hospital.

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central building (7 floors), emergency (6 floors), Clinic (2 floors), nu-

clear medicine (1 floor), Laboratory (3 floors), wastewater treatment 1 Setting up an electronic record for patients
plant (1 floor) garbage storage and Disposal (1 floor), mosque (1 floor), 2 The necessity of developing and using information technology
bank (1 floor), store (2 floors), and computer site (1 floor). It also has and information in the healthcare field.
834 beds. This hospital is a part of Tehran’s medical science faculty and 3 The necessity of providing, preserving and developing the
nowadays considering Hospital constructive development and adding society’s Health level and reforming Lifestyles quality through
57,762 m; it is one of the most developed and largest hospitals. the continuous development of the quality of services in the
framework of laws and health policy.
4 The existence of codified rules on observations and controlling
4.6. Customizing the model for Iranian hospital the laboratory, medicine, and environmental health factors.
5 The existence of referral system rules in the hospital with a focus
For Customizing The model for Iranian hospital, in the first step, de- on Family Medicine.
termining questionnaire for estimating values of important elements and 6 The existence of rules for decreasing Tariff of Medical Services
components of TOGAF. It has 145 questions in the 5-point Likert Scale expenses.
(completely agree 5 marks, agree 4 marks, no comment 3 marks, disagree 7 The existence of a rule of public medical services insurance.
2 marks and completely agree 1 mark). After collecting and codification of
the questionnaires and correction check by professors of University, some
Two below hypotheses were rejected:
questions were modified, and validity is approved. Then it was distributed
among the 20 people, and the Cronbach’s alpha equaled 0.91. Then the
questionnaire was distributed between all people in the final level 1 An increase in expectations of people for health information
Cronbach’s alpha equaled 0.97. So, the reliability of the questionnaire was security.
approved. In the next step, for determining the normality of data, the 2 An increase in people's expectations for having a healthy life
Kolmogorov-Smirnov test with SPSS used and showed the distribution of along with long life without any sicknesses and disability.
data is not normal. So, we should have analyzed it with a nonparametric
test such as binomial. One-way analysis of variance and then the binomial
test was used for analyzing the results for every existing hypothesis using b-Strategy: strategy is a direction in which the hospital has decided
SPSS software. The result showed that all the hypotheses in the ques- to create its activities framework to achieving its goal according to the
tionnaire with ANOVA by SPSS software, all hospitals hypotheses have p- results of binomials test, below hypotheses about Hospital strategies are
value equaled 0, which is less than 0.01. Therefore, the supposed zero accepted with 95% of certainty.
according to mediums equality is rejected and supposed one with a
meaningful level of 99% is admitted. It means that there is a meaningful
1 Applying information technology and communication as a
difference between at least two hypotheses. Therefore, we conclude that
supporter of the main operation for creating variety and
none of their existing hypotheses in different dimensions of hospitals have
increasing the services quality
the same values and effect. Using binomial test and determining p-value
2 Creating necessary electronic infrastructure for qualifications
effect or lack of effect of every single hypothesis in every dimension of
and performing patient electronic records.
conceptual models of TOGAF was examined too; the results will be ex-
3 The establishment of clinical governance and supervision, laws,
plained for every dimension.
and regulations which are related to the quality of
a-The dimensions of vision and Driver of Hospital: hospitals
hospitalization and ambulatory health services.
visions, orientation, and identity explain hospitals Aims and an image
4 Giving favorable services to patients.
of future. Hospital’s driver is an effective Factor in the processes,
5 Creating a necessary infrastructure for codification and
events, and actions which determine Hospital's future and will shape
Performing Health National code
future trends. A strategy is a way in which the hospital seeks to create
6 Creating a necessary infrastructure and developing supportive
its format of activities to fulfill the goals. The results of these two
institutions for enabling Information Technology services in
subdivisions are listed below:
hospitals like research centers and Science and Technology
Considering binomial test, below hypotheses are admitted with 95%
Development Centers.
of certainty for hospital’s vision.
7 Creating necessary conditions for providing the health
insurance system.
1 Having the highest level of service quality based on developing 8 Establishment of a strategy Management Systems in emergency
clinical operations of Hospital. Ward.
2 An increase in Individuals satisfaction percentage in benefiting 9 Establishment of a system of managing complaints and medical
from Hospital services. errors.
3 The best hospitals in delivering educational, medical, and 10 Establishing a new system for Hospital management.
Research Services. 11 Establishment a comprehensive system of management of
4 A decrease in the number of deaths and accidents in different medicines and equipment for medical, dental and Laboratory.
Wards of Hospital. 12 Establishment of a comprehensive management system for
contagious and non-contagious diseases
13 Establishment of a comprehensive health systems for creating a
And these three hypotheses were rejected. responsive system for giving Medical Services to the society.
14 Establishment of a notification and communication system in
the department of health and medical education.
1 A better understanding of the health situations of society.
15 Establishment of a statistics and information comprehensive
2 A decrease in the duration of the first doctor's appointment in
system in Department of Health and Medical Education.
medical emergencies.
16 Establishment of a comprehensive system of health information
3 A fare increases in giving medical services to people.
management including all human resources, physical and
According to the results of the binomial test, below hypotheses were financial information.
admitted to hospitals with 95% of certainty.

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A. Haghighathoseini et al. International Journal of Medical Informatics 114 (2018) 88–100

17 The establishment of a comprehensive system of Health Service These activities involve defining an architecture for hospitals, tools
management with an emphasis on the fair and efficient and defining its principals. Business architecture involves business
allocation of resources. strategies, control, organizing and physical processes existing in a
18 The establishment of reporting and documentation system in hospital. This layer determines the lines of business and every business
Health Department. line, has a single rule in performing a business mission and operations
19 The establishment of the national health accounting system. of a business determines a group of Business Services. Having a business
architecture is a prerequisite for architecture in any other field, data,
c-The hospital's capability: Capabilities are visible combinations applications, and technology. Therefore, it is that first architectural
of knowledge, skills, and abilities which result in the steady develop- activity which is needed to be done. Treatment processes have a great
ment of individual and organizational capabilities for the hospital's effect on the service quality of the hospital. Accordingly, existing in-
responsibilities be done with favorable results. definite equal pattern for processes instructions and determining the
These are H0 or null hypothesis which they were analyzed with order of the level and the time for better performance of processes of
binomial test, and all of them was approved. providing help for individuals in the hospital is necessary. Accordingly,
the hospital’s business architecture is described with below details:

1 Giving basic health services as a comprehensive boarding

system. • Recognizing rules and defining involved individuals in hospital ac-
tivities.
2 Management and a decrease in effect resulting from doctor’s
• Recognizing business processes in hospitals
mistakes during Services time
3 Providing Emergency Services to the people • Determining different parts of Hospital
4 Better interactions with people for informed medical decision-
Considering above mentioned business architecture involves a series
making
of total activities and three subdivisions for the institutional writing of
5 The management of volume, variety and heterogeneity, medical
these activities which is listed below. According to binomial test results,
information and Hospital
below hypotheses about business architecture are admitted with 95% of
6 Supporting the standards of medical and Hospital information
certainty.
Exchange
7 Development of a better medical and biological management in
hospitals through creating the possibility of sharing information 1 Defining business strategy of the hospital and expressing
resources limitations
8 The management of operation and complex processes or 2 Recognizing hospitals stakeholders and responding to
Hospital stakeholder’s concerns
3 Recognizing and distracting hospital effected element, defining
d-Hospital standards: Hospital standards are about quality ac-
restrictions and theories
creditations and New attitudes and scientific method about service,
4 Creating control, structure, and activities for monitoring and
facilities and physical space of hospital standard, through which it gives
control of architecture on architectural factors
a clear image about the standard criteria of physical space of medical
5 Creating a comprehensive design in line with adopted
units and can evaluate activities according to standards. Considering
frameworks of the project management by hospitals
binomial test results, below hypotheses were accepted with 95% of
6 Official decision making and the hospital management
certainty.
commitment for doing TOGAF enterprise architecture
7 Defining TOFAG and careful method for Enterprise architectural
development in hospitals
1 Using Hospital information exchanged standards HL7
8 Recognizing Enterprise architectural needs and its priorities
2 Controlling hospital compliance requirements and standards
consisting of necessities theories and gaps
3 Having clinical standards in hospitals based on components of
9 Validating business principles, aims, entrepreneurs and key
the quality of services
performance indicators
4 Applying a standard use of a Comprehensive Health Care reform
10 Examining different hospital fields for performing an enterprise
(SNONED)
architecture
5 Applying LOINC standard based on sending e-lab results
11 Recognizing the suggested values for answering needs and
6 Implying imaging equipment with a digital output and
hospital limitations
according to Dicom standard
7 Implying ICD coding standards
8 Having high international standards for medical equipment
Five below hypotheses were rejected:
9 Functional assessment certificates for Hospital information
system
10 Using standard vocabularies and definitions in a hospital
1 Choosing and implementation of supportive tools and other
11 Getting a license according to SEPAS standard Iran's Health
infrastructure, for supporting architectural operations
electronic records system
2 Defining TOGAF’s place in a hospital
12 Hospital accreditation standards certification in Iran
3 Defining ranges and priorities of TOGAF
4 Expressing Concepts, principles and TOGAF goals
e-Business architecture at the hospital: TOGAF perspective, in
5 The certainty of steady obligation and cooperation of the
the field of business architecture, involves information about the fields
stakeholders on architectural fields
definition, recognizing stakeholders, restrictions, and expectations,
creating architectural perspective and obtaining licenses in their per-
spectives for Hospital Enterprise architecture is successful investment in
a project, Enterprise architecture is prepared and assumes preparing In the part of recognizing rules and definition of individuals in
and setting up activities for understanding the ways of business for a hospital activities, the results of the binomial test for below groups were
new enterprise architecture. admitted with 95% of certainty.

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A. Haghighathoseini et al. International Journal of Medical Informatics 114 (2018) 88–100

1 Doctors 1 The process related to administrative units including the process

2 Nurses of archiving files, the process of collecting and sending the
3 Patients statistics of the hospital, that process of paying staff’s salary, the
4 The hospital’s manager process of calculating and sending Insurance bills and insurance
5 The staff working in different parts of a Hospital for an outpatient prescription to insurance organizations.
6 The head of IT
g-Determining Different Wards of a Hospital: according to the
7 The director of the clinic
results of the binomial test below hypotheses were admitted with 95%
8 The director of the lab
of certainty.
9 The director of the Hospital imaging
10 The director of Pharmacy
1 Intensive care Ward including ICU, CAT lab, surgery Room, Post-
ICU, etc.
In the meantime, below groups rules were rejected.
2 Clinical wards including emergency, orthopedic Urology,
neonatal ward, maternity ward, transplant surgery, etc.
1 The back of people 3 The clinics in a hospital including internal Clinic, GL Clinic,
2 The researchers Endocrinology, Neurological Clinic, heart surgery, maternity and
neonatal award.
4 Para clinic parts and wards including Physiotherapy, lab, and an
f-Recognizing the hospital's business processes: this part em- Imaging unit.
phasizes on working aspects of hospital and its function. Every process 5 Pharmacy inside the hospital including Central pharmacy,
has it is under process which is divided into tasks and activities. outpatient pharmacy, specialized pharmacy, and dispensary.
Considering binomial test results below hypotheses are admitted with 6 Headquarter units including the office of the management, the
95% of certainty. nursing service office, the office of quality improvement
including development Office.
7 The service and administrative departments including reception
1 The processes related to hospital administrative division,
and clearance, public relations, accounting, and Secretariat.
admission, and discharge, the process of therapy, the process of
sending the patient to another hospital, the process of different
And two below hypotheses were rejected:
parts of that hospital like laboratories, pharmacy, etc.
2 The process related to providing health including the process of
the patient’s relationship with the doctor like guidance, 1 Central committee's, including the committee on accreditation,
following up, inscription, the process of asking and answering clinical governance, statistics and medical documentation, a
questions, the process of Patient to Patient relationship through committee of medical Ethics, Family Medicine committee,
interactive Tools in the hospital, the process of doctor to doctor medicine, and health committee.
relationship and cooperation through interactive Tools in the 2 Institutes and research centers including the blood and oncology,
hospital – the process of patient access to information and research centers and Institute of the digestive system and liver
research sources of the hospital like warnings, books, articles, disease, Institute of endocrinology and metabolism.
etc. the process related to registration and access to individual's
health information including the process of patient registration h-Hospital information system architecture: Using architecture
and do registration, the process of keeping records of patients for designing a practical system with interaction and communication
observing the progression of the disease and stop point of view for hospitals main business. Determining and recognizing
3 The process of registering documents relating to patients or that need for information systems for Hospital is important for daily
individuals, the process of doctor and the patient access to health and specialized processes. These systems involved two groups of hos-
records in the hospitals for disease management. pital information systems and practical information system in the hos-
4 The patient’s management including the process of patience pital.
partnership in producing health information content through a Hospital information systems
survey, the process of creating social communication with a Considering binomial test results below hypotheses were admitted
group of patients for training and notices through Groups and with 95% of certainty:
forums, the process of collecting patient information for
researchers related to health, etc.
5 The processes related to hospitals including the process of 1 Admissions information service (AIS)
management, planning and controlling the hospital, the process 2 Medical documents information system
of assurance and quality control of that hospital. 3 Discharge Information System
6 The process related to disease including the process of 4 Outpatient information system
controlling and disease Care and the process of disease 5 Hospital ward information system
prevention. 6 Operating room information system
7 The process relating to Public Health warnings involving the 7 laboratory information system
process of notices or performing health plans, the process of 8 Radiology information system
Public Notices or warnings in case of Public Health Dangers. 9 Pharmacy information system
8 The process of choosing Hospital doctors including the process of
And one below hypothesis was rejected:
searching the doctor according to expertise and area, the process
of searching the hospitals and health centers according to
medical and equipment services. 1 Hospital nutrition
system
And one hypothesis was rejected:

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Hospital functional services The data storage and retrieval of data: considering the results of
Considering binomial test results below hypotheses were admitted the binomial test below hypotheses were admitted with 95% of cer-
with 95% of certainty: tainty.

1 Electronic medical record (EMR) 1 Correct registration of patient information during reception and
2 Electronic nursing record therapy.
3 Personnel Staffing and scheduling information system 2 Data registration in information and statistics systems of
4 Bed management information system hospitals statistics and Hospital information system
5 Telemedicine service 3 Registering the individual's health records in hospital’s
6 Resource management information system information system.
And four below hypotheses were rejected: Data’s access and data integration: considering ANOVA and bi-
nomial test results, below hypotheses with 95% of certainty.

1 Security Service
2 Decision Support 1 The possibility of easy, fast and correct access to hospital’s
System information system data.
3 Communication Service
And one hypothesis was rejected:
4 Terminology Service
i-Architecture of Hospital information system (data): the ar-
chitecture of Data, emphasizes on necessary information about 1 Existing of a fast and simple method for entering data into
Enterprise architecture framework for using in hospitals. The assets of hospital’s information system.
this layer of Data and information which supports the line of businesses j-Hospital technology infrastructure architecture: Technology
plan and operation. In other words, it is a frame for the defining col- architecture involves a set of hardware and software capabilities and
lectivity, integration, integrity and amount of data access. This archi- network which is needed for businesses development, support data, and
tecture includes four main parts [29]: services application. Considering the results of the binomial test below
hypotheses were admitted with 95% of certainty.
1. data entity
2. Analyzing and reporting data
3. Storing and retrieving data 1 Software infrastructure including Hospital’s physical and
4. Data’s access and data integration necessary administrative Soft-wares and software equipment in
hospitals like basic software, software help, public software and
The results which are extracted from Shariati hospital are as follows. the services of Hospital workflow management.
The data entity: The Hospitals data entity were admitted with 95 of 2 Application platform interfaces including describing necessary
certainty. Considering the results of the binomial test according to the soft-wares for connections between applications and services for
list below: access to hospital services
3 Content management infrastructure including access control
tools, the protection tool, and data security forth security of
1 The patient records including the personal information, the Health Information Systems, the data’s management tools for
disease records, and health records storage and retrieving existing information in hospitals, content
2 The medical records including the personal information, management tools, for collecting and identifying patient’s
scientific records, the field of expertise. information.
3 The information about that method of therapy for each disease
4 The information about diseases symptoms And 6 below hypotheses were rejected
5 Descriptive information about diseases
6 The information and sources of scientific health
1 The network infrastructure including access to Port can be
And one hypothesis was rejected. connected to internet networks with internet broadband, the
details of a technical network of hospital, equipment
communication, The networks of hospitals. The soft-wares of
1 The information about Hospitals and Clinics for instance network and Hospital Network management
location, equipment, and Records 2 Hardware infrastructure: including ports can be connected to the
The Data Analysis and Reporting: Considering binomial test re- internet, the internet Broadband access, architectural details of
sults below hypotheses were admitted with 95% of certainty. hospitals, technical Network equipment of hospitals,
communication network, the network and network management
software.
1 Description and definition of different data and Hospital data 3 The operating system that was compatible with Hospital
2 Description of important information about the process of information systems: could be any operating system.
therapy 4 Free storage infrastructure including restoring tools for restoring
information of Hospital for accelerating restoring and retrieving
And two below hypotheses were rejected
operation (integrated database management tools for hospitals)
5 Communicative infrastructure: Including describing necessary
1 Describing the entity of network of data hardware and software for communicating between different
2 Data technological description of the definition of each entity as systems and organizations.
a required data for the information system in hospitals

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6 Telecom infrastructure: Including telecommunication Networks, supporter as well as investigators were not admitted and the rest were
the connection between users, health centers, and databases. admitted. It means that among two groups of stakeholders, 12 were
Stakeholders and hospital system, access to internet broadband rejected. The omitted items are justified for this reason that Shariati
network, the hardware of security equipment for physical data Hospital has outsourced some of its services and does not need em-
protection like providing physical backup guard, etc. ploying new staffs. In the meantime, because the hospital is a subset of a
university and its staff and doctors themselves are researchers, there is
no capacity for other researchers.
5. Discussion In the 3rd subdivision, eight processes were admitted out of nine,
and one was rejected. The rejection is due to outsourcing services which
17 Hospital Enterprise architecture Frameworks were examined in are reasonable.
the present research. Due to the lack of appropriate research on using In the 4th subdivision, 7 cases were admitted out of 9 hospitals
these models in hospitals, the decision was made based on determining wards. The rejection of “Central Committee” and “Research centers” is
the frameworks with hospital conditions. Therefore five criteria were because it is under the state of University Not the Hospital.
chosen by experts to determine the suitability. Then TOGAF was de- Part 6: The hospital architecture of Information Technology in-
termined as the best framework using expert’s opinions and Analytical cludes two subdivisions; Hospital information system and hospitals
hierarchy process. Five mentioned criteria are 1- covering Hospital usage Information Systems.
activities and processes 2-An up to date framework 3 -Access to First subdivision i.e. Hospital information system consists of ten
Frameworks details and information 4 -Adaptability of customizing and theories, nine were admitted, and the Hospital nutrition system was
applying in Hospitals 5-Support by Hospitals modeling tools. rejected because of Outsourcing. The importance of these services is
The results show that according to experts none of the works satisfy focused on Velde [30] article. Ten services in the field of functional
first Criterion, i.e. covering hospital activities and processes. It means services were recognized in the form of questions, among that six ser-
that despite their need for a framework in this field, there is a witness in vices were admitted. Security Services, decision-making backup system,
this part because there is no extracted framework for this field. Communication Service and terminology service were rejected. Because
Then TOGAF was designed with eight parts (Fig. 2). Then a ques- these services are not considered a priority, and they are also expensive.
tionnaire with 145 questions was designed using different sources and According to Haren [23], an information system architecture, the sys-
interviewing with experts and following sources [25–28] for de- tems may develop steadily or simultaneously. Therefore these systems
termining effective factors for every 8 Frameworks. The results of these could be developed at other levels in case it is needed.
parts are as follow: Part 7: The architecture of Hospital information system (Data): this
The analyses of calculated result through one-way analysis of var- part consists of 4 subdivisions. Velde [31] and Wager and others [29]
iance admitted all 145 hypotheses, in other words, it showed that there has also focused on the importance of these four parts.
is no meaningful difference between at least two hypotheses. Then bi- The subdivisions of the hospital data entity have seven hypotheses
nomial test which shows experts equipment was used to show its ap- among these seven hypotheses only one is not admitted. Hospital in-
propriateness or inappropriateness of the condition of the hospital. formation and health centers are rejected because Enterprise archi-
Part 1: It means hospitals point of view including two subdivisions tecture inside the hospital is not considered a priority and could be
of view and driver. In Point of View Part, four hypotheses were ad- developed later. Second subdivision is analysis and Reporting data
mitted out of seven. These four hypotheses emphasize on the highest which consists of four hypotheses. The hypothesis of description of
service level, satisfaction and a decrease in vulnerability. network entities and technologic description data which is used in
It seems that three omitted cases, i.e. a better understanding of so- hospitals where rejected. The first one was rejected because individuals
ciety and more Justice are related to the health system, not the hospital. in the organizations are familiar with these descriptions and that second
In the meantime, a decrease in the time of the first dose the appoint- one was rejected because the individuals are not interested in that
ment is acceptable in first four primary hypotheses. technology part.
In driving part, seven hypotheses were admitted, and two were re- In the third subdivision – saving and retrieving data- all hypotheses
jected i.e. people's expectations from health information safety and an were admitted. The importance of this case has been focused in Velde
increase in the quality of life. [31].
Part 2: Strategy sector of a hospital: in strategic sector 19 strategies In the 4th Subdivision – access and integration of data’s hypothesis –
were certified. Using Information Technology and all subsystems of and – the possibility of fast, easy and accessible access to data or
Enterprise architecture were admitted as a strategy. It shows the im- Hospital information- were admitted, and second hypothesis – the
portance of related issues. presence of a simple and fast method for entering data in systems or
Part 3: Hospitals capacities which have eight hypotheses which Hospital information- was rejected. Because the priority is information
were all admitted. These capabilities are in line with the Vision and accuracy and not its speed.
strategy. Part 8: Hospital infrastructure architecture; this part has nine in-
Part 4: Hospital standard: In this part, the necessity of all 12 hy- frastructures among which 3 cases were admitted, and the other 6 cases
potheses, in other words, all standards related to hospital wards were which are about Services support had been outsourced and therefore
admitted. are not considered a priority.
Part 5: Architecture of business hospital has 4 Fields; First field Recently, a research was done in Portuguese showed hospitals with
involves micro activities and the other three fields involved needed about 700 beds claimed for the urgent need of using new management
organizations for doing the activities. 16 activities were mentioned as approaches for dealing with the complexity of their information sys-
hypotheses in the first subdivision, 11 hypotheses were accepted, and tems, the high duplication in data and inefficiency in the communica-
five hypotheses were rejected. tion. They presented an Enterprise Architecture as a solution for their
The results of interviews with stakeholders for result analysis needs.
showed that because of the necessity of doing the decree of the pre- They distinguished for main contributes in the field: 1) the Zachman
sident and since hospital chief considers himself committed to pur- framework; 2) The Open Group Architectural Framework (TOGAF); 3)
chasing the best equipment, therefore, the rejected hypotheses are not The Federal Enterprise Architecture (FEA); and 4) the Gartner
considered as main activities despite their importance. It seems that the Methodology, but this work didn't use any special EA and was based on
result could be generalized to other countries if there is such a com- an exploratory and empirical study to apply the principles of the EA
mitment. In a second subdivision, the stakeholder’s roles, the role of a architecture body of knowledge to the reality of a Portuguese Hospital

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A. Haghighathoseini et al. International Journal of Medical Informatics 114 (2018) 88–100

[32]. This study was done in 2015, and it was based on empirical study. Conflict of interest
They didn't use any special EA. However, they stated that TOGAF is a
good EA and considered a process definition to obtain the architecture. None.
FEA has a comprehensive taxonomy, like Zachman’s, and an archi-
tectural process, like TOGAF. They didn’t show their customized fra- Summary points
mework, and they only explain the process of their work.

• The aim of this paper is presenting an Enterprise architecture

In our work, the process of selection the method and the criteria
were highlighted. 17 EA frameworks were investigated, so it is a
framework for the hospital.
comprehensive study. 5 EA frameworks were chosen based on five
criteria. Then for selection the best framework, 44 characteristics were • Using two dimensions of implementation and having appro-
priate characteristics, the best Frameworks were chosen
extracted from the literature review. All five frameworks were eval-
among 17 frameworks.
•
uated by these 44 characteristics. Then eight important characteristics
In the next step, TOGAF was chosen in terms of having ap-
for choosing framework were introduced, and TOGAF was selected as
propriate characteristics and ability to be implemented
the best framework. At the end, 145 items of architectures in 8 layers
among reference formats, using AHP method.
•
were explained, and 111 items were admitted. These items can be used
Then an enterprise architecture framework was designed with
as EA in similar hospitals too.
a format of a conceptual model having for inputs and for
infrastructural layers.
6. Conclusion • The results showed during customization of TOGAF for Iran,
that among those 145 parts, 111 parts were chosen and
certified to be used in the hospital.
•
For entering to the smart world according to the internet of objects,
This new model could be used to be performed in other
with more than billions smart machines, the presence of Enterprise
Iranian hospitals.
architecture is necessary. It is necessary for all parts, including hospitals
for giving direct and indirect services. This research aimed to present a
hospital Enterprise architecture framework. The results of this research
showed that despite the presence of an Enterprise architecture for References
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