STRUCTURED APPROACH FOR THE INTRODUCTION OF

INFORMATION SERVICES INTO THE PRIVATE SOCIAL

SOLIDARITY INSTITUTIONS

Alexandra Queirós, Nelson Rocha

Escola Superior de Saúde, Universidade de Aveiro, Campo Universitário, 3810 Aveiro, Portugal

Keywords: Social Solidarity Institutions, Reference Information Model, Electronic Social Record.

Abstract: The paper presents an overview of a Reference Information Model for the introduction of information

services into the social solidarity institutions. The model is based on a complete description of the different

institutional process, from a high level to a deep detail perspective, and was used for the implementation of

a Client Management Information Service for Private Social Solidarity Institutions.

1 INTRODUCTION

In the presence of the pressures and challenges

placed on the welfare structures it is urgent to

optimise the available resources. In Portugal, the

welfare public services represent only a small part of

the social support that is given to the citizens. The

Private Social Solidarity Institutions (PSSI) play a

very important role to fulfil the gaps of the public

services, since they are the ones that give most of the

support and are closed to the society.

According to the Law nº 119/83 of 25 of

February (PSSI statutes), the PSSI “are non-profit

and non-public institutions which main purpose is to

provide social support to necessitous persons but

also to promote education and prevention of

diseases”.

The government recognises the relevance of PSSI in

the provision of social services to the population

threw the establishment of cooperation and financial

agreements. In fact, the family support has been

decreasing and the public welfare agencies consider

the PSSI a strategic part in the care system. They

provide a number of social services, namely

domiciliary support or health care.

In many PSSI it is possible to evidence that care

providers are involved in repetitive administrative

tasks. Such tasks can be supported by technological

solutions so that more time could be left for the

clients. The present situation is particularly

inadequate because, on one hand, the cost of the

human resources consumes a great part of the PSSI

budgets and, on the other hand, the actual paradigms

promote an easy access to the existing resources and

the knowledge sharing wherever and whenever

necessary. It must also be pointed out that in care

providing the multidisciplinary teamwork involving

different service providers has an extreme

importance, but the relationship between the

different entities is not always trouble-free,

contributing decisively to the reduction of

productivity.

Therefore, the systematic use of Information

Technologies (IT) in the communication,

management, processing, availability and exchange

of information between PSSI, citizens and social

agents must be stimulated. A clear desire is the

development of citizen centred services using new

organizational frameworks that integrate

heterogeneous compilations of resources to be

acceded as a uniform conglomeration of information

and knowledge. This need elapses from the care

providers’ own action. Assuming that they must be

information managers, IT must be used to introduce

more objectivity on the different social tasks.

However, it is important that the technological

introduction might be done in a sustainable way and

not supported by a set of unframed projects.

2 OBJECTIVES

The present paper reflects the results of a research

work that intends to contribute to the development

343

Queirós A. and Rocha N. (2006).

STRUCTURED APPROACH FOR THE INTRODUCTION OF INFORMATION SERVICES INTO THE PRIVATE SOCIAL SOLIDARITY INSTITUTIONS.

In Proceedings of the Eighth International Conference on Enterprise Information Systems - ISAS, pages 343-348

DOI: 10.5220/0002442403430348

 SciTePress

of methodologies that will help the technological

evolution of the PSSI. The main issue is to evaluate

if a conceptual framework for the PSSI essential

information can facilitate the introduction of IT

services and promote the participation of the PSSI

collaborators in the different phases of the required

reorganization procedures.

A regional project within the Programme Aveiro

- Digital (Rocha, 2002) is being used to validate the

outcomes of the research effort. Therefore, it is

possible to take benefit from a regional perspective,

since a sustainable development has more chances of

success when it is geographically located and when

there is the opportunity of repeating experiences. It

is also advisable not to forget that the regional

dimension is fundamental in the conception and

implementation of policies since it is at the base

level that the relationships are more easily handled.

The next section provides a short description of

the constraints related with the improvements of the

PSSI organizational procedures. The fourth section

presents a Reference Information Model for the

PSSI information services. The fifth section

describes the Electronic Social Record, a main

element to model the PSSI essential information.

The sixth section contains a presentation of the

experience gained in a regional project involved

several PSSI (which provide support services to

elderly and disabled people) and public welfare

agencies. Finally, an outlook on the results is

provided in the seventh section.

3 THE PSSI SITUATION

The technological evolution of the Portuguese PSSI

is somewhat precarious. A study done for the PSSI

of the Aveiro region (Souza, 2004) shows that

almost all the inquired PSSI have several computers,

though the connections to a network are almost

inexistent. The Microsoft Office is quite spread and

some PSSI also make use of applications for

administrative purposes, mostly not integrated.

There is not any specific software for the

management of the clients’ information (in all the

studied institutions, the clients’ records are based on

paper).

Concerning to the communication itself, the most

used means of communication are: the telephone (in

the communication with the exterior), telephone,

paper and personal contact (in the communication

inside the PSSI) and the meetings (in what concerns

to communication in a teamwork context). The

electronic mail is already available in most of the

PSSI, but it is not much used.

Regarding to the investment priorities and its

short-run planning, in spite of the great majority of

the inquired PSSI consider that the existing

computers are insufficient, a significant number of

them have a clear intention to invest more in the

connection of the computers to a network. They also

consider that it would be useful to invest in

integrated applications, and a few reveal the

intention of doing it in a short run.

It is important to mention that there is not, in

none of the considered PSSI, anyone responsible for

the information systems. There are, in the majority

of the cases, administrative personnel and even

social workers that give some technical support.

Finally, in terms of acquisition and adoption of IT

based solutions, the PSSI are aware of the

importance of people’s training, formalization of

tasks, standardization of procedures and integration

of information. It is still important to mention that it

is implicit the need that the information which is

currently scattered by several institutions, centres

and professional fields, should correspond to a one

single and coherent body.

However, this evolution strikes against a

diversified set of barriers, namely the lack of the

financial resources, the collaborators low level of

schooling and reduced experience in use of IT,

resistance to change, collaborators expertise directed

towards the necessity of running the daily problems

and not available for planning and realising

advanced organisational and technological

innovations, the level of complexity apprehended by

PSSI collaborators regarding technology, poor

formalization of the tasks, lack of standardized

procedures, low level of integration of the existing

systems and some lack of recognition of the

importance of technology.

In reference to eventual facilitators to the

introduction of IT based services, some factors can

be named, namely, the experience resulting from

several projects, a slight change on the PSSI

collaborators’ attitude (starting to show more

predisposition to work using IT and showing also a

higher recognition of its usefulness), the positive

way of facing the deepening of the PSSI

collaborators’ knowledge, the appearance of

younger professionals who are more receptive and

qualified to use this kind of tools and the level of

increasing importance which is given to the

technology acquisition.

At the time being Portugal presents a fast

introduction of IT in the public welfare agencies,

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within the modernization of the public

administration. This puts a considerable political

pressure to the PSSI. Furthermore, due to several

modifications of the social and healthcare political

frameworks, the PSSI are being pressed to evolve

for a new perspective of care providing with an

efficient cooperation between social and health

services.

This evolution has been very difficult to achieve

due to several causes, namely, the fragmentation of

social and health services, the reduced degree of

decentralization of the policies in the country, the

low level of allotment of resources between social

and health systems, the importance of the power for

the professionals, the hermetic characteristics of the

health entities, the prejudices among professionals,

the discrimination regarding certain groups of

collaborators, the professionals and institutions fear

of being evaluated and even aspects such as the high

level of individualism of the society.

In fact, the fragmented supply of the care

providing is a real problem in the existing social and

health systems, which contributes to the inefficiency

of the services and to low quality standards in the

care provision. However, an integrated perspective

of the care providing (Kodner, 2002) needs the

creation of multidisciplinary teams (horizontal

integration) in the same level of care or the linkage

between different levels: primary, secondary and

tertiary care (vertical integration). In this process,

the goals, the skills and the roles of each part must

be clarified and the IT solutions must be used to

create virtual organizations, formally separated, but

allowing the information sharing and the teamwork.

4 REFERENCE INFORMATION

MODEL

The PSSI are short of good practices in the

introduction of IT and in the development of

protocols and guidelines for care providing. A

specific methodology, the Best Institution Practice

(BIP), was developed to respond to this need. It is

based on a set of principles or good practices and it

is focused on the organizational processes and on the

optimisation of activities inherent to the teamwork,

within a PSSI and between different PSSI (Rocha,

2005).

Another important component is the Reference

Information Model. Usually, a PSSI is composed by

a set of autonomous services that can be

geographically distributed and with different levels

of complexity. Due to this distributed nature,

monolithic IT applications can hardly be adapted to

the requirements of the PSSI. On the other hand, a

distributed architecture presents several advantages,

since it allows the most adequate technological

solution for each unit that compose an organization

of this type. However, the specific characteristics of

the care providing can lead, in technological terms,

to a great number of different and heterogeneous

applications, conceived to satisfy the requirements

of particular users and most probably not compatible

among them.

Therefore, it is important to guarantee the

evolution, integration and interoperability between a

set of different and heterogeneous applications that

can be developed at different moments by different

suppliers with different technologies but, logically,

are part of the same information service.

It should be pointed that the available technology

allows in an easy way the interconnection of

distributed applications, even if they are

heterogeneous and part of different physical

systems. However, this type of interconnection is

only related with technical aspects and do not

provide the applications interoperability in terms of

information consistency, which is the important

issue for the final users. Furthermore, is not enough

a simple messages exchange for the cooperation

between different applications, inasmuch as this

solution only allows a relative interoperability,

without a real integrated organizational perspective.

The establishment of common information

models, able to relate the different types of data

available to all the applications required for the

information services, can promote real information

integration. The main concept behind such model is

that, independently of its characteristics and goals, a

PSSI can be considered as a set of users,

individually different and carrying out very specific

tasks, but all of them needing to share a common

and reliable infrastructure of basic information. This

common information structure cannot belong to a

particular application, but must be accessible to all

applications through public and well-defined

interfaces, which do not have to depend on any

technical characteristic of a particular system

configuration.

For this, a reference model is required. The

Reference Information Model guarantees a common

conception of the information that is transferred,

which cannot be defined without having a common

vision of processes, procedures and concepts,

despite the differences that, necessarily, exist

between the PSSI. Such approach makes possible

STRUCTURED APPROACH FOR THE INTRODUCTION OF INFORMATION SERVICES INTO THE PRIVATE

SOCIAL SOLIDARITY INSTITUTIONS

345

the generalization of common functions and the

specification of specific functions for each particular

social service. The base for the development of the

Reference Information Model was the correct

description of the different processes, from a high

level to a deep detail perspective. Considering the

heterogeneity of the PSSI, the processes are similar

up to certain level (even so can be different), but

when a greater detail is incorporated, the processes

necessarily will be different, partially due to the

local procedures and rules.

5 ELECTRONIC SOCIAL

RECORD

In order to guarantee the interoperability between

different applications it is essential to define a way

to structure the essential information of the PSSI. On

possible way is to consider a nuclear group the data

regarding the clients (including not only their

characteristics and needs, but also the results of the

different activities centred in them). By analogy with

what happens in the health domain (Beale, 2001) we

assigned this nuclear group of data as an Electronic

Social Record (ESR). The conceptual framework of

the electronic support for the clients’ records is a

fundamental tool and it allows (Himss, 2004) the

improvement of the quality, security and efficiency

of care providing, emphasizes the client centred

care, improves the prevention, reduces the

information redundancy, facilitates the information

sharing among institutions (because it can be

consulted starting from any point by properly

authorized users) and reduces the probability of

errors in adverse situations, through the access to the

complete client record and the use of decision

support systems.

The conceptual framework of the ESR is derived

from the paper based client record, which is used by

most of the PSSI, but that presents some difficulties,

namely, incapacity to access the clients’ global data

(many times scattered by several care providers),

inadequate forms of archiving, data supports that can

be damaged by handling, difficulties in updating the

data, impossibility to guarantee privacy, among

others.

A client can be described through several

concepts, because it assumes several roles

throughout the life cycle. For the PSSI, the client

visibility starts with the registration, can continue

with an individual care plan until the interaction

with the PSSI ends. Once more, the fact that some

data is defined by an activity that occurs explicitly

outside of the PSSI should be valued. In fact, some

data can be received from external centres as a result

of external processes and represents autonomous and

self-consistent information only related to the client.

The definition of the ESR architecture considers

that it should support information services that are

essential for the care providing, reflecting on

different organizational levels and different types of

processes, namely in respect to processing of client

data, such as, observation, reasoning and intention.

The information that supports the various activities

and processes can be more or less complex,

constitute a more or less significant part of the

potential set of all the necessary data for the

functioning of a PSSI. In the scope of an information

system to the care providing, the ESR is responsible

to support the applications for the clients’

management and must contain all data that is

necessary to assure the consistency of care

providing. Therefore, the information model must

allow the retrieve of the social and clinical history of

the client, as well as all the relevant moments of

interaction.

The development approach that was followed was

to separate the information semantics and

knowledge into two different levels: the information

model and the knowledge model.

The information model is a generic one, in order

to be able to embraces all type of information

necessary to record the client’s information, but also

adjustable to answer to the requirements of each

service in what concerns to the access to the

information. It contains only non-volatile concepts

in order to be maintainable, and it is the fundamental

model for the software engineers to perform the

technical implementation of the information

systems.

The main components of ESR model allow

answering to six basic questions linked to each

record: what, when, where, who, why and how.

Therefore, it is composed by four basics elements

(see the high level diagram of the Figure 1):

transaction, entry, collection and item. The ESR is

composed by several versioned transactions, which

can contain one or more entries of different types:

observation, assessment or instruction. The

information contained in an entry is grouped in

collections. The collections are constituted by items,

which correspond to the elementary units of

information. Furthermore, the transaction must be

capable to reflect the context (who validated the

inserted information and why it was inserted) and

the collection must reflect the procedural context

ICEIS 2006 - INFORMATION SYSTEMS ANALYSIS AND SPECIFICATION

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and time, where the information was created, as well

who is the author of the information.

The presented structure is a generic one (prepared

to suffer evolutions, whether they are technological

or organizational structure) that allow to store all

information about the clients, without however to be

compulsive the use of all the data for all the services

or institutions. Therefore, it is necessary to define a

set of different models that organize the information

according to the different services or the needs of the

different care providers. This corresponds to a

second level of abstraction (the knowledge model)

where the numerous, volatile concepts of most

domains are expressed.

The knowledge model adjusts the information

model to the needs of each PSSI, service or care

provider in what concerns to the information that

should be part of the client record and to the forms

of accessing this information. For that it is necessary

to define archetypes that are distinct domain entities

that express constraints on instances of the

underlying information model (Beale, 2001). In the

followed approach, archetypes are instances in an

object oriented system implementation, which

means they can be created and manipulated by

graphical user interface tools, alter as desired

without changing the underlying information system

technical specifications.

The main advantage of the followed approach is

that software engineers develop the technical

models, while a phased approach with an active

involvement of the PSSI collaborators is used to

develop the concepts of the knowledge model.

Therefore, the final users are empowered to directly

produce artefacts to control how their system will

function.

This technical approach allows the introduction

of a new information service in an incremental way,

being the PSSI collaborators the ones who define the

relevant information to maintain in the system, how

the user interfaces should behave, what are the

suitable forms for accessing the information and

how the care providing process should be organized.

6 EVALUATION

Due to the opportunities and challenges of the

development of the information society it is urgent

to find the best practical ways for that development.

The Programme Aveiro - Digital (Rocha, 2002)

attempts to respond to this important challenge

through the search for better ways to the

development and introduction of IT solutions in a

region scale as well as by showing evidence of the

advantages they can provide. The making of the

Aveiro - Digital has been accomplished more on the

basis of a radical transformation of the habits and

behaviour of the citizens and institutions, rather than

just providing it with the necessary infrastructures

and systems. Therefore, the Aveiro - Digital

represents an opportunity and an ideal scenario to

evaluate the developed tools and models. The

Information Services for the Social Solidarity

Institutions, a three years project of the Programme

Aveiro - Digital that congregates a representative

Figure 1: Main Components of the ESR information model.

-subject

-author

-terminology

Entry

-content

-executor perfil

-sumary

-instruction date

Instruction

-content

-assessment date

Assessment

-content

-observation date

-mode

Observation

-local

-participants

-reason

-language

-validation date

-who validates

-service

Transacti o n

-version

Version

-denomination

Item

-denomination

Collection

0..*

1..*

0..*

STRUCTURED APPROACH FOR THE INTRODUCTION OF INFORMATION SERVICES INTO THE PRIVATE

SOCIAL SOLIDARITY INSTITUTIONS

347

group of PSSI and public welfare agencies, has been

selected for this evaluation.

Therefore, the ESR was part of a Client

Management Information Service that allows the

care providers to have a distributed access to the

information about the clients.

The underlying information systems follow a

multi-layer architecture. At the presentation level,

different interfaces may exist according to final

user’s preferences, needs and terminal equipment

that are being used. This corresponds to an

abstraction layer that comprises all the

communication between the system and the users,

with their profiles stored in the system. The profiles

can determine how the interface to a given user is

presented. This approach has been easily

implemented due to XML technologies.

Several archetypes were developed and they were

included in a concept layer that is used to access the

ESR. The ESR belongs to a middleware layer that

presents other common functions such as a person

identification service or security related functions

(namely, authentication of the identity of the user

that is requesting an information access or the basic

mechanisms describing the users authorised to

access the system and the functions they are able to

perform).

From the engineering point of view, the web

services technologies were selected for the

implementation of various components. This system

architecture is technologically neutral, guarantees

the interoperability with standardized solutions and

allows the integration of software components from

different sources.

7 CONCLUSIONS

Within the Aveiro - Digital a structured approach

has been followed to capture heterogeneous users’

requirements, to define complex technical

specifications, to help the systematisation of broad

range of concepts of the social care domain and to

facilitate the reorganization of internal procedures of

several PSSI. The main result was the establishment

of new practices, namely those related to the record

of the performed activities (almost inexistent

before). The developed Client Management

Information Service allowed a continuous record of

the performed activities and had motivated the

standardization of procedures for the

accomplishment of certain actions or interventions.

Furthermore, the implementation approach of

having a generic information model for the ESR that

can be customize by defining the appropriate

knowledge model (archetypes) allows the

generalization of the information systems (the same

implementation has been introduced in different

PSSI, although different archetypes were defined).

The experience gained shows a high level of

acceptance by the involved PSSI. Among others, the

reasons for the acceptance are related with the

structured approach, namely the existence of

reference models and a set of comprehensible tools

that facilitates the involvement of the PSSI

collaborators.

At this moment, the aim is to identify a set of

performance indicators in order to quantify the

profits and to measure the return of the investment in

terms of benefits that contribute to the PSSI

objectives.

REFERENCES

Rocha, N., 2002, Aveiro - Digital Town: A Social

Services Experiment. In Advances in Digital

Government - Technology, Human Factors and

Policy. Kluwer Academic Publishers.

Souza, E., Santana, S., Rocha, N., 2004. The Supporting

Role of Technology in the Provision of Care,

Inhibitors and Facilitators in its Implementation,

Universidade de Aveiro. Aveiro.

Kodner, D., 2002, Integrated Care: Meaning, Logic,

Applications, and Implications: A Discussion Paper.

In International Journal of Integrated Care, Vol.2.

Rocha, N., Queirós, A., 2005, Introduction of Information

Services into the Private Social Solidarity Institutions.

In Innovation and the Knowledge Economy – Issues,

Applications, Case Studies. IOS Press.

Beale, T., 2001, Health Information Standards Manifesto,

www.deepthought.com.au.

Himss, 2004, HIMSS Electronic Health Record

Definitional Model, EHR Definition, Attributes and

Essential Requirements – version 1.0, Electronic

Health Record Committee.

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