EXPLORING CRUCIAL FACTORS FOR INTEGRATING MEDICAL CLOUD AND HEALTHCARE
LOGISTICS BY DANP Shih-Ming Ou*1 *1 Department of Logistics
Management, Fujian Jiangxia University, Fuzhou, China DOI: https://doi.org/10.29121/IJOEST.v4.i1.2020.66 ABSTRACT This study aims to investigate and explore the critical success factors which affect the integration of medical cloud and pharmaceutical logistics operations. To achieve research objective, we firstly collected the opinions of medical management experts through the process of the Delphi method, and then affecting the integration of medical cloud and healthcare logistics operations were screened and summarized. Secondly, the questionnaire was conducted and 11 experts’ assessments of the influence between every two factors were acquired. Furthermore, this study employed DANP to calculate the weight for each factor when there exists interaction relationship among the factors and to plot causal map. Reviewing the causal map and the weights for each factor, “To induct artificial intelligence (AI) into medical treatment” and “To develop intelligent healthcare logistics” are significantly higher than other factors in terms of total influence value, net influence value and relative importance. Our findings can provide hospitals and pharmaceutical companies as a basis in formulating cloud medical development strategy. Keywords: Medical Cloud; Healthcare Logistics; Crucial Factors; DANP. 1. INTRODUCTION As the people’s
needs on material culture are getting higher and higher, they are also paying
more attention to their health. More and more hospitals at home and abroad are seeking
solutions to reduce medical costs, increase the flexibility of the pharmaceutical
supply chain, and strengthen the hospital’s service level to cope with
increasing efficiency requirements. There are minimal studies on cloud medical
and pharmaceutical distribution at home and aboard, including very few
integrated applications for cloud medical and pharmaceutical distribution.
Under such a social background, we should emphasize their importance. Currently, some
hospitals have started to use the integrated cloud medical and distribution,
but they have failed to produce good results due to many problems hidden
within. There is a lack of studies in this area, and there are very few
hospitals using this concept, not to mention the little flexibility of the
pharmaceutical supply chain as well as the entire supply chain. The reasons are
inadequate information sharing among pharmaceutical material suppliers, drug
suppliers, hospitals, and consumers. The slow drug distribution from the
hospitals has thus resulted in low customer satisfaction. So, this paper aims
to integrate the definition and connotation, types, measurement research, and
other means of elaboration on cloud medical and pharmaceutical distribution.
The undertakings are integrating cloud medical and pharmaceutical distribution
properly, making a systematic plan to deal with diversified consumer needs
brought about by economic globalization and sustainable development. The paper is
divided into five parts to analyze and evaluate the integration of cloud
medical and pharmaceutical distribution. The hospitals at Fuzhou were chosen as
examples for an explanation. Part 1 will elaborate on the research background,
research purposes, significance, and clarification of the scope and research
limitations. Part 2 will review the relevant literature on pharmaceutical
distribution, cloud medical, and decision-making experimental analysis methods.
Part 3 will introduce the DEMATEL-based Analytic Network Process (DANP)
algorithm. Part 4 will introduce and analyze the current status of SPD and
medical logistics in Fuzhou regional hospitals, construct the factors and
structural aspects that affect the integration of cloud medical and
pharmaceutical logistics, get the expert’s assessment, and perform the final DANP
analysis. Part 5 will thoroughly combine the measurement and evaluation
results, and propose feasible suggestions for integrating cloud medical and
pharmaceutical distribution to make them more realistic. 2. LITERATURE REVIEW 2.1. Pharmaceutical Supply, Processing, and
Distribution (SPD) American
scholars originally proposed the concept of SPD. Although this concept was
first put forward in the United States, many hospitals in Japan began to
implement this system shortly after the proposal. Now China is also actively
supporting and encouraging to implement SPD, where many hospitals have made
small achievements in this regard. The management
models of the SPD procurement supply chain refer to the comprehensive
statistics of the hospital’s
upper-level suppliers, the hospital’s required drug facilities, communication with the hospital through
modern information channels, and concentrating the procurement of drugs from
the suppliers. At the same time, the suppliers should provide the hospital with
full logistics management, such as inventory management, customized drug
packaging in separated or combination forms [12]. The
implementation of the SPD model in hospitals can strengthen the supervision and
circulation of drugs, reduce the costs of medical care, and improve the social
and economic effects of hospitals, thereby paving the way for them in future
development. It is necessary to strengthen the construction of information
technology to improve SPD efficiency. Now that modern society has become a
changeable society; any system has to be integrated with reality. Only then can
we realize the modern logistics [13]. 2.2. Cloud Medical 1) The meaning of cloud medical Cloud medical is
a new type of medical service. It is the combination of high-tech technologies,
such as the Internet, the Internet of Things (IoT), and big data with medical
services to promote fast hospital operation. Such a new operating concept and
pleasant customer experience will enhance the hospital’s comprehensive strength and competitiveness
[2]. Gao Feng, Mao
Dian, and Wang Sheng have defined cloud medical as the use of network
interaction methods to integrate all hospital processes (including
appointments, doctor consultation, dispensing the drugs to customers, etc.)
through a network platform to increase customer satisfaction. The concept of
applying a cloud medical concept can improve the hospital’s previous inherent problems and save time,
thereby reducing the registration time, queueing, and payment significantly.
Cloud medical is a new medical model and a new service model, and the effect of
using this model is evident [11]. 2) Significance and advantages to realize cloud
medical First of all,
there are many small-scale hospitals where fewer people would like to go. Even
if the hospitals have used the cloud medical management system, they still
cannot change their inherent problems. So, having a standardized medical system
is the core to attract patients to visit. The cloud medical-based management
system can make full use of its advantages and achieve the best results. Cloud
medical can only play its roles well if supported by a large number of
patients, helping all service data links in the hospital and clinic to
communicate with each other and work out the procedures effectively. Secondly, the
cloud has one of the most critical advantages of reasonable cost control. The
cloud belongs to the hospital information organization and needs more funds
when it is initially implemented. A continuous rise in the economic level will
increase people’s
needs and harder to satisfy their demands. After a while, when the people’s demand preferences have changed, the
system will subsequently be altered. Listed below are
some of the highlights of cloud medical: ·
Time-saving.
The use of a cloud medical platform will enable the doctors to view the
patients’ status on the network.
If the patients do not have any significant problems, they can skip going to
the hospital and save time. They can also use some network reservation
platforms to shorten their waiting time, allowing them to schedule their
appointments with the doctors orderly. ·
Wide
coverage. The global interoperability of the Internet has expanded the coverage
of the cloud medical platform. 3) Although cloud medical is meant to serve the
people, it is also convenient for the hospitals for not having to establish
specialized medical technology in them. Therefore, investment in medical
technology is significantly small. The corresponding costs are not as high as
we think. ·
Cloud
medical acceptability As far as China
is concerned, the concept of cloud medical is generally accepted by residents
in the first-tier and second-tier cities where the city lives are faster, the
economic development is quicker, and the scientific technology level is higher.
Not only do young people have a deeper understanding of scientific technology,
but many older people can also keep track of their lives. Their thinking is
relatively open, and their acceptability is stronger, so their degree of
acceptance on cloud medical is naturally higher. However, for some second-tier
and third-tier cities, their acceptability is far less than that of the
first-tier cities with a higher level of economic development. In
underdeveloped cities, not only are the elderly conservative, but many young
people also cannot keep up with the pace of the times, and it is hard for them
to accept and apply new things that promote development. The so-called cloud
medical in many cities is confined to online outpatient appointments. 2.3. Intelligent Pharmaceutical Logistics The so-called
pharmaceutical logistics means that the resources of the entire supply chain
are effectively integrated under the support of some information systems
related to logistics, and technologies related to logistics. The optimization
of various pharmaceutical distribution processes can accelerate the hospital’s order processing capability, enhance its
efficiency, and improve customer satisfaction. Once the customer satisfaction
has increased, it will subsequently improve the number of orders and reduce
costs. Yang Wan-hong, Jiang Wei, and Wu Shi-yu believe that in the logistics operation process, there
is a very high requirement on the quality of drugs [14]. Dong Wen-chen pointed out that cold chain logistics includes the
distribution of pharmaceutical logistics. In the distribution process, the
medical supplies must be frozen to ensure that they will not deteriorate and
affect the health of residents. The pharmaceutical logistics is deemed
successful if only it is integrated with all aspects of distribution, i.e.,
combining the use of refrigeration technology such as freezers and tracking the
entire process through the network information technology. The whole of the
cold chain logistics process must be carried out in a low-temperature
environment. Many prescribed drugs and non-prescribed drugs, such as
traditional Chinese medicines, western medicines, and vitamins, are classified
in the scope of pharmaceutical distribution, and naturally listed in the range
of cold chain logistics. Basically, drugs need to be delivered in frozen form
to maintain their activity. Once the temperature is too high, many drugs will
deteriorate and lose their activeness [4]. Many problems
still exist in China’s
pharmaceutical logistics. As pharmaceutical logistics belongs to a branch of
cold chain logistics, many scholars have seen their issues through different
angles and proposed countermeasures to solve them. For example, Ge Li-qing, Zhang Jing-chao, and Wu Yan-yun
have studied the mode and method of China’s pharmaceutical cold chain logistics
services and proposed improvement suggestions [10] [6]. 3.
DEMATEL-BASED ANALYTIC NETWORK
PROCESS(DANP) Listed below is
the DANP algorithm. Step 1: Defining
the criteria (impact factors) and establishing a hierarchical structure of
aspects and guidelines Step 2:
Obtaining the expert’s
assessment on the impact of pairwise comparisons among the criteria Step 3:
Constructing the initial impact matrix Step 4:
Normalizing the initial impact matrix Step 5:
Exporting the total impact matrix Step 6: Drawing
a causal diagram of the aspects and criteria Step 7:
Processing the estimated values of aspect impact Step 8:
Constructing an unweighted supermatrix Step 9:
Constructing a weighted supermatrix Step 10:
Calculating the supermatrix limitations 4.
CASE
ANALYSIS OF FUZHOU REGIONAL HOSPITALS Fuzhou General
Hospital is regarded as a three-level hospital. After decades of development,
it has been improved with advanced infrastructure and high medical skills,
allocated with many excellent doctors, and has managed the information
technology soundly. According to a survey, this study found that the SPD used
by Fuzhou General Hospital has mostly remained on making outpatient
appointments through the online platform. The application of SPD only occurs
between the hospital and the pharmaceutical suppliers, and there is no
pharmaceutical distribution between the hospital and patients. The patients can
only line up to pick up the doctors’prescriptions at the dispensary. Many hospitals
in Fuzhou have attempted to establish a hospital order by making appointments
through the online platform, but the practice is very insignificant. Many older
people do not make appointments on the Internet. Even if the family members
have helped them to make online appointments, they will not pick up the number
at the hospital’s
terminal. Even if everyone has made the appointments, the queuing order is
still chaotic. Many people will queue up before the doctors come, and the
doctors will diagnose the patients first under the active request of the
patients. They do not adopt the “invalid overdue number”
system, thus resulting in chaotic diagnoses. Once the
patients visit the hospitals, the hospitals are designed to meet their needs.
The hospitals must provide patients with the fastest, most convenient, most
effective, and lowest cost services. Life needs innovation, and these words in
the medical world will not be outdated. The hospitals must always find suitable
systems and regulations, and supervise their executions and deepen the reforms.
Nowadays, not only do the hospitals need to emphasize their medical strength,
but they also stress cost reduction and improve the operational efficiency to
meet with the trend of the times. The chaotic queuing and pharmaceutical
distribution phenomena are still prevalent in many hospitals in Fuzhou.
Currently, the pharmaceutical distribution practice is even done manually in a
flow line manner, thus causing increasing loss and damage of drugs. It is for
this reason that we must work harder and apply all available means to enhance
the efficiency of SPD. From the
relevant literature, it is found that most hospitals have the apparent problems
of backward infrastructure equipment, inflexible distribution supply chain, and
low SPD efficiency. Based on the research and analysis on the integration of
cloud medical and pharmaceutical distribution, four aspects were proposed by
this study to analyze and discuss the operation management, urban traffic
pressure, quality and level of the distribution services, and distribution
service benefits of the cloud medical platform, and 18 criteria were
subsequently summarized. Table 1: The factors and their
description
A
causal diagram was drawn after obtaining the expert evaluation and data
processing results. Figure 1: Causal map The overall weight of the DANP was also obtained through the ANP
algorithm. From the causal diagram and the overall
weight, the factors that have a more significant impact on cloud medical and
pharmaceutical distribution, such as “information network technology,” and “different
needs for drugs from various patients,” were selected among the factors
affecting the planning of cloud medical and pharmaceutical distribution system.
Regardless of the total impact, net impact, and overall weight, they are
significantly higher than other factors. They are known as crucial factors. 5.
CONCLUSION In this paper,
four significant aspects and 18 guidelines were summarized after collecting and
analyzing the relevant data affecting the integration of cloud medical and
pharmaceutical distribution. The analysis was further conducted on the causal
relationship that affects cloud medical and pharmaceutical distribution, and
the following conclusions were obtained: First, the
management level of the cloud medical platform is an essential factor affecting
cloud medical and pharmaceutical distribution. The management level of the
cloud medical platform includes platform maintenance, the management of
relevant platform personnel, and the supervision of the platform operations. Second, the
practicality of the cloud medical platform. For one thing, there are
uncertainties, or perhaps extremely high uncertainties, to achieve real
diagnoses of patients through the network, and whether or not it can genuinely
prescribe the right drugs for the patients according to their illnesses. This
concept has not been adequately promoted in many hospitals in Fuzhou, as some
hospitals have poor infrastructure and insufficient quality facilities. On the
other hand, the elderly take up a large portion of
patients, considering that the platform is a new thing that they do not know
how to use. Both aspects are sufficient to illustrate the importance of the
practicality of the cloud medical platform. So, the platform must be realistic
and implementable before we can further discuss the efficiency issue. Third, patient
satisfaction with the services. As everything about the supply chain design and
all logistics activities ultimately aims to improve customer satisfaction, it
will increase the competitiveness of the hospital, and naturally, enhance its
core competitiveness. More and more patients will then choose to visit this
hospital, inquire about the diagnoses on the hospital’s platform, and agree to
its pharmaceutical distribution. This enterprise will eventually stand firm in
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