The MOBEL Project

This chapter presents results and experiences from the MOBEL (MOBile ELectronic patient record) project at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. MOBEL was a multidisciplinary research project established in 2000. The problem area of the project was communication and information needs in hospital wards, and the aim of the project was to develop and explore methods and prototypes for point of care clinical information systems (PoCCS) that support clinicians in their patient-centered activities. The chapter summarizes four sub studies performed during the project. Each study presents different approaches to user-centered design of PoCCS. Findings from these studies confirm the need for mobile information and communication technology (ICT) in hospitals. Furthermore, the studies demonstrate how more user involvement and complementary approaches to traditional requirements engineering (RE) and system development methods can be useful when developing mobile information and communication systems for clinicians.

Towards an Evaluation Framework for E-health Services

The purpose of this study is to explore the user’s perspective in evaluating e-health services, and to present evaluation criteria that influence user’s utilization and satisfaction of e-health services. The evaluation criteria are based on two lines of studies relating to the behaviour of users of new products or services and on broad examining and critical analysis of the existing evaluations initiatives in e-health context. The evaluation criteria can serve as part of an e-health evaluation framework, and also to provide useful tools to allow the development of successful e-health initiatives by assisting the healthcare organisation to address areas that require further attention.

A Quality Assurance Approach to Healthcare

Despite decades of research, healthcare information systems have been characterised by cost over-runs, poor specifications and lack of user uptake. A new approach is required which provides organisations with a reason to invest in this type of software. W Edwards Deming argues that quality is not an entity but derives from using feedback, iteratively to seek improvement to processes, in order to increase productivity and to make better use of resources. The authors propose that supporting this form of quality assurance (QA) using information systems (IS) has the potential to deliver a return on investment. An object-oriented analysis, where healthcare is viewed as the delivery of interdependent processes to which Deming’s form of QA is applied, results in a class model of data types that has some useful characteristics. It is able to store data about medical and nonmedical events; to save descriptions of procedures and to represent the QA process itself. With software based on the model, organisations will have a memory of previous attempts at making improvements as well as data about feedback from patients and staff to drive future change. A critical research in information systems (CRIS) analysis of this model proposes a number of criticisms deriving from theories about rationality; concepts of technology; politics and hidden agendas, as well as the social consequences of technology. The view that QA is a standardised, ongoing conversation about the important characteristics of a process pre-empts many of these counter arguments. The CRIS critique also highlights the need to ensure that development is in harmony with the needs of the many stakeholders in healthcare IS. These concepts lead to new directions in healthcare IS research. The class model needs to be tested against clinical and non-clinical use-cases for its viability not only as support for QA but also as an electronic patient record. A standard terminology is required for processes and for how objects from the model should be used to represent them. The model predicts that user interfaces will have to collect more detailed data than hitherto. Also use of the software should be tested in controlled trials to demonstrate whether the required improvements in quality not only benefit the patient but also the organisations managing their care.

Investing Trust Relationships in a Healthcare Network

Public hospitals currently face an ever increasing demand on their resources, and there are many attempts at streamlining processes and patient flows. However, in many cases, optimizing processes is not enough, as ‘soft’ factors such as the relationships between hospital wards influence how efficiently the resources needed to treat patients are utilized. These factors are often ignored when attempting to improve patient flows. In this chapter, the authors describe a case study investigating the relationships between an acute stroke ward and a specialist stroke rehabilitation ward of a large metropolitan health service. The motivation for this study was the hospital management’s interest in improving communication and collaboration across wards as a means to optimize hospital processes, and thus, patient care. To assess the relationships between the two wards, the authors examined the patient handover process that links the wards’ activities and applied the Trust-Confidence-Distrust (TCD) framework of Gans et al. (2003), which was developed to model trust relationships in social networks, to examine the trust relationships between the wards.

Improving Patient Safety with Information Technology

Over three-quarters of a million people are injured or die in hospitals annually from adverse drug events. The majority of medication errors result from poorly designed health care systems rather than from negligence on the part of health care providers. Health care systems, in general, rely on voluntary reporting which seriously underestimates the number of medication errors and adverse drug events (ADEs) by as much as 90%. This chapter reviews the literature on (1) the incidence and costs of medication errors and ADEs; (2) detecting and reporting medication errors and related ADEs; (3) and the use of information technology to reduce the number of medication errors and ADEs in health care settings. Results from an analysis of data on medication errors from a regional data sharing consortium and from computer simulation models designed to analyze the effectiveness of information technology (IT) in preventing medication errors are summarized.

HealthGrids in Health Informatics

Healthcare is a vast domain encapsulating not only multiple sub-domains or sub-sectors but also many diverse operations and logistics within each sub-sector. This diversity needs to be handled in a systematic and well-characterized manner in order to maintain consistency of various healthcare tasks. Integration of health information systems within each healthcare sub-sectors is crucial for ubiquitous access and sharing of information. The emerging technology of HealthGrids holds the promise to successfully integrate health information systems and various healthcare entities onto a common, globally shared and easily accessible platform. Many different types of HealthGrids exist but there lacks a taxonomy to classify them into a hierarchical order. This chapter presents a well-characterized taxonomy of different types of HealthGrid and classifies them into four major types, namely BioGrid, MediGrid, PharmaGrid and CareGrid. Each of these HealthGrids possesses dedicated features and functionalities. The proposed taxonomy serves to better understand the realtionship among various HealthGrid types and would lay a basis for future research.

Managing ICT in Healthcare Organization

The objective of this chapter is to illustrate a case study of a medical research institute in Malaysia in order to discuss issues pertaining to ICT adoption in healthcare organizations, in particular exploring the culture, challenges, and issues of ICT adoption among medical teams, patients, etc. In this chapter, we examine the question of ‘What are the challenges of implementing ICT in healthcare organizations?’ Some of the lessons learned from the case study were: ICT was successfully adopted and implemented based on several factors such as supportive organizational culture, competent IT workers, committed IT department and heavy investment on ICT infrastructure. Yet challenges also arise which hinges upon factors like initial deployment of outside IT resources or expertise for ICT implementation, lack of user training and continuous communication between involved parties in the initial stage.

Computerization of Primary Care in the United States

The objective of this study was to assess the current level of information technology use by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall, between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, point-of-care decision support tools, and electronic communication with patients. This indicates a slow rate of adoption since 2000. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members in the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products, and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

Speeding Up Decision Support

Discrete-Event Simulation (DES) is a decision support technique that allows stakeholders to conduct experiments with models that represent real-world systems of interest. Its use in healthcare is comparatively new. Healthcare needs have grown and healthcare organisations become larger, more complex and more costly. There has never been a greater need for carefully informed decisions and policy. DES is valuable as it can provide evidence of how to cope with these complex health problems. However, the size of a healthcare system can lead to large models that can take an extremely long time to simulate. In this chapter the authors investigate how a technique called distributed simulation allows us to use multiple computers to speed up this simulation. Based on a case study of the UK National Blood Service they demonstrate the effectiveness of this technique and argue that it is a vital technique in healthcare informatics with respect to supporting decision making in large healthcare systems.

Evaluation of Health Information Systems

This chapter summarizes the problems and challenges that occur when health information systems are evaluated. The main problem areas presented are the complexity of the evaluation object, the complexity of an evaluation project, and the motivation for evaluation. Based on the analysis of those problem areas, the chapter then presents recommendations of how to address them. In particular, it discusses in more detail what benefits can be obtained from applying triangulation in evaluation studies. Based on the example of the evaluation of a nursing documentation system, it shows how both the validation of results and the completeness of results can be supported by triangulation. The authors hope to contribute to a better understanding of the peculiarities of evaluation in healthcare, and to provide information how to overcome them.