Introducing E-Procurement in a Local Healthcare Agency

This chapter deals with the introduction of electronic procurement in the public healthcare domain. After a brief discussion on the healthcare spending characteristics and on the suitability of e-procurement tools in the public sector; the long-lasting experience of e-procurement implementation promoted by an Italian Local Healthcare Public Agency is described. This initiative included some pilot projects and applied many different solutions; always involving both a new ICT tool and a thorough process redesign. The development of the innovation introductions is discussed; together with their organizational and managerial background; the description of the new processes; and the analysis of the most relevant results. The chapter provides a fairly comprehensive illustration of available solutions; opportunities; and challenges in this still neglected topic.

Transforming Continuing Healthcare Education with E-Learning 2.0

The e-learning 2.0 transformation of continuing education of healthcare professionals (CE/CME) will be characterized by a fundamental shift from the delivery of static information online to a seamless, digital operation in which all users have the ability to access, create, and share knowledge in a multidimensional, instantaneous, collaborative, and interactive manner. This transformation will be disruptive, blurring existing boundaries between CE/CME professionals, content experts, and student learners, and modifying the traditional structured learning process to a more informal one. While the opportunities are unlimited, the transformation will present not only technology challenges but also social and educational challenges. Recent experiences with similar disruptive technologies show that a meaningful transformation can be achieved only if the application of technology is accompanied by strategic operational changes. This chapter offers a conceptual framework to guide CE/CME professionals interested in transforming their operations with new e-learning 2.0 technologies. Employing several usage scenarios, a new e-learning 2.0-based model of CE/CME operation is introduced. We also present several examples of approaches adopted by our academic group to address the various challenges discussed in this chapter.

Pediatric Telepsychiatry as Innovation in Healthcare Delivery

Although a great deal has been written about the potential for telemedicine to increase access to care, applications in paediatrics are sparse. This chapter details how one paediatric telepsychiatry program has facilitated the creation of integrated healthcare solutions in patient psychiatric care for children and youth in remote and rural communities. It demonstrates how the telepsychiatry model of healthcare service delivery has improved access, enhanced capacity, and promoted knowledge exchange in rural communities. A case study is used to highlight theoretical and empirical research on the value of televideo information technology in mental healthcare and its impact on the healthcare stakeholders who utilize this technology. An overview of the clinical, education, and evaluation components of the program is outlined, with a focus on knowledge translation and exchange as the underpinning foundation to the success of the program.

An Evidence-Based Health Information System Theory

The aim of this chapter is to bridge the gap between what is known about IS theory and the specifics characteristics of health to develop an evidence based health information systems theory. An initial background first sets the significance for the need to have a solid information systems theory in health and then argues that neither the information systems literature nor the health sector have been able to provide any satisfactory pathway to facilitate the adoption of information systems in health settings. The chapter further continues by reviewing the common pathway to develop information systems theory and the knowledge foundations used in the process, and then proceeds to highlight how this theory was developed. Subsequently, the building blocks (constructs, premises, supporting evidence and conclusions) that underpins the constructs and a brief explanation of the relationships between them is included. A discussion and limitation section is then followed by a conclusion.

Multicriteria Models for E-Health Service Evaluation

The use of advanced telecommunication and information technologies has been investigated for several decades as an effort in improving healthcare services. Over the last ten years, in particular, efforts have been centered on telemedicine, which has become an increasingly attractive field of research in healthcare service delivery. This chapter discusses multiple criteria evaluation of electronic healthcare (e-health) services, a branch of telemedicine, with both users’ and practitioners’ (service provider) perspectives. The proposed approach integrates several analytical decision making techniques and can be helpful in increasing the flexibility and efficiency of e-health service planning. Several different discrete alternative methods, namely AHP, Borda Count, LINMAP, and PROMETHEE are utilized to prioritize different e-health services and to evaluate preferences of both users and practitioners.

Towards Process-of-Care Aware Emergency Department Information Systems

The critical role of emergency departments (EDs) as the first point of contact for ill and injured patients has presented significant challenges for the elicitation of detailed process models. Patient complexity has limited the ability of ED information systems (EDIS) in prediction of patient treatment and patient movement. This article formulates a novel approach to building EDIS Activity Views that paves the way for EDIS that can predict patient workflow. The resulting Activity View pertains to “what is being done,” rather than “what experts think is being done.” The approach is based on analysis of data that is routinely recorded during patient treatment. The practical significance of the proposed approach is clinically acceptable, verifiable, and statistically valid process-oriented clusters of ED activities that can be used for targeted process elicitation, thus informing the design of EDIS. Its theoretical significance is in providing the new “middle ground” between existing “soft” and “computational” process elicitation methods.

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.

Electronic Medical Records, HIPAA, and Patient Privacy

The continued growth of healthcare information systems (HCIS) promises to improve quality of care, lower costs, and streamline the entire healthcare system. But the resulting dependence on electronic medical records (EMRs) has also kindled patient concern about who has access to sensitive medical records. Healthcare organizations are obliged to protect patient records under HIPAA. The purpose of this study is to develop a formal privacy policy to protect the privacy and security of EMRs. This article describes the impact of EMRs and HIPAA on patient privacy in healthcare. It proposes access control and audit log policies to safeguard patient privacy. To illustrate the best practices in the healthcare industry, this article presents the case of the University of Texas M. D. Anderson Cancer Center. The case demonstrates that it is critical for a healthcare organization to have a privacy policy.

Physician Characteristics Associated with Early Adoption of Electronic Medical Records in Smaller Group Practices

To examine physician characteristics and practice patterns associated with the adoption of electronic medical records (EMRs) in smaller group practices. Primary care physicians in Kentucky were surveyed regarding their use of EMRs. Respondents were asked if their practice had fully implemented, partially implemented, or not implemented EMRs. Of the 482 physicians surveyed, the rate of EMR adoption was 28%, with 14% full implementation and 14% partial implementation. Younger physicians were significantly more likely to use EMRs (p = 0.00). For those in their thirties, 45% had fully or partially implemented EMRs compared with 15% of physicians aged 60 and above. In logistic regression analyses that controlled for practice characteristics, age, male gender, and rural location predicted EMR adoption. Younger physicians in smaller group practices are more likely to adopt EMRs than older physicians. EMRs were also associated with an increased use of chronic disease management.

Developing Global Competitiveness in Healthcare

Healthcare is a competitive business in its own right. Global competition in healthcare adds yet another complex dimension to the success of a healthcare organization. Providing state of the art technology along with the manpower and management skills to bridge boundaries and cultures, confronts today’s healthcare organizations with challenges that, while on the surface may appear simple, may also prove to be a bigger challenge to their success and survival than the medical care they are actually providing. This case study explores one major healthcare organization in Thailand posing the question of what it sees as critical to the success of healthcare competition in the global community. An inductive approach was utilized for a method of determining competitiveness. The resulting qualitative analysis of that data addresses issues of seeking and maintaining global competitiveness, providing superior quality care with competitive and reasonable pricing of sub-specialty and high acuity services and work effectively through strategic alliances. In the case of the healthcare organization in this study, global competitiveness is maintained through what they term “Thainess”. That “Thainess” or ability to provide comfort and hospitality at the same time as providing excellent medical care and facilities give them both economy of scale to provide reasonable pricing and a uniqueness in the medical care provided. Uniqueness and quality in service attracts strategic alliances of similar quality and allows for expansion into global communities that were not possible in the past.