An Integrated and Distributed Framework for a Malaysian Telemedicine System (MyTel)

The overall aim of the research was to produce a validated framework for a Malaysian integrated and distributed telemedicine system. The framework was constructed so that it was capable of being useful in retrieving and storing a patient's lifetime health record continuously and seamlessly during the downtime of the computer system and the unavailability of a landline telecommunication network. The research methodology suitable for this research was identified including the verification and validation strategies. A case study approach was selected for facilitating the processes and development of this research. The empirical data regarding the Malaysian health system and telemedicine context were gathered through a case study carried out at the Ministry of Health Malaysia (MOHM). The telemedicine approach in other countries was also analysed through a literature review and was compared and contrasted with that in the Malaysian context. A critical appraisal of the collated data resulted in the development of the proposed framework (MyTel) a flexible telemedicine framework for the continuous upkeep o f patients' lifetime health records. Further data were collected through another case study (by way of a structured interview in the outpatient clinics/departments of MOHM) for developing and proposing a lifetime health record (LHR) dataset for supporting the implementation of the MyTel framework. The LHR dataset was developed after having conducted a critical analysis of the findings of the clinical consultation workflow and the usage o f patients' demographic and clinical records in the outpatient clinics. At the end of the analysis, the LHR components, LHR structures and LHR messages were created and proposed. A common LHR dataset may assist in making the proposed framework more flexible and interoperable. The first draft of the framework was validated in the three divisions of MOHM that were involved directly in the development of the National Health JCT project. The division includes the Telehealth Division, Public and Family Health Division and Planning and Development Division. The three divisions are directly involved in managing and developing the telehealth application, the teleprimary care application and the total hospital information system respectively. The feedback and responses from the validation process were analysed. The observations and suggestions made and experiences gained advocated that some modifications were essential for making the MyTel framework more functional, resulting in a revised/ final framework. The proposed framework may assist in achieving continual access to a patient's lifetime health record and for the provision of seamless and continuous care. The lifetime health record, which correlates each episode of care of an individual into a continuous health record, is the central key to delivery of the Malaysian integrated telehealth application. The important consideration, however, is that the lifetime health record should contain not only longitudinal health summary information but also the possibility of on-line retrieval of all of the patient's health history whenever required, even during the computer system's downtime and the unavailability of the landline telecommunication network

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective

Background Electronic health records (EHR) make health care more efficient. They improve the quality of care by making patients’ medical history more accessible. However, little is known about the factors contributing to the successful EHR implementation in dental clinics. Objectives This article aims to identify the perceived critical success factors of EHR system implementation in a dental clinic context. Methods We used Grounded Theory to analyse data collected in the context of Brunei’s national EHR − the Healthcare Information and Management System (Bru-HIMS). Data analysis followed the stages of open, axial and selective coding. Results Six perceived critical success factors emerged: usability of the system, emergent behaviours, requirements analysis, training, change management, and project organisation. The study identified a mismatch between end-users and product owner/vendor perspectives. Discussion Workflow changes were significant challenges to clinicians’ confident use, particularly as the system offered limited modularity and configurability. Recommendations are made for all the parties involved in healthcare information systems implementation to manage the change process by agreeing system goals and functionalities through wider consensual debate, and participated supporting strategies realised through common commitment

Implementation of e-health interoperability in developing country contexts : the case of Zimbabwe

The provision of information technology-enabled healthcare services (e-health) has been adopted by numerous public and private facilities in both developing nations and advanced nations. However, one of the obstacles to the adoption of health information systems has been cited as their lack of interoperability resulting in their reduced effectiveness. In view of this, the study sought to explore the interoperability of health information systems employed in the country and then propose a framework to direct the process of implementing e-health interoperability. The study’s methodology was qualitative and a case study was undertaken. Semi-structured interviews were employed to gather data from e-health stakeholders in state-owned institutions and private enterprises. Document review was also conducted to substantiate findings from interviews. Data was analysed using thematic analysis and NVivo 12 software. The study’s findings revealed that several health information systems were implemented and their interoperability was low. Technological, terminology, organizational as well as regulatory and legal barriers were identified as hindrances to interoperability. The enablers for implementing e-health interoperability also revealed by this study include: development of re-usable software components, train the trainer approach to transfer of skills and regional conformance testing. The consequences of lack of interoperability among health information systems reported by this study include: burden on the worker, wastage of resources and high cost. The study also proposed a dual framework to guide the implementation of e-health interoperability. The study’s recommendations include the development of an e-health policy, an e-health strategy and the upgrade of ICT and telecommunication infrastructure to facilitate health information exchange.School of ComputingD. Phil. (Information Systems

Issues of the adoption of HIT related standards at the decision-making stage of six tertiary healthcare organisations in Saudi Arabia

Due to interoperability barriers between clinical information systems, healthcare organisations are facing potential limitations with regard to acquiring the benefits such systems offer; in particular, in terms of reducing the cost of medical services. However, to achieve the level of interoperability required to reduce these problems, a high degree of consensus is required regarding health data standards. Although such standards essentially constitute a solution to the interoperability barriers mentioned above, the level of adoption of these standards remains frustratingly low. One reason for this is that health data standards are an authoritative field in which marketplace mechanisms do not work owing to the fact that health data standards developed for a particular market cannot, in general, be applied in other markets without modification. Many countries have launched national initiatives to develop and promote national health data standards but, although certain authors have mapped the landscape of the standardisation process for health data in some countries, these studies have failed to explain why the healthcare organisations seem unwilling to adopt those standards. In addressing this gap in the literature, a conceptual model of the adoption process of HIT related standards at the decision-making stage in healthcare organisations is proposed in this research. This model was based on two predominant theories regarding IT related standards in the IS field: Rogers paradigm (1995) and the economics of standards theory. In addition, the twenty one constructs of this model resulted from a comprehensive set of factors derived from the related literature; these were then grouped in accordance with the Technology-Organisation Environment (TOE), a well-known taxonomy within innovation adoption studies in the IS field. Moving from a conceptual to an empirical position, an interpretive, exploratory, multiple-case study methodology was conducted in Saudi Arabia to examine the proposed model. The empirical qualitative evidence gained necessitated some revision to be made to the proposed model. One factor was abandoned, four were modified and eight new factors were added. This consistent empirical model makes a novel contribution at two levels. First, with regard to the body of knowledge in the IS area, this model offers an in-depth understanding of the adoption process of HIT related standards which the literature still lacks. It also examines the applicability of IS theories in a new area which allows others to relate their experiences to those reported. Secondly, this model can be used by decision makers in the healthcare sector, particularly those in developing countries, as a guideline while planning for the adoption of health data standards

Turning modularity upside down:Patient-centered Down syndrome care from a service modularity perspective

Modularity involves the decomposition of a service into components and modules that can be mixed and matched to individual needs, so that each customer receives an individualized modular package. As such, every customer can be offered a different combination of components and modules and thus each is treated as unique. This is especially important in healthcare since patients are becoming more demanding and call for healthcare services that are tailored to their needs. However, evidence on the applicability of modularity in complex healthcare services, for example on healthcare for people with complex care needs, is missing. This doctoral thesis is composed of five studies to advance knowledge on service modularity in complex healthcare provision and explore to what extent service modularity can support the provision of patient-centered service provision. These studies characterized chronic healthcare provision for children with Down syndrome from a modular perspective and show how modularity, and specifically interfaces, can contribute to the delivery of coordinated and patient-centered care provision. In general, this doctoral thesis contributes to the service modularity literature, and in particular to interfaces in service modularity, as well to the practice of delivering patient-centered care for patients with complex care needs, such as individuals with Down syndrome

The adoption of ICT in Malaysian public hospitals: the interoperability of electronic health records and health information systems

There have been a number of researches that investigated ICT adoption in Malaysian healthcare. With the small number of hospitals that adopt ICT in their daily clinical and administrative operations, the possibility to enable data exchange across 131 public hospitals in Malaysia is still a long journey. In addition to those studies, this research was framed under six objectives, which aim to critically review existing literature on the subject matter, identify barriers of ICT adoption in Malaysia, understand the administrative context during the pre and post-ICT adoption, and recommend possible solutions to the Ministry of Health of Malaysia (MoHM) in its efforts to implement interoperable electronic health records (EHR) and health information systems (HTIS). Specifically, this research aimed to identify the factors that had significant impacts to the processes of implementing interoperable EHR and HTIS by the MoHM. Furthermore, it also aimed to propose relevant actors who should involve in the implementation phases. These factors and actors were used to develop a model for implementing interoperable EHR and HTIS in Malaysia. To gather the needed data, series of interviews were conducted with three groups of participants. They were ICT administrators of MoHM, ICT and medical record administrators of three hospitals, and physicians of three hospitals. To ensure the interview feedback was representing the context of EHR and HTIS implementation in Malaysia, two hospital categories were selected, which included the hospitals with HTIS and non-HTIS hospitals. The government documents were then used to triangulate the feedback to ensure dependability, credibility, transferability and conformity of the findings. Two techniques were used to analyse the data, which were thematic analysis and theme matching. These two techniques were modified from its original method, known as pattern matching. The originality of this research was presented in the findings and methods to transform them into solutions and provide recommendation to the MoHM. In general, the results showed that the technological factors contributed less to the success of the implementation of interoperable EHR and HTIS compared to the managerial and administrative factors. Four main practical and social contributions were identified from this research, which included synchronisation of managerial elements, political determination and change management transformation, optimisation of use of existing legacy system (Patient Management System) and finally the roles of actors. Nevertheless, the findings of this research would be more dependable and transferable if more participants had been willing to participate especially among the physicians and those who managed the ICT adoptions under the MoHM