The rationale of e-health evaluation: The case of NHS Direct

An important area of research is that of the evaluation of e-health services. A holistic e-health evaluation framework should address the aspects that are hampering healthcare services from embracing the full potential of information and communication technologies towards successful e-health initiatives. Towards building a holistic evaluation framework for e-health services, this paper is intended to examine the rationale of e-health evaluation, as the paper argues that this aspect should be addressed first in the development of such a framework. NHS Direct which is one of the largest e-health services in the world has been chosen to discuss and validate a set of evaluation rationales and their applicability in practice

An integrated electronic medical record system (iEMRS) with decision support capability in medical prescription

Author name used in this manuscript: George T. S. Ho2012-2013 > Academic research: refereed > Publication in refereed journalAccepted ManuscriptPublishe

Cross disciplinary evaluation framework for e-health services

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel UniversityE-health is an emerging field in the intersection of information systems, healthcare and business management, referring mainly to healthcare services delivered and enhanced through the use of information and communication technologies (ICT). In a broader sense, the term characterizes not only a technical development, but also a wider way of thinking, an attitude, and a commitment for a network to improve and connect provider, patients and governments. Such a network will be used to educate and inform healthcare professionals, managers and healthcare users; to stimulate innovation in care delivery and health system management; and to improve the healthcare system locally, regionally, and globally. The evaluation of e-health services in both theory and practice has proved to be important and complex. E-health evaluation will help achieve better user services utilization, justify the enormous investments of governments on delivering e-health services, and address the aspects that are hampering healthcare services from embracing the full potential of ICT towards successful e-health initiatives. The complexity of evaluation is mostly due to the challenges faced at the intersection of three areas, each well-known for its complexity; healthcare services, information systems, and evaluation methodologies. However, despite the importance of the evaluation of e-health services, literature shows that e-health evaluation is still in its infancy in terms of development and management. The aim of this research study is to develop, and assess a cross disciplinary evaluation framework for e-health services and to propose evaluation criteria for better user’s utilization and satisfaction of e-health services. The evaluation framework is criteria based, while the criteria are determined by an evaluation matrix of three elements, the evaluation rationales, the evaluation timeframes, and the evaluation stakeholders. The evaluation criteria have to be multi-dimensional as well as grounded in, or derived from, one or more specific perspectives or theories. The framework is designed to deal effectively with the challenges of e-health evaluation and overcome the limitation of existing evaluation frameworks. The cross disciplinary evaluation framework has been examined and validated by adopting an interpretive case study methodology. The chosen case study is NHS direct which is currently one of the largest e-health services in the world. The data collection process has been carried out by using three research methods; archival records, documentation analysis and semi-structured interviews. The use of multiple methods is essential to generate comparable data patterns and structures, and enhance the reliability of conclusions through data triangulation. The contribution of the research study is in bridging the gap between the theory and practice in the evaluation of e-health services by providing an efficient evaluation framework that can be applied to a wide range of e-health application and able to answer real-world concerns. The study also offers three sets of well-argued and balanced hierarchies of evaluation criteria that influence user’s utilization and satisfaction of e-health services. The evaluation criteria can be used to help achieve better user services utilization, to serve as part of e-health evaluation framework, and to address areas that require further attention in the development of future e-health initiatives

Pharmacies and medication information system in Jeddah City, Saudi Arabia

It is acknowledged that the introduction of Health Information Systems (HIS) have contributed to the reorganization of the methods used in health services for Health Information Management. Managers in the health services benefit from Health Information Systems provision both strategically and operationally, for example in the planning of new services and more routinely in assisting health professionals in making informed medical decisions. Health services in developed countries already have Health Information Systems (HIS) in place but their adoption in developing countries has been less widespread. In Jeddah, KSA there is a lack of a unified HIS. Health service provision in Jeddah is spread between a wide range of governmental and private health services. The lack of unification of these services and a bespoke HIS has led to problems for both patients and healthcare professionals. This research focuses on the methods of prescribing medication, provision of supplies and the dispensing of medication within pharmacies. [Continues.

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

National e-health innovation : conduct of international e-health technology transfers in Africa

The sociology and economics of the conduct of international e-health technology transfers (IeTTs) is examined. Most African countries are perennial recipients with variations in their domestic e-health utilisation, development and implementation. We identify, explore, and demonstrate how complex and interlinked global, continental, national and subnational actions and institutions condition their national e-health implementations. Multidisciplinary literatures are from national e-health implementations, national innovation system (NIS) interactive learning, international technology transfers, global development and globalisation. Methodically, a unique combination of middle-range and moderate Science and Technology Studies constructivism, NIS institutionalism and Deleuzian poststructuralist narrative is employed. The conduct of IeTTs is characterised by technological path dependency, history, complexity, power, politics, multiple identities, self-interests and contestations in complex global and transnational interactions. Recipients‘ exercises of National Agency mirror their varied domestic technology acquisition dynamics and trajectories. Successful transfers are institutionally conditioned by interactions of global geopolitics, fragmented continental governance and national reticence. Agential asymmetry that results, accounts for why most recipients are variably struggling in their technology acquisitions. The exercise of National Agency is paramount. National economic size and maturity of extant national innovation capacity can determine if a recipient can acquire domestic e-health innovation and industrial competences. Actions taken by National governments, can strategically determine if technologies are accumulated and technical knowledge assimilated, for addressing the challenges of technology inappropriateness, incompatibilities and obsolescence encountered during subnational utilisations. We contend that implementing a national e-health infrastructure is a long-term and large-scale institutional engineering endeavour. Cumulative advantage explains difference between Schumpeter and Schumacher on e-health technology design and production. A Schumpeterian domestic industrial model of hi-tech e-health technology development, rather than a cosmopolitan Schumacher consumerist one, is proposed. Whilst, appreciating that Schumacher on incremental accumulation and assimilation from small-scale technological implementations can be instrumental. Uniquely, we identify that global geopolitical contention between global west and east economies and competitive global markets and global technoeconomic changes can either condition scale and depth of domestic acquisition. Nevertheless, these conditions and events have historically and contemporaneously shaped global e-health innovations. In a Schumpeterian evolutionary sense, Satcom technologies that powered e-health services in the past are now being substituted by mobile ones. This technological transition is bringing about a convergence of consumer electronics (i.e. Smartphones) and lifesciences industries, driven by a combinatorial biomedical, telecommunication and computing e-health innovations. With these findings, an innovation-based macro-societal perspective is proposed for studying e-health implementation, as opposed to the prevalent information based microbehavioural studies. Further contributions to academia and policy are made to ICT4D, Global Health and m-health practices. Policy recommendations are made to national, continental and global institutions on how to foster national technology acquisitions. Recipients are encouraged to learn from incremental domestic e-health implementations in global technology frontiers. Their share in intellectual property rights accruing from global-subnational e-health coinnovations must be repatriated. We conclude by proposing a global collaboration framework to guide and to foster cooperation amongst those involved in the conduct of IeTTs. Symmetry – an alignment of vertical hierarchical and diffuse horizontal complex sociotechnical interactions, though, not as the implied flat, circumscribed and cyclical dynamics of actor network theory, is proposed. So, an alignment of the constitutive diverse and competing interests and identities, is deemed strategic, to foster domestic accumulations and assimilations.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

E-health in the East Asian tigers

The article analyzes e-health progress in East Asia's leading tiger economies: Japan, Hong Kong, Singapore, South Korea and Taiwan. It describes five main dimensions of e-health provision in the tigers: policymaking, regulation, provision, funding and physician-patient relations. We conducted a series of fieldwork interviews and analyzed key healthcare websites. Our main finding is that the development of e-health in the region is less advanced than might be expected. Our explanation focuses on institutional, cultural and financial factors. © 2004 Elsevier Ireland Ltd. All rights reserved.link_to_subscribed_fulltex