Towards an interoperable healthcare information infrastructure - working from the bottom up

Historically, the healthcare system has not made effective use of information technology. On the face of things, it would seem to provide a natural and richly varied domain in which to target benefit from IT solutions. But history shows that it is one of the most difficult domains in which to bring them to fruition. This paper provides an overview of the changing context and information requirements of healthcare that help to explain these characteristics.First and foremost, the disciplines and professions that healthcare encompasses have immense complexity and diversity to deal with, in structuring knowledge about what medicine and healthcare are, how they function, and what differentiates good practice and good performance. The need to maintain macro-economic stability of the health service, faced with this and many other uncertainties, means that management bottom lines predominate over choices and decisions that have to be made within everyday individual patient services. Individual practice and care, the bedrock of healthcare, is, for this and other reasons, more and more subject to professional and managerial control and regulation.One characteristic of organisations shown to be good at making effective use of IT is their capacity to devolve decisions within the organisation to where they can be best made, for the purpose of meeting their customers' needs. IT should, in this context, contribute as an enabler and not as an enforcer of good information services. The information infrastructure must work effectively, both top down and bottom up, to accommodate these countervailing pressures. This issue is explored in the context of infrastructure to support electronic health records.Because of the diverse and changing requirements of the huge healthcare sector, and the need to sustain health records over many decades, standardised systems must concentrate on doing the easier things well and as simply as possible, while accommodating immense diversity of requirements and practice. The manner in which the healthcare information infrastructure can be formulated and implemented to meet useful practical goals is explored, in the context of two case studies of research in CHIME at UCL and their user communities.Healthcare has severe problems both as a provider of information and as a purchaser of information systems. This has an impact on both its customer and its supplier relationships. Healthcare needs to become a better purchaser, more aware and realistic about what technology can and cannot do and where research is needed. Industry needs a greater awareness of the complexity of the healthcare domain, and the subtle ways in which information is part of the basic contract between healthcare professionals and patients, and the trust and understanding that must exist between them. It is an ideal domain for deeper collaboration between academic institutions and industry

Acceptability of medical digital libraries

Evidenced-based medicine has increased the importance of quick accessibility to reputable, upto-date information. Web-accessible digital libraries (DLs) on the wards can address the demand for such information. The use and acceptability of these resources has, however, been lower than expected due to a poor understanding of the context of use. To appreciate the social and organizational impacts of ward-accessible DLs for clinicians, results of a study within a large London-based hospital are presented. In-depth interviews and focus groups with 73 clinicians (from pre-registration nurses to surgeons) were conducted, and the data analysed using the grounded theory method. It was found that clinical social structures interact with inadequate training provision (for senior clinicians), technical support and DL usability to produce a knowledge gap between junior and senior staff, resulting in information – and technology – hoarding behaviours. Findings also detail the perceived effectiveness of traditional and digital libraries and the impact of clinician status on information control and access. One important conclusion is that increased DL usability and adequate support and training for senior clinicians would increase perceptions of DLs as support for, rather than replacement of, their clinical expertise. © 2002, The Continuum Publishing Group Ltd. All rights reserved

An electronic healthcare record server implemented in PostgreSQL

This paper describes the implementation of an Electronic Healthcare Record server inside a PostgreSQL relational database without dependency on any further middleware infrastructure. The five-part international standard for communicating healthcare records (ISO EN 13606) is used as the information basis for the design of the server. We describe some of the features that this standard demands that are provided by the server, and other areas where assumptions about the durability of communications or the presence of middleware lead to a poor fit. Finally, we discuss the use of the server in two real-world scenarios including a commercial application

Opening the Black Box: Explaining the Process of Basing a Health Recommender System on the I-Change Behavioral Change Model

Recommender systems are gaining traction in healthcare because they can tailor recommendations based on users' feedback concerning their appreciation of previous health-related messages. However, recommender systems are often not grounded in behavioral change theories, which may further increase the effectiveness of their recommendations. This paper's objective is to describe principles for designing and developing a health recommender system grounded in the I-Change behavioral change model that shall be implemented through a mobile app for a smoking cessation support clinical trial. We built upon an existing smoking cessation health recommender system that delivered motivational messages through a mobile app. A group of experts assessed how the system may be improved to address the behavioral change determinants of the I-Change behavioral change model. The resulting system features a hybrid recommender algorithm for computer tailoring smoking cessation messages. A total of 331 different motivational messages were designed using 10 health communication methods. The algorithm was designed to match 58 message characteristics to each user pro le by following the principles of the I-Change model and maintaining the bene ts of the recommender system algorithms. The mobile app resulted in a streamlined version that aimed to improve the user experience, and this system's design bridges the gap between health recommender systems and the use of behavioral change theories. This article presents a novel approach integrating recommender system technology, health behavior technology, and computer-tailored technology. Future researchers will be able to build upon the principles applied in this case study.European Union's Horizon 2020 Research and Innovation Programme under Grant 68112

Making sense of assets: Community asset mapping and related approaches for cultivating capacities

This working paper critically reviews some main aspects from asset based approaches highlights key strengths and weaknesses for future research/development. Drawing on a large body of reports and relevant literature we draw on different theoretical traditions and critiques, as well as practices and processes embedded within a broad range of approaches including, widely acknowledged frameworks such Asset Based Community Development (ABCD), Appreciative Inquiry (AI), Sustainable Livelihood Approaches (SLA) and Community Capitals Framework (CCF). Although these are presented as distinct approaches, there is a sense of evolution through them and many of them overlap (in terms of both theories and methodologies). We also include emerging frameworks, including geographical, socio-spatial, visual and creative approaches, stemming from a number of projects within AHRC’s Connected Communities programme and additional collaborations

Referent tracking for corporate memories

For corporate memory and enterprise ontology systems to be maximally useful, they must be freed from certain barriers placed around them by traditional knowledge management paradigms. This means, above all, that they must mirror more faithfully those portions of reality which are salient to the workings of the enterprise, including the changes that occur with the passage of time. The purpose of this chapter is to demonstrate how theories based on philosophical realism can contribute to this objective. We discuss how realism-based ontologies (capturing what is generic) combined with referent tracking (capturing what is specific) can play a key role in building the robust and useful corporate memories of the future

Design Ltd.: Renovated Myths for the Development of Socially Embedded Technologies

This paper argues that traditional and mainstream mythologies, which have been continually told within the Information Technology domain among designers and advocators of conceptual modelling since the 1960s in different fields of computing sciences, could now be renovated or substituted in the mould of more recent discourses about performativity, complexity and end-user creativity that have been constructed across different fields in the meanwhile. In the paper, it is submitted that these discourses could motivate IT professionals in undertaking alternative approaches toward the co-construction of socio-technical systems, i.e., social settings where humans cooperate to reach common goals by means of mediating computational tools. The authors advocate further discussion about and consolidation of some concepts in design research, design practice and more generally Information Technology (IT) development, like those of: task-artifact entanglement, universatility (sic) of End-User Development (EUD) environments, bricolant/bricoleur end-user, logic of bricolage, maieuta-designers (sic), and laissez-faire method to socio-technical construction. Points backing these and similar concepts are made to promote further discussion on the need to rethink the main assumptions underlying IT design and development some fifty years later the coming of age of software and modern IT in the organizational domain.Comment: This is the peer-unreviewed of a manuscript that is to appear in D. Randall, K. Schmidt, & V. Wulf (Eds.), Designing Socially Embedded Technologies: A European Challenge (2013, forthcoming) with the title "Building Socially Embedded Technologies: Implications on Design" within an EUSSET editorial initiative (www.eusset.eu/

Mobile Social Media as a Strategic Capability: Expanding Opportunties Social Media Has to Offer to B2B Firms

Mobile social media (MSM), an interaction, exchange of information and creation of user-generated content, mediated by mobile devices is becoming the locomotive that drives forward evolution of online world. So far, limited number of academic studies touched upon the MSM subject with all the papers being of conceptual nature. No empirical evidence is available to prove whether and how firms utilise MSM for their best advantage. This paper addresses this gap by employing the grounded theory approach (GT) to analyse interviews conducted in twenty-six B2B firms. This study found that eighteen firms use mobile technology primarily as a platform to access social media sites, understand canons of MSM consumption and utilise MSM as a strategic capability to reinforce the strategic position of a firm. Our data illustrates that the MSM strategic capability includes four main activities: (1) market sensing; (2) managing relationships; (3) branding and (4) developing content. These activities can results in the decreased research and development spendings without sacrificing innovativeness because MSM is a valuable source of information about the market and a source of ideas for new products/services. In practical terms firms can examine MSM activities and decide whether there is an opportunity to utilise MSM advantageously