Tiedonhallinta hyvinvointialueiden tiedon laadun kehittämisessä

Vuoden 2023 alussa tapahtuva Sote-uudistus johtaa mittaviin hallinnollisiin uudistuksiin. Soteuudistuksen myötä hyvinvointialueiden tietojohtamista ja kansallista sote-tietopohjaa kehitetään Toivo-ohjelmassa. Lisäksi hyvinvointialueen järjestämislaki (2021/612) 29 § määrää sote-alueiden velvollisuuden seurata palveluiden tarvetta, saatavuutta, laatua, vaikuttavuutta ja yhdenvertaisuutta. Tiedon laadulla on suuri merkitys hyvinvointialueen tietojohtamisessa ja lain määräämien tehtävien toteuttamisessa. Hyvinvointialueen tiedon laatua voidaan kehittää sen tiedon hyödyntämisen prosessin vaiheissa: kirjaaminen, tiedonhankinta, käsittely, analyysi ja jakelu. Tämän työn tarkoituksena on selvittää miten tiedonhallintaa voidaan hyödyntää hyvinvointialueiden tiedon laadun kehittämisessä. Tiedonhallinta on toimintaa, jonka ensisijainen tarkoitus on määrittää organisaation tietoon liittyvät käytännöt, toimintatavat, määritykset ja vastuut. Tiedonhallinnan merkitys on kasvanut yhä enemmän tiedon määrän kasvun myötä. Tutkimusongelmasta on muodostettu päätutkimuskysymys: Miten tiedonhallinnan avulla voidaan tukea hyvinvointialueen tiedon laadun kehittämistä? Työn keskeisiä käsitteitä on tiedonhallinta, tiedon laadun mittaaminen sekä VIRTA-arkkitehtuuri, johon sisältyy Data Vault 2.0 mukaisen Error Martin toteutus. Tämä tutkimus on toteutettu kirjallisuuskatsauksena hyödyntäen Finkin systemaattista kirjallisuuskatsausmallia. Poiketen Finkin mallin vaiheista aineistoa on haettu myös muualta kuin tieteellisistä tietokannoista. Hyvinvointialueiden nykytilaan liittyviä haasteita ja tiedon raportointiin liittyviä vaatimuksia löytyy kansallisten toimijoiden, kuten DigiFinland, THL ja Valvira, julkaisuista. Lisäksi Tilastokeskus on määrittänyt Tiedon laatukehikko -hankkeessa tiedon laatukriteerit, joita on hyödynnetty tutkimuksessa. Tiedonhallintaan liittyvä aineisto on enimmäkseen englanninkielistä. Tutkimuksessa käsitellään ensiksi tiedonhallinnan teoriaa, jonka jälkeen määritetään hyvinvointialueiden tiedon hyödyntämisen prosessin vaiheet ja tiedon laatuun liittyvät haasteet. Tiedonhallinnan teoria jaettiin tiedonhallinnan kypsyystasoihin ja onnistumisen kriittisiin tekijöihin, tiedonhallinnan rooleihin, tiedonhallinnan prosesseihin ja periaatteisiin ja tiedon laatukriteereihin ja periaatteisiin. Tiedonhallinnan teorian jälkeen käsitellään hyvinvointialueiden tiedon käsittelemisen prosesseja ja tiedon laadun haasteita. Tutkimuksen tuloksena luotiin kokonaisuus, jota hyvinvointialueet voivat soveltaa tiedon laadun kehittämiseen. Tiedonhallinnan roolien ja päätösalueiden määrittämiseen voidaan hyödyntää RACI-taulukkoa. Tutkimustuloksissa RACI-taulukon roolit ja päätösalueet on yhdistetty jo olemassa oleviin hyvinvointialueen tiedon hyödyntämisen prosesseihin. Näin tekemällä tiedonhallinnan implementointi osaksi toimintaa tehdään mahdollisimman helpoksi. Jokaisessa päätösalueessa otetaan huomioon myös mitä tiedonhallinnan onnistumisen kriittisiä tekijöitä täytyy ottaa huomioon, jotta tiedonhallinnan toteutuminen onnistuu. Ehdotetut toimenpiteet liittyvät kirjaamiseen liittyvien prosessien, standardien ja vastuiden määrittämiseen, tietovarastossa laadun tarkistamiseen Error Martin avulla ja tiedon laadun mittaamiseen ja raportointiin

ECSCW 2013 Adjunct Proceedings The 13th European Conference on Computer Supported Cooperative Work 21 - 25. September 2013, Paphos, Cyprus

This volume presents the adjunct proceedings of ECSCW 2013.While the proceedings published by Springer Verlag contains the core of the technical program, namely the full papers, the adjunct proceedings includes contributions on work in progress, workshops and master classes, demos and videos, the doctoral colloquium, and keynotes, thus indicating what our field may become in the future

An investigation into trust and security in the mandatory and imposed use of financial ICTs upon older people

Care needs to be taken to reduce the number of people who are fearful and mistrustful of using ICT where that usage is forced upon them without choice or alternative. The growing incidence of mandatory and imposed online systems can result in confusion, misuse, fear, and rejection by people with only rudimentary ICT skills. A cohort where a high percentage of such people occur is older people, defined in this study as people over the age of 60 Examples of compulsory ICT interactions include some banks limiting bank statement access through online rather than paper-based options. Other examples include the purchase of theatre or sports events tickets through ticketing systems that require an online transaction to take place. Increasingly, people are living beyond the normal retiring age. As the older cohort increases in size and in overall global population percentage, the problem of forced technology usage affects technology acceptance, technology trust, and technology rejection. People care about ICT systems where reduced trusted acceptance of technology reduces the advantages of digital health care, the perceived security of banking and shopping, and the autonomy of ICT-driven lifestyle choices. This study aims to solve one of the puzzles of ICT-driven change, where older people can show trepidation towards using technology. By understanding the drivers that influence the choices older people make in relation to ICT systems, it may be possible to introduce a much higher level of trusted acceptance in ICT systems. Although many people adopt ICTs into their lives, many older people face difficulty in using technology when it is forced upon them. This study aims to understand the connection between how choice (or lack of choice) can lead to the rejection or resistance towards ICT usage. Older people sometimes opt towards practices that place themselves at risk of financial or informational disadvantage. This study used a qualitative approach to understanding the factors that influenced the trusted acceptance, trepidation, and in some cases rejection of ICT usage by interviewing a sample of older people. Participants were asked to consider a wide range of ICT-usage scenarios and to describe their intentions. The study focussed on circumstances where ICT usage fell under either mandatory, imposed, or voluntary conditions in order to compare user behaviour. Settings included a range of technology-reliant states that examined IT security, volition and choice, aging, trusted acceptance, and technology adoption. Participants were interviewed to discover and sort the conditions (whether singly or in combination) under which the expectation of ICT acceptance was in some way altered, diminished, or prevented. This research found that older people made poor decisions when the choice to use a technology was replaced with a mandatory or strongly imposed pathway. Mandatory ICT usage across the broad area of financial transactions brought about widespread fear and distrust of online technology usage. The results revealed that many older people not only find these innovations daunting and confronting, but they also have difficulty placing their trust in ICT systems and applications that have become mandatory. In normative conditions, increased ICT acceptance and ICT usage is expected. When ICTs are mandatory in their usage, acceptance is replaced with compulsory procedure. This does not mean that mandatory things cannot be accepted, but rather that older people will accept the need to use a technology according to their perception of what is necessary for their daily and routine interactions. This study showed that voluntary ICT usages including choices increase informed decision-making, security of online financial interactions, and trusted reliance upon ICTs. Choice in ICT usage carries greater trust than mandatory, obligated, or heavily imposed ICTs. The study revealed that mandatory ICT systems can create perceptions of fear, mistrust and uncertainty. In situations where a mandatory ICT system becomes the normative method of transaction, a strong risk to the trusted acceptance of a technology is not merely the lack of ICT-based choice, but also the inability to gain reassurance or secondary confirmation through either face to face or telephone-based communication. Trust in not just the usage, but the implied secure usage of mandated and imposed ICTs, is problematic for older people. This study revealed the significance of mandated ICT systems that limit choices for people, because older humans more readily validate and associate their trust in new innovations when they can access various different professional, technical, peer-based, social and popular opinions. The research also showed that older people are fearful and less trusting in mandatory and imposed systems because they have less financial resilience, and less opportunity to bounce back from loss and disadvantage brought about by digital and online interactions. Older people were worried and reluctant to accept technology at first glance because they knew that they had spent more time than others in a pre-internet, pre-digital environment, and their seminal life experiences are correspondingly less technology-related. The results showed that many older people preferred human communication and interaction rather than communicating, buying, paying, and trusting in purely digital, ICT-based experiences. This demonstrated a gap in the trust and security of digital systems, and the need to address those ICTs that impose and mandate instruments and procedures for daily life. Specifically this study looked at what could reduce unsafe and insecure banking practices by understanding the role of choice in the trusted usage of ICT systems. This study is significant because it shows that older people make financial and social, decisions under reactionary, insecure, and under-informed conditions as a result of a gap in terms of trust security and choice. On the one hand older people develop trust towards a new innovation based on accumulated human discussion, information and reputation. On the other hand older people hold the perception that online systems offer reduced choices. This study led to the development of a model for trusted technology choice (TTCM). It differs from traditional acceptance and diffusion thinking, by having outputs as either ICT acceptance or ICT rejection. It diverges from diffusion and technology acceptance models (TAM), because technology acceptance is not regarded as a foregone conclusion. Instead, it places a very high value upon choice and volition, trust, security and human interaction. The TTCM model, together with a framework for identifying volition barriers, provides a different set of criteria for understanding the needs of older people and their meaningful interactions with new innovation and ICTs. The practical applications for using such a model directly impact upon financial and social stability for older people. Where choices are either removed or limited due to ICT usage, older citizens are unfairly disadvantaged. A model that accurately predicts the trusted usage of ICT innovations can have a widespread effect on the implementation of large-scale public and private systems where the trusted acceptance (or rejection) of each system has on flow impact on financial, health, and other critical services that include the growing population of older people

Factors affecting progress of the National e-Health Strategy in the NHS in England: A Socio-technical Evaluation.

Background: This is a formative socio-technical study of the “middle out” NHS e-health strategy in England. It began in 2015 with an objective to become “paperless at the point of care by 2020”, focussing nationally on the “electronic glue”, (interoperability), to facilitate the inter-organisational exchange digital communications of patient data and leaving the choice of EHRs to local organisations. No academic research has been published into the strategy and similar studies rarely include sample groups of suppliers or IT consultants. So this study seeks to fill both gaps in knowledge. Such strategies are prevalent across westernised developed countries and can consume large sums of government funding and local resources. In consequence, their failure can be very costly. This study seeks to mitigate that risk whilst recognising that, as they operate in highly complex environments, choosing any particular type of “bottom up”, “middle out” or “top down” strategy construct does not guarantee success. Their outcome is dependent upon the successful navigation through a mix of factors, known and unknown, across technical, human and social, organisational, macro-environmental and wider socio-political dimensions through time. Findings: The “middle out” strategy is broadly more appropriate, rather than “bottom up” or “top down”, but the target, of becoming “paperless by 2020”, is unattainable. Major cultural barriers include resistance by powerful clinicians, who can perceive such strategies as threats to the moral order and their traditional role as gatekeepers of access to patient data. Other barriers include inadequate and delayed national funding; disruption caused by government reorganisations; major premature programme re-structuring and a shift away from the original intent, resulting in the inappropriate selection of single organisation pilot sites rather than multi-organisational community wide ones to promote interoperability. New factors found include: the threats of cyber security incidents and the need for protective measures; the mismatch between strategy timescales and local procurement cycles; the quality of IT suppliers and the competing demands of similar change management programmes for scarce local NHS resources. Proposition: To reflect those findings a new socio-technical model is proposed that incorporates those additional factors as well as two further cross cutting dimensions to reflect “Lifecycle” and “Purpose”, drawing on elements of both Change Management and Technology Lifecycle Theory. “Lifecycle” reflects the “passage of time” as the evidence suggests that factors affecting progress may vary in their presence and impact over time as a strategy moves though its lifecycle. The addition of a “Purpose” dimension supports a reflection on the “why”. Some support is found for the proposal that a “middle out” strategy is more likely to facilitate progress than “bottom up” or “top down” ones. However a shift in approach is advocated. It is proposed that “middle out” e-health strategies are more likely to be successful if their “purpose” shifts away from promoting EHRs, per se, like with single organisation pilot sites, towards inter-organisational clinical and social care workflow improvement across health and social care economies. To achieve that, the focus should shift towards interoperability and cyber security programmes. Those should promote and mandate the use of national interoperability infrastructure, national systems and national standards. They should also provide national funding support to health economy wide clinical and social care workflow improvement pilots and initiatives that span those economies