The Challenges of Establishing Partners in Health Information Exchange (HIE)

Health information exchange (HIE) has become a focus of the health care industry. The ability to share information electronically between multiple health care providers is thought to be a key ingredient in the creation of a more efficient global health care system. VA Hospital Memphis has significant challenges in regard to HIE. The Virtual Lifetime Electronic Record (VLER) coordinator at the facility has been charged with establishing an HIE system. This requires the coordinator to identify partners to share health information with electronically, obtain buy-in from patients and providers through education, and to promote/market the VLER program facility-wide. The VA recognizes that sharing health care information electronically is a much needed process. However, the powers that be must understand that establishing HIE is not an easy task and that there are many challenges. This paper details the challenges faced by VA Hospital Memphis as the facility attempts to establish partners in health HIE

Consumer buying behaviour in online legal services

Abstract. Online legal services refer to electronic or digital legal services (in the form of software, apps, web pages, etc.) that can increase common people understanding of legal issues, access to legal information and social participation in legal related matters. By automating tasks traditionally performed only by lawyers and by making legal services available on the Internet, online legal services make the access to justice more affordable and accessible to all. In this modern context, where common consumers have the opportunity buy and use legal services completely on the internet and without the help of a traditional lawyer, it is necessary to investigate how consumers behave when they shop for legal services online. In accordance, the purpose of the research is to understand the consumer buying behaviour in online legal services, based on empirical research, contributing to the literature about online legal services; and to provide managerial implications for legal services companies about how to improve their marketing strategies and build their consumer relationships, based on the empirical findings. Therefore, the study delves into the minds of consumers to uncover their needs, motivations and intentions about online legal services, and it is the first study to investigate the consumer buying behaviour in online legal services. The research is planned focusing on the theories of consumer buying behaviour, technology acceptance and on prior research of online legal services. The empirical research is conducted using a survey questionnaire, employing a mixed-method approach. Brazil was chosen as the field for the research, because it is the world’s fifth-largest country by area and the fifth most populous, where legal services are highly demanded and where online legal services have potential to be widely utilized, although not much is known about the consumer behaviour towards them. The sample studied is 419 potential consumers of online legal services. To process the data, the author makes statistical analysis of each quantitative reply, qualitative thematic content analysis for each qualitative answer, and deeply analyse the final results of the research, developing a framework for the consumer buying behaviour in online legal services. The empirical findings show that the consumers of online legal services behave motivated by Price, Legal problem-solving capability, Convenience (Perceived ease of use), Speed, Safety, Quality and Trustability and that consumers have an overall positive attitude about online legal services, even though negative attitudes were also identified. Utilitarian needs and motivations, behavioural intention, attitude, perceived usefulness, perceived ease of use, information search, evaluation of alternatives, social influence, facilitating conditions, trust, perceived risk, and price value; influence and characterize the buying behaviour in online legal services and lead to the consequent consumer purchase decision. Furthermore, the buying process in online legal services follows the Five-stage buying process, but the consumer might deviate during it, because of, among other reasons, social influence and the lack of trust

Ivan Illich’s Medical Nemesis and the ‘age of the show’: On the Expropriation of Death

What Ivan Illich regarded in his Medical Nemesis as the ‘expropriation of health’ is exacerbated by the screens all around us, including our phones but also the patient monitors and increasingly the iPads that intervene between nurse and patient. To explore what Illich called the ‘age of the show’, this essay uses film examples, like Creed and the controversial documentary Vaxxed, and the television series Nurse Jackie. Rocky’s cancer in his last film (and his option to submit to chemo to ‘fight’ cancer) highlights what Illich along with Petr Skrabanek called the ‘expropriation of death’. In contrast to what Illich denotes as ‘Umsonstigkeit’ – grace or gift, given freely, gratuitously – medical science tends to be tempted by what Illich terms scientistic ‘black magic’, taking over (expropriating) the life (and death) of the patient in increasingly technological ways, a point underscored in the concluding section on the commercial prospects of xenotransplants using factory farm produced human-pig hybrids or chimeras

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