A conceptual IT governance framework to guide the development of interoperable health information systems

In light of changing health needs, health information systems are presented with a plethora of challenges. For instance, the rise of COVID-19 in the past year has led to the discourse on the strength of current health systems to support health needs and the readiness for the National Health Insurance in South Africa. In addition to operating in resource-constrained environments, the lack of synchrony between health information systems across health facilities led to the fragmentation of health information and diminished access to quality healthcare. This research, following the Design Science Research Methodology (DSRM) process, developed an IT governance conceptual framework (HISIG-CF), to inform the interoperability of health information systems. The HISIG-CF is developed from literature and qualitative data collected using an expert reviews method from practitioners in the healthcare sector who evaluated the constructs of the HISIG-CF. Thematic analysis and hermeneutics were used to analyse and interpret the data. The results revealed a need for more guidance to inform interoperability interventions and strengthen current health information systems. The contribution of this study is the HISIG-CF which is deemed relevant and potentially fit-for-purpose to improve health information systems interoperability within the healthcare sector in South Africa.Thesis (MCom) -- Faculty of Commerce, Department of Information Systems, 202

A conceptual IT governance framework to guide the development of interoperable health information systems

In light of changing health needs, health information systems are presented with a plethora of challenges. For instance, the rise of COVID-19 in the past year has led to the discourse on the strength of current health systems to support health needs and the readiness for the National Health Insurance in South Africa. In addition to operating in resource-constrained environments, the lack of synchrony between health information systems across health facilities led to the fragmentation of health information and diminished access to quality healthcare. This research, following the Design Science Research Methodology (DSRM) process, developed an IT governance conceptual framework (HISIG-CF), to inform the interoperability of health information systems. The HISIG-CF is developed from literature and qualitative data collected using an expert reviews method from practitioners in the healthcare sector who evaluated the constructs of the HISIG-CF. Thematic analysis and hermeneutics were used to analyse and interpret the data. The results revealed a need for more guidance to inform interoperability interventions and strengthen current health information systems. The contribution of this study is the HISIG-CF which is deemed relevant and potentially fit-for-purpose to improve health information systems interoperability within the healthcare sector in South Africa.Thesis (MCom) -- Faculty of Commerce, Department of Information Systems, 202

CogStack - experiences of deploying integrated information retrieval and extraction services in a large National Health Service Foundation Trust hospital.

BACKGROUND: Traditional health information systems are generally devised to support clinical data collection at the point of care. However, as the significance of the modern information economy expands in scope and permeates the healthcare domain, there is an increasing urgency for healthcare organisations to offer information systems that address the expectations of clinicians, researchers and the business intelligence community alike. Amongst other emergent requirements, the principal unmet need might be defined as the 3R principle (right data, right place, right time) to address deficiencies in organisational data flow while retaining the strict information governance policies that apply within the UK National Health Service (NHS). Here, we describe our work on creating and deploying a low cost structured and unstructured information retrieval and extraction architecture within King's College Hospital, the management of governance concerns and the associated use cases and cost saving opportunities that such components present. RESULTS: To date, our CogStack architecture has processed over 300 million lines of clinical data, making it available for internal service improvement projects at King's College London. On generated data designed to simulate real world clinical text, our de-identification algorithm achieved up to 94% precision and up to 96% recall. CONCLUSION: We describe a toolkit which we feel is of huge value to the UK (and beyond) healthcare community. It is the only open source, easily deployable solution designed for the UK healthcare environment, in a landscape populated by expensive proprietary systems. Solutions such as these provide a crucial foundation for the genomic revolution in medicine

A safer place for patients: learning to improve patient safety

1 Every day over one million people are treated successfully by National Health Service (NHS) acute, ambulance and mental health trusts. However, healthcare relies on a range of complex interactions of people, skills, technologies and drugs, and sometimes things do go wrong. For most countries, patient safety is now the key issue in healthcare quality and risk management. The Department of Health (the Department) estimates that one in ten patients admitted to NHS hospitals will be unintentionally harmed, a rate similar to other developed countries. Around 50 per cent of these patient safety incidentsa could have been avoided, if only lessons from previous incidents had been learned. 2 There are numerous stakeholders with a role in keeping patients safe in the NHS, many of whom require trusts to report details of patient safety incidents and near misses to them (Figure 2). However, a number of previous National Audit Office reports have highlighted concerns that the NHS has limited information on the extent and impact of clinical and non-clinical incidents and trusts need to learn from these incidents and share good practice across the NHS more effectively (Appendix 1). 3 In 2000, the Chief Medical Officer’s report An organisation with a memory 1 , identified that the key barriers to reducing the number of patient safety incidents were an organisational culture that inhibited reporting and the lack of a cohesive national system for identifying and sharing lessons learnt. 4 In response, the Department published Building a safer NHS for patients3 detailing plans and a timetable for promoting patient safety. The goal was to encourage improvements in reporting and learning through the development of a new mandatory national reporting scheme for patient safety incidents and near misses. Central to the plan was establishing the National Patient Safety Agency to improve patient safety by reducing the risk of harm through error. The National Patient Safety Agency was expected to: collect and analyse information; assimilate other safety-related information from a variety of existing reporting systems; learn lessons and produce solutions. 5 We therefore examined whether the NHS has been successful in improving the patient safety culture, encouraging reporting and learning from patient safety incidents. Key parts of our approach were a census of 267 NHS acute, ambulance and mental health trusts in Autumn 2004, followed by a re-survey in August 2005 and an omnibus survey of patients (Appendix 2). We also reviewed practices in other industries (Appendix 3) and international healthcare systems (Appendix 4), and the National Patient Safety Agency’s progress in developing its National Reporting and Learning System (Appendix 5) and other related activities (Appendix 6). 6 An organisation with a memory1 was an important milestone in the NHS’s patient safety agenda and marked the drive to improve reporting and learning. At the local level the vast majority of trusts have developed a predominantly open and fair reporting culture but with pockets of blame and scope to improve their strategies for sharing good practice. Indeed in our re-survey we found that local performance had continued to improve with more trusts reporting having an open and fair reporting culture, more trusts with open reporting systems and improvements in perceptions of the levels of under-reporting. At the national level, progress on developing the national reporting system for learning has been slower than set out in the Department’s strategy of 2001 3 and there is a need to improve evaluation and sharing of lessons and solutions by all organisations with a stake in patient safety. There is also no clear system for monitoring that lessons are learned at the local level. Specifically: a The safety culture within trusts is improving, driven largely by the Department’s clinical governance initiative 4 and the development of more effective risk management systems in response to incentives under initiatives such as the NHS Litigation Authority’s Clinical Negligence Scheme for Trusts (Appendix 7). However, trusts are still predominantly reactive in their response to patient safety issues and parts of some organisations still operate a blame culture. b All trusts have established effective reporting systems at the local level, although under-reporting remains a problem within some groups of staff, types of incidents and near misses. The National Patient Safety Agency did not develop and roll out the National Reporting and Learning System by December 2002 as originally envisaged. All trusts were linked to the system by 31 December 2004. By August 2005, at least 35 trusts still had not submitted any data to the National Reporting and Learning System. c Most trusts pointed to specific improvements derived from lessons learnt from their local incident reporting systems, but these are still not widely promulgated, either within or between trusts. The National Patient Safety Agency has provided only limited feedback to trusts of evidence-based solutions or actions derived from the national reporting system. It published its first feedback report from the Patient Safety Observatory in July 2005

Growing an information infrastructure for healthcare based on the development of large-scale Electronic Patient Records

The papers of this thesis are not available in Munin. Paper 1. Silsand, L., Ellingsen, G. (2014). Generification by Translation: Designing Generic Systems in Context of the Local. Available in: Journal of Association for Information Systems, vol. 15(4): 3. Paper 2. Christensen, B., Silsand, L., Wynn, R. and Ellingsen, G. (2014). The biography of participation. In Proceedings of the 13th Participatory Design Conference, 6-10 Oct. Windhoek, Namibia. ACM Digital Library. Paper 3. Silsand, L. and Ellingsen, G. (2016). Complex Decision-Making in Clinical Practice. In: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM Digital Library. ISBN: 978-1-4503-3592-8. Paper 4: Silsand, L., Ellingsen, G. (2017). Governance of openEHR-based information Infrastructures. (Manuscript). Paper 5. Silsand, L. (2017). The ‘Holy Grail’ of Interoperability of Health Information Systems: Challenges and Implications. Available in: Stigberg S., Karlsen J., Holone H., Linnes C. (eds) Nordic Contributions in IS Research. SCIS 2017. Lecture Notes in Business Information Processing, vol 294. Springer, Cham. This thesis provides empirical insights about socio-technical interdependencies affecting the making and scaling of an Information Infrastructure (II) for healthcare based on the development of large-scale Electronic Patient Records. The Ph.D. study is an interpretive case study, where the empirical data has been collected from 2012 to 2017. In most developed countries, the pressures from politicians and public in general for better IT solutions have grown enormously, not least within Electronic Patient Record (EPR) systems. Considerable attention has been given to the proposition that the exchange of health information is a critical component to reach the triple aim of (1) better patient experiences through quality and satisfaction; (2) better health outcomes of populations; and (3) reduction of per capita cost of health care. A promising strategy for dealing with the challenges of accessibility, efficiency, and effective sharing of clinical information to support the triple aim is an open health-computing platform approach, exemplified by the openEHR approach in the empirical case. An open platform approach for computing EPR systems addresses some vital differences from the traditional proprietary systems. Accordingly, the study has payed attention to the vital difference, and analyze the technology and open platform approach to understand the challenges and implications faced by the empirical process. There are two main messages coming out of this Ph.D. study. First, when choosing an open platform approach to establish a regional or national information infrastructure for healthcare, it is important to define it as a process, not a project. Because limiting the realization of a large-scale open platform based infrastructure to the strict timeline of a project may hamper infrastructure growth. Second, realizing an open platform based information infrastructure requires large structural and organizational changes, addressing the need for integrating policy design with infrastructure design

Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries

Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones – antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed

Clinical governance, education and learning to manage health information

Purpose – This paper aims to suggest that the concept of clinical governance goes beyond a bureaucratic accountability structure and can be viewed as a negotiated balance between imperfectly aligned and sometimes conflicting goals within a complex adaptive system. On this view, the information system cannot be separated conceptually from the system of governance it supports or the people whose work it facilitates or hinders. Design/methodology/approach – The study, located within the English National Health Service (NHS) between 1999 and 2005, is case study based using a multi method approach to data collection within two primary care organisations (PCOs). The research strategy is conducted within a social constructionist ontological perspective. Findings – The findings reflect the following broad-based themes: mutual adjustment of a plurality of stakeholder perceptions, preferences and priorities; the development of information and communication systems, empowered by informatics; an emphasis on education and training to build capacity and capability. Research limitations/implications – Limitations of case study methodology include a tendency to provide selected accounts. These are potentially biased and risk trivialising findings. Rooted in specific context, their generalisability to other contexts is limited by the extent to which contexts are similar. Reasonable attempts were made to minimise any bias. The diversity of data collection methods used in the study was an attempt to counterbalance the limitations highlighted in one method by strength from alternative techniques. Practical implications – The paper makes recommendations in two key governance areas: education and learning to manage health information. In practice, the lessons learned provide opportunities to inform future approaches to health informatics educational programmes. Originality/value – With regard to topicality, it is suggested that many of the developmental issues highlighted during the establishment of quality improvement programmes within primary care organisations (PCGs/PCTs) are relevant in the light of current NHS reforms and move towards commissioning consortia

The disease of corruption: views on how to fight corruption to advance 21st century global health goals

Corruption has been described as a disease. When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle, despite its enormous costs, which have been estimated in the billions of dollars. In this forum article, we asked anti-corruption experts to identify key priority areas that urgently need global attention in order to advance the fight against global health corruption. The views shared by this multidisciplinary group of contributors reveal several fundamental challenges and allow us to explore potential solutions to address the unique risks posed by health-related corruption. Collectively, these perspectives also provide a roadmap that can be used in support of global health anti-corruption efforts in the post-2015 development agenda

Designing national electronic services in the public healthcare sector.

Papers 2 and 5 of this thesis are not available in Munin 2. Larsen, E. and LK. Johannessen (2014), 'Top-down or bottom-up? Building information system for healthcare', (manuscript) 5. Larsen, E. and G. Ellingsen (2014) 'Nothing free about free market', Rossitto, C. et al. (eds.), COOP Proceedings of the 11th International Conference on the Design of Cooperative Systems: COOP 2014 Nice, France, May 27 – 30, Proceedings of the 11th International Conference on the Design of Cooperative Systems, Springer: 69-85. Available at http://dx.doi.org/10.1007/978-3-319-06498-7_5This thesis deals with a socio-technical approach towards the development of inter-organisational ICT tools in healthcare. My overall case is Norwegian healthcare, and I investigated how national inter-organisational ICT tools were developed and why good results were difficult to achieve. Three public projects make up the basis of my data collection in which the main categories of data are interviews, participant observations and document studies. The data collection period spanned 2005 to the completion of this thesis. The main contribution of this thesis is the empirical insight into the long-standing establishment of inter-organisational health care services in Norway, a country that is characterised primarily by a publicly funded healthcare system. Studying this domain have demanded an inter-disciplinary approach because of the need to understand work practices, the implications of development and the complexities of information infrastructures, financing, project management, political governance and political philosophies. This study demonstrates how the strategies adopted by Norwegian authorities have changed. These strategies began as measures for invigorating the sector through the funding of public projects that establish specifications which vendors can use in developing new services. The strategies have transitioned into a top-down approach, with the Directorate of Health as the dominant stakeholder in a dedicated and specialised market. The recent strategy represents an approach that prioritises projects in a political process instead of basing such projects in extensive discussions in the healthcare sector. On the basis of the results, I suggest that a middle position be adopted in organising large-scale projects on integrated information systems. Such a strategy will give more power to the users of the information system. I believe that in real-world settings, a step-by-step strategy is favourable but requires good conditions for continued growth. Critical tasks are to break down large projects into a series of smaller ones, prioritise direct business value and assemble stable, full-time and cross-functional teams that execute these projects along a disciplined agile and optimisation approach