Information Technology Development Needs in Community Pharmacies : A Strategic Approach

In the context of health care, information technology (IT) has an important role in the operational infrastructure, ranging from business management to patient care. An essential part of the system is medication management in inpatient and outpatient care. Community pharmacists strategy has been to extend practice responsibilities beyond dispensing towards patient care services. Few studies have evaluated the strategic development of IT systems to support this vision. The objectives of this study were to assess and compare independent Finnish community pharmacy owners and staff pharmacists priorities concerning the content and structure of the next generation of community pharmacy IT systems, to explore international experts visions and strategic views on IT development needs in relation to services provided in community pharmacies, to identify IT innovations facilitating patient care services and to evaluate their development and implementation processes, and to assess community pharmacists readiness to adopt innovations. This study applied both qualitative and quantitative methods. A qualitative personal interview of 14 experts in community pharmacy services and related IT from eight countries and a national survey of Finnish community pharmacy owners (mail survey, response rate 53%, n=308), and of a representative sample of staff pharmacists (online survey, response rate 22%, n=373) were conducted. Finnish independent community pharmacy owners gave priority to logistical functions but also to those related to medication information and patient care. The managers and staff pharmacists have different views of the importance of IT features, reflecting their different professional duties in the community pharmacy. This indicates the need for involving different occupation groups in planning the new IT systems for community pharmacies. A majority of the international experts shared the vision of community pharmacy adopting a patient care orientation; supported by IT-based documentation, new technological solutions, access to information, and shared patient data. Community pharmacy IT innovations were rare, which is paradoxical because owners and staff pharmacists perception of their innovativeness was seen as being high. Community pharmacy IT systems development processes usually had not undergone systematic needs assessment research beforehand or evaluation after the implementation and were most often coordinated by national governments without subsequent commercialization. Specifically, community pharmacy IT developments lack research, organization, leadership and user involvement in the process. Those responsible for IT development in the community pharmacy sector should create long-term IT development strategies that are in line with community pharmacy service development strategies. This could provide systematic guidance for future projects to ensure that potential innovations are based on a sufficient understanding of pharmacy practice problems that they are intended to solve, and to encourage strong leadership in research, development of innovations so that community pharmacists potential innovativeness is used, and that professional needs and strategic priorities will be considered even if the development process is led by those outside the profession.Strateginen näkökulma apteekkien tietojärjestelmien kehittämiseen Suomalaisten apteekkien strategiana on ollut laajentaa vastuuta lääkkeiden toimittamisesta potilaiden lääkehoitoa tukeviin palveluihin. Tietotekniikan avulla toteutettu lääkehoidon hallinta vahvistaa apteekkien roolia merkittävänä lääkehuollon toimijana. Tietotekniikan osuutta apteekkien strategian toteuttamisessa on tähän mennessä tutkittu vähän. Suomalaiset apteekkarit kokivat logistiikkaa tukevat tietojärjestelmän ominaisuudet erittäin tärkeiksi, mutta arvostivat myös lääkityksen hallintaan liittyviä ominaisuuksia. Apteekissa työskentelevien eri ammattiryhmien näkemykset tietojärjestelmän eri ominaisuuksien tärkeydestä poikkesivat toisistaan, omien työtehtävien kannalta tutut ominaisuudet koettiin tärkeiksi. Tutkimustulokset osoittavat, ettei tietojärjestelmiä voida kehittää ainoastaan apteekkareiden näkemysten perusteella, vaan arvokasta tietoa saadaan myös muulta henkilöstöltä ja erityisesti asiakaspalvelussa työskenteleviltä farmaseuteilta, joilla on keskeinen merkitys asiakaslähtöisissä toiminnoissa. Kansainvälisistä asiantuntijoista suurin osa jakaa vision apteekkien potilaskeskeisestä toimintamallista, jota tietotekniset sovellukset tukevat. Tutkimuksen mukaan apteekkien tietotekniset innovaatiot ovat harvinaisia, vaikka apteekkilaiset itse arvioivat oman innovatiivisuutensa korkeaksi. Kansainvälisesti apteekkien tietojärjestelmien kehitysprosessit eivät noudattaneet teoreettisen viitekehyksen mallia, vaan tyypillisimmin tutkimusvaihe ennen kehitystyötä sekä toteutusvaiheen jälkeen jäi puuttumaan. Lisäksi kehitysprosessi oli yleensä koordinoitu yhteiskunnan taholta ilman varsinaista kaupallista tuotteistusta. Erityisen puutteellisina osa-alueina kansainväliset asiantuntijat pitivät tutkimusta, organisointia, johtamista sekä tulevien käyttäjien osallistumista kehitystyöhön. Apteekkien tietojärjestelmien kehittämisestä vastaavien tahojen tulisi luoda pitkän aikavälin strategia tukemaan ammattiapteekkistrategiaa ja ohjaamaan tulevia projekteja, jotta varmistettaisiin innovaatioiden kehittäminen apteekkityön tarpeisiin. Lisäksi tarvitaan vahvaa johtajuutta tutkimuksessa ja kehitystyössä, jotta apteekeissa työskentelevien ammattilaisten innovatiivisuus tulee hyödynnettyä. Apteekkien ammatilliset tarpeet ja strategia tulee huomioida apteekin tietojärjestelmien kehitystyössä. Tutkimuksen aineisto kerättiin suomalaisille apteekkareille, proviisoreille ja farmaseuteille osoitetulla kyselytutkimuksella sekä kansainvälisten asiantuntijoiden haastattelututkimuksella

Human-Machine Communication: Complete Volume. Volume 2

This is the complete volume of HMC Volume 2

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606

Analysis of healthcare professionals’ acceptance of service innovations in the German telemonitoring market for diabetes.

La diabetes mellitus supone una importante carga financiera y organizativa para el sistema sanitario alemán. Una forma de cibersalud (o e‐health) es la telemonitorización de los pacientes, que permite a los profesionales sanitarios controlar de forma remota las condiciones médicas y el estilo de vida que pueden respaldar un determinado diagnóstico y terapia. Para cubrir una monitorización 24/7, los centros de telemedicina pueden considerarse como proveedores de estos servicios. Así, estas infraestructuras de telemedicina interactiva pueden ser una respuesta a los desafíos que plantea tanto la hospitalización y las emergencias de estos pacientes, como la falta de especialistas y el aumento del número de diabéticos. Pero incluso en Alemania, que es un país altamente industrializado, las estructuras digitales no están lo suficientemente avanzadas. Las implementaciones están afectadas por la tecnología en sí, por las políticas y la legislación correspondientes, por la financiación disponible, por el contexto organizacional y, no menos importante, por la aceptación de los usuarios potenciales. La literatura científica se centra en la aceptación de la tecnología por parte del paciente, pero se ha profundizado poco en los factores de aceptación de los servicios de telemonitorización interactivos por parte de los iniciadores de la terapia: los especialistas en salud diabética, en Alemania. Por lo tanto, esta investigación tiene como objetivo identificar, construir y evaluar los constructos de aceptación de tecnología adecuados dentro de un modelo, así como su operacionalización en un cuestionario. Este enfoque debería brindar una visión más completa de todos los posibles factores de contexto relevantes para comprender la Intención de Comportamiento (Behavioral Intention, BI) de los profesionales de la salud diabética en Alemania ante esas posibles soluciones. El modelo específico se ha construido sobre la base del Modelo de Aceptación de Tecnología (TAM) de Davis. Se ha realizado una revisión de la literatura y se han filtrado los factores ya identificados que influyen en la aceptación de un profesional de la salud para utilizar un programa de telemedicina. Un reducido número de estudios se han centrado en el contexto alemán con participación de centros de telemedicina. Así, a los constructos de estudios previos que abarcan lo técnico, organizativo, social, jurídico e individual, se han sumado las variables “Relación con el paciente” y “Confianza en el centro de telemedicina” con el fin de incluir los aspectos de “interacción”. Las variables relacionadas con el mercado se han adaptado a las características propias del sistema sanitario alemán. Con la ayuda de una encuesta online, el cuestionario se ha validado en una prueba preliminar con 40 profesionales sanitarios alemanes. Para el estudio de campo principal, se ha enviado una encuesta por correo a los diabetólogos y asesores en diabetes de todas las oficinas especializadas en diabetes de la Asociación de Seguros Médicos Obligatorios en la región Westfalia‐Lippe, en Alemania, obteniéndose un total de 57 observaciones. Con la ayuda de Smart PLS se ha aplicado el modelado de ecuaciones estructurales para comprobar la validez y las relaciones causales entre las variables. Los análisis estadísticos han confirmado que el constructo Facilidad de Uso Percibida influye en el constructo Utilidad Percibida, y han mostrado posteriormente la relación de la Utilidad Percibida con la Intención de Comportamiento. Se ha comprobado también el efecto de la Compatibilidad con el Estilo de Trabajo y la Importancia de la Seguridad de los Datos sobre la Intención de Comportamiento. Los proveedores de tales servicios tecnológicos deben enfocarse, por lo tanto, en la capacitación y en una comunicación detallada de las opciones y beneficios de las implementaciones. Se ha demostrado que el Modelo de Aceptación del Servicio de Telemonitorización Interactivo diseñado explica la Intención de Comportamiento de los futuros profesionales de la salud diabética con respecto a esta telemedicina interactiva.Administración y Dirección de Empresa

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Computer deployment in the health services of developed and developing countries : a comparative case study of the UK and Oman

Organisations are increasingly deploying and using computer technology in various ways, involving the allocation of large amounts of capital and human resources. However, in many cases, computer deployment has been accompanied by failure, particularly in health care services. Therefore, information technology has raised grave questions, misunderstanding, fears, and hostility.This study emphasises the importance of computer deployment and development in developed and developing countries' health care services with examples from advanced and less advanced nations. It describes strategy development for IT/ISs using information system methodologies and explores the development of ISs strategy in the NHS in the light of fundholding and the internal market. A number of problems that commonly influence the success or failure of computer deployment and development are identified. These issues are explained through two case studies: the Omani health system and General Practices (GPRs) in the UK, which have introduced computers.The research focuses on five main sets of issues related to computer deployment and utilisation in health care: strategic planning; computer utilisation; computer fears; computer impact; and computer technical problems and performance. Users' overall satisfaction with systems in use is also considered.Data collection was carried out using two surveys. One survey was conducted in GPRs in Humberside and the other conducted in Royal Hospital and Sultan Qaboos University Hospital in Oman. Data sources included observations, review of relevant documents, such as reports, research papers and manuals, structured and non-structured interviews with selected users and a questionnaire.A number of conclusions can been drawn from this study: firstly, computer deployment, utilisation and development still faces problems in both the systems studied, more especially the Omani system. Secondly, GPRs have carried out strategic planning for computer deployment and utilisation and are prepared to use information system methodology for IT/IS strategy and there is a plan to use this for competitive advantage but Omani hospitals did not set a constructive strategic plan for their systems. Thirdly, the main problems of computer failure are related to human issues rather technical issues. The most important of these human issues are the style of the leadership planning, poor utilisation of computer applications, lack of skills and poor training. Finally, the results of the survey suggested that though the respondents were aware of the potential of computer technology, the problems of computer fears, training and lack of skills were experienced, and often, few individuals possessed computingknowledge.The author suggests several points to be considered: 1) that any thinking about computer deployment and development should employ appropriate information system development methodologies; 2) the decisions on computer deployment, use and development should be made by a special committee that has expertise in IT matters; 3) good strategic planning for computer deployment, use and development; should be connected to the organisation's overall strategy and 4) there is a need of mandate review for such development and planning. With these points in mind the researcher presents a diagram to help improving strategic planning and development of IT/IS methods with particular emphasis on the Omani environment

Impact of written drug information in patient package inserts: Acceptance and impact on benefit/risk perception

This thesis discusses the patient package insert (PPI), a folded sheet of paper in the drug package with a text which is supposed to be comprehensible for the general public. The PPI contains information on how the drug must be taken, on the risks of taking the drug, and a limited amount of information on whatthe drug is for. Belgium was the first country in Europe, together with Switzerland, to introduce PPIs. PPIs were first introduced in 1988 and the process was completed in 1992. In Europe, health authorities decided in 1992 that all medicinal product packages should contain a comprehensible insert. This decision is slowly but surely being implemented in all European countries. Similar developments did not take place in the US and other parts of the world, where medicines are distributed in bulk and dispensed without much information, even when dealing with powerful prescription drugs. During the introduction of PPIs in Belgium, a research programme wasconducted to evaluate this change in the way drug information was provided in the drug distribution system. This thesis provides an overview of the studiescarried out during that period. In addition, a number of other descriptive studies of the flow of drug information in specific patients groups is provided. Finally, a number of experimental studies is presented, which evaluate the impact of written drug information on patients? benefit/risk perception. The acceptance of a drug distribution system with mandatory PPIs in all drug packages will be evaluated on the basis of Belgium?s relatively long and welldocumented experience with PPIs. We address the following questions: what is the percentage of patients who read, accept and appreciate PPIs; what happens when a country changes from technical inserts with difficult jargon to comprehensible PPIs; what do we know about the impact of PPIs on patients knowledge and feelings about their drugs? In this thesis, an attempt is made to understand the mental processing of drug information which precedes patients' decisions and coping strategies, necessary for successful drug treatment. The question here is whether the PPI is capable of influencing the benefit/risk perception of patients. A further step is to study the impact of the PPI on behaviour. Here, other questions are at stake. Does the PPI have an impact on patients' reporting of health problems and side-effects, on their ability to carry out a treatment correctly and safely, on their adherence to therapy at the beginning of treatment, and on their motivation to continue crucial therapy? These questions are addressed only to a limited extent in this work, as we have focused on the preceding cognitive process of benefit/risk perception

Optimising the use of ICTs by health & social care professionals in the community

This research was commissioned as part of the Department of Health's Information and Communication Technology (ICT) Research Initiative, to identify ways in which ICTs might provide benefits to health and social care professionals working across boundaries and to the clients/ patients that they serve. The project aimed to examine the use of existing ICTs in supporting isolated users in the community (principally professionals but also lay users), and to consider ways in which use of such ICTs might be improved, focusing initially on non-person identifiable information. A single patient group was selected as the main focus of the study - older people (and their carers). This group was chosen because the needs of older people and their carers reflect those of the wider isolated populations served by health and social welfare professionals in terms of their clinical, psychological and social care needs. Other isolated groups might include the physically disabled, the mentally ill, or those socially and potentially service isolated through geography, lifestyles or other factors. Older people would be represented in all these categories. Therefore, a study focusing on the information needs of professionals who support older patients or clients should provide findings that are generalisable to other groups, such as those mentioned above. Furthermore, it was evident that this is an important group on which to focus in terms of inter-agency working because of the various policy initiatives that aim to enhance working between professionals across the health and social care interface in relation to older people

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

The development and implementation of e-health services for the Libyan NHS: case studies of hospitals and clinics in both urban and rural areas

This thesis provides an assessment of the readiness levels within both urban and rural hospitals and clinics in Libya for the implementation of E-health systems. This then enabled the construction of a framework for E-health implementation in the Libyan National Health Service (LNHS). The E-health readiness study assessed how medications were prescribed, how patients were referred, how information communication technology (ICT) was utilised in recording patient records, how healthcare staff were trained to use ICT, and how the ways in which consultations were carried out by healthcare staff. The research was done in five rural clinics and five urban medical centres and focused on the E-health readiness levels of the technology, social attitudes, engagement levels and any other needs that were apparent. Collection of the data was carried out using a mixed methods approach with qualitative interviews and quantitative questionnaires. The study indicated that any IT equipment present was not being utilised for clinical purposes and there was no evidence of any E-health technologies being employed. This implies that the maturity level of the healthcare institutions studied was at level zero in the E-health maturity model used in this thesis. In order for the LNHS to raise its maturity levels for the implementation of E-health systems, it needs to persuade LNHS staff and patients to adopt E-health systems. This can be carried out at a local level throughout the LNHS, though this will need to be coordinated at a national level through training, education and programmes to encourage compliance and providing incentives. In order to move E-health technology usage in the participating Libyan healthcare institutions from Level 0 to Level 2 in the E-health Maturity Model levels, an E-health framework was created that is based on the findings of this research study. The primary aim of the LNHS E-Health Framework is the integration of E-health services for improving the delivery of healthcare within the LNHS. To construct the framework and ensure that it was creditable and applicable, work on it was informed directly by the findings from document analysis, literature review, and expert feedback, in conjunction with the primary research findings presented in Chapter Five. When the LNHS E-Health Framework was compiled there were several things taken into consideration, such as: the abilities of healthcare staff, the needs of healthcare institutions and the existing ICT infrastructure that had been recorded in the E-readiness assessment which was carried out in the healthcare institutions (Chapter 5). The framework also provides proposals for E-health systems based on the infrastructure network that will be developed. The processes addressed are electronic health records, E-consultations, E-prescriptions, E-referrals and E-training. The researcher has received very positive, even enthusiastic, feedback from the LNHS and other officals, and that expect the framework to be further developed and implemented by the LNHS in the near future