The Status Quo of IS Conference Publications on Theorising eHealth in Developing Countries

The purpose of this systematic review is to consolidate existing evidence on electronic health (eHealth) initiatives examined in developing countries to better inform future practice and research. More specifically, this paper examines the status quo of theorising eHealth in developing countries across a range of top Information Systems (IS) conference publications over a fifteen year period (2000–2015). While some work has been done on examining the application of theory within the eHealth domain, the associated context in which this work is performed is often over looked. Examining the papers from a theoretical and contextual perspective reveal that IS researchers’ primary attention is generalisable theory (in the form of explanation) with some consideration given to the interaction with the healthcare context. IS researchers should leverage the lessons learned from other IS sub domains and move beyond generalisable theories to further enrich the understanding of eHealth in developing countries

The status quo of IS conference publications on theorising eHealth in developing countries.

The purpose of this systematic review is to consolidate existing evidence on electronic health (eHealth) initiatives examined in developing countries to better inform future practice and research. More specifically, this paper examines the status quo of theorising eHealth in developing countries across a range of top Information Systems (IS) conference publications over a fifteen year period (2000–2015). While some work has been done on examining the application of theory within the eHealth domain, the associated context in which this work is performed is often over looked. Examining the papers from a theoretical and contextual perspective reveal that IS researchers’ primary attention is generalisable theory (in the form of explanation) with some consideration given to the interaction with the healthcare context. IS researchers should leverage the lessons learned from other IS sub domains and move beyond generalizable theories to further enrich the understanding of eHealth in developing countries

UNDERSTANDING THE PRESENT TO PREPARE FOR THE FUTURE: A REVIEW OF HEALTH INFORMATION SYSTEMS RESEARCH IN NIGERIA (7)

Health Information Systems (HIS) present many opportunities to address health challenges in developing countries such as Nigeria. However, in order to leverage the potential of HIS, the opportunities and challenges facing implementation must be explored and understood. This paper conducts an archival analysis of the existing literature on HIS in Nigeria published in premier Information Systems (IS) and Health Informatics outlets; in an effort to provide a comprehensive picture of existing literature by identifying trends, discussing findings, and proposing new research opportunities. The 18 articles meeting the inclusion criteria are reviewed. Current trends are discussed using the framework developed by McLeon et al. (2013) for understanding the factors influencing health IS implementation in developing countries. At present, several challenges face IS implementation in Nigeria such as the lack of policy guidance, resistance among end users, and cultural barriers. In addition, existing studies are limited in scope, theory, and level of analysis applied. The paper contributes to the literature by investigating the status quo, presenting new areas ripe for future investigation including the organisational, financial, and technological issues at play, and illuminating important issues which can guide pilot testing and implementation of new health IS initiatives in Nigeria

Philosophical Dimensions of Research in M-Health-Based Disease Surveillance in Sub-Saharan Africa: A Systematic Literature Review

We examine the current literature on mobile health (m-Health) based disease surveillance in sub-Saharan Africa (SSA). We aim to uncover the philosophical assumptions scholars use to drive research studies in the field. We considered this pertinent because philosophical assumptions play significant roles in how Information Systems (IS) and their users are conceptualised. We sought to address the following broad review question using a systematic literature review approach: what are the philosophical assumptions that drive research in m-Health-based disease surveillance and the impact on methodological assumptions and theoretical frameworks adopted by scholars? Our findings reveal that positivist and pragmatist traditions dominate the research area. However, given the complex contextual conditions in SSA, alternative philosophical assumptions in the post-positivist philosophy, particularly interpretivism, could enhance our understanding of phenomena surrounding m-Health-based disease surveillance. Therefore, we seek to stimulate the IS community\u27s interest in investigating m-Health-based disease surveillance from interpretivist perspectives to offer more meaningful contributions in theorising the phenomenon

Trends, Findings, and Opportunities: An Archival Review of Health Information Systems Research in Nigeria

Low and middle income countries continue to struggle with limited availability of healthcare capability and resources. Recently, a variety of health information systems (HIS) projects have been piloted in an attempt to overcome these challenges by improving the quality of data to support the delivery of healthcare services from the community to hospital settings. Indeed, existing literature considers a breath of pilot HIS studies that have been undertaken in African countries. This study focuses on HIS interventions in the West African country of Nigeria. This paper conducts an archival analysis of existing literature on HIS in Nigeria published in premier Information Systems (IS) and Health Informatics outlets. This analysis provides a comprehensive picture of existing literature by identifying trends, discussing findings, and proposing new research opportunities. The 18 articles meeting the inclusion criteria are reviewed. Using a framework developed by Leon, Schneider, and Daviaud (2012), we consider current trends to elucidate the factors influencing health IS implementation in developing countries. Several challenges face IS implementation in Nigeria such as the lack of policy guidance, resistance among end users, and cultural barriers. Existing studies are limited in scope, theory, and level of analysis applied. The paper contributes to the literature by providing practical recommendations to better navigate future HIS implementations in developing countries, while also identifying avenues through which IS researchers can advance the HIS literature in an empirical, theoretical, and practical sense

What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare

Telehealth and telecare research has been dominated by efficacy trials. The field lacks a sophisticated theorisation of [a] what matters to older people with assisted living needs; [b] how illness affects people's capacity to use technologies; and [c] the materiality of assistive technologies. We sought to develop a phenomenologically and socio-materially informed theoretical model of assistive technology use. Forty people aged 60–98 (recruited via NHS, social care and third sector) were visited at home several times in 2011–13. Using ethnographic methods, we built a detailed picture of participants' lives, illness experiences and use (or non-use) of technologies. Data were analysed phenomenologically, drawing on the work of Heidegger, and contextualised using a structuration approach with reference to Bourdieu's notions of habitus and field. We found that participants' needs were diverse and unique. Each had multiple, mutually reinforcing impairments (e.g. tremor and visual loss and stiff hands) that were steadily worsening, culturally framed and bound up with the prospect of decline and death. They managed these conditions subjectively and experientially, appropriating or adapting technologies so as to enhance their capacity to sense and act on their world. Installed assistive technologies met few participants' needs; some devices had been abandoned and a few deliberately disabled. Successful technology arrangements were often characterised by ‘bricolage’ (pragmatic customisation, combining new with legacy devices) by the participant or someone who knew and cared about them. With few exceptions, the current generation of so-called ‘assisted living technologies’ does not assist people to live with illness. To overcome this irony, technology providers need to move beyond the goal of representing technology users informationally (e.g. as biometric data) to providing flexible components from which individuals and their carers can ‘think with things’ to improve the situated, lived experience of multi-morbidity. A radical revision of assistive technology design policy may be needed

Converging outcomes in nationally shareable electronic health records (NEHRs): An historical institutionalist explanation of similar NEHR outcomes in Australia, England and the United States of America

The adoption of nationally shareable electronic health records (NEHRs) in Australia, England and the United States became major policy and political issues between c1998 and 2015. They continue to be so. As a policy issue, the benefits of ehealth, and subsequently NEHRs as mechanisms for institutional change, were rhetorically popular. Politically however, the development, implementation and regulation of NEHRs proved to be difficult and fraught with criticism from nearly all ehealth stakeholders. The NEHR programs each country pursued at the national level were exceptionally expensive and complex infrastructure undertakings. They involved institutional change management that produced tension amongst stakeholders, required the state to decide on trade-offs that produced winners and losers, and resulted in unintended consequences. Initially, each country approached these policy and political issues differently. Examining why they then had substantially similar outcomes is the substantive puzzle that lies at the centre of this research. This thesis adopts an historical institutionalist approach to explain why state efforts to pursue the development, implementation and regulation of NEHRs at the national level in Australia, England and the United States resulted in substantially similar outcomes despite adopting initially different approaches. The thesis first compares why each case study country pursued ehealth, embarked on organisational change in order to achieve its ehealth and NEHR goals, and adopted NEHRs, noting similarities and major differences. The thesis then compares the state's role in the development of NEHRs at the national level in each country, again noting similarities and differences. A comparative evaluation of the cases is then undertaken in order to explain why each state continued to pursue NEHRs, despite the significant barriers to institutional change they faced. Here, the theoretical concepts of path dependency, critical junctures and incremental change are used to enhance the explanation. The thesis will then explain why the outcomes, as assessed through the lens of public policy evaluation, were substantially similar in each country. Finally, the thesis details the findings of the research through the lens of historical institutionalism and states the significance and implications of the research. The research found that while each case study country approached the policy and political issues of ehealth and NEHRs differently, the outcomes were substantially the same because their goals, and the barriers they faced in trying to achieve them, were very similar. Australia started with a decentralised national health information network (NHIN) then changed to a centralised NEHR. England started with, and continued to pursue, a centralised NEHR. The United States eschewed government development and implementation of an NEHR and took the path of incentivising and regulating electronic health records (EHRs) in an effort to make them nationally shareable. Similar goals across the three countries included moving from a paper to an EHR system; giving patients more control over their health information; making EHRs interoperable; increasing EHR usability and the meaningful use of patient health information; and improving the efficiency and effectiveness of care. Similar barriers included: cost, privacy, trust, stakeholder preferences, and the state attempting to drive change too quickly producing stakeholder resistance and negative outcomes. The thesis findings also provide support for theoretical explanations of institutional stasis and change within the context of path dependency, critical junctures and incremental institutional change

Public health, free movement and macroeconomic coordination:mapping the evolving governance of European Union health policy

Health is a unique and intriguing sphere of European Union (EU) policy, not least of all because it has only been recognised as such for the last 15 years. From piecemeal origins in public health and occupational safety it underwent dramatic expansion as a result of exposure to free movement and internal market law in the 1990s. Now, in the aftermath of the economic crisis, it is entering another unprecedented era. As the focus of the European project has turned to fiscal sustainability and the strengthening of collective economic governance, health policy has been swept into frameworks designed for the oversight of macroeconomic policy and national expenditure. Crucially, these frameworks extend EU health influence into areas reserved in the founding treaties for exclusive national control. This thesis seeks to map the changing nature, scope and governance of EU health policy, contributing to the existing patchwork of literature and reviewing the prevailing narrative in light of the critical juncture now being faced. It draws on the theories of European integration, the Europeanisation framework and the more recent governance approaches to assess the continuing relevance of core themes – crisis politics, regulatory policy, the internal market, new modes of governance, and the role of the Court – in health policy development. Using six case studies and data from 41 interviews with experts, policy-makers and officials, it examines the catalysts, drivers and dynamics of health policy integration. It finds that as the actors and interests involved in health policy have proliferated, health issues have become increasingly politicised. Addressing the consequences of this trend, the thesis explores the growing dependence on, and progressive strengthening of, voluntarist governance, as well as the declining scope and influence of EU health policy. Finally, it reflects upon the future of health within a politicised European integration project