Diffusion of innovations in the National Health Service: A Case Study investigating the implementation of an electronic patient record system in a UK secondary care Trust.

The aim of the research was to explore the experiences of consultants during the implementation stages of a major IT programme in a UK health care organisation and to explain what factors affected the adoption of the new technologies. A single site case study approach using semi-structured interviews and project documentation was employed. The data was analysed using a method similar to Template Analysis. It was found that the Trust employed a top down, centrally driven model which was perceived as a technology push, even though it was claimed to be clinical lead. Innovation attributes that were the most influential were the poor performance and its impact on the perceptions of relative advantage, voluntariness and cost. Organisational problems encountered included differences between the structures of the IT directorate and the centralised structure of the organisation. Managing the perceptions of consultants towards IT is an essential element to facilitate the successful adoption of information technology

Using System Analysis and Personas for e-Health Interaction Design

Today, designers obtain more central roles in product and service development (Perks, Cooper, & Jones, 2005). They have to deal with increasingly complicated problems, like integrating the needs of various stakeholders while taking care about social, ethical and ecological consequences of their designs. To deal with this demanding design situation, they need to apply new methods to organize the available information and to negotiate the stakeholder’s perspectives. This paper describes how systems analysis supports the design process in a complex environment. In a case study, we demonstrate how this method enables designers to describe user requirements for complex design environments while considering the perspectives of various stakeholders. We present a design research project applying cybernetic systems analysis using the software ''System-Tools'' (Vester, 2002). Results from the analysis were taken to inform the design of an electronic patient record (EPR), considering the particularities of the German health care system. Based on the analysis, we developed a set of requirements for every stakeholder group, detailing the patients' perspective with persona descriptions. We then picked a main persona as reference for the EPR design. We describe the resulting design sketch and discuss the value of cybernetic systems analysis as a tool to deal with complex social environments. The result shows how the method helps designers to structure and organize information about the context and identify fruitful intervention opportunities for design. Keywords: E-Health; System Analysis, Cybernetics; Personas.</p

PACS integrated situational alignment framework: a quantitative approach for successful PACS alignment and performance assessment in hospitals

Hospitals are investing in Information Technology and Information Systems in order to improve their processes and workflow and hence, to optimize patient care. Picture Archiving and Communications Systems (PACS) have seen gradual uptake in hospitals to achieve this goal. PACS implementations and the consecutive expansion and integration with the Electronic Patient Record requires massive investments and cultural changes by hospital (clinical) staff prior and during organizational adoption. It is therefore essential that these systems are aligned properly with the hospital operations. Alignment approaches for PACS implementations and appropriate assessment methods have been underexposed in scientific literature. In this paper, we propose the PACS integrated situational alignment (PISA) Framework, a theoretical framework that is designed for the continuous assessment, monitoring, successful alignment of PACS, and performance measures for PACS deployment in the hospital enterprise. In addition, we set out a research agenda to elaborate on this elementary topic

Proof-of-Concept Application - Annual Report Year 2

This document first gives an introduction to Application Layer Networks and subsequently presents the catallactic resource allocation model and its integration into the middleware architecture of the developed prototype. Furthermore use cases for employed service models in such scenarios are presented as general application scenarios as well as two very detailed cases: Query services and Data Mining services. This work concludes by describing the middleware implementation and evaluation as well as future work in this area. --Grid Computing

Summary care record early adopter programme: an independent evaluation by University College London.

Benefits The main potential benefit of the SCR is considered to be in emergency and unscheduled care settings, especially for people who are unconscious, confused, unsure of their medical details, or unable to communicate effectively in English. Other benefits may include improved efficiency of care and avoidance of hospital admission, but it is too early for potential benefits to be verified or quantified. Progress As of end April 2008, the SCR of 153,188 patients in the first two Early Adopter sites (Bolton and Bury) had been created. A total of 614,052 patients in four Early Adopter sites had been sent a letter informing them of the programme and their choices for opting out of having a SCR. Staff attitudes and usage The evaluation found that many NHS staff in Early Adopter sites (which had been selected partly for their keenness to innovate in ICT) were enthusiastic about the SCR and keen to see it up and running, but a significant minority of GPs had chosen not to participate in the programme and others had deferred participation until data quality improvement work was completed. Whilst 80 per cent of patients interviewed were either positive about the idea of having a SCR or ?did not mind?, others were strongly opposed ?on principle?. Staff who had attempted to use the SCR when caring for patients felt that the current version was technically immature (describing it as ?clunky? and ?complicated?), and were looking forward to a more definitive version of the technology. A comparable technology (the Emergency Care Summary) introduced in Scotland two years ago is now working well, and over a million records have been accessed in emergency and out-of-hours care. Patient attitudes and awareness Having a SCR is optional (people may opt out if they wish, though fewer than one per cent of people in Early Adopter sites have done so) and technical security is said to be high via a system of password protection and strict access controls. Nevertheless, the evaluation showed that recent stories about data loss by government and NHS organisations had raised concerns amongst both staff and patients that human fallibility could potentially jeopardise the operational security of the system. Despite an extensive information programme to inform the public in Early Adopter sites about the SCR, many patients interviewed by the UCL team were not aware of the programme at all. This raises important questions about the ethics of an ?implied consent? model for creating the SCR. The evaluation recommended that the developers of the SCR should consider a model in which the patient is asked for ?consent to view? whenever a member of staff wishes to access their record. Not a single patient interviewed in the evaluation was confident that the SCR would be 100 per cent secure, but they were philosophical about the risks of security breaches. Typically, people said that the potential benefit of a doctor having access to key medical details in an emergency outweighed the small but real risk of data loss due to human or technical error. Even patients whose medical record contained potentially sensitive data such as mental health problems, HIV or drug use were often (though not always) keen to have a SCR and generally trusted NHS staff to treat sensitive data appropriately. However, they and many other NHS patients wanted to be able to control which staff members were allowed to access their record at the point of care. Some doctors, nurses and receptionists, it seems, are trusted to view a person?s SCR, whereas others are not, and this is a decision which patients would like to make in real time

Automated tools and techniques for distributed Grid Software: Development of the testbed infrastructure

Grid technology is becoming more and more important as the new paradigm for sharing computational resources across different organizations in a secure way. The great powerfulness of this solution, requires the definition of a generic stack of services and protocols and this is the scope of the different Grid initiatives. As a result of international collaborations for its development, the Open Grid Forum created the Open Grid Services Architecture (OGSA) which aims to define the common set of services that will enable interoperability across the different implementations. This master thesis has been developed in this framework, as part of the two European-funded projects ETICS and OMII-Europe. The main objective is to contribute to the design and maintenance of large distributed development projects with the automated tool that enables to implement Software Engineering techniques oriented to achieve an acceptable level of quality at the release process. Specifically, this thesis develops the testbed concept as the virtual production-like scenario where to perform compliance tests. As proof of concept, the OGSA Basic Execution Service has been chosen in order to implement and execute conformance tests within the ETICS automated testbed framework

eHealth key issues in portuguese public hospitals

Hospital managers, health and IT Professionals have their work increasingly supported and dependent on information systems and technologies. To be more effective and efficient in the way health care is delivered, considerable improvements in health information systems and technologies still have to be made at the local and national levels. This is a study that seeks for a deeper understanding of the Portuguese hospitals main stakeholder’s concerns regarding their interaction with Information Technology, so opportunities for improvement can be later identified. Seven public hospitals have been selected to participate in this study. In each hospital, managers, IT and health professional were interviewed leading to the discussion of some global and shared perceptions that resulted in a list of eHealth key issues in public Portuguese hospitals.The authors would like to thank the Central Administration for Health Services (ACSS) of the Portuguese Health Ministry for sponsoring this study

Wireless Regulations and Dynamic Spectrum Access in Australia

Australia assigns and allocates spectrum using three broad types of regulatory approaches; command and control, property rights and open access. Each approach entails numerous pros and cons, buttressed by uncertainties over future consumer demand, interference management, barriers to entry, and technological evolution. The development and commercialisation of dynamic spectrum access technologies (DSA) requires new regulatory approaches. This article discusses an array of intermediary, dynamically efficient spectrum management approaches, which may make better use of DSA opportunities. The article then discusses the practical hurdles and legal challenges posed by their adoption and regulation in an Australian context