64 research outputs found

    Medical Interpreters\u27 Experience Working with Distressed Families in Pediatric Settings

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    Effective communication between families and pediatric clinicians is essential for mitigating family stress and improving quality of care. Families who speak a primary language other than English must contend with the added stress of language barriers during stressful encounters, which could impact the quality of patient care and health outcomes. Trained medical interpreters facilitate communication, including distress expressions, during interpreted medical encounters (IME). Little is known about how interpreters identify distress and what factors impact distress identification during IME. This project describes how interpreters identify distress of families during IME, and how they identify cultural nuances in distress expression and communication of families during IME. Special attention is placed on factors that influence why and how interpreters identify distress expression, such as their intersecting social identities and lived personal and professional experiences. Interpreters from the current study collectively reported that families in IME expressed distress in various ways: through visual, auditory, interpersonal, and contextual cues. Interpreters also perceived that distress expression among Spanish-speaking families in IME is diverse and simultaneously culture-specific and universal, influenced by cultural norms specific to the families’ intersecting social identities. Therefore, cultural concepts of distress and more covert culture bound expressions of distress (e.g., withdrawal) should be considered when evaluating family distress. Medical care teams inclusive of health care clinicians and medical interpreters should continue to cultivate their own cultural and emotional intelligence to better understand cultural concepts of distress among families from multiply minoritized backgrounds in the health care system. Clinicians and medical interpreters may benefit from collaboratively working together to better identify and respond when families are distressed

    The Implication for Organisation and Governance Through User-Drivern Standardisation of Semantic Interoperable Electronic Patient Record Systems

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    The increased demand for more effective sharing of healthcare information to support complex patient pathways crossing organisational boundaries calls for semantic interoperable process-oriented Electronic Patient Record (EPR) systems. It follows the need for common standards to ensure that information is understood and interpreted consistently across various contexts. A considerable body of literature has demonstrated that standardisation within healthcare has proven difficult to achieve. Moreover, standardisation processes have traditionally had a top-down approach, for which little attention has been paid to users’ work practices. The many failures of standardisation efforts have put focus into alternative standardisation strategies, in which one promising method is promoted through the emerging openEHR approach for standardising the content of the EPRs. A network of voluntary clinical users should have a prominent role in standardisation processes and running the process in a distributed and negotiated manner over the Internet. In this paper, we seek to give empirical insight regarding the evolving process of developing and implementing a sematic interoperable EPR system based on the openEHR framework, and the implication for organisation and governance addressed by the evolving process. We analyse the case through an information infrastructure perspective, and claim that user-driven standardisation of semantic interoperable EPR systems has to be supported by a multi-level organisational infrastructure, in addition to governance organisations that make decisions and monitor results and performances at different healthcare levels. The organisational and governance infrastructure has to be established simultaneously, but preferably, in advance of new development projects. Empirically, we have followed the interplay between the developing process of an EPR system based on the openEHR approach and a government-led establishment of an archetype repository

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

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    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

    Enhancing the Benefits Management Model for Complex eHealth Efforts

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    This thesis suggests five ways to improve BM in complex eHealth efforts. First, the concept of BR was defined to clarify the existing conflation of the BR and BM concepts. Second, an extended and enhanced BMM was developed that incorporated the BM context, levels of complexity for both organizational and interorganizational initiatives, and the critical aspects of learning and governance. Third, three propositions concerning learning and governance in BM were suggested based on the new model, which can be used to inform future BM studies and guide empirical work. Fourth, the propositions were further translated into a six-question checklist to stimulate learning from the BM process itself. Finally, I provide suggestions for BM governance in interorganizational ICT efforts aiming to realize societal benefits.publishedVersio

    The influence of stakeholder relations on the implementation of information systems strategy in public hospitals in South Africa: an activity theory perspective

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    Includes bibliographical references.Literature reveals that there exists a research gap between the development of information systems (IS) strategy and the implementation thereof. There is also a need for further research regarding the implementation of IS strategy in public hospitals in South Africa. The exploration of implementation in the context of public hospitals in South Africa, a country with many good policies and strategies that have been developed but that are not always implemented, is highly relevant. In this study we undertook to explore the intricacies of stakeholder relations and the implications of these relations on the implementation of IS strategy in public hospitals in South Africa. This research was interpretive following a case study approach. Two provinces of South Africa were selected as cases: the Western Cape province and the Kwazulu Natal province. The Activity Analysis and Development (ActAD) framework, an enhanced form of activity theory, was used as the theoretical framework. Data was collected using semi-structured interviews, meetings, documents analysis and physical artefacts observation. The collected data was analysed using thematic analysis. The findings of this study reveal that factors related to stakeholder relations include the situational stakeholder relations dynamics and the level and motive of involvement in IS strategic activities and IS strategy operationalization processes at the different hierarchical levels. These factors affect the implementation of the IS strategy in public hospitals in South Africa by influencing different elements of the IS strategy implementation activity system. In the end we developed a framework, the stakeholder relations’ influence (SRI) framework which depicts the influence of stakeholder relations on the implementation of IS strategy in public hospitals in South Africa

    Institutional perspective on introducing enterprise architecture : The case of the Norwegian hospital sector

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    Paper I, II, and III are not available as a part of the dissertation due to the copyright.The findings from this thesis point to the incongruence between the characteristics of EA and the healthcare domain as specific tensions among the EA logic and different professional logics as a source of deviation. The incongruence comes from the long-term plan-driven EA approach versus healthcare traditions and needs for ad-hoc initiatives. Other themes stem from the EA logic of process standardisation, which poses challenges in gaining acceptance and trust that the processes dinscribe appropriate clinical knowledge and provide support for local variations. Moreover, the EA vision of data integration across organisational units and across IS has implications for concerns about privacy and protection of sensitive data, but this can collide with the healthcare view on patient safety and the need for mission-critical data. This dissertation makes several contributions to research and practice. First, it augments the EA research stream by offering rich insights and specific implications related to challenges of EA institutionalisation in healthcare. A description of the enterprise architects’ logics and the EA logic supplements the EA knowledge base. Likewise, it presents a model of a predicted evolution of the EA initiatives through the phases of optimism, resistance, decline and finally, reconsolidation of the most persistent ones, unless firm mandates are established from the start. Furthermore, the study provides a model that illustrates how coexisting institutional logics maintain their distinct character while allowing compromises that shape EA operationalisation. The model shows a set of scenarios for settling tensions in project decisions. In these scenarios, EA is foregrounded, blended with other available institutional logics or suppressed. Second, this dissertation contributes to an enhanced theoretical and empirical understanding of EA institutionalisation, where regulative, normative and culturalcognitive elements create and maintain EA as an institution, and unsurprisingly, the organisational response impedes the institutionalisation process. The organisational response can be explained by selective activated institutional logics among the actors. However, with targeted institutional work from the actors that want EA to be institutionalised, the process can be reinforced. This thesis also offers some practical suggestions at the national policy level. First, financial arrangements should be assessed to encourage broader involvement from the sub-organisations. Second, through active ownership, they can address the need for enhanced EA understanding and should secure the education of the actors, not the least at the executive level, together with the targeted hires. Furthermore, the need for organisational changes related to EA is under-communicated. The thesis also makes practical suggestions to deal with the challenges, the incongruence and the consequent tensions, mainly by finding solutions that balance between the institutional logics of EA and of healthcare.publishedVersio

    Auditory P300 In College-Aged Females At-Risk for Eating Disorders

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    55, [10] leaves. Advisor: Steven Faux.Neurological impairment in eating disorders has been widely documented. The P300 component of event-related potentials has demonstrated efficacy in identifying individuals who suffer from mental disorders and cognitive deficits. More recently, a number of researchers have used P300 event-related potentials (ERPs) to elucidate the effects of food intake and glucose metabolism on brain function and performance on cognitive tasks. Minor food deprivation decreases P300 amplitude and increases P300 latency, indicators of impaired cognitive performance. Short-term memory disruptions correlate with such ERP decrements. The present study examined the auditory P300 in females who are at-risk for developing an eating disorder as defined by a score of 14 or more on the Drive for Thinness subscale of the Eating Disorder Inventory-:! (EDI-2). Memory performance was also examined. The results failed to support the hypothesis that at-risk females, compared to normal controls would restrict their food intake and would therefore exhibit smaller P300 amplitudes, longer P300 latencies, and impaired short-term memory. There was also no statistically significant difference between the at-risk and normal controls group on a self-report measure of amount of and time since last food consumption. Interestingly, the at-risk and normal controls groups also differed significantly on EDI-2 scores for the bulimia, interoceptive awareness, and asceticism subscales
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