Electronic prescribing systems in hospitals to improve medication safety: a multimethods research programme.

Electronic prescribing (ePrescribing) systems allow health-care professionals to enter prescriptions and manage medicines using a computer. We set out to find out how these ePrescribing systems are chosen, set up and used in English hospitals. Given that these systems are designed to improve medication safety, we looked at whether or not these systems affected the number of prescribing errors made (mistakes such as ordering the wrong dose of medication). We also tried to see whether or not the systems were good value for money (or more cost-effective). Finally, we made recommendations to help hospitals choose, set up and use ePrescribing systems. We found that setting up ePrescribing systems was very difficult because there is a need to take into consideration how different pharmacists, nurses and doctors work, and the different work that needs to be carried out for different diseases and medical conditions. We recorded a link between the implementation of ePrescribing systems and a reduction in some high-risk prescribing errors in two out of three study sites. Given that the error reductions corresponded to the warnings triggered by the system, we concluded that the system is likely to have caused the error reduction. Prescribing errors may lead to adverse events that lead to death, impaired quality of life and longer hospital stays. The cost of an ePrescribing system increased in proportion to reduced errors, reaching £4.31 per patient per year for the site that experienced the greatest reduction in prescribing errors (i.e. site S). This estimate is based on assumptions in the model and how much a health service is willing to pay for a unit of health benefit. To help professionals choose, set up and use ePrescribing systems in the future, we produced an online ePrescribing Toolkit (www.eprescribingtoolkit.com/; accessed 21 December 2019) that, with support from NHS England, is becoming widely used internationally

Inside The Lines: Essays on the Performance of Whole Organizational Networks

University of Minnesota Ph.D. dissertation. May 2019. Major: Business Administration. Advisors: Akbar Zaheer, Russell Funk. 1 computer file (PDF); xv, 155 pages.This dissertation is focused on the study of heterogeneous network performance. For decades, most strategy and organizational research has focused on understanding how networks influence a single “node,” typically an organization or individual. In contrast, I shift my perspective to view a whole network as the unit of analysis. This approach is designed to deepen scholarly understanding of strategic outcomes and collective performance that only exist at the higher level – the whole network level. The motivation for this dissertation is the realization many of society’s most complex problems and Grand Challenges require the concerted efforts of organizations towards shared goals, which may not always coincide with local (organization level) incentives. As such, I use the context of healthcare reform in the United States to examine how analyzing the complex patterns of interorganizational patient care may help us better understand the determinants of emergent outcomes at the whole network level. Specifically, the Affordable Care Act of 2010 led to the formation of hundreds of new interorganizational networks, called Accountable Care Organizations, within the Medicare system. Using patient treatment networks based on claims data, I examine two research questions. First, what are the relationships among various network level properties and collective performance? Second, how did the formation of Accountable Care Organizations alter existing patient care patterns and outcomes, if at all? In sum, this dissertation makes theoretical contributions to the study of organizational networks, particularly with regards to network level outcomes. Moreover, this research offers insights into how network studies may inform policy and practice in healthcare

Positive health: The passport approach to improving continuity of care for low income South African chronic disease sufferers

Research Problem: The South African health system faces numerous challenges associated with its status as a middle-income developing nation. Wasteful expenditure and poor clinical outcomes arise from inefficient inter-organizational communication of patient information and the lack of a centralized health database. Research question: How does the experience of chronic disease patients with their health information inform the development of future health records in low income population groups? Proposition: Exploration of patient and health care workers experiences of medical records can inform their future development to enhance continuity of care. Objectives, methodology, procedures and outcome: Identification of an appropriate format, technological basis and functional design of a prototype medical record system by means of a phenomenological study conducted through in-depth interviews of patients and doctors in order to improve clinical care. Left and right hermeneutics were used to analyse the data and develop themes. Findings: Health records play a critical role in the clinics workflow processes, document the patients' management and clinical progress. They are an important intermediary in the relationship between the patient and the facility. Inefficiencies in the paper-based system lead to ineffective consultations, loss of continuity of care and discord between practitioners and patients. Improvement of the records format is required to provide ubiquitous access to health and improve patient health literacy

Modern Socio-Technical Perspectives on Privacy

This open access book provides researchers and professionals with a foundational understanding of online privacy as well as insight into the socio-technical privacy issues that are most pertinent to modern information systems, covering several modern topics (e.g., privacy in social media, IoT) and underexplored areas (e.g., privacy accessibility, privacy for vulnerable populations, cross-cultural privacy). The book is structured in four parts, which follow after an introduction to privacy on both a technical and social level: Privacy Theory and Methods covers a range of theoretical lenses through which one can view the concept of privacy. The chapters in this part relate to modern privacy phenomena, thus emphasizing its relevance to our digital, networked lives. Next, Domains covers a number of areas in which privacy concerns and implications are particularly salient, including among others social media, healthcare, smart cities, wearable IT, and trackers. The Audiences section then highlights audiences that have traditionally been ignored when creating privacy-preserving experiences: people from other (non-Western) cultures, people with accessibility needs, adolescents, and people who are underrepresented in terms of their race, class, gender or sexual identity, religion or some combination. Finally, the chapters in Moving Forward outline approaches to privacy that move beyond one-size-fits-all solutions, explore ethical considerations, and describe the regulatory landscape that governs privacy through laws and policies. Perhaps even more so than the other chapters in this book, these chapters are forward-looking by using current personalized, ethical and legal approaches as a starting point for re-conceptualizations of privacy to serve the modern technological landscape. The book’s primary goal is to inform IT students, researchers, and professionals about both the fundamentals of online privacy and the issues that are most pertinent to modern information systems. Lecturers or teacherscan assign (parts of) the book for a “professional issues” course. IT professionals may select chapters covering domains and audiences relevant to their field of work, as well as the Moving Forward chapters that cover ethical and legal aspects. Academicswho are interested in studying privacy or privacy-related topics will find a broad introduction in both technical and social aspects

Modern Socio-Technical Perspectives on Privacy

This open access book provides researchers and professionals with a foundational understanding of online privacy as well as insight into the socio-technical privacy issues that are most pertinent to modern information systems, covering several modern topics (e.g., privacy in social media, IoT) and underexplored areas (e.g., privacy accessibility, privacy for vulnerable populations, cross-cultural privacy). The book is structured in four parts, which follow after an introduction to privacy on both a technical and social level: Privacy Theory and Methods covers a range of theoretical lenses through which one can view the concept of privacy. The chapters in this part relate to modern privacy phenomena, thus emphasizing its relevance to our digital, networked lives. Next, Domains covers a number of areas in which privacy concerns and implications are particularly salient, including among others social media, healthcare, smart cities, wearable IT, and trackers. The Audiences section then highlights audiences that have traditionally been ignored when creating privacy-preserving experiences: people from other (non-Western) cultures, people with accessibility needs, adolescents, and people who are underrepresented in terms of their race, class, gender or sexual identity, religion or some combination. Finally, the chapters in Moving Forward outline approaches to privacy that move beyond one-size-fits-all solutions, explore ethical considerations, and describe the regulatory landscape that governs privacy through laws and policies. Perhaps even more so than the other chapters in this book, these chapters are forward-looking by using current personalized, ethical and legal approaches as a starting point for re-conceptualizations of privacy to serve the modern technological landscape. The book’s primary goal is to inform IT students, researchers, and professionals about both the fundamentals of online privacy and the issues that are most pertinent to modern information systems. Lecturers or teacherscan assign (parts of) the book for a “professional issues” course. IT professionals may select chapters covering domains and audiences relevant to their field of work, as well as the Moving Forward chapters that cover ethical and legal aspects. Academicswho are interested in studying privacy or privacy-related topics will find a broad introduction in both technical and social aspects

Mapping the Genres of Healthcare Information Work: An Interdisciplinary Study of the Interactions Between Oral, Paper, and Electronic Forms of Communication

Electronic Patient Records (EPRs) are becoming standard tools in healthcare, lauded for improving patient access and outcomes. However, the healthcare professionals who work with, around, and despite these technologies in their daily practices often regard EPRs as troublesome. In order to investigate how EPRs can prompt such opposing opinions, this project examines the EPR as a collection of communication genres set in complex contexts. In this project, I investigate an EPR as it was used on the Nephrology ward at a large, Canadian, urban, paediatric teaching hospital. In this setting, this study investigates EPR-use in relation to the following aspects of context: (a) the visual rhetoric of the EPR's user-interface design; (b) the varied social contexts in which the EPR was used, including a diversity of professional collaborators who had varying levels of professional experience; (c) the span of social actions involved in EPR use; and (d) the other genres used in coordination with the EPR. This qualitative study was conducted in two simultaneous stages, over the course of 8 months. Stage one consisted of a visual rhetorical analysis of a set of genres (including the EPR) employed by participants during a specific work activity. Stage two involved an elaborated, qualitative case study consisting of non-participant observations and semi-structured interviews. Stage two used a constructivist grounded theory methodology. A combination of theoretical perspectives -- Visual Rhetoric, Rhetorical Genre Studies, Activity Theory, and Actor-Network Theory -- supported the analysis of study data. This research reveals that participants routinely transformed EPR-based information into paper documents when the EPR's visual designs did not support the professional goals and activities of the participants. Results indicate that healthcare professionals work around EPR-based patient information when that genre's visual organization is incompatible with professional activities. This study suggests that visual rhetorical analysis, complemented with observation and interview data, can provide useful insights into a genre's social actions. This research also examines the effects of such EPR-to-paper genre transformations. Although at one level of analysis, the EPR-to-paper-genre transformation may be considered inefficient for participants and so should be automated, at another level of analysis, the same transformation activity can be seen as beneficially supporting the detailed reviewing of patient information by healthcare professionals. To account for this function in the transformation dysfunction, my research suggests that many contextual factors need to be considered during data analysis in order to construct a sufficiently nuanced understanding of a genre's social actions. To accomplish such an analysis, I develop a five-step approach to data analysis called 'context mapping. ' Context mapping examines genres in relation to the varied social contexts in which they are used, the span of social actions in which they are involved, and a range of genres with which they are coordinated. To conduct this analysis, context mapping relies heavily on theories of "genre ecologies" (Spinuzzi, 2003a, 2003b; Spinuzzi, Hart-Davidson & Zachry, 2004; Spinuzzi & Zachry, 2000) and "Knotworking" (Engestrom, Engestrom & Vahaaho, 1999). Context mapping's first three steps compile study data into results that accommodate a wide range of contextual analysis considerations. These three steps involve the use of a composite scenario of observation data, genre ecologies and the description of a starting point for analysis. The final two steps of this approach analyse results using the theory of Knotworking and investigate some of the implications of the patterns of genre use on the ward. Through context mapping analysis, this study demonstrates that EPR-based innovations created by a study participant could result in the generation of other improvisations, in a range of genres, by the original participant and/or by other collaborators. These genre modifications had ramifications across multiple social contexts and involved a wide range of genres and associated social actions. Context mapping analysis demonstrates how the effects of participant-made EPR-based variations can be considered as having both beneficial and detrimental effects in the research site depending on the social perspective adopted. Contributions from this work are directed towards the fields of Rhetorical Genre Studies, Activity Theory research, and Health Informatics research, as well as to the research site itself. This study demonstrates that context mapping can support text-in-context style research in complex settings as a means for evaluating the effects of genre uses