Translating Health IT Policy into Practice in the UK National Health Service

The challenge to provide a nation-wide integrated health service is central to UK government policy. The National Programme for Information Technology was launched in 2002 to transform healthcare using information and communications technology. As the largest, non-military, non-scientific government funded IT programme worldwide, it was planned over a decade with an estimated total cost expected to exceed £20bn. This paper is a longitudinal study of the National Care Record Service, which was the largest part of the programme, aimed to provide 50 million UK (English) citizens with an electronic health record. Using episodic interviewing techniques over ten years and secondary source material, the findings reveal a series of IT policy changes to the original Programme. Delays to roll out electronic health records are linked to issues about procurement strategies with IT suppliers, benefits realisation, risk assessment and clinical engagement. This study extends academic work on the deployment of large scale, long-term publicly funded IT projects, which go beyond the technical imperative to transform healthcare. Findings suggest government agencies need to embed cultural, social and economic criteria into health IT policy-making. Tracking this Programme for a decade, we observe how a centralised, top-down approach was replaced by localised IT procurement and implementation, giving NHS organisations more decision-making powers. However, the Programme was beset by continuous policy changes affecting the structure, organisation and IT of the NHS, where attempts to achieve benefits finally resulted in the break-up of the Programme

From ASP to Web Services: Identifying Key Performance Areas and Indicators for Healthcare

Value creation from e-business for customers in healthcare is an important topic in academic and practitioner circles. This paper reports the findings from a two-year research study, which found that disappointing results from the much hyped application service provider (ASP) business model, is currently being replaced by perceived new opportunities from Web Services. Yet past failings from ASP do not guarantee future success with web services models, particularly as evidence shows that accruing value added benefits from e-business initiatives is often fraught with difficulty. Healthcare is no exception, and is likely to pose more problems given the complexity of the organisational structures, processes, procedures and activities within this vertical sector. This research study calls for a more rigorous approach in identifying and evaluating key performance areas and indicators from new e-business initiatives involving emerging technologies and platforms such as Web services. Yet the measures and metrics used for healthcare may differ from those adopted in other sectors. Healthcare professionals will therefore need to develop context specific KPAs and KPIs, and caution against accepting ‘face value’ the value proposition devised by Web service providers

Offshore Information Systems Outsourcing: Strategies and Scenarios

This paper presents the findings of an ongoing research study into offshore information technology and systems outsourcing. Fieldwork was conducted in India and the United Kingdom to identify different strategies and scenarios. Based on the premise that offshore outsourcing poses greater risks than using suppliers from the home country, the research develops a risk assessment matrix comprising four scenarios: body shopping; maintenance and support of system hardware and software; IT architecture design; and strategy and product development. As offshore outsourcers develop resources and capabilities to offer high value-added work, this increases their own risk, and those of the customer

Applying sense-making to integrated health IT: Renal care in the UK and Sweden

Information technology (IT) in healthcare combines opportunities for improved integrated healthcare delivery with barrierswhich include clinician resistance and low adoption rates. While national level initiatives are taken to promote electronichealthcare (e-health), it is at the grassroots level that their outcomes unfold. This paper employs sense-making theory toextend prior research on the implementation of health IT by investigating the introduction of IT into renal care units in theUK and Sweden. Issues such as management support, user training, usability of systems and perceived benefits of technologywere found to have a direct impact on users’ sense-making processes. The manner in which people make sense of imposedsystems has far reaching effects, as the gap between intended results and actual outcomes is not limited to disparities betweenmicro-level end-users alone, but spans multiple levels including higher authorities, as well as individuals at the grassrootslevel

Healthcare IT Adoption under Different Government Models: Debating the HITECH Impacts

Governments around the world are investing in healthcare as they attempt to increase access to care and the quality of care, while simultaneously lowering the costs of providing care. Many of these investments are in healthcare IT (HIT). The IT software industry is preparing for intensive competition for their HIT packages and workers in response to government and private industry investments. Yet different national healthcare models have produced widely differing healthcare outcomes and HIT adoption rates, with the U.S. performing poorly on both. The objective of this panel is to provide insights based on HIT research conducted in multiple healthcare contexts under different national government models, and then to engage the panel audience in debating the prospects for success of three IT-enabled healthcare delivery reforms being government-funded in the U.S. over the next 5 years. Our larger goal is to provide a forum for information sharing that will motivate other IS researchers across the global IS research community to contribute to the design of solutions and the capturing of best practices that will address some of the key goals of IT-enabled healthcare reform: improved access and quality, and decreased costs

Dialectic tensions in the financial markets: a longitudinal study of pre- and post-crisis regulatory technology

This article presents the findings from a longitudinal research study on regulatory technology in the UK financial services industry. The financial crisis with serious corporate and mutual fund scandals raised the profile of compliance as governmental bodies, institutional and private investors introduced a ‘tsunami’ of financial regulations. Adopting a multi-level analysis, this study examines how regulatory technology was used by financial firms to meet their compliance obligations, pre- and post-crisis. Empirical data collected over 12 years examine the deployment of an investment management system in eight financial firms. Interviews with public regulatory bodies, financial institutions and technology providers reveal a culture of compliance with increased transparency, surveillance and accountability. Findings show that dialectic tensions arise as the pursuit of transparency, surveillance and accountability in compliance mandates is simultaneously rationalized, facilitated and obscured by regulatory technology. Responding to these challenges, regulatory bodies continue to impose revised compliance mandates on financial firms to force them to adapt their financial technologies in an ever-changing multi-jurisdictional regulatory landscape

Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570