An investment decision-making process for investments in clinical ICT systems in public health care organizations

Aspects such as population aging and the ability of governments and municipalities to finance health services have challenged current ways of producing public health care services. Information and Communication Technology (ICT) has the potential to enable a significant transformation in the delivery of health care. Health care organizations lack a framework to assist in investment decisions when investing in clinical ICT systems. This thesis explores the clinical ICT investment decision-making process in a public health care organization. The aim of this study is to systematize the investment decision-making process in order to ensure the financial performance of the investment is in line with the organization’s existing operating environment. This is approached by answering the following two questions: 1) Which contingency factors will, with reasonable accuracy, contribute to the investment decision-making process when selecting a clinical ICT system in public health care? 2) Which contextual variables will, with sufficient accuracy, enhance the performance of clinical ICT system investments in public health care?The results show that investment decision-making in a public health care organization should begin with an analysis of the alternative technologies and their operational potential (technology variable). Decision-making should particularly emphasize three factors: standards, the integration potential of the system and the strategic fit with the health care organization’s strategy. These should form the basis of the financial analysis of the investment, which is then made using a modified capital budgeting method. The decision-making process should continue with ensuring that other important variables are taken into account. Legislation and the organization’s culture are variables, which should be considered before making the final decision to invest in a clinical ICT system. Since these variables might also affect the technology variable, the financial analysis might need to be re-visited during the decision-making process. This dissertation identifies the use of the contingency theory in clinical IT investment decisions in a public health care organization from a management accounting perspective. It also analyzes the contingency variables which may contribute to the investment analysis when investing in clinical IT in a public health care organization. Future research will be needed in order to identify the relationship between health care organizations’ management accounting systems and investment decision-making process. In addition, the contingency theory should be future tested to provide more insight into how the independent variables interact with each other.Ikääntyvä väestö sekä julkisen sektorin kyky tuottaa ja rahoittaa terveydenhuollon palveluita edellyttävät muutoksia nykyisiin toimintatapoihin. Tieto- ja viestintäteknologia (ICT) mahdollistaa merkittävän muutoksen terveydenhuollon toimintaan ja sen tapaan tuottaa palveluita. Julkisessa terveydenhuollossa on selkeä tarve löytää malli, joka auttaa tekemään investointipäätöksiä investoitaessa kliinisiin tietojärjestelmiin. Tässä työssä tutkitaan kliinisen tietojärjestelmäninvestointipäätöksen tekoa julkisessa terveydenhuolto-organisaatiossa. Tämän tutkimuksentavoitteena on systematisoida investointipäätösprosessi, jotta varmistetaan investoinninkannattavuus sekä investoinnin sopivuus organisaation toimintaympäristöön. Tämä saavutetaan vastaamalla kahteen kysymykseen: 1) mitkä tilannetekijät kohtuullisella tarkkuudella edistävät investointipäätösprosessia valittaessa julkisen terveydenhuolto-organisaation kliinistä tietojärjestelmää? 2) mitkä taustamuuttujat lisäävät riittävällä tarkkuudella julkisen terveydenhuollonkliinisen tietojärjestelmän investointipäätöksen tuloksellisuutta?Tämä tutkimus osoittaa, että julkisen terveydenhuolto-organisaation investointipäätösprosessi tulee aloittaa analysoimalla vaihtoehtoisia järjestelmiä ja niiden toimintaedellytyksiä (teknologiamuuttuja). Päätöksenteossa tulisi erityisesti ottaa huomioon kolme tekijää: standardit, järjestelmänintegroitavuus sekä sopivuus terveydenhuollon ja organisaation strategiaan. Edellä mainitut tekijät ovat perusta käytettäessä erilaisia investointilaskentamenetelmiä. Taloudellisten analyysien jälkeen investointipäätöksentekoprosessia tulisi jatkaa ottamalla huomioon muut merkittävät tilannetekijät. Ennen kaikkea lainsäädäntö sekä organisaation kulttuuri ovat tilannetekijöitä, jotka tulisi ottaa huomioon ennen lopullista kliiniseen tietojärjestelmän investointipäätöstä. Nämä tekijät saattavat vaikuttaa myös teknologisiin valintoihin, joten investointilaskelmia on hyvä tarkastella vielä uudelleen, kun kaikki tilannetekijät on analysoitu.Tässä väitöskirjassa tarkastellaan kontingenssiteorian käytettävyyttä laskentatoimen näkökulmasta tehtäessä investointipäätöksiä kliinisiin tietojärjestelmiin julkisessa terveydenhuollossa ja analysoidaan investointipäätökseen vaikuttavat kontingenssimuuttujat. Lisää tutkimusta tarvitaan siitä, miten terveydenhuollon organisaation laskentatoimi on kytketty investointipäätöksiin. Lisätutkimusta tarvitaan myös testaamaan sitä, miten riippumattomat kontingenssimuuttujat ovat vuorovaikutuksessa toistensa kanssa.<br/

Halpoja hintoja vai luotettavaa mielikuvaa? : kyselytutkimus optisen alan mainonnasta

Opinnäytetyömme tarkoituksena oli kartoittaa mielipiteitä optisen alan mainonnasta. Halusimme muun muassa tietää, koetaanko optisen alan mainonta yleisesti luotettavaksi ja millainen mainonta koetaan harhaanjohtavaksi. Halusimme myös vertailla, onko kuluttajien mielipiteissä eroavaisuuksia verrattuna joihinkin muihin aloihin. Valitsimme verrattaviksi aloiksi vaate- ja huonekalualan. Pyrimme selvittämään, koetaanko näiden alojen samantyyliset mainokset samalla tavalla esimerkiksi luotettaviksi tai harhaanjohtaviksi. Lisäksi olimme kiinnostuneita siitä, mitä tekijöitä asiakkaat arvostavat tehdessään ostopäätöstä silmälaseista, huonekaluista ja vaatteista. Tuloksista pyrimme myös vetämään johtopäätöksiä, millä keinoilla optisen alan yrityksen on kannattavaa mainostaa. Teimme tutkimuksen kvantitatiivisesti kyselylomaketta käyttäen. Kyselylomakkeen ohella vastaajan käytössä oli kolme mainosarkkia, joihin oli koottu silmälasi-, huonekalu- ja vaatemainoksia aloittain. Jokaisesta mainosarkista oli tarkoitus valita luotettavin, houkuttelevin, vähiten houkuttelevin ja harhaanjohtavin mainos. Lisäksi valittiin mainos, josta vastaaja olisi halunnut saada lisää tietoa. Jokaista mainosvalintaa vastaaja sai halutessaan perustella sanallisesti. Kyselylomakkeen viimeiset kysymykset käsittelivät vain optista alaa. Tutkimuksemme otos oli 35 henkilöä. Optisella alalla asiantuntijuus ja asiakaspalvelu koettiin selkeästi useammin ostopäätökseen vaikuttaviksi tekijöiksi kuin muilla aloilla. Mainosvalintojen tulokset olivat pääosin yksiselitteisiä. Optisella alalla hyväksi mainokseksi valikoitui vastaajien perustelujen mukaan selkeäksi koettu mainos, jossa oli eritelty, mitä hintaan kuuluu. Myös muista tuloksista kävi ilmi, että mainonnalta toivottaisiin enemmän selkeästi ymmärrettävissä olevaa hintatietoa. Mielipiteet optisen alan mainonnan luotettavuudesta jakautuivat kahtia. Alle 26-vuotiaat ja yli 52-vuotiaat kokivat mainonnan luotettavaksi, toisin kuin ikäryhmät tältä väliltä. Tulos oli tilastollisesti merkittävä. Tutkimuksemme tuloksista voidaan todeta, että optikon asiantuntijuutta voisi hyödyntää työn lisäksi mainonnassa, koska asiantuntijuus vaikuttaa kuluttajan ostopäätökseen. Tuloksista voidaan myös päätellä, että hinnan käyttämiseen silmälasimainonnassa tulisi kiinnittää erityistä huomiota. Hinnan olisi hyvä olla selkeästi esillä ja mainoksesta tulisi käydä ilmi, mitä mainostettava hinta sisältää.The purpose of this study was to survey opinions about advertising in the optical field. The advertising in the optical field has been emphasized for the price. We wanted to investigate, among other things, do consumers find the advertising in the optical field generally reliable and what kind of advertising is perceived to be misleading. We also wanted to compare whether there are differences in the opinions of consumers between optical field and some other fields. We decided to compare opinions to clothing and furniture. We tried to find out do consumers experience the same-style ads in the same way, for example to be reliable or misleading. In addition, we were interested in the factors that customers value when buying spectacles, furniture and clothing. We also tried to draw conclusions what kind of techniques are useful for companies to advertise. We conducted a quantitative survey using a questionnaire. In addition to answering the questionnaire, there were three ad sheets, in which had been collected spectacle, furniture, and clothing advertisements. From each ad sheet respondents had to select the most reliable, the most attractive, the least attractive and misleading advertisement. Moreover, respondents had to choose an ad of which they wanted to get more information. Respondent was allowed to give reasons for their ad selections. The final questions of the questionnaire dealt only with the optical field. Our sample consisted of 35 people. In the optical field expertise and customer service was clearly experienced more significant factors affecting the purchase decision than in other fields. Results of the ad selections were mainly unambiguous. In the optical field the advertisement that was experienced as good included a specification of what the price consists of. Also, the other results showed that advertising of the price is hoped to be more understandable. Opinions of the reliability of the advertising in the optical field were separated in two. Respondents under 26 years and over 52 years old experienced the advertising reliable, on the contrary to the age groups in between. This result was statistically significant. Our study results indicate that optometrist’s expertise could be used at work but also in advertising because expertise affects the consumer’s purchasing decision. The results also indicate that using of the price in the spectacle advertising should be paid special attention. The price should be clearly on view and there should be a specification of what the price includes

Decision making process for clinical it investments in a public health care organization – contingency approach to support the investment decision process

Purpose Health care organizations are lacking a clear decision-making framework in IT investment decisions. This study aims at finding a practical tool able to take the different financial and non-financial factors into account. The usefulness of one possible tool, the Contingency Theory, is evaluated.The Contingency Theory seeks to understand which external factors in particular have an impact on the organization's operations or which internal factors must be taken into account to make the optimal investment. In the public health care context the internal variables such as organization's culture and condition of existing technology, and external variables such as legislation and politics play an important role.Methods The Contingency Theory is applied to a complex real-world investment case a posteriori, and the variables thus obtained are compared with the actual acquisition process which took place. The relevant information has been gathered from the accounting systems, and by interviews.Results The Contingency Theory finds a relevant set of variables to consider in the decision-making process, and the set of variables mostly coincides with the actual parameters considered in the decision-making process. The actual acquisition process placed more weight on cost factors than the Contingency Theory approach would have done.Conclusions The application of contingency theory suggests that in this case the expected value of costs was over-emphasized. It is likely that a contingency-based approach would have given a more balanced view of the different parameters. Further research is required to establish its usefulness in different types of public health care acquisitions

Muistoissamme kirjastosihteeri Jussi Luukka 1956-2018

In memoriam: Kirjastosihteeri Jussi Luukka 17.10.1956 – 23.4.201

Härkäpapusäilörehun ja rypsitason vaikutukset maitotuotokseen ja ravintoaineiden hyväksikäyttöön

Non peer reviewe

PRISM : recovering cell-type-specific expression profiles from individual composite RNA-seq samples

Motivation: A major challenge in analyzing cancer patient transcriptomes is that the tumors are inherently heterogeneous and evolving. We analyzed 214 bulk RNA samples of a longitudinal, prospective ovarian cancer cohort and found that the sample composition changes systematically due to chemotherapy and between the anatomical sites, preventing direct comparison of treatment-naive and treated samples. Results: To overcome this, we developed PRISM, a latent statistical framework to simultaneously extract the sample composition and cell-type-specific whole-transcriptome profiles adapted to each individual sample. Our results indicate that the PRISM-derived composition-free transcriptomic profiles and signatures derived from them predict the patient response better than the composite raw bulk data. We validated our findings in independent ovarian cancer and melanoma cohorts, and verified that PRISM accurately estimates the composition and cell-type-specific expression through whole-genome sequencing and RNA in situ hybridization experiments.Peer reviewe

Longitudinal single-cell RNA-seq analysis reveals stress-promoted chemoresistance in metastatic ovarian cancer

Chemotherapy resistance is a critical contributor to cancer mortality and thus an urgent unmet challenge in oncology. To characterize chemotherapy resistance processes in high-grade serous ovarian cancer, we prospectively collected tissue samples before and after chemotherapy and analyzed their transcriptomic profiles at a single-cell resolution. After removing patient-specific signals by a novel analysis approach, PRIMUS, we found a consistent increase in stress-associated cell state during chemotherapy, which was validated by RNA in situ hybridization and bulk RNA sequencing. The stress-associated state exists before chemotherapy, is subclonally enriched during the treatment, and associates with poor progression-free survival. Co-occurrence with an inflammatory cancer-associated fibroblast subtype in tumors implies that chemotherapy is associated with stress response in both cancer cells and stroma, driving a paracrine feed-forward loop. In summary, we have found a resistant state that integrates stromal signaling and subclonal evolution and offers targets to overcome chemotherapy resistance.Peer reviewe

PRISM: Recovering cell type specific expression profiles from individual composite RNA-seq samples

Motivation: A major challenge in analyzing cancer patient transcriptomes is that the tumors are inherently heterogeneous and evolving. We analyzed 214 bulk RNA samples of a longitudinal, prospective ovarian cancer cohort and found that the sample composition changes systematically due to chemotherapy and between the anatomical sites, preventing direct comparison of treatment-naive and treated samples.Results: To overcome this, we developed PRISM, a latent statistical framework to simultaneously extract the sample composition and cell type specific whole-transcriptome profiles adapted to each individual sample. Our results indicate that the PRISM-derived composition-free transcriptomic profiles and signatures derived from them predict the patient response better than the composite raw bulk data. We validated our findings in independent ovarian cancer and melanoma cohorts, and verified that PRISM accurately estimates the composition and cell type specific expression through whole-genome sequencing and RNA in situ hybridization experiments.</p

Longitudinal single-cell RNA-seq analysis reveals stress-promoted chemoresistance in metastatic ovarian cancer

Chemotherapy resistance is a critical contributor to cancer mortality and thus an urgent unmet challenge in oncology. To characterize chemotherapy resistance processes in high-grade serous ovarian cancer, we prospectively collected tissue samples before and after chemotherapy and analyzed their transcriptomic profiles at a single-cell resolution. After removing patient-specific signals by a novel analysis approach, PRIMUS, we found a consistent increase in stress-associated cell state during chemotherapy, which was validated by RNA in situ hybridization and bulk RNA sequencing. The stress-associated state exists before chemotherapy, is subclonally enriched during the treatment, and associates with poor progression-free survival. Co-occurrence with an inflammatory cancer-associated fibroblast subtype in tumors implies that chemotherapy is associated with stress response in both cancer cells and stroma, driving a paracrine feed-forward loop. In summary, we have found a resistant state that integrates stromal signaling and subclonal evolution and offers targets to overcome chemotherapy resistance