Reinforcing Health Management Intervention Effects with mHealth

The combination of both digital and in-person interventions could lead to significant health behavior change, yet it is not clear what are the mechanisms by which mHealth intervention can help individuals sustain their health records and what factors could lead to long-term engagement with mHealth. The purpose of the study is to determine the potential impact of mHealth on reinforcing self-management knowledge, skills, and confidence gained through completion of an in-person health management program. Specifically, we assess the impact of engagement with mHealth on health behaviors maintenance and explore the role of virtual presence and perceived benefits in engagement with mHealth. Our mixed methods study will be conducted in two phases involving focus groups and semi-structured interviews with adolescents who completed an in-person health management program as well as their usage analytics from technology

Designing Personally Relevant Avatars for Digital Health Interventions: The Biocultural Perspective of Presence

Digital health interventions (DHIs) show great promise in empowering patients to take positive action toward their self-care by helping them with chronic disease self-management efforts. However, problematic user engagement with DHIs is a key issue preventing the full realization of DHI benefits. DHI design issues, such as lack of personal relevance, can negatively impact user engagement and consequently prevent patients from entering the empowerment process. The literature recognizes that avatars can be used to assimilate a self-concept during human-computer interaction and enhance personal relevance through self-presence. Yet, little is known about designing avatars to achieve self-presence in the context of digital health. This paper reports the results of a design science research study that explores key design elements that can facilitate a personal connection between users and technology by inducing self-presence through avatars. This study has implications for the theory-driven design of DHI to engage users with chronic conditions

Diagnosing Patients and Recommending mHealth Technology? Exploring Physicians' Intention to Influence Patients' Use of Self-Health Management Technology

This paper introduces a new type of IT role, IT influencers. We define IT influencers as persons whose decision-making is critical but who do not directly use the focal technology. Then we contextualize the social role of IT influencers within the unified theory of acceptance and use of technology (UTAUT) framework to explore the conditions under which such individuals demonstrate IT-directed social behavior, termed intention to influence and become a social influence upon the targeted user’s technology use. We look at physicians, as IT influencers, and chronic diabetic patients, as IT users, who work together to promote patients' self-management of chronic diabetes using mobile health (mHealth) technology. The results demonstrated that physicians' evaluation of both IT and patients' technical ability led to intention to influence patients' use of mHealth technology. Furthermore, intent to influence is promoted in a social context in which supporting resources are available for both IT users

Appropriating Enterprise Resource Planning Systems in Colleges of Business: Extending Adaptive Stucturation Theory for Testability

Enterprise resource planning systems are a form of advanced information technology that is quickly becoming commonplace in colleges of business. The nature of software, industry involvement, and academe influences how enterprise resource planning systems are integrated into business education processes. The appropriation of these systems in an academic setting involves a great deal of change, which, if not carefully considered, could result in failure to achieve mutually beneficial outcomes for students, the academic institution and industry stakeholders. Adaptive structuration theory provides a conceptual change model that helps capture the longitudinal change process. In order to provide a better understanding of the periods of routine use at the center of adaptive structuration theory, we introduce theory from the concerns-based adoption model. We integrate aspects of these two theories in the academic setting to provide a theoretical framework that explains the enterprise resource planning systems appropriation process and provide a method for studying the utilization of advanced information technologies for educational purposes. This framework may also be used as a practical means of identifying and considering appropriation issues when planning and evaluating enterprise resource planning systems usage in the classroom

Configuring Technology Mediated Service Encounters: A Multi-level Model of Equifinality for Telemedicine Work Design

The world economy is rapidly shifting from a manufacturing based economy to a service economy, where successful service encounters are a focus of organizational work. Service encounters are critical interactions between service providers and recipients that indicate an organization’s capability to fulfill its mission and shape consumers’ impressions of the organization (M. J. Bitner, Booms, & Mohr, 1994; Winsted, 1997). Companies are increasingly turning to technology to enhance information and communication flow to customers in order to improve efficiency, cost-effectiveness, and/or quality (Froehle & Roth, 2004). It is unclear to what extent (if at all) research that investigates the dimensions of work in the form of face-to-face service encounters addresses the phenomena created by introducing technology into the consumer-service provider encounter process to create a virtual service space (Froehle & Roth, 2004). In healthcare, service encounters occur regularly between a healthcare provider and a patient. One such encounter, which is mediated by technology, is the use of telemedicine. While telemedicine is a form of virtual work that can deliver a wide range of healthcare services, this study uses video conferencing for direct patient care as the research context (see Figure 1). The sparse research on technology use in the context of technology mediated service encounters has centered on task execution work (e.g., routine customer service), rather than relationship building (e.g. consulting/ expert services) work (e.g., Mary Jo Bitner, Ostrom, & Meuter, 2002; Froehle, 2006). Furthermore, most work to date has focused on in a lean media environment (e.g. e-mail), rather than a rich media environment (e.g. video conferencing). Given current medical attention to patient-centered care, the telemedicine encounter provides a work phenomenon that entwines task execution and relationship building within a rich media environment. In order for such a critical service encounter to be successfully executed, additional knowledge is needed about the nature of this encounter and particularly how to explain how order comes about in using this technology from a multi-level perspective (outside environment level, organizational unit level, team level, and individual level). Technology mediated service encounters introduce new ways to communicate, new processes, and opens what may have been a relatively closed network in the past with face-to-face encounters to something more complex, multi-level and organic. Technology must be used in a way to provide an interdependent, complementary balance at all levels (in this case, outside environment level, organizational unit level, team level, and individual level) to provide some form of equifinality to reach intended goals. We use configuration theory ((Meyer, Tsui, & Hinings, 1993) to explore the give and take among levels by identifying various attributes and formal structures at each level of analysis that might encourage technology fit into the work context of providing direct patient care through the use of video conferencing. We show that equifinality in the case of complex virtual work structures, like telemedicine encounters, is a give and take of counterbalancing fit facilitators and inhibitors to produce order in complex technological work situations

Educating Students in Healthcare Information Technology: IS Community Barriers, Challenges, and Paths Forward

Healthcare information technology (HIT) is an exciting field to which information systems (IS) scholars have much to contribute. As the IS community continues to tackle enrollment and growth issues across the nation, HIT becomes an attractive topic for the IS educators to embrace. Careful consideration and domain understanding are needed to ensure a suitable depth and balance in curricula. The intent of this article is to provide guidance to the IS community to support and promote successful HIT educational courses and programs by investigating three important questions: (1) Does IS have a role in HIT? (2) Where does an IS educator look to begin with HIT education? (3) How do IS educators frame their vision for HIT curricula leveraging the discipline’s strengths? Our hope is that this article will illuminate HIT curriculum matters for the general IS faculty and generate purposeful debate regarding how best to position HIT education within the IS discipline if IS faculty want to join in the quest to successfully educate and place graduates in the growing health technology sector

Back to the future of IT adoption and evaluation in healthcare

This is a time of expansion, hope and change in the area of Health Information Technology (HIT). In this study, we provide an in-depth perspective into the adoption and diffusion of IT in healthcare based on a review of the current literature and upon expert panel assessments of adoption and diffusion issues, achievements to date, challenges facing key e-health technologies and future possibilities. These data are synthesised in the form of a research framework showing the main three areas of e-health (Electronic Medical Records, Clinical and Administrative systems and Telehealth) on three levels (individual, organisation and system). Current adoption and diffusion challenges and future possibilities are systematically presented via this research framework to inspire practice and research with both an individual and collective view of the key health systems currently confronting the healthcare sector

What’s on your keyboard? A systematic review of the contamination of peripheral computer devices in healthcare settings

Objective To determine the extent and type of microbial contamination of computer peripheral devices used in healthcare settings, evaluate the effectiveness of interventions to reduce contamination of these devices and establish the risk of patient and healthcare worker infection from contaminated devices. Design Systematic review Methods We searched four online databases: MEDLINE, CINAHL, Embase and Scopus for articles reporting primary data collection on contamination of computer-related equipment (including keyboards, mice, laptops and tablets) and/or studies demonstrating the effectiveness of a disinfection technique. Pooling of contamination rates was conducted where possible, and narrative synthesis was used to describe the rates of device contamination, types of bacterial and viral contamination, effectiveness of interventions and any associations between device contamination and human infections. Results Of the 4432 records identified, a total of 75 studies involving 2804 computer devices were included. Of these, 50 studies reported contamination of computer-related hardware, and 25 also measured the effects of a decontamination intervention. The overall proportion of contamination ranged from 24% to 100%. The most common microbial contaminants were skin commensals, but also included potential pathogens including methicillin-resistantStaphylococcus aureus, Clostridiumdifficile, vancomycin-resistantenterococci and Escherichia coli. Interventions demonstrating effective decontamination included wipes/pads using isopropyl alcohol, quaternary ammonium, chlorhexidine or dipotassium peroxodisulfate, ultraviolet light emitting devices, enhanced cleaning protocols and chlorine/bleach products. However, results were inconsistent, and there was insufficient data to demonstrate comparative effectiveness. We found little evidence on the link between device contamination and patient/healthcare worker colonisation or infection

Factors affecting the initiation of a shared decision making program in obstetric practices

As healthcare systems progress toward initiatives that increase patient engagement, stake-holder hopes are that shared decision making (SDM) will become routine practice. Yet, there is limited empirical evidence to guide such SDM program implementations, particularly in obstetric practices. The first stage of any project implementation is the “initiation stage”, in which project leaders define a project’s purpose and stakeholders and structures are put in place to support the new initiative. Our study’s objective was to identify factors affecting the initiation stage of an SDM program implementation project for TOLAC, trial of labor after Cesarean. We conducted a multiple-case study of an SDM program implementation in three obstetric settings in Washington State. The research design and analysis were guided by implementation science frameworks and project management literature. Data sources included interviews with key informants from the State, SDM tool vendors, and three project sites, as well as implementation documents. The study results provide insight into how the identified project implementation factors provide an essential foundation for informing project planning, execution, and reflection/evaluation. In this study, the State’s decision aid certification program pressured the project sites to shape the project purpose and engage stakeholders that would meet immediate project requirements (specifically, state require-ments). The study reveals that external demands may not be in perfect alignment with the internal necessities required for an SDM program’s long-term viability and sustainability. Findings may be used by implementers and researchers to model and strategize the early stages of SDM program implementation projects, particularly in the obstetric setting