Explaining the Health Information Technology Paradox

Excerpt] The substantial gap between the promise inherent in upgrading information systems in health care and the documented reality has baffled health care scholars. Why is a technology so clearly capable of creating efficiencies, increasing safety, and promoting greater information sharing and coordination across professionals failing to live up to expectations

Measurement Error in Performance Studies of Health Information Technology: Lessons from the Management Literature

Just as researchers and clinicians struggle to pin down the benefits attendant to health information technology (IT), management scholars have long labored to identify the performance effects arising from new technologies and from other organizational innovations, namely the reorganization of work and the devolution of decision-making authority. This paper applies lessons from that literature to theorize the likely sources of measurement error that yield the weak statistical relationship between measures of health IT and various performance outcomes. In so doing, it complements the evaluation literature’s more conceptual examination of health IT’s limited performance impact. The paper focuses on seven issues, in particular, that likely bias downward the estimated performance effects of health IT. They are 1.) negative self-selection, 2.) omitted or unobserved variables, 3.) mis-measured contextual variables, 4.) mismeasured health IT variables, 5.) lack of attention to the specific stage of the adoption-to-use continuum being examined, 6.) too short of a time horizon, and 7.) inappropriate units-of-analysis. The authors offer ways to counter these challenges. Looking forward more broadly, they suggest that researchers take an organizationally-grounded approach that privileges internal validity over generalizability. This focus on statistical and empirical issues in health IT-performance studies should be complemented by a focus on theoretical issues, in particular, the ways that health IT creates value and apportions it to various stakeholders

Financial Information Mediation: A Case Study of Standards Integration for Electronic Bill Presentment and Payment Using the COIN Mediation Technology

Each player in the financial industry, each bank, stock exchange, government agency, or insurance company operates its own financial information system or systems. By its very nature, financial information, like the money that it represents, changes hands. Therefore the interoperation of financial information systems is the cornerstone of the financial services they support. E-services frameworks such as web services are an unprecedented opportunity for the flexible interoperation of financial systems. Naturally the critical economic role and the complexity of financial information led to the development of various standards. Yet standards alone are not the panacea: different groups of players use different standards or different interpretations of the same standard. We believe that the solution lies in the convergence of flexible E-services such as web-services and semantically rich meta-data as promised by the semantic Web; then a mediation architecture can be used for the documentation, identification, and resolution of semantic conflicts arising from the interoperation of heterogeneous financial services. In this paper we illustrate the nature of the problem in the Electronic Bill Presentment and Payment (EBPP) industry and the viability of the solution we propose. We describe and analyze the integration of services using four different formats: the IFX, OFX and SWIFT standards, and an example proprietary format. To accomplish this integration we use the COntext INterchange (COIN) framework. The COIN architecture leverages a model of sources and receivers’ contexts in reference to a rich domain model or ontology for the description and resolution of semantic heterogeneity.Singapore-MIT Alliance (SMA

Editorial Essay: Introduction to a Special Issue on Work and Employment Relations in Health Care

[Excerpt] This special issue of the ILR Review is designed to showcase the central role that work organization and employment relations play in shaping important outcomes such as the quality of care and organizational performance. Each of the articles included in this special issue makes an important contribution to our understanding of the large and rapidly changing health care sector. Specifically, these articles provide novel empirical evidence about the relationship between organizations, institutions, and work practices and a wide array of central outcomes across different levels of analysis. This breadth is especially important because the health care literature has largely neglected employment-related factors in explaining organizational and worker outcomes in this industry. Individually, these articles shed new light on the role that health information technologies play in affecting patient care and productivity (see Hitt and Tambe; Meyerhoefer et al.); the relationship between work practices and organizational reliability (Vogus and Iacobucci); staffing practices, processes, and outcomes (Kramer and son; Hockenberry and Becker; Kossek et al.); health care unions’ effects on the quality of patient care (Arindrajit, Kaplan, and Thompson); and the relationship between the quality of jobs and the quality of care (Burns, Hyde, and Killet). Below, we position the articles in this special issue against the backdrop of the pressures and challenges facing the industry and the organizations operating within it. We highlight the implications that organizational responses to industry pressures have had for organizations, the patients they care for, and the employees who deliver this care

On the edge of a new frontier: Is gerontological social work in the UK ready to meet twenty-first-century challenges?

This article is available open access through the publisher’s website. Copyright @ 2013 The Authors.This article explores the readiness of gerontological social work in the UK for meeting the challenges of an ageing society by investigating the focus on work with older people in social work education and the scope of gerontological social work research. The discussion draws on findings from two exploratory studies: a survey of qualifying master's programmes in England and a survey of the content relating to older people over a six-year period in four leading UK social work journals. The evidence from master's programmes suggests widespread neglect of ageing in teaching content and practice learning. Social work journals present a more nuanced picture. Older people emerge within coverage of generic policy issues for adults, such as personalisation and safeguarding, and there is good evidence of the complexity of need in late life. However, there is little attention to effective social work interventions, with an increasingly diverse older population, or to the quality of gerontological social work education. The case is made for infusing content on older people throughout the social work curriculum, for extending practice learning opportunities in social work with older people and for increasing the volume and reporting of gerontological social work research.Brunel Institute for Ageing Studie

Radiative acceleration and transient, radiation-induced electric fields

The radiative acceleration of particles and the electrostatic potential fields that arise in low density plasmas hit by radiation produced by a transient, compact source are investigated. We calculate the dynamical evolution and asymptotic energy of the charged particles accelerated by the photons and the radiation-induced electric double layer in the full relativistic, Klein-Nishina regime. For fluxes in excess of $10^{27}$ ${\rm erg} {\rm cm}^{-2} {\rm s}^{-1}$, the radiative force on a diluted plasma (n\la 10^{11} cm$^{-3}$) is so strong that electrons are accelerated rapidly to relativistic speeds while ions lag behind owing to their larger inertia. The ions are later effectively accelerated by the strong radiation-induced double layer electric field up to Lorentz factors $\approx 100$, attainable in the case of negligible Compton drag. The asymptotic energies achieved by both ions and electrons are larger by a factor 2--4 with respect to what one could naively expect assuming that the electron-ion assembly is a rigidly coupled system. The regime we investigate may be relevant within the framework of giant flares from soft gamma-repeaters.Comment: 14 pages, 7 figures, ApJ, in press (tentatively scheduled for the v. 592, 2003 issue

Microwave Electronics

Contains reports on three research projects.U.S Navy (Office of Naval Research) under Contract Nonr-1841(49)U.S. Air Force under Air Force Contract AF19(604)-5200Lincoln Laboratory, Purchase Order DDL-B22

What Developers Want and Need from Program Analysis: An Empirical Study

Program Analysis has been a rich and fruitful field of research for many decades, and countless high quality program analysis tools have been produced by academia. Though there are some well-known examples of tools that have found their way into routine use by practitioners, a common challenge faced by researchers is knowing how to achieve broad and lasting adoption of their tools. In an effort to understand what makes a program analyzer most attractive to developers, we mounted a multi-method investigation at Microsoft. Through interviews and surveys of developers as well as analysis of defect data, we provide insight and answers to four high level research questions that can help researchers design program analyzers meeting the needs of software developers. First, we explore what barriers hinder the adoption of program analyzers, like poorly expressed warning messages. Second, we shed light on what functionality developers want from analyzers, including the types of code issues that developers care about. Next, we answer what non-functional characteristics an analyzer should have to be widely used, how the analyzer should fit into the development process, and how its results should be reported. Finally, we investigate defects in one of Microsoft's flagship software services, to understand what types of code issues are most important to minimize, potentially through program analysis