Identifying healthcare actors involved in the adoption of information systems

The adoption of information systems in healthcare is no less significant than in any other commercial or caring organisation. The literature on IS adoption in healthcare, makes it clear that the actors involved in the adoption process are almost universally seen as crucial, which matches our research results too. However, how such actors should be identified remains a topic for investigatory work since these are early days in achieving this. We derive and propose a structured method to model how actors might be identified: structured because such a rationale is explicable and such a method is more readily usable when transferred to others. Our structured method, named IGOHcaps, uses a static and then a dynamic step to pull out the individual, group, organisational and human determinants of the critical actors. In this process, the individual actors’ differing views emerge which could enable decision-making bodies to produce more robust proposals if they incorporated some of the appropriate views. We discuss the application of IGOHcaps through a hospital case study. While a single case study cannot be a proof, the engagement of the actors was encouraging

Information systems and healthcare XXIV: Factors affecting the EAI adoption in the healthcare sector

Recent developments in the field of integration technologies like Enterprise Application Integration (EAI) have emerged to support organizations towards improving the quality of services and reducing integration costs. Despite the importance of EAI, there is limited empirical research reported on its adoption in the healthcare sector. Khoumbati et al. [2006] developed a model for the evaluation of EAI in healthcare organizations. In doing so, the causal interrelationship of EAI adoption factors was identified by using fuzzy cognitive mapping. This paper is a progression of previous work in the area and seeks to contribute by validating the model through a different case environment. Thus, this paper contributes by deriving and proposing the MAESTRO model for EAI adoption. MAESTRO identifies a set of factors that influence EAI adoption and it is evaluated through a real-life case study. It provides an understanding of the EAI adoption process through its grounding on empirical data. In doing so, the MAESTRO model supports the management of healthcare organizations during the decision-making process for EAI adoption

Analysis of Barriers to the Deployment of Health Information Systems: a Stakeholder Perspective

© 2018 The Author(s). This paper argues that the cross-analysis of barriers with stakeholders provides a richer picture than analyzing the barriers on their own, as most of the literature in this area does. To test this hypothesis, we used the data from 33 interviews across 19 different types of stakeholders that were involved in a telemedicine system for the Chronically-ill Patient. Our findings show encouraging results. For instance, it was found that the group of stakeholders who are directly related to the governance and policy-making identified most of the barriers. This finding may imply that this group is more aware of the challenges when implementing HIS, or it may suggest that this group poses more resistance due to the current economic and Organizational models in health care. It was also found that some barriers are cited by all stakeholders whereas others not, suggesting that some barriers may be more relevant than others

Achieving knowledge management integration through EAI: a case study from healthcare sector

The non-integrated nature of healthcare Information Systems (IS) is strongly associated with a reduction in the quality of care services. Therefore, healthcare organisations can not efficiently exchange data and knowledge. Thus, numerous medical errors occur that impact healthcare services. In response, healthcare organisations have attempted to integrate their IS using Enterprise Application Integration (EAI). Recent literature findings indicate that EAI achieves integration at four layers namely: (a) connectivity, (b) transportation, (c) transformation and (d) process integration. In this paper, we suggest that among others, EAI achieves Knowledge integration and we propose a revised model (REAL) which was tested through a case study. The results are significant as they show that cases leading to medical errors, wrong prescription and diagnosis can be prevented by integrating knowledge through EAI. This is of high importance, since around 23,000 and 100,000 patients die per year in UK and USA respectively from medical errors

Infusing agility in business processes through an event-centric approach

For business processes we consider agility to be the capability to modify and adjust them in the face of unexpected contingencies even during execution phase. Traditional process-centric approaches dictate action sequence definition within the context of a specific business process designed to cover organisations requirements at some former point in time. To address the phenomenon of business processes that fail to match newly evolved organisational needs we propose an event-centric approach identifying meaningful events that drive action execution. We consider actions as autonomous units being aware of only the events initiating them as well as the events they trigger. In that sense, the notion of business process sequence is eliminated; the needed functionality is modelled in a flexible manner in terms of autonomous actions, events and event combinations, promoting the dynamic formation of process instances at execution time. Our approach materialises through a set of methods, named actors-actions-events (AAE), which can be followed as a guide towards identifying the events and actions representing enterprise functionality. Its practical applicability is demonstrated through a simplified example in a medical setting. Copyright © 2010 Inderscience Enterprises Ltd

Proposal for the implementation of quality standards in a medical unit through integration to the hospital information system

Quality standards (QS) support and enhance health care services provided to patients and citizens, especially in sophisticated medical departments, such as Intensive Care Units (ICU). However, ICU staff lag behind in the adoption and compliance of QS protocols. In this paper, QS protocols implemented in the Intensive Care Unit of the Attiko University Hospital, a tertiary teaching hospital of the University of Athens, will be discussed. In this hospital, standardized procedures are implemented through the HIS, facilitating routine administration and services. We are aiming to facilitate educational processes and enhance staff compliance with the protocols by utilizing the Hospital Information System (HIS). In doing this, we propose the application of pop-up windows on the different user (medical or nursing) interfaces of the HIS, inter-connecting every electronic process with the corresponding QS protocol that has been developed in the ICU. This application may prove a valuable educational tool and may reinforce staff training and enhance compliance with the QS protocols. © 2017 The authors and IOS Press. All rights reserved

The relevance of peripheral blood T-helper 1 and 2 cytokine pattern in the evaluation of patients with mycosis fungoides and Sezary syndrome

Background There is evidence that a T-helper (Th) 2 cytokine pattern dominates in the peripheral blood as well as in tissue of patients with Sezary syndrome (SS), and that the malignant clone is of Th2 phenotype. However, there are conflicting studies on the cytokine pattern in the peripheral blood in different stages of cutaneous T-cell lymphoma (CTCL). Objectives To examine, by means of flow cytometry (FC), the Th1/Th2 cytokine profile [cytoplasmic interferon (IFN)-gamma/interleukin (IL)-4] in peripheral blood T cells from patients with mycosis fungoides (MF) and SS, the most common forms of CTCL, and to correlate their expression with clinical stage, clonality and T-cell immunophenotype changes in order to evaluate their relevance in CTCL progression. Methods We investigated by FC the percentage of CD3+ T cells expressing cytoplasmic IFN-gamma and IL-4 after stimulation in blood specimens of 43 CTCL patients (32 stage I-II and 11 stage III-IV), eight of whom were erythrodermic. Next, we compared cytoplasmic IFN-gamma and IL-4 expression between patients of different stages and controls, and correlated our findings to T-cell receptor (TCR)-gamma gene rearrangement, used as a marker of clonality, and changes in T-cell immunophenotype (CD4+, CD8+, CD4+/CD7-, CD4+/CD25+) and natural killer cells. Polymerase chain reaction amplification of the TCR-gamma gene was performed in 41 blood and 26 skin specimens. We also examined the cytokine expression pattern in patients with erythrodermic MF and SS. Results A significantly higher frequency of CD3+/IL-4+ T cells was found in late (III-IV) compared with early (I-II) CTCL patients (P = 0.002) or controls (P < 0.001). There were significant positive correlations between the percentages of CD3+/IL-4+ and the percentages of CD3+/CD4+ T cells (r = 0.385, P = 0.05), CD4+/CD7- T cells (r = 0.335, P < 0.05) and CD4+/CD25+ T cells (r = 0.433, P = 0.01); there was a negative correlation between the percentages of CD3+/IL-4+ and CD3+/CD8+ T cells (r = -0.463, P = 0.005) and a positive correlation between the percentages of CD3+/IFN-gamma+ and CD3+/CD8+ T cells (r = 0.368, P = 0.02). Increased percentages of CD3+/IL-4+, CD3+/CD4+ and CD4+/CD7- T lymphocytes were associated with the presence of clonality (P = 0.025, P < 0.001 and P = 0.0031, respectively). All independent variables showed a statistically significant difference between SS and erythrodermic MF patients, or controls, apart from cytoplasmic IL-4, which was high both in erythrodermic MF and SS patients compared with controls (P = 0.003 and P = 0.008, respectively). In multiple regression logistic analysis, the probability of belonging to advanced CTCL stages was associated only with increased cytoplasmic IL-4 (P = 0.007, odds ratio 1.13, 95% confidence interval 1.033-1.229). Conclusions Increased T-cell cytoplasmic IL-4 is more frequent in late CTCL stages, correlates with T-cell immunophenotype changes found in advanced disease and is associated with clonality. Increased cytoplasmic IL-4 is frequent both in erythrodermic MF and SS patients, in contrast to other variables found increased only in SS, suggesting that IL-4 may be an early indicator of disease progression. Moreover, our results show that increased cytoplasmic IL-4 is the sole predictor of advanced CTCL disease and confirm the relevance of FC determination of IL-4 in the routine evaluation of CTCL cases

Advisory on ambient assisted living solutions : towards an advisor concept and training curriculum

Ambient Assisted Living (AAL) solutions have opened up a market of service provision for older adults and their caregivers. Insufficient public awareness and end-user involvement on AAL solutions have been influencing the market negatively. Advisory services on AAL solutions are a promising strategy to address those challenges but those are typically missing, provided at a very small scale or by the providers in the context of sales activities. This study aims to identify the prospective benefits of an advisor on AAL solutions, as well as the profile, knowledge and skills required for this role and training preferences. A qualitative study was performed resorting to workshops and interviews with AAL stakeholders to collect data. A comprehensive literature review was carried out to identify experiences and practices on education for AAL advisors. Both data were subjected to a content analysis. Findings were used to define and refine the concept of Authorised Active Advisors, resulting in a clarification of its added-value, on the definition of advisor profiles, as well as on a list of skills and knowledge required. Training preferences revealed by the participants together with the literature analysis, feed a training concept presented in this paper. Finally, the training objectives, contents, learning outcomes and learning/teaching methods are defined and a training hub mock-up is shown. The preferred training modality is based on a blended-learning approach