Factors that Effect the Impact of State Telemedicine Policies on Telemedicine Activities

Policies that govern the telecommunications industry will significantly impact the use and evolution of IT. Although there is substantial research on telecommunications policy at the national level, very little has been done at the state level. A major policy initiative at the state level has been the creation of a telemedicine industry. This research piece studied factors that effect the impact of state government telemedicine policy on telemedicine activities

DEPLOYING RESOURCES TO SAVE LIVES: PARTNERS TELE-STROKE SERVICE

Innovative ICT applications such as patient-present telemedicine consultation services can save lives, yet following pilot-testing few have achieved long-term viability. Partners Health Care’s TeleStroke service, in full operation, is financially self-sustaining. Interviews with clinical, technical and administrative personnel at Partners and two “spoke” hospitals revealed practical lessons learned. Analysis through the lens of the Resource Based View reveals that many valuable assets and capabilities that Partners and its spoke hospitals developed are necessary for a successful TeleStroke program yet could be acquired or copied (they are not rare or inimitable). We note further that Partners’ overriding goal for TeleStroke is to achieve clinical success in its catchment area, without depleting financial resources; competitive advantage is sought within the catchment area but not beyond it. Resource analysis reveals that other institutions could develop successful telemedicine services for acute stroke care, since the needed assets are readily available, most of the capabilities can be imitated, and viable substitutes are limited. We contend that the lessons learned in this case study -- about the effective deployment of assets and capabilities -- are broadly applicable to other settings, in health care and other industries

Conceptual Data Modeling in the Introductory Database Course: Is it Time for UML?

Traditionally, the typical undergraduate database course uses a form of Entity-Relationship (ER) notation when teaching conceptual modeling. While we have seen an increase in the academic coverage of UML in the database course, it is very rare to see UML as the primary modeling notation when teaching conceptual data modeling. However, outside of academe, there has been advocacy for the use of UML as an effective modeling tool for database design and for it to provide a unifying modeling framework. This paper examines the level of support for using UML vs. established ER notations for teaching conceptual data modeling in the introductory undergraduate database course. An analysis of textbook and tool support as well as a survey of what IS undergraduate programs are using in their introductory undergraduate database courses is included

Seeing a Patient\u27s Eyes: System Trust in Telemedicine

This paper reports on system trust and interpersonal trust issues revealed in an embedded-case study of two telemedicine services offered by a teaching hospital. Consistent with McKnight (2005) perceived system competence was an important dimension of system trustworthiness. Drawing on representation theory (Wand and Weber, 1995) we observed: 1. Some clinicians feel telemedicine provides a better representation than they can achieve in conventional practice. 2) The ability to control specific technical features leads to increased representational quality, perceived system trustworthiness and usage. 3) Some clinicians adapt the telemedicine system to improve it. 4) Some users do not distinguish between the technology artifact and a human helper when judging system trustworthiness. We conclude with two key findings: 1) judgments about system trustworthiness interact with users’ technical and clinical skills and 2) system trust and interpersonal trust are reciprocal

Exploring Mechanisms in Tacit Knowledge Externalization: Preliminary Findings from Participatory Agricultural Innovation Practices in Ethiopia

Tacit knowledge is embedded in people’s experiences, expertise, know-how, skills, techniques, insights, judgments, actions or behaviors. This knowledge is a source of innovation that can provide dynamic responses to context specific problems. Effective exploitation and management of tacit knowledge is critical, but the subject of tacit knowledge in general and the process of its externalization and sharing in particular are still relatively unexplored and not fully understood. In addition, the agricultural sector has rarely been the topic of inquiry in research related to tacit knowledge elicitation and most previous studies focus on high tech industries and business organizations. This paper explored what mechanisms are being used to externalize tacit knowledge and what factors impact this process given the context of participatory agricultural research in Ethiopia. We applied a qualitative case study method using an in-depth semi-structured interviews, focus group discussions and document analysis as data collection tool

Innovative capability development process: A Singapore IT healtcare case study

How do emotions affect telemedicine adoption and usage for critical-care episodes? We report on early findings from a grounded theory approach in a multiple-case study of critical care telepediatrics (research in progress). Thus far our findings suggest that specialists believe that generalist clinicians at remote “spoke” hospitals are anxious and fearful when performing in a high stress crisis situation involving an acutely ill or gravely injured child, leading to tunneling of attention (overlooking important clinical details). The specialists at tertiary care “hub” hospitals feel they are able to keep an emotional distance from the situation and they also report feeling less anxious because they have had extensive training for these acute care situations. Both emotional distance and higher skill level seem to help the specialists to take in more clinically-relevant information and use this to guide the generalists. The generalists’ fear of negative evaluation by the specialists, or embarrassment in front of other clinicians, may have some impact on their decision to use tele-pediatrics, but does not seem to be a salient concern during critical care episodes. These findings suggest that emotions do play a role in telemedicine use and possibly also in other forms of technology-mediated interorganizational collaboration

PROPOSING A KNOWLEDGE MANAGEMENT SYSTEM (KMS) ARCHITECTURE TO PROMOTE KNOWLEDGE SHARING AMONG EMPLOYEES

Knowledge is a strategic resource for knowledge intensive organizations like commercial banks. However, the use of knowledge as resource depends on an organization´s ability to select, capture, store, disseminate and apply its knowledge resources. This organizational capability is created if the organization undertakes explicit initiatives to establish and sustain a KMS as one of its core business functions. An empirical investigation of the Commercial Bank of Ethiopia (CBE) shows that there is no explicit initiative or responsible unit to manage its knowledge resources. This study uses a design science research method to investigate the problems KM in CBE and propose KMS architecture which is believed, when implemented, to solve current problems. The main theoretical contribution of the study is that it demonstrates how to design a KMS architecture using system analysis and ontology methods. The paper has also implication for practice as it suggests solutions for observed problems and ways to increase CBE´s capability to use its knowledge resources

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

Investigating the Emotional Context of Pediatric Critical Care Telemedicine Consultations

Patient-present physician-to-physician telemedicine consultations have been shown to be effective, yet diffusion is not widespread. While much prior research has investigated how computer anxiety affects acceptance and usage of telemedicine and other systems, few prior studies have addressed the impact of situational anxiety (e.g., anxiety caused by the stress of treating a critically-ill child under time pressure) or other emotions on telemedicine acceptance and ongoing use. We report on findings from an embedded-cases study of four hospitals that participate in a telemedicine consultation service provided by a rural tertiary-care hospital. Interviews revealed that telemedicine can help clinicians cope with emotions such as anxiety, grief, and anger that arise from the high-stakes pediatric critical care context. Study findings point to design principles for telemedicine and for collaborative systems in other domains, in and beyond health care