The digital future beyond the pill

A recent story in the FT has the title Digital disrupters take big pharma ‘beyond the pill’ It gives a distinctive twist to the idea of digital drugs. The argument is that a phone app or similar, as a monitoring device and as a front end to diverse networked resources including counselling, can be a direct substitute for a pill and a doctor. So direct a substitute, the article argues, that big pharma are taking a strategic interest as digital innovations in delivery of health services and therapies threaten to ‘undermine the industry’s decades-old business model’

The new world of digital drugs

In his recent book The Nature of Technology, the economist and complexity scholar Brian Arthur identifies three core ideas underlying technologies of all types: 1) an intention to fulfil some human purpose; 2) an assemblage of practices and components; and 3) future innovative potential achieved by drawing on available repertoires of components and engineering practices. The drugs used in providing healthcare are an important contemporary technology, and these three ideas are central to understanding the ways in which they become digital

INSTITUTIONAL INTERPLAY AND IMPROVISATIONS IN E-GOVERNMENT PROJECTS

This paper examines the process and outcomes of an e-government project in Dubai. The case study is of a public sector organization that has been engaged in the implementation of e-government systems for almost a decade. Using the Technology Enactment Framework, the paper explores the ways in which the e-government project exposed and resolved institutional contradictions. The paper then explains the implications of this for the ICT staff working there, the organization and the e-government project itself. The case presented here shows that that the institutionalization of e-government (its achievement of a ?taken-for granted? and ?how we do it here? status within the public sector) is more than a product of conformity to powerful managerial discourses and regulative forces. Rather it is also a product of the actions of ICT staff (their agency) as they work on the systems, and respond to competing institutions they are embedded within. Thus, the paper argues that there is a need to conceptualize the process of e-government implementation, and the ICT staff?s actions, as central to the institutionalization of e-government. Key words: E-government projects, implementation, institutionalization processes, technology enactment framewor

STRATEGIC DRIVERS OF OPEN SOURCE SOFTWARE ADOPTION IN THE PUBLIC SECTOR: CHALLENGES AND OPPORTUNITIES

This paper draws upon the results of a qualitative study on the procurement and adoption of open source software by public sector organizations spanning Europe, Brazil and the USA. The premise of this work was to understand the role ?cost? or total cost of ownership of software plays in government procurement decisions. We found, however, that this was more a rhetoric to gain acceptance for open source and to achieve a level playing field. Interviews with key stakeholders from government agencies and system integrators led us to understand and organize our findings on open source adoption under four broad categories; economic concerns, technical and development features, risk management, and innovation and strategic issues. We conclude with a number of insights to help other public sector organizations make better procurement decisions for information technology

User-centered healthcare IT: meaningful or meaningless?

This panel aims to discuss concepts, assumptions and visions of user- centered information technology for healthcare. It presents two opposite views on the subject. The discussion is informed by findings of three research projects evaluating the implementation of e-prescribing systems, electronic transmission of prescriptions, and electronic health records in the UK. The timeliness and perhaps urgency of such a debate are due to the incessantly increasing worldwide computerization of healthcare, concurrent to an ambiguity of the effect of IT on care processes, outcomes and user satisfaction

Understanding agility in software development through a complex adaptive systems perspective

This paper examines dimensions of social capital in the distributed collaborative development of the UK particle physics Grid. It is shown that the GridPP project effectively draws upon social capital rooted in the tradition and culture of particle physics experiments, characterized with trust, equality, shared vision, collaboration, and pragmatism. These factors contribute to overcoming the challenges in the creation and sharing of knowledge in the development of the Grid, a cutting-edge technology that has to be delivered as a working system with limited time and resources. This case sheds lights on, and provides a good example of, the importance of social capital in distributed systems development

Evaluation as a Multi-Ontological Endeavour: A Case from the English National Program for IT in Healthcare

This paper analyzes how researchers’ different ontological and epistemological assumptions shape the process and outcomes of evaluation research. Focusing on the critical realism (CR) and social constructionism (SC) philosophical approaches, it outlines the rationale for multi-ontological evaluation and develops principles for conducting it. The paper draws from experience of evaluating a national implementation program of electronic health records in hospitals, one of the projects of the English National Programme for IT. It argues that an evaluation based on SC and one based on CR are significantly different in how they use knowledge gained in the field, and in the kind of evidence and recommendations that they can offer policy makers. The CR philosophy applied to evaluation research provides foundations from which judgments and abstractions can be presented in the form expected by the policy makers and managers who commission evaluations. In line with its ontological standing, social constructionism cannot simply or directly abstract and generalize across contexts, though it can offer other types of valuable evaluative insight. We show that, despite their differences, these two philosophical positions can, when taken together, produce jointly useful knowledge. This paper argues for the use of multi-ontological evaluation approaches and provides guidelines for undertaking such endeavors by emphasizing the need for mutual respect, dialogue, negotiation, and reflection