The role of identity in health information systems development: A case analysis from Mozambique

There is a need to look beyond the immediate process of implementation of computerized information systems to understand the broader social context in which the information and communication technology is being implemented. Using an interpretive approach to the implementation of a computerized health information system in a rural district in Mozambique we reconstruct an important aspect of this context from our interviews and observations—how the process of collective identity formation and information systems implementation are interconnected. Using this understanding of collective identity, we emphasize the importance of communication and shared meanings in developing and extending the primary health care network and in the successful implementation of a computerized health information system. © 2005 Wiley Periodicals, Inc.     

The significance of attitudes towards evidence-based practice in information technology use in the health sector: an empirical investigation

The article investigates the relationship between attitudes towards evidence-based practice (EBP) and the use of information and communication technology (ICT) in practice and demonstrates that the poor correlation reported in the literature is a methodological artifact rather than a substantive fact. Results are based on structured surveying of 1015 medical and nursing staff, drawn from 15 Greek hospitals. We used unfolding item response theory models to demonstrate that by placing the statements assessing attitude towards EBP and ICT self-reported use on a single attitude–behaviour continuum, behaviour statements have a systematically different location on the attitude–behaviour continuum from the attitude statements. Based on the latent probabilistic relation among attitudes towards EBP and ICT use, the practical implications of the study are discussed.     

Analyzing the problem of unsustainable health information systems in less-developed economies: Case studies from Tanzania and Mozambique

Most of donor-supported information technology (IT)–based projects developed or implemented in less-developed economies (LDEs) end up as complete or partial failures or unsustainable. Notably, a number of intra-organizational and external factors are associated with this problem, including inadequate infrastructure and human resource capacity, fragmented donor policy, and lack of policies to manage the sustainability problem. Accordingly, IT initiatives are often donor-driven, top-down, and hijacked by top managers who (normally) do not have adequate skills, but have enormous power to enforce such initiatives across organizational hierarchies.

In analyzing the concepts from sustainability and institutionalization, key insights towards a better understanding of the problem of unsustainability are developed. It is argued that health information systems (HISs) become sustainable if they are institutionalized in the sense of being integrated into the everyday routine of the user organization. However, a sustainable HIS should also be flexible enough to allow changes as the user needs change. Moreover, introduction of a new HIS is not only a technical change, but requires the cultivation and institutionalization of a new kind of culture.

Through a comparative case analysis of the HIS development and implementation processes in Tanzania and Mozambique, we have identified two sets of relationships, between the Ministry of Health (MoH) and donor agencies and between the MoH and software development agencies as critical and contributing factors to the unsustainability of a HIS. Given this setting, we highlight three key strategies for dealing with the problem of unsustainability in LDEs: (a) integration of a HIS, (b) local shaping of new cultures, and (c) cultivation approach to systems development. © 2005 Wiley Periodicals, Inc.     

Dynamics and stability in optical communication networks: a system theory framework

This paper addresses the problem of dynamics analysis in optical networks from a system control perspective. A general framework for finding the transfer matrix representation of an optical network is developed, based on linear fractional transformations. Under the natural assumption of equal time-delay for all channels in a link, the network transfer matrix is simplified such that channel cross-coupling is evidenced. The optical network stability problem is then reformulated as a robust stability problem and stability conditions are developed by applying μ-analysis.     

Contextualizing a professional social network for health care: Experiences from an action design research study

Professional social networks (PSN) are online environments where practitioners can present themselves, get in contact and socialize with coworkers, share and discuss ideas, or exchange business‐related knowledge. Despite the fact that collaboration and information sharing are becoming more relevant for delivering high‐quality services, PSN are not yet widely adopted in complex domains such as health care. While most of the literature is still focusing on the exposition of the unbound potential of PSN, this paper seeks to clarify the question of how to capture and manage the professional identity of an industry such that PSN can be purposefully anchored in the working context. Following an Action Design Research approach, we describe practical design propositions and possible tensions along the contextualization of a PSN, which was specifically catered for improving interprofessional and interorganizational collaboration in and between hospitals. We identify several implications for future research. In particular, we explain intended and unintended uses of PSN in hospitals and provide metaphors for explaining possible alternative understandings of domain engineering.     

Roles for knowledge-based computer systems: Case studies in maternity care

The design of medical knowledge-based computer systems requires effective interdisciplinary communication for the development of a community sharing common goals and a common language for design. Over the past 9 years the Perinatal Research Group, an interdisciplinary team of computer scientists, engineers and clinicians, have developed a prototype knowledge-based computer system to aid clinicians in the care of women in labour. The group were uncertain which approach to adopt to progress this system from a prototype to a useful clinical tool to support decision making. A case study and activity theory analysis, of an existing clinical knowledge-based computer system in routine use, helped to resolve a number of communication and methodological issues that the design team encountered. Sharing of backgrounds and perspectives caused the design team to question previous assumptions and to explore alternative functions and roles for knowledge-based computer systems in maternity care. We are now undertaking a longitudinal case study and activity theory analysis of obstetric teams and women in labour to analyse the relationships between clinicians, patients and technology. This work will inform the development of our knowledge-based computer system to place the patient at the centre of the decision-making process.     

Control and emotions: Understanding the dynamics of controllee behaviours in a health care information systems project

The control of information systems (IS) projects is important for organizations seeking to realize the value‐creating capabilities of information technology (IT). However, their achievement has proven complex and has triggered research on the unique challenges related to IS project control. The existing research focuses primarily on the contextual antecedents and performance effects of control‐mode choices but largely neglects the dynamics of control activities, and particularly the socio‐emotional aspects of such activities. We conducted longitudinal fieldwork to evaluate the dynamic interplay between control activities and emotions in the context of a large‐scale, health care IS project. Our case analysis provides empirical evidence for the link between controllers' control styles and controllees' emotions and subsequent behaviours. For instance, our analysis results point to “suppressed” effects of negative emotions on control effectiveness. We find that while controllees' negative emotional appraisals of control activities do not necessarily translate into immediate resistance behaviours, they can give rise to delayed resistance behaviours triggered by shifting control styles.     

Connected scholars: Examining the role of social media in research practices of faculty using the UTAUT model

Social media has become mainstream in recent years, and its adoption has skyrocketed. Following this trend among the general public, scholars are also increasingly adopting these tools for their professional work. The current study seeks to learn if, why and how scholars are using social media for communication and information dissemination, as well as validate and update the results of previous scholarship in this area. The study is based on the content analysis of 51 semi-structured interviews of scholars in the Information Science and Technology field. Unlike previous studies, the current work aims not only to highlight the specific social media tools used, but also discover factors that influence intention and use of social media by scholars. To achieve this, the paper uses the Unified Theory of Acceptance and Use of Technology (UTAUT), a widely adopted technology acceptance theory. This paper contributes new knowledge to methodological discussions as it is the first known study to employ UTAUT to interpret scholarly use of social media. It also offers recommendations about how UTAUT can be expanded to better fit examinations of social media use within scholarly practices.     

Impacts of case-based health knowledge system in hospital management: The mediating role of group effectiveness

With the rise of artificial intelligence, case-based health knowledge management systems (CBHKS) have been widely adopted in hospitals. CBHKS are data-driven intelligent platforms that integrate latest technologies, such as artificial intelligence and cloud computing. As an integral part of smart hospitals, CBHKS can support decision processes at different levels in hospitals. However, researchers have not yet clearly addressed how CBHBKS improves hospital management outcomes. Based on group effectiveness and leadership performance-maintenance theories, we develop a conceptual model to explain the role of CBHKS in hospital management. To test the research hypotheses in the conceptual model, we collected survey data from 214 doctors, and performed data analysis using partial least squares (PLS)-based structural equation modeling. The empirical testing results show that the CBHKS implementation significantly and positively influences group performance, group members’ satisfaction, group learning, and external satisfaction; and group members’ satisfaction and external satisfaction significantly and positively affect management performance and maintenance.     

Studying the multilevel impact of cohesion versus structural holes in knowledge networks on adaptation to IT‐enabled patient‐care practices

We investigate the impact of cohesion versus structural holes in two different types of knowledge networks—help‐seeking networks and voluntary contribution networks—on adaptation to health IT‐enabled patient‐care practices. In a multimethod study conducted within a large hospital system, qualitative and quantitative data were collected from 806 clinicians working with electronic medical record systems in 27 inpatient patient‐care units. Multilevel analysis of the data revealed that overall network cohesiveness versus location in structural hole positions related to adaptation differently, depending on the type of network. In help‐seeking networks, location in structural hole positions was negatively related to adaptation, while network cohesion had a bell‐shaped curvilinear relationship with adaptation; in voluntary contribution networks, the overall cohesiveness of the network was negatively related to adaptation, but location in structural hole positions was irrelevant to adaptation. Our findings suggest a more nuanced way of monitoring and utilising different sets of informal social interactions at work to maximise employees' adaptation to IT‐enabled work.     

The relevance of association networks for/in a sustainable information and communication society

This contribution deals with taking up the challenge of sustainable development through human centred systems which aim at the creation and repatriation of global quality in each society, and which are seen to operate as a whole, on a local, regional or even a planetary scale. The paper argues that, particularly in a field such as information, communication, environment, technological processes and innovations, which have structurally revolutionised first of all manufacturing but also education and daily living at the same time. However, producing new pathogenous structures require, by necessity, a political ecology in order to relate these fields to new figures of meditation/mediance and crossbreeding built up by associative networks. PRELUDE'S experience, as an international networking programme of scientists pursuing with other social factors objectives of codevelopments (in response to the failure of bad development in the North and in the South), and its contribution to the theme Global Perspective 2010 of the CE-FAST Programme suggest the actual relevance and, turning to the future, the decisive function of associative networks as a way of approaching more efficiently, because of their flexibility, complex, highly heterogeneous situations to be tackled in a systemic and global fashion. In complementing institutions and established companies these networks give their new performances and efficacity to institute, and so doing displace acquired balances, and increase their capacity to innovate.     

Rapid adoption of information systems in an organization with poor management: the case of fund-holding in UK primary health care

Abstract. Reorganization of the UK primary health care system to create an internal market for health services depends upon local family doctors (general practitioners) taking on budgetary responsibilities and purchasing services from hospitals. These budgets will be monitored by local committees. The success of the internal market is heavily dependent upon computerized management information systems. This paper investigates the introduction of information systems into an organization that is ill prepared for change.     

The role of system-use practices for sustaining motivation in crowdsourcing: A technology-in-practice perspective

The success of crowdsourcing (CS) systems depends on sustained participation, which is an ongoing challenge for the majority of CS providers. Unfortunately, participants are frequently demotivated by technical difficulties and the incorrect use of CS systems, which can result in CS failure. Although the literature generally assumes that sustained participation in CS is determined by a shift between intrinsic and extrinsic motivation, the role of system-use practices in facilitating such a shift remains unknown. We explore how CS system-use practices influence participants' sustained motivation, evolving from initiation to progression to sustention. Using the notion of technology-in-practice as a lens, we develop and examine a process model using an in-depth case study of a large-scale ongoing CS project, the Australian Newspaper Digitisation Program. The findings suggest that CS participants' motivation is shaped by an evolving combination of three basic components (i.e., contextual condition, outcome and action intensity) and mediated by two types of system-use practice (i.e., passive and active). Passive-use practices facilitate sustaining motivation from initiation to progression, whereas active-use practices have a key role in sustention. Our study contributes to the emerging literature on the substantial role of system-use practices in sustaining motivation, resulting in sustained participation. The findings also offer actionable insights into improving the viability of CS systems in retaining and motivating continuous and increased contributions from participants.     

Online social networking and psychological experiences: The perceptions of young people with mental health difficulties

ObjectivesThis study explores the interaction between online social networking experiences and wellbeing in 12 young people accessing mental health services.MethodsData from semi-structured interviews was analysed using Grounded Theory methodology.Results“Threats and judgement” and “connection and support” were experienced by adolescents, facilitated by having continuous access to a vast social network. These experiences influenced adolescents' psychological wellbeing, mediated by their responses to threat and judgement and maintaining “safe sharing” with their network. Social network use was conceived as a gamble of balancing its potentially positive and negative impact in a culture in which social network use appears to be unavoidable.ConclusionsThe findings indicate the importance of routine assessment and formulation of social networking use in understanding adolescents' psychological distress. Furthermore, a range of opportunities exist for clinicians to utilise the anonymity and peer support that social networks offer to broaden the range of mental health services offered to young people.     

The effect of the asymmetry of road transportation networks on the traveling salesman problem

The routing of vehicles on road transportation networks is an area of great importance to transportation planners within scientific literature. This field includes well known and studied problems like traveling salesman problems or TSP or the more realistic asymmetric variant or ATSP, whose applications extend to other areas of transport and operations research. This work studies the effect that the asymmetry of road transportation networks, geographical location and territory have over TSP and ATSP methods. We conduct comprehensive experiments in order to assess the effects that these factors have on some of the best known algorithms for the TSP/ATSP. We demonstrate that all these factors have a significant influence in solution time and quality. Furthermore, we show that the solutions obtained with Euclidean matrices and those obtained with real distance matrices differ significantly.     

The role of presence awareness in organizational communication: An exploratory field experiment

Millions of adults currently use instant messaging (IM) in the workplace, and yet there is very little research examining how use and perceptions of this new medium affect intra-organizational communication. While one of the characteristics of instant messaging is the ability to exchange real-time communication, what truly distinguishes instant messaging from other widely adopted forms of mediated communication is the integration of presence technology, which allows parties to detect if others are online and available to communicate. In this paper, we propose a theory of productivity benefits of presence-aware communication technology, building upon past research. Based on this model, we use a quasi-experimental longitudinal research design to test how providing instant messaging to selected workgroups at a Fortune 500 company impacts employees' attitudes and work behavior.

Results suggest that IM use had a positive effect on improving productivity with participants citing reductions in voice mail and phone tag, improvements to how easy it was to see if colleagues were online and available to communicate as well as increased productivity served by back-channel communications conducted via IM. Results and future research directions are discussed.     

Balancing documentation and direct patient care activities: A study of a mature electronic health record system

US hospitals now fully embrace electronic documentation systems as a way to reduce medical errors and improve patient safety outcomes. Whether spending time on electronic documentation detracts from the time available for direct patient care, however, is still unresolved. There is no knowledge on the permanent effects of documenting electronically and whether it takes away significant time from patient care when the healthcare information system is mature. To understand the time spent on documentation, direct patient care tasks, and other clinical tasks in a mature information system, we conducted an observational and interview study in a midwestern academic hospital. The hospital implemented an electronic medical record system 11 years ago. We observed 22 health care workers across intensive care units, inpatient floors, and an outpatient clinic in the hospital. Results show that healthcare workers spend more time on documentation activities compared to patient care activities. Clinical roles have no influence on the time spent on documentation. This paper describes results on the time spent between documentation and patient care tasks, and discusses implications for future practice.Relevance to industryThe study applies to healthcare industry that faces immense challenges in balancing documentation activities and patient care activities.     

Understanding the mechanism of social tie in the propagation process of social network with communication channel

The propagation of information in online social networks plays a critical role in modern life, and thus has been studied broadly. Researchers have proposed a series of propagation models, generally, which use a single transition probability or consider factors such as content and time to describe the way how a user activates her/his neighbors. However, the research on the mechanism how social ties between users play roles in propagation process is still limited. Specifically, comprehensive summary of factors which affect user’s decision whether to share neighbor’s content was lacked in existing works, so that the existing models failed to clearly describe the process a user be activated by a neighbor. To this end, in this paper, we analyze the close correspondence between social tie in propagation process and communication channel, thus we propose to exploit the communication channel to describe the information propagation process between users, and design a social tie channel (STC) model. The model can naturally incorporate many factors affecting the information propagation through edges such as content topic and user preference, and thus can effectively capture the user behavior and relationship characteristics which indicate the property of a social tie. Extensive experiments conducted on two real-world datasets demonstrate the effectiveness of our model on content sharing prediction between users.     

Power and resistance in the implementation of a medical management information system

Abstract.  This paper presents an analysis of the implementation of a large information system in a New Zealand hospital. The system was intended to monitor and scrutinize clinical activity, and management hoped to influence clinical behaviour through the increased visibility afforded by the system. However, doctors were not the passive subjects of a computerized control system, and some were able to resist the application of the information produced by challenging its validity or using it to argue for more resources. Nevertheless, the interrelatedness of the information system with the organizational forms and practices within which it was used and which it helped shape reinforced the concepts, norms and values associated with the new management and economic discourse prevalent in the hospital, and helped to produce more defined accountabilities for doctors. With time, the role of the information system was reinterpreted, and in the face of continued resistance by doctors, it was relegated to a less significant role. The potential for engendering self-disciplining behaviour in organizational participants through the pervasive, everyday use of the information the system produced likewise diminished.