Evidence based healthcare planning in developing countries : an informatics perspective

Most of the national Health Information Systems (HIS) in resource limited developing countries do not serve the purpose of management support and thus the service is adversely affected. While emphasising the importance of timely and accurate health information in decision making in healthcare planning, this paper explains that Health Management Information System Failure is commonly seen in developing countries as well as the developed countries. It is suggested that the possibility of applying principles of Health Informatics and the technology of Decision Support Systems should be seriously considered to improve the situation. A brief scientific explanation of the evolution of these two disciplines is included.

The maintenance implications of the customization of ERP software

Enterprise resource planning (ERP) software is a dominant approach for dealing with legacy information system problems. In order to avoid invalidating maintenance and development support from the ERP vendor, most organizations reengineer their business processes in line with those implicit within the software. Regardless, some customization is typically required. This paper presents two case studies of ERP projects where customizations have been performed. The case analysis suggests that while customizations can give true organizational benefits, careful consideration is required to determine whether a customization is viable given its potential impact upon future maintenance. Copyright © 2001 John Wiley & Sons, Ltd.

Utilisation of hospital emergency departments among immigrants from refugee source-countries in Queensland

Despite the increasing number of immigrants, there is a limited body of literature describing the use of hospital emergency department (ED) care by immigrants in Australia. This study aims to describe how immigrants from refugee source countries (IRSC) utilise ED care, compared to immigrants from the main English speaking countries (MESC), immigrants from other countries (IOC) and the local population in Queensland. A retrospective analysis of a Queensland state-wide hospital ED dataset (ED Information System) from 1-1-2008 to 31-12-2010 was conducted. Our study showed that immigrants are not a homogenous group. We found that immigrants from IRSC are more likely to use interpreters (8.9%) in the ED compared to IOC. Furthermore, IRSC have a higher rate of ambulance use (odds ratio 1.2, 95% confidence interval (CI) 1.2–1.3), are less likely to be admitted to the hospital from the ED (odds ratio 0.7 (95% CI 0.7–0.8), and have a longer length of stay (LOS; mean differences 33.0, 95% CI 28.8–37.2), in minutes, in the ED compared to the Australian born population. Our findings highlight the need to develop policies and educational interventions to ensure the equitable use of health services among vulnerable immigrant populations.

The design science research roadmap : in progress evaluation

Although Design Science Research (DSR) is now an accepted approach to research in the Information Systems (IS) discipline, consensus on the methodology of DSR has yet to be achieved. Lack of a comprehensive and detailed methodology for Design Science Research (DSR) in the Information System (IS) discipline is a main issue. Prior research (the parent-study) aimed to remedy this situation and resulted in the DSR-Roadmap (Alturki et al., 2011a). Continuing empirical validation and revision of the DSR-Roadmap strives towards a methodology with appropriate levels of detail, integration, and completeness for novice researchers to efficiently and effectively conduct and report DSR in IS. The sub-study reported herein contributes to this larger, ongoing effort. This paper reports results from a formative evaluation effort of the DSR-Roadmap conducted using focus group analysis. Generally, participants endorsed the utility and intuitiveness of the DSR-Roadmap, while also suggesting valuable refinements. Both parent-study and sub-study make methodological contributions. The parent-study is the first attempt of utilizing DSR to develop a research methodology showing an example of how to use DSR in research methodology construction. The sub-study demonstrates the value of the focus group method in DSR for formative product evaluation.

Evaluating patient presentations for care delivered by emergency nurse practitioners : a retrospective analysis of 12 months

Background The delivery of quality patient care in the emergency department (ED) is emerging as one of the most important service indicators to be measured in health services today. The emergency nurse practitioner role was implemented as a service innovation in a Emergency & Trauma Centre (ETC), Melbourne, Australia, in July 2004 .The primary aim of the role was intended to enhance healthcare services, improve the efficiency and timely delivery of high quality care to patients. Aim To conduct a retrospective study of patient presentations at the ETC to obtain a profile of the characteristics of patients managed by emergency nurse practitioners. Specifically the objectives of the study were to: 1) examine the demographics of the patient population 2) evaluate data on emergency department service indicators for this patient cohort Method All patients presenting to the ETC from January 01 2011 to December 31 2011 and managed by emergency nurse practitioners were included in the review. Data collection included baseline demographics, waiting times to be seen, length of stay, emergency department discharge diagnoses and referral patterns. Data were extracted and imported directly from the emergency department Patient Information System (Cerner log), for the specified time frame. Results A total of 5212 patients were reviewed in the study period. The median age of patients was 35 years and 61% of patients were male. The most common discharge diagnosis was open wounds to hand/wrist. Waiting times to be seen by the emergency nurse practitioner were 14 minutes and length of stay for patients with a discharge disposition of home were 122 minutes. Conclusions This study has provided information on patient baseline characteristics and performance on important service indicators for this patient sample that will inform further research to evaluate specific outcomes of the emergency nurse practitioner service.

Pulse: The London Symphony Orchestra Student Mobile Project

This report documents the key findings of a year-long collaborative research project focusing on the London Symphony Orchestra’s (LSO) development, implementation and testing of a mobile ticketing and information system. This ticketing system was developed in association with the LSO’s technical partners, Kodime Limited and in collaboration with the Aurora Orchestra.

Towards modelling web search behaviour : integrating users’ cognitive styles

With the rapid growth of information on the Web, the study of information searching has let to an increased interest. Information behaviour (IB) researchers and information systems (IS) developers are continuously exploring user - Web search interactions to understand and to help users to provide assistance with their information searching. In attempting to develop models of IB, several studies have identified various factors that govern user's information searching and information retrieval (IR), such as age, gender, prior knowledge and task complexity. However, how users' contextual factors, such as cognitive styles, affect Web search interactions has not been clearly explained by the current models of Web Searching and IR. This study explores the influence of users' cognitive styles on their Web search behaviour. The main goal of the study is to enhance Web search models with a better understanding of how these cognitive styles affect Web searching. Modelling Web search behaviour with a greater understanding of user's cognitive styles can help information science researchers and IS designers to bridge the semantic gap between the user and the IS. To achieve the aims of the study, a user study with 50 participants was conducted. The study adopted a mixed method approach incorporating several data collection strategies to gather a range of qualitative and quantitative data. The study utilised pre-search and post-search questionnaires to collect the participants' demographic information and their level of satisfaction about the search interactions. Riding's (1991) Cognitive Style Analysis (CSA) test was used to assess the participants' cognitive styles. Participants completed three predesigned search tasks and the whole user - web search interactions, including thinkaloud, were captured using a monitoring program. Data analysis involved several qualitative and quantitative techniques: the quantitative data gave raise to detailed findings about users' Web searching and cognitive styles, the qualitative data enriched the findings with illustrative examples. The study results provide valuable insights into Web searching behaviour among different cognitive style users. The findings of the study extend our understanding of Web search behaviour and how users search information on the Web. Three key study findings emerged: • Users' Web search behaviour was demonstrated through information searching strategies, Web navigation styles, query reformulation behaviour and information processing approaches while performing Web searches. The manner in which these Web search patterns were demonstrated varied among the users with different cognitive style groups. • Users' cognitive styles influenced their information searching strategies, query reformulation behaviour, Web navigational styles and information processing approaches. Users with particular cognitive styles followed certain Web search patterns. • Fundamental relationships were evident between users' cognitive styles and their Web search behaviours; and these relationships can be illustrated through modelling Web search behaviour. Two models that depict the associations between Web search interactions, user characteristics and users' cognitive styles were developed. These models provide a greater understanding of Web search behaviour from the user perspective, particularly how users' cognitive styles influence their Web search behaviour. The significance of this research is twofold: it will provide insights for information science researchers, information system designers, academics, educators, trainers and librarians who want to better understand how users with different cognitive styles perform information searching on the Web; at the same time, it will provide assistance and support to the users. The major outcomes of this study are 1) a comprehensive analysis of how users search the Web; 2) extensive discussion on the implications of the models developed in this study for future work; and 3) a theoretical framework to bridge high-level search models and cognitive models.

Impact of socio-ecological variability on the transmission of malaria in Yunnan Province, China

This thesis is a population-based epidemiological study to explore the spatial and temporal pattern of malaria, and to assess the relationship between socio-ecological factors and malaria in Yunnan, China. Geospatial and temporal approaches were applied; the high risk areas of the disease were identified; and socio-ecological drivers of malaria were assessed. These findings will provide important evidence for the control and prevention of malaria in China and other countries with a similar situation of endemic malaria.

A conceptualization of complexity in IS-driven organizational transformations

Organizational transformations reliant on successful ICT system developments (continue to) fail to deliver projected benefits even when contemporary governance models are applied rigorously. Modifications to traditional program, project and systems development management methods have produced little material improvement to successful transformation as they are unable to routinely address the complexity and uncertainty of dynamic alignment of IS investments and innovation. Complexity theory provides insight into why this phenomenon occurs and is used to develop a conceptualization of complexity in IS-driven organizational transformations. This research-in-progress aims to identify complexity formulations relevant to organizational transformation. Political/power based influences, interrelated business rules, socio-technical innovation, impacts on stakeholders and emergent behaviors are commonly considered as characterizing complexity while the proposed conceptualization accommodates these as connectivity, irreducibility, entropy and/or information gain in hierarchically approximation and scaling, number of states in a finite automata and/or dimension of attractor, and information and/or variety.

Examining the impact of climate change on dengue transmission in the Asia-Pacific region

Dengue fever (DF) is a serious public health concern in many parts of the world. An increase in DF incidence has been observed globally over the past decades. Multiple factors including urbanisation, increased international travels and global climate change are thought to be responsible for increased DF. However, little research has been conducted in the Asia-Pacific region about the impact of these changes on dengue transmission. The overarching aim of this thesis is to explore the spatiotemporal pattern of DF transmission in the Asia-Pacific region and project the future risk of DF attributable to climate change. Annual data of DF outbreaks for sixteen countries in the Asia-Pacific region over the last fifty years were used in this study. The results show that the geographic range of DF in this region increased significantly over the study period. Thailand, Vietnam and Laos were identified as the highest risk areas and there was a southward expansion observed in the transmission pattern of DF which might have originated from Philippines or Thailand. Additionally, the detailed DF data were obtained and the space-time clustering of DF transmission was examined in Bangladesh. Monthly DF data were used for the entire country at the district level during 2000-2009. Dhaka district was identified as the most likely DF cluster in Bangladesh and several districts of the southern part of Bangladesh were identified as secondary clusters in the years 2000-2002. In order to examine the association between meteorological factors and DF transmission and to project the future risk of DF using different climate change scenarios, the climate-DF relationship was examined in Dhaka, Bangladesh. The results show that climate variability (particularly maximum temperature and relative humidity) was positively associated with DF transmission in Dhaka. The effects of climate variability were observed at a lag of four months which might help to potentially control and prevent DF outbreaks through effective vector management and community education. Based on the quantitative assessment of the climate-DF relationship, projected climate change will likely increase mosquito abundance and activity and DF in this area. Assuming a temperature increase of 3.3oC without any adaptation measures and significant changes in socio-economic conditions, the consequence will be devastating, with a projected annual increase of 16,030 cases in Dhaka, Bangladesh by the end of this century. Therefore, public health authorities need to be prepared for likely increase of DF transmission in this region. This study adds to the literature on the recent trends of DF and impacts of climate change on DF transmission. These findings may have significant public health implications for the control and prevention of DF, particularly in the Asia- Pacific region.

Process model comprehension : the effects of cognitive abilities, learning style, and strategy

Process models are used to convey semantics about business operations that are to be supported by an information system. A wide variety of professionals is targeted to use such models, including people who have little modeling or domain expertise. We identify important user characteristics that influence the comprehension of process models. Through a free simulation experiment, we provide evidence that selected cognitive abilities, learning style, and learning strategy influence the development of process model comprehension. These insights draw attention to the importance of research that views process model comprehension as an emergent learning process rather than as an attribute of the models as objects. Based on our findings, we identify a set of organizational intervention strategies that can lead to more successful process modeling workshops.

Designing mobile systems for social navigation in urban public places

This thesis presents social requirements and design considerations from a study evaluating interactive approaches to social navigation and user-generated information sharing in urban environments using mobile devices. It investigates innovative ways to leverage mobile information and communication technology in order to provide a social navigation platform for residents and visitors in and for public urban places. Through a design case study this work presents CityFlocks, a mobile information system that offers an easy way for information-seeking new residents or visitors to access tacit knowledge from local people about their new community. It is intended to enable visitors and new residents in a city to tap into the knowledge and experiences of local residents in order to gather information about their new environment. Its design specifically aims to lower existing barriers of access and facilitate social navigation in urban places. In various user tests it evaluates two general user interaction alternatives – direct and indirect social navigation – and analyses which interaction method works better for people using a mobile device to socially navigate urban environments. The outcomes are relevant for the user interaction design of future mobile information systems that leverage the social navigation approach.

Space-time clusters of dengue fever in Bangladesh

Objective:  To examine the space-time clustering of dengue fever (DF) transmission in Bangladesh using geographical information system and spatial scan statistics (SaTScan). Methods:  We obtained data on monthly suspected DF cases and deaths by district in Bangladesh for the period of 2000–2009 from Directorate General of Health Services. Population and district boundary data of each district were collected from national census managed by Bangladesh Bureau of Statistics. To identify the space-time clusters of DF transmission a discrete Poisson model was performed using SaTScan software. Results:  Space-time distribution of DF transmission was clustered during three periods 2000–2002, 2003–2005 and 2006–2009. Dhaka was the most likely cluster for DF in all three periods. Several other districts were significant secondary clusters. However, the geographical range of DF transmission appears to have declined in Bangladesh over the last decade. Conclusion:  There were significant space-time clusters of DF in Bangladesh over the last decade. Our results would prompt future studies to explore how social and ecological factors may affect DF transmission and would also be useful for improving DF control and prevention programs in Bangladesh.

Can SNOMED CT as implemented in New South Wales, Australia be used for road trauma injury surveillance in emergency departments?

The introduction of Systematized Nomenclature of Medicine - Clinical Terms (Snomed CT) for diagnosis coding in emergency departments (EDs) in New South Wales (NSW) has implications for injury surveillance abilities. This study aimed to assess the consequences of its introduction, as implemented as part of the ED information system in NSW, for identifying road trauma-related injuries in EDs. It involved a retrospective analysis of road trauma-related injuries identified in linked police, ED and mortality records during March 2007 to December 2009. Between 53.7% to 78.4% of all Snomed CT classifications in the principal provisional diagnosis field referred to the type of injury or symptom experienced by the individual. Of the road users identified by police, 3.2% of vehicle occupants, 6% of motorcyclists, 10.0% of pedal cyclists and 5.2% of pedestrians were identified using Snomed CT classifications in the principal provisional diagnosis field. The introduction of Snomed CT may provide flexible terminologies for clinicians. However, unless carefully implemented in information systems, its flexibility can lead to mismatches between the intention and actual use of defined data fields. Choices available in Snomed CT to indicate either symptoms, diagnoses, or injury mechanisms need to be controlled and these three concepts need to be retained in separate data fields to ensure a clear distinction between their classification in the ED.

A comparison of methods to identify alcohol involvement in youth injury-related emergency department presentation data

Aims: To compare different methods for identifying alcohol involvement in injury-related emergency department presentation in Queensland youth, and to explore the alcohol terminology used in triage text. Methods: Emergency Department Information System data were provided for patients aged 12-24 years with an injury-related diagnosis code for a 5 year period 2006-2010 presenting to a Queensland emergency department (N=348895). Three approaches were used to estimate alcohol involvement: 1) analysis of coded data, 2) mining of triage text, and 3) estimation using an adaptation of alcohol attributable fractions (AAF). Cases were identified as ‘alcohol-involved’ by code and text, as well as AAF weighted. Results: Around 6.4% of these injury presentations overall had some documentation of alcohol involvement, with higher proportions of alcohol involvement documented for 18-24 year olds, females, indigenous youth, where presentations occurred on a Saturday or Sunday, and where presentations occurred between midnight and 5am. The most common alcohol terms identified for all subgroups were generic alcohol terms (eg. ETOH or alcohol) with almost half of the cases where alcohol involvement was documented having a generic alcohol term recorded in the triage text. Conclusions: Emergency department data is a useful source of information for identification of high risk sub-groups to target intervention opportunities, though it is not a reliable source of data for incidence or trend estimation in its current unstandardised form. Improving the accuracy and consistency of identification, documenting and coding of alcohol-involvement at the point of data capture in the emergency department is the most desirable long term approach to produce a more solid evidence base to support policy and practice in this field.