Transforming the English NHS using information technology: the story so far

The use of information and communication technologies (ICT) for transforming the way publicservices are delivered, has been an area of investment and focus in many countries in recentyears. The UK government envisioned moving from e-Government to transformationalgovernment by 2008, and initiatives such as the National Programme for IT (NPfIT) wereunderway towards this end. NPfIT was the largest civil IT programme worldwide at an initialestimated cost of £12.4bn over a ten-year period. It was launched in 2002 by the UKgovernment as part of its policy to transform the English NHS and to implement standardised ITsolutions at a national level. However, this top down, government led approach came underincreasing scrutiny, and is now being reconfigured towards a more decentralised mode of operations. This paper looks into the implementation of NPfIT and analyses the reasons behindits failure, and what effect the new NHS reforms are likely to have on the health sector. Wedraw from past studies (Weill and Ross, 2005) to highlight the key areas of concern in ITgovernance, using the NPfIT as an illustration

Strengthening citizen agency and accountability through ICT

We investigated the role of Information and Communication Technologies (ICT, namely mobile phones) in support of citizen agency and its potential in calling authorities to account. We focused on Eastern Africa and we used a mixed methodology, which allowed us to explore the current uses of ICT to strengthen accountability and to forecast the growth of mobile phones' adaption in that region. Evidence from both analyses suggests that there are two main areas where citizen agency and ICT can reinforce each other in bottom–up and horizontal processes: participation and engagement of citizens, and the diffusion of information.

Information communication technologies and distance education in Sri Lanka: a case study of two universities

Sri Lanka's participation rates in higher education are low and have risen only slightly in the last few decades; the number of places for higher education in the state university system only caters for around 3% of the university entrant age cohort. The literature reveals that the highly competitive global knowledge economy increasingly favours workers with high levels of education who are also lifelong learners. This lack of access to higher education for a sizable proportion of the labour force is identified as a severe impediment to Sri Lanka‟s competitiveness in the global knowledge economy. The literature also suggests that Information and Communication Technologies are increasingly relied upon in many contexts in order to deliver flexible learning, to cater especially for the needs of lifelong learners in today‟s higher educational landscape. The government of Sri Lanka invested heavily in ICTs for distance education during the period 2003-2009 in a bid to increase access to higher education; but there has been little research into the impact of this. To address this lack, this study investigated the impact of ICTs on distance education in Sri Lanka with respect to increasing access to higher education. In order to achieve this aim, the research focused on Sri Lanka‟s effort from three perspectives: policy perspective, implementation perspective and user perspective. A multiple case study research using an ethnographic approach was conducted to observe Orange Valley University‟s and Yellow Fields University‟s (pseudonymous) implementation of distance education programmes using questionnaires, qualitative interviewing and document analysis. In total, data for the analysis was collected from 129 questionnaires, 33 individual interviews and 2 group interviews. The research revealed that ICTs have indeed increased opportunities for higher education; but mainly for people of affluent families from the Western Province. Issues identified were categorized under the themes: quality assurance, location, language, digital literacies and access to resources. Recommendations were offered to tackle the identified issues in accordance with the study findings. The study also revealed the strong presence of a multifaceted digital divide in the country. In conclusion, this research has shown that iii although ICT-enabled distance education has the potential to increase access to higher education the present implementation of the system in Sri Lanka has been less than successful.

Adoption of ICT among small business: vision vs. reality

The aim of this paper is to present a case study of the adoption of Information and Communication Technologies (ICT) among 6000 small businesses within a locality of Greater Manchester, England. The paper presents an analysis of factors affecting adoption and discusses the wider implications for achieving the European vision of regional 'digital ecosystems".

Resources, staff beliefs and organizational culture: factors in the use of information and communication technology for adults with intellectual disabilities

Background  Access to, and the use of, information and communication technology (ICT) is increasingly becoming a vital component of mainstream life. First-order (e.g. time and money) and second-order factors (e.g. beliefs of staff members) affect the use of ICT in different contexts. It is timely to investigate what these factors may be in the context of service provision for adults with intellectual disabilities given the role ICT could play in facilitating communication and access to information and opportunities as suggested in Valuing People. Method  Taking a qualitative approach, nine day service sites within one organization were visited over a period of 6 months to observe ICT-related practice and seek the views of staff members working with adults with intellectual disabilities. All day services were equipped with modern ICT equipment including computers, digital cameras, Internet connections and related peripherals. Results  Staff members reported time, training and budget as significant first-order factors. Organizational culture and beliefs about the suitability of technology for older or less able service users were the striking second-order factors mentioned. Despite similar levels of equipment, support and training, ICT use had developed in very different ways across sites. Conclusion  The provision of ICT equipment and training is not sufficient to ensure their use; the beliefs of staff members and organizational culture of sites play a substantial role in how ICT is used with and by service users. Activity theory provides a useful framework for considering how first- and second-order factors are related. Staff members need to be given clear information about the broader purpose of activities in day services, especially in relation to the lifelong learning agenda, in order to see the relevance and usefulness of ICT resources for all service users.

Codification vs personalisation: A study of the information evaluation practice between aerospace and construction industries

In the emerging digital economy, the management of information in aerospace and construction organisations is facing a particular challenge due to the ever-increasing volume of information and the extensive use of information and communication technologies (ICTs). This paper addresses the problems of information overload and the value of information in both industries by providing some cross-disciplinary insights. In particular it identifies major issues and challenges in the current information evaluation practice in these two industries. Interviews were conducted to get a spectrum of industrial perspectives (director/strategic, project management and ICT/document management) on these issues in particular to information storage and retrieval strategies and the contrasting approaches to knowledge and information management of personalisation and codification. Industry feedback was collected by a follow-up workshop to strengthen the findings of the research. An information-handling agenda is outlined for the development of a future Information Evaluation Methodology (IEM) which could facilitate the practice of the codification of high-value information in order to support through-life knowledge and information management (K&IM) practice.

Higher Education: Understanding the impact of distance learning mode on user information assimilation and satisfaction

There is increasing pressure to capture of video within Higher Education. Although much research has looked at how communication technologies enhance information transfer during playback of video, consideration of technical issues seems incongruous if we do not consider how presentation mode affects information assimilated by, and satisfaction of, learners with a range of individual differences, and from a range of different backgrounds. This paper considers whether a relationship exists between the media and presentation mode used in recorded content, and the level of information assimilation and satisfaction perceived by learners with a range of individual differences. Results aim to inform learning practitioners whether generic delivery is justified, or whether tailoring content delivery enhances the experience of specific learner groups.

Transaction costs, information technologies and the choice of marketplace among farmers in Northern Ghana

Using a transactions costs framework, we examine the impact of information and communication technologies (mobile phones and radios) use on market participation in developing country agricultural markets using a novel transaction-level data set of Ghanaian farmers. Our analysis of the choice of markets by farmers suggests that market information from a broader range of markets may not always induce farmers to sell in more distant markets; instead farmers may use broader market information to enhance their bargaining power in closer markets. Finally, we find weak evidence on the impact of using mobile phones in attracting farm gate buyers.

The internet, information architecture and community memory

This article reviews current technological developments, particularly Peer-to-Peer technologies and Distributed Data Systems, and their value to community memory projects, particularly those concerned with the preservation of the cultural, literary and administrative data of cultures which have suffered genocide or are at risk of genocide. It draws attention to the comparatively good representation online of genocide denial groups and changes in the technological strategies of holocaust denial and other far-right groups. It draws on the author's work in providing IT support for a UK-based Non-Governmental Organization providing support for survivors of genocide in Rwanda.

A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

Background: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-eff ectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months’ follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0∙58, 95% CI 0∙38–0∙89); a β blocker if they had asthma (0∙73, 0∙58–0∙91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0∙51, 0∙34–0∙78). PINCER has a 95% probability of being cost eff ective if the decision-maker’s ceiling willingness to pay reaches £75 per error avoided at 6 months. Interpretation: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. Funding: Patient Safety Research Portfolio, Department of Health, England.