The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist’s time and activities

Objective To assess the impact of a closed-loop electronic prescribing and automated dispensing system on the time spent providing a ward pharmacy service and the activities carried out. Setting Surgical ward, London teaching hospital. Method All data were collected two months pre- and one year post-intervention. First, the ward pharmacist recorded the time taken each day for four weeks. Second, an observational study was conducted over 10 weekdays, using two-dimensional work sampling, to identify the ward pharmacist's activities. Finally, medication orders were examined to identify pharmacists' endorsements that should have been, and were actually, made. Key findings Mean time to provide a weekday ward pharmacy service increased from 1 h 8 min to 1 h 38 min per day (P = 0.001; unpaired t-test). There were significant increases in time spent prescription monitoring, recommending changes in therapy/monitoring, giving advice or information, and non-productive time. There were decreases for supply, looking for charts and checking patients' own drugs. There was an increase in the amount of time spent with medical and pharmacy staff, and with 'self'. Seventy-eight per cent of patients' medication records could be assessed for endorsements pre- and 100% post-intervention. Endorsements were required for 390 (50%) of 787 medication orders pre-intervention and 190 (21%) of 897 afterwards (P < 0.0001; chi-square test). Endorsements were made for 214 (55%) of endorsement opportunities pre-intervention and 57 (30%) afterwards (P < 0.0001; chi-square test). Conclusion The intervention increased the overall time required to provide a ward pharmacy service and changed the types of activity undertaken. Contact time with medical and pharmacy staff increased. There was no significant change in time spent with patients. Fewer pharmacy endorsements were required post-intervention, but a lower percentage were actually made. The findings have important implications for the design, introduction and use of similar systems.

WREN: electronic management system for facilities management

This paper describes a case study of an electronic data management system developed in-house by the Facilities Management Directorate (FMD) of an educational institution in the UK. The FMD Maintenance and Business Services department is responsible for the maintenance of the built-estate owned by the university. The department needs to have a clear definition of the type of work undertaken and the administration that enables any maintenance work to be carried out. These include the management of resources, budget, cash flow and workflow of reactive, preventative and planned maintenance of the campus. In order to be more efficient in supporting the business process, the FMD had decided to move from a paper-based information system to an electronic system, WREN, to support the business process of the FMD. Some of the main advantages of WREN are that it is tailor-made to fit the purpose of the users; it is cost effective when it comes to modifications on the system; and the database can also be used as a knowledge management tool. There is a trade-off; as WREN is tailored to the specific requirements of the FMD, it may not be easy to implement within a different institution without extensive modifications. However, WREN is successful in not only allowing the FMD to carry out the tasks of maintaining and looking after the built-estate of the university, but also has achieved its aim to minimise costs and maximise efficiency.

The local adsorption geometry and electronic structure of alanine on Cu{110}

The adsorption of alanine on Cu {110} was studied by a combination of near edge X-ray absorption fine structure (NEXAFS) spectroscopy, X-ray photoelectron spectroscopy (XPS) and density functional theory (DFT). Large chemical shifts in the C 1s, N 1s, and O 1s XP spectra were found between the alanine multilayer and the chemisorbed and pseudo-(3 x 2) alaninate layers. From C, N, and O K-shell NEXAFS spectra the tilt angles of the carboxylate group (approximate to 26 degrees in plane with respect to [1 (1) over bar0] and approximate to 45 degrees out of plane) and the C-N bond angle with respect to [1 (1) over bar0] could be determined for the pseudo-(3 x 2) overlayer. Using this information three adsorption geometries could be eliminated from five p(3 x 2) structures which lead to almost identical heats of adsorption in the DFT calculations between 1.40 and 1.47 eV/molecule. Due to the small energy difference between the remaining two structures it is not unlikely that these coexist on the surface at room temperature. (c) 2006 Elsevier B.V. All rights reserved.

Electronic voting systems in undergraduate teaching

One of the major differences undergraduates experience during the transition to university is the style of teaching. In schools and colleges most students study key stage 5 subjects in relatively small informal groups where teacher–pupil interaction is encouraged and two-way feedback occurs through question and answer type delivery. On starting in HE students are amazed by the sizes of the classes. For even a relatively small chemistry department with an intake of 60-70 students, biologists, pharmacists, and other first year undergraduates requiring chemistry can boost numbers in the lecture hall to around 200 or higher. In many universities class sizes of 400 are not unusual for first year groups where efficiency is crucial. Clearly the personalised classroom-style delivery is not practical and it is a brave student who shows his ignorance by venturing to ask a question in front of such an audience. In these environments learning can be a very passive process, the lecture acts as a vehicle for the conveyance of information and our students are expected to reinforce their understanding by ‘self-study’, a term, the meaning of which, many struggle to understand. The use of electronic voting systems (EVS) in such situations can vastly change the students’ learning experience from a passive to a highly interactive process. This principle has already been demonstrated in Physics, most notably in the work of Bates and colleagues at Edinburgh.1 These small hand-held devices, similar to those which have become familiar through programmes such as ‘Who Wants to be a Millionaire’ can be used to provide instant feedback to students and teachers alike. Advances in technology now allow them to be used in a range of more sophisticated settings and comprehensive guides on use have been developed for even the most techno-phobic staff.

Small business collaboration through electronic marketplace

It is widely recognized that small businesses with less than 50 employees make significant contributions to the prosperity of local, regional, and national economies. They are a major source of job creation and a driving force of economic growth for developed countries like the USA (Headd, 2005; SBA, 2005), the UK (Dixon, Thompson, & McAllister, 2002; SBS, 2005), Europe (European Commission, 2003), and developing countries such as China (Bo, 2005). The economic potential is further strengthened when firms collaborate with each other; for example, formation of a supply chain, strategic alliances, or sharing of information and resources (Horvath, 2001; O’Donnell, Cilmore, Cummins, & Carson, 2001; MacGregor, 2004; Todeva & Knoke, 2005). Owing to heterogeneous aspects of small businesses, such as firm size and business sector, a single e-business solution is unlikely to be suitable for all firms (Dixon et al., 2002; Taylor & Murphy, 2004a); however, collaboration requires individual firms to adopt standardized, simplified solutions based on open architectures and data design (Horvath, 2001). The purpose of this article is to propose a conceptual e-business framework and a generic e-catalogue, which enables small businesses to collaborate through the creation of an e-marketplace. To assist with the task, analysis of data from 6,000 small businesses situated within a locality of Greater Manchester, England within the context of an e-business portal is incorporated within this study.

A conceptual life event framework for government-to-citizen electronic service provision

In recent years, life event approach has been widely used by governments all over the world for designing and providing web services to citizens through their e-government portals. Despite the wide usage of this approach, there is still a challenge of how to use this approach to design e-government portals in order to automatically provide personalised services to citizens. We propose a conceptual framework for e-government service provision based on life event approach and the use of citizen profile to capture the citizen needs, since the process of finding Web services from a government-to-citizen (G2C) system involves understanding the citizens’ needs and demands, selecting the relevant services, and delivering services that matches the requirements. The proposed framework that incorporates the citizen profile is based on three components that complement each other, namely, anticipatory life events, non-anticipatory life events and recurring services.

Extending feature usage: a study of the post-adoption of electronic medical records

Technology Acceptance Model (TAM) posits that Perceived Ease of Use (PEOU) and Perceived Usefulness (PU) influence the ‘intention to use’. The Post-Acceptance Model (PAM) posits that continued use is influenced by prior experience. In order to study the factors that influence how professionals use complex systems, we create a tentative research model that builds on PAM and TAM. Specifically we include PEOU and the construct ‘Professional Association Guidance’. We postulate that feature usage is enhanced when professional associations influence PU by highlighting additional benefits. We explore the theory in the context of post-adoption use of Electronic Medical Records (EMRs) by primary care physicians in Ontario. The methodology can be extended to other professional environments and we suggest directions for future research.

Content validation for level of use of feature rich systems: a Delphi study of electronic medical records systems

Introduction. Feature usage is a pre-requisite to realising the benefits of investments in feature rich systems. We propose that conceptualising the dependent variable 'system use' as 'level of use' and specifying it as a formative construct has greater value for measuring the post-adoption use of feature rich systems. We then validate the content of the construct as a first step in developing a research instrument to measure it. The context of our study is the post-adoption use of electronic medical records (EMR) by primary care physicians. Method. Initially, a literature review of the empirical context defines the scope based on prior studies. Having identified core features from the literature, they are further refined with the help of experts in a consensus seeking process that follows the Delphi technique. Results.The methodology was successfully applied to EMRs, which were selected as an example of feature rich systems. A review of EMR usage and regulatory standards provided the feature input for the first round of the Delphi process. A panel of experts then reached consensus after four rounds, identifying ten task-based features that would be indicators of level of use. Conclusions. To study why some users deploy more advanced features than others, theories of post-adoption require a rich formative dependent variable that measures level of use. We have demonstrated that a context sensitive literature review followed by refinement through a consensus seeking process is a suitable methodology to validate the content of this dependent variable. This is the first step of instrument development prior to statistical confirmation with a larger sample.

Pragmatic oriented data interoperability for smart healthcare information systems

Smart healthcare is a complex domain for systems integration due to human and technical factors and heterogeneous data sources involved. As a part of smart city, it is such a complex area where clinical functions require smartness of multi-systems collaborations for effective communications among departments, and radiology is one of the areas highly relies on intelligent information integration and communication. Therefore, it faces many challenges regarding integration and its interoperability such as information collision, heterogeneous data sources, policy obstacles, and procedure mismanagement. The purpose of this study is to conduct an analysis of data, semantic, and pragmatic interoperability of systems integration in radiology department, and to develop a pragmatic interoperability framework for guiding the integration. We select an on-going project at a local hospital for undertaking our case study. The project is to achieve data sharing and interoperability among Radiology Information Systems (RIS), Electronic Patient Record (EPR), and Picture Archiving and Communication Systems (PACS). Qualitative data collection and analysis methods are used. The data sources consisted of documentation including publications and internal working papers, one year of non-participant observations and 37 interviews with radiologists, clinicians, directors of IT services, referring clinicians, radiographers, receptionists and secretary. We identified four primary phases of data analysis process for the case study: requirements and barriers identification, integration approach, interoperability measurements, and knowledge foundations. Each phase is discussed and supported by qualitative data. Through the analysis we also develop a pragmatic interoperability framework that summaries the empirical findings and proposes recommendations for guiding the integration in the radiology context.

Electronic commerce in agriculture and agribusiness: the case of Emilia-Romagna (Italy )

Despite the expectations of the benefits of this tool, the adoption of Electronic Commerce (EC) by small and medium firms of the agro-food sector in Italy is still not frequent, however, the understanding of opportunities it could create and how they can be exploited remains a relevant issue. This study, carried out in the Emilia -Romagna region during 2002, illustrates the results of a survey of 208 firms at all stages of the agro-food chain aimed at understanding the use of the Internet and the strategies adopted for EC implementation. The results show a low level of implementation of the instrument and a limited variety of adoption strategies. Agro-food firms actually invest very little in EC focusing their efforts on the Internet as promotion tool, while web-based direct selling is confined to market niches. The view that the Internet would reverse the disadvantages of small firms appears by now non realistic, even if interesting opportunities for further development are still present.