Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings

OBJECTIVE: To describe the electronic medical databases used in antiretroviral therapy (ART) programmes in lower-income countries and assess the measures such programmes employ to maintain and improve data quality and reduce the loss of patients to follow-up. METHODS: In 15 countries of Africa, South America and Asia, a survey was conducted from December 2006 to February 2007 on the use of electronic medical record systems in ART programmes. Patients enrolled in the sites at the time of the survey but not seen during the previous 12 months were considered lost to follow-up. The quality of the data was assessed by computing the percentage of missing key variables (age, sex, clinical stage of HIV infection, CD4+ lymphocyte count and year of ART initiation). Associations between site characteristics (such as number of staff members dedicated to data management), measures to reduce loss to follow-up (such as the presence of staff dedicated to tracing patients) and data quality and loss to follow-up were analysed using multivariate logit models. FINDINGS: Twenty-one sites that together provided ART to 50 060 patients were included (median number of patients per site: 1000; interquartile range, IQR: 72-19 320). Eighteen sites (86%) used an electronic database for medical record-keeping; 15 (83%) such sites relied on software intended for personal or small business use. The median percentage of missing data for key variables per site was 10.9% (IQR: 2.0-18.9%) and declined with training in data management (odds ratio, OR: 0.58; 95% confidence interval, CI: 0.37-0.90) and weekly hours spent by a clerk on the database per 100 patients on ART (OR: 0.95; 95% CI: 0.90-0.99). About 10 weekly hours per 100 patients on ART were required to reduce missing data for key variables to below 10%. The median percentage of patients lost to follow-up 1 year after starting ART was 8.5% (IQR: 4.2-19.7%). Strategies to reduce loss to follow-up included outreach teams, community-based organizations and checking death registry data. Implementation of all three strategies substantially reduced losses to follow-up (OR: 0.17; 95% CI: 0.15-0.20). CONCLUSION: The quality of the data collected and the retention of patients in ART treatment programmes are unsatisfactory for many sites involved in the scale-up of ART in resource-limited settings, mainly because of insufficient staff trained to manage data and trace patients lost to follow-up.

Information Systems Outsourcing. Enduring themes, global challenges, and process opportunities

he notion of outsourcing – making arrangements with an external entity for the provision of goods or services to supplement or replace internal efforts – has been around for centuries. The outsourcing of information systems (IS) is however a much newer concept but one which has been growing dramatically. This book attempts to synthesize what is known about IS outsourcing by dividing the subject into three interrelated parts: (1) Traditional Information Technology Outsourcing, (2) Information Technolgy Offshoring, and (3) Business Process Outsourcing. The book should be of interest to all academics and students in the field of Information Systems as well as corporate executives and professionals who seek a more profound analysis and understanding of the underlying factors and mechanisms of outsourcing.

Systemic Determinants of the Information Systems Outsourcing Decision: A Comparative Study of German and United States Firms

The practice of information systems (IS) outsourcing is widely established among organizations. Nonetheless, evidence suggests that organizations differ considerably in the extent to which they deploy IS outsourcing. This variation has motivated research into the determinants of the IS outsourcing decision. Most of this research is based on the assumption that a decision on the outsourcing of a particular IS function is made independently of other IS functions. This modular view ignores the systemic nature of the IS function, which posits that IS effectiveness depends on how the various IS functions work together effectively. This study proposes that systemic influences are important criteria in evaluating the outsourcing option. It further proposes that the recognition of systemic influences in outsourcing decisions is culturally sensitive. Specifically, we provide evidence that systemic effects are factored into the IS outsourcing decision differently in more individualist cultures than in collectivist ones. Our results of a survey of United States and German firms indicate that perceived in-house advantages in the systemic impact of an IS function are, indeed, a significant determinant of IS outsourcing in a moderately individualist country (i.e., Germany), whereas insignificant in a strongly individualist country (i.e., the United States). The country differences are even stronger with regard to perceived in-house advantages in the systemic view of IS professionals. In fact, the direction of this impact is reversed in the United States sample. Other IS outsourcing determinants that were included as controls, such as cost efficiency, did not show significant country differences.

SLA-Driven Simulation of Multi-Tenant Scalable Cloud-Distributed Enterprise Information Systems

Cloud Computing is an enabler for delivering large-scale, distributed enterprise applications with strict requirements in terms of performance. It is often the case that such applications have complex scaling and Service Level Agreement (SLA) management requirements. In this paper we present a simulation approach for validating and comparing SLA-aware scaling policies using the CloudSim simulator, using data from an actual Distributed Enterprise Information System (dEIS). We extend CloudSim with concurrent and multi-tenant task simulation capabilities. We then show how different scaling policies can be used for simulating multiple dEIS applications. We present multiple experiments depicting the impact of VM scaling on both datacenter energy consumption and dEIS performance indicators.

The Emergence of Formal Control Specificity in Information Systems Outsourcing: A Process-View

Information systems (IS) outsourcing projects often fail to achieve initial goals. To avoid project failure, managers need to design formal controls that meet the specific contextual demands of the project. However, the dynamic and uncertain nature of IS outsourcing projects makes it difficult to design such specific formal controls at the outset of a project. It is hence crucial to translate high-level project goals into specific formal controls during the course of a project. This study seeks to understand the underlying patterns of such translation processes. Based on a comparative case study of four outsourced software development projects, we inductively develop a process model that consists of three unique patterns. The process model shows that the performance implications of emergent controls with higher specificity depend on differences in the translation process. Specific formal controls have positive implications for goal achievement if only the stakeholder context is adapted, while they are negative for goal achievement if in the translation process tasks are unintendedly adapted. In the latter case projects incrementally drift away from their initial direction. Our findings help to better understand control dynamics in IS outsourcing projects. We contribute to a process theoretic understanding of IS outsourcing governance and we derive implications for control theory and the IS project escalation literature.

Information Systems Outsourcing: Towards Sustainable Business Value

This book attempts to synthesize research that contributes to a better understanding of how to reach sustainable business value through information systems (IS) outsourcing. Important topics in this realm are how IS outsourcing can contribute to innovation, how it can be dynamically governed, how to cope with its increasing complexity through multi-vendor arrangements, how service quality standards can be met, how corporate social responsibility can be upheld and how to cope with increasing demands of internationalization and new sourcing models, such as crowdsourcing and platform-based cooperation. These issues are viewed from either the client or vendor perspective, or both. The book should be of interest to all academics and students in the fields of Information Systems, Management and Organization as well as corporate executives and professionals who seek a more profound analysis and understanding of the underlying factors and mechanisms of outsourcing.

Resource-Constrained Project Scheduling with Project Management Information Systems

Most commercial project management software packages include planning methods to devise schedules for resource-constrained projects. As it is proprietary information of the software vendors which planning methods are implemented, the question arises how the software packages differ in quality with respect to their resource-allocation capabilities. We experimentally evaluate the resource-allocation capabilities of eight recent software packages by using 1,560 instances with 30, 60, and 120 activities of the well-known PSPLIB library. In some of the analyzed packages, the user may influence the resource allocation by means of multi-level priority rules, whereas in other packages, only few options can be chosen. We study the impact of various complexity parameters and priority rules on the project duration obtained by the software packages. The results indicate that the resource-allocation capabilities of these packages differ significantly. In general, the relative gap between the packages gets larger with increasing resource scarcity and with increasing number of activities. Moreover, the selection of the priority rule has a considerable impact on the project duration. Surprisingly, when selecting a priority rule in the packages where it is possible, both the mean and the variance of the project duration are in general worse than for the packages which do not offer the selection of a priority rule.