eHealth as a challenge to `expert' power: a focus group study of internet use for health information and management

Objective To investigate current use of the internet and eHealth amongst adults. Design Focus groups were conducted to explore participants' attitudes to and reasons for health internet use. Main outcome measures The focus group data were analysed and interpreted using thematic analysis. Results Three superordinate themes exploring eHealth behaviours were identified: decline in expert authority, pervasiveness of health information on the internet and empowerment. Results showed participants enjoyed the immediate benefits of eHealth information and felt empowered by increased knowledge, but they would be reluctant to lose face-to-face consultations with their GP. Conclusions Our findings illustrate changes in patient identity and a decline in expert authority with ramifications for the practitioner–patient relationship and subsequent implications for health management more generally.

Technical efficiency:efficiency, change, technical progress and productivity growth in the national health systems of continental African countries

In May 2006, the Ministers of Health of all the countries on the African continent, at a special session of the African Union, undertook to institutionalise efficiency monitoring within their respective national health information management systems. The specific objectives of this study were: (i) to assess the technical efficiency of National Health Systems (NHSs) of African countries for measuring male and female life expectancies, and (ii) to assess changes in health productivity over time with a view to analysing changes in efficiency and changes in technology. The analysis was based on a five-year panel data (1999-2003) from all the 53 countries of continental Africa. Data Envelopment Analysis (DEA) - a non-parametric linear programming approach - was employed to assess the technical efficiency. Malmquist Total Factor Productivity (MTFP) was used to analyse efficiency and productivity change over time among the 53 countries' national health systems. The data consisted of two outputs (male and female life expectancies) and two inputs (per capital total health expenditure and adult literacy). The DEA revealed that 49 (92.5%) countries' NHSs were run inefficiently in 1999 and 2000; 50 (94.3%), 48 (90.6%) and 47 (88.7%) operated inefficiently in 2001, 2002, and 2003 respectively. All the 53 countries' national health systems registered improvements in total factor productivity attributable mainly to technical progress. Fifty-two countries did not experience any change in scale efficiency, while thirty (56.6%) countries' national health systems had a Pure Efficiency Change (PEFFCH) index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change. All the 53 countries' national health systems registered improvements in total factor productivity, attributable mainly to technical progress. Over half of the countries' national health systems had a pure efficiency index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change. African countries may need to critically evaluate the utility of institutionalising Malmquist TFP type of analyses to monitor changes in health systems economic efficiency and productivity over time. African national health systems, per capita total health expenditure, technical efficiency, scale efficiency, Malmquist indices of productivity change, DEA

Information management for viable organisations

The recent global „credit crunch? has brought sharply into focus the need for better understanding of what it takes for organisations to survive. This research seeks to help organisations maintain their „viability? – the ability to maintain a separate existence and survive on their own. Whilst there are a multitude of factors that contribute to organisational viability, information can be viewed as the lifeblood of organisations. This research increases our understanding of how organisations can manage information effectively to help maintain their viability. The viable systems model (VSM) is an established modelling technique that enables the detailed analysis of organisational activity to examine how the structure and functions performed in an organisation contribute to its „viability?. The VSM has been widely applied, in small/large companies, industries and governments. However, whilst the VSM concentrates on the structure and functions necessary for an organisation to be viable, it pays much less attention to information deployment in organisations. Indeed, the VSM is criticised in the literature for being unable to provide much help with detailed information and communication structures and new theories are called for to explore the way people interact and what information they need in the VSM. This research analyses qualitative data collected from four case studies to contribute to our understanding of the role that information plays in organisational viability, making three key contributions to the academic literature. In the information management literature, this research provides new insight into the roles that specific information plays in organisations. In the systems thinking literature, this research extends our understanding of the VSM and builds on its powerful diagnostic capability to provide further criteria to aid in the diagnosis of viable organisations. In the information systems literature, this research develops a framework that can be used to help organisations design more effective information systems.

Information management and the holistic, process-oriented enterprise

This research examines the role of the information management process within a process-oriented enterprise, Xerox Ltd. The research approach is based on a post-positive paradigm and has resulted in thirty-five idiographic statements. The three major outcomes are: 1. The process-oriented holistic enterprise is an organisation that requires a long-term management commitment to its development. It depends on the careful management of people, tasks, information and technology. A complex integration of business processes is required and this can be managed through the use of consistent documentation techniques, clarity in the definition of process responsibilities and management attention to the global metrics and the centralisation of the management of the process model are critical to its success. 2. The role of the information management process within the context of a process-oriented enterprise is to provide flexible and cost-effective applications, technological, and process support to the business. This is best achieved through a centralisation of the management of information management and of the process model. A business-led approach combined with the consolidation of applications, information, process, and data architectures is central to providing effective business and process-focused support. 3. In a process oriented holistic enterprise, process and information management are inextricably linked. The model of process management depends heavily on information management, whilst the model of information management is totally focused around supporting and creating the process model. The two models are mutually creating - one cannot exist without the other. There is a duality concept of process and information management.

Primary health care management in Nigeria

This research sets out to assess if the PHC system in rural Nigeria is effective by testing the research hypothesis: `PHC can be effective if and only if the Health Care Delivery System matches the attitudes and expectations of the Community'. The field surveys to accomplish this task were carried out in IBO, YORUBA, and HAUSA rural communities. A variety of techniques have been used as Research Methodology and these include questionnaires, interviews and personal observations of events in the rural community. This thesis embraces three main parts. Part I traces the socio-cultural aspects of PHC in rural Nigeria, describes PHC management activities in Nigeria and the practical problems inherent in the system. Part II describes various theoretical and practical research techniques used for the study and concentrates on the field work programme, data analysis and the research hypothesis-testing. Part III focusses on general strategies to improve PHC system in Nigeria to make it more effective. The research contributions to knowledge and the summary of main conclusions of the study are highlighted in this part also. Based on testing and exploring the research hypothesis as stated above, some conclusions have been arrived at, which suggested that PHC in rural Nigeria is ineffective as revealed in people's low opinions of the system and dissatisfaction with PHC services. Many people had expressed the view that they could not obtain health care services in time, at a cost they could afford and in a manner acceptable to them. Following the conclusions, some alternative ways to implement PHC programmes in rural Nigeria have been put forward to improve and make the Nigerian PHC system more effective.

River basin surveillance using remotely sensed data: a water resources information management system

This thesis describes the development of an operational river basin water resources information management system. The river or drainage basin is the fundamental unit of the system; in both the modelling and prediction of hydrological processes, and in the monitoring of the effect of catchment management policies. A primary concern of the study is the collection of sufficient and sufficiently accurate information to model hydrological processes. Remote sensing, in combination with conventional point source measurement, can be a valuable source of information, but is often overlooked by hydrologists, due to the cost of acquisition and processing. This thesis describes a number of cost effective methods of acquiring remotely sensed imagery, from airborne video survey to real time ingestion of meteorological satellite data. Inexpensive micro-computer systems and peripherals are used throughout to process and manipulate the data. Spatial information systems provide a means of integrating these data with topographic and thematic cartographic data, and historical records. For the system to have any real potential the data must be stored in a readily accessible format and be easily manipulated within the database. The design of efficient man-machine interfaces and the use of software enginering methodologies are therefore included in this thesis as a major part of the design of the system. The use of low cost technologies, from micro-computers to video cameras, enables the introduction of water resources information management systems into developing countries where the potential benefits are greatest.

Task-based annotation and retrieval for image information management

Continuing advances in digital image capture and storage are resulting in a proliferation of imagery and associated problems of information overload in image domains. In this work we present a framework that supports image management using an interactive approach that captures and reuses task-based contextual information. Our framework models the relationship between images and domain tasks they support by monitoring the interactive manipulation and annotation of task-relevant imagery. During image analysis, interactions are captured and a task context is dynamically constructed so that human expertise, proficiency and knowledge can be leveraged to support other users in carrying out similar domain tasks using case-based reasoning techniques. In this article we present our framework for capturing task context and describe how we have implemented the framework as two image retrieval applications in the geo-spatial and medical domains. We present an evaluation that tests the efficiency of our algorithms for retrieving image context information and the effectiveness of the framework for carrying out goal-directed image tasks. © 2010 Springer Science+Business Media, LLC.

Community accessibility of health information and the consequent impact for translation into community languages

This paper reports on a research project that investigated the accessibility of health information and the consequent impact for translation into community languages. This is a critical aspect of the mediation of intercultural and interlingual communication in the domain of public health information and yet very little research has been undertaken to address such issues. The project was carried out in collaboration with the New South Wales Multicultural Health Communication Service (MHCS), which provides advice and services to state-based health professionals aiming to communicate with non-English speaking communities. The research employed a mixed-method and action research based approach involving two phases. The primary focus of this paper is to discuss major quantitative findings from the first pilot phase, which indicated that there is much room to improve the way in which health information is written in English for effective community-wide communication within a multilingual society.

A solution for information management in logistics operations of modern manufacturing chains

One dominant feature of the modern manufacturing chains is the movement of goods. Manufacturing companies would remain an unprofitable investment if the supplies/logistics of raw materials, semi-finished products or final goods are not handled in an effective way. Both levels of a modern manufacturing chain-actual production and logistics-are characterized by continuous data creation at a much faster rate than they can be meaningfully analyzed and acted upon manually. Often, instant and reliable decisions need to be taken based on huge, previously inconceivable amounts of heterogeneous, contradictory or incomplete data. The paper will highlight aspects of information flows related to business process data visibility and observability in modern manufacturing networks. An information management platform developed in the framework of the EU FP7 project ADVANCE will be presented.

Balancing push and pull information management within the supply chain

The aim of this paper is to explore the management of information in an aerospace manufacturer's supply chain by analysing supply chain disruption risks. The social network perspective will be used to examine the flows of information in the supply chain. The examination of information flows will also be explored in terms of push and pull information management. The supply chain risk management (SCRM) strategy is to assess the management of information that allows companies to gather information which will allow them to mitigate that risk before any disruption to the supply chain occurs. There is a shortage of models in analysing the supply chain risk associated with information flows, possibly due to the omission of appropriate modelling techniques in this area (Tang and Nurmaya, 2011). This paper uses an exploratory case study consisting of a multi method qualitative approach using fifteen interviews and four focus groups.

Proposing a systems vision of knowledge management in emergency care

This paper makes a case for taking a systems view of knowledge management within health-care provision, concentrating on the emergency care process in the UK National Health Service. It draws upon research in two casestudy organizations (a hospital and an ambulance service). The case-study organizations appear to be approaching knowledge (and information) management in a somewhat fragmented way. They are trying to think more holistically, but (perhaps) because of the ways their organizations and their work are structured, they cannot ‘see’ the whole of the care process. The paper explores the complexity of knowledge management in emergency health care and draws the distinction for knowledge management between managing local and operational knowledge, and global and clinical knowledge.

Information systems design for the community health services

This system is concerned with the design and implementation of a community health information system which fulfils some of the local needs of fourteen nursing and para-medical professions in a district health authority, whilst satisfying the statutory requirements of the NHS Korner steering group for those professions. A national survey of community health computer applications, documented in the form of an applications register, shows the need for such a system. A series of general requirements for an informations systems design methodology are identified, together with specific requirements for this problem situation. A number of existing methodologies are reviewed, but none of these were appropriate for this application. Some existing approaches, tools and techniques are used to define a more suitable methodology. It is unreasonable to rely on one single general methodology for all types of application development. There is a need for pragmatism, adaptation and flexibility. In this research, participation in the development stages by those who will eventually use the system was thought desirable. This was achieved by forming a representative design group. Results would seem to show a highly favourable response from users to this participation which contributed to the overall success of the system implemented. A prototype was developed for the chiropody and school nursing staff groups of Darlington health authority, and evaluations show that a significant number of the problems and objectives of those groups have been successfully addressed; the value of community health information has been increased; and information has been successfully fed back to staff and better utilised.

Source of legitimacy in M-government initiatives in Turkey:concerns human vs. technical resource management

Emerging markets have recently been experiencing a dramatic increased in the number of mobile phone per capita. M-government has, hence, been heralded as an opportunity to leap-frog the technology cycle and provide cheaper and more inclusive and services to all. This chapter explores, within an emerging market context, the legitimacy and resistance facing civil servants’ at the engagement stage with m-government activities and the direct implication for resource management. Thirty in depth interview, in Turkey, are drawn-upon with key ICT civil servant in local organizations. The findings show that three types of resources are perceived as central namely: (i) diffusion of information management, (ii) operating system resource management and (iii) human resource management. The main evidence suggests that legitimacy for each resource management, at local level, is an ongoing struggle where all groups deploy multiples forms of resistance. Overall, greater attention in the resource management strategy for m-government application needs to be devoted to enablers such as civil servants rather than the final consumers or citizens.

WSRF-based modeling of clinical trial information for collaborative cancer research

The CancerGrid consortium is developing open-standards cancer informatics to address the challenges posed by modern cancer clinical trials. This paper presents the service-oriented software paradigm implemented in CancerGrid to derive clinical trial information management systems for collaborative cancer research across multiple institutions. Our proposal is founded on a combination of a clinical trial (meta)model and WSRF (Web Services Resource Framework), and is currently being evaluated for use in early phase trials. Although primarily targeted at cancer research, our approach is readily applicable to other areas for which a similar information model is available.

The evolving role of information specialists:change agents in process redesign

The research investigates the past, present and potential future role of Information Specialists (ISps) in process oriented companies. It tests the proposition that ISps in companies that have undertaken formal process reengineering exercises are likely to become more proactive and more business oriented (as opposed to technically oriented) than they had previously been when their organisations were organised along traditional, functional lines. A review of existing literature in the area of Business Process Reengineering and Information Management reveals a lack of consensus amongst researchers concerning the appropriate role for ISps during and after BPR. Opinion is divided as to whether IS professionals should reactively support BPR or whether IT/IS developments should be driving these initiatives. A questionnaire based ‘Descriptive Survey’ with 60 respondents is used as a first stage of primary data gathering. This is followed by follow-up interviews with 20 of the participating organisations to gather further information on their experiences. The final stage of data collection consists of further in-depth interview with four case study companies to provide an even richer picture of their experiences. The results of the questionnaire are analysed and displayed in the form of simple means, frequencies and bar graphs. The ‘NU-DIST’ computer based discourse analysis package was tried in relation to summarising the interview findings, but this proved cumbersome and a visual collation method is preferred. Overall, the researcher contends that the supposition outlined above is proven, and she concludes the research by suggesting the implications of these findings. In particular she offers a ‘Framework for Understanding and Action’ which is deemed to be relevant to both practitioners and future researchers.