Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.

Redefining the Academic Library Managing the Migration to Digital Information Services

Academic libraries are faced with a daunting series of challenges brought on by the digital revolution. In an era when millions of books, articles, images, and videos available instantaneously via the web, libraries across all institutional types are experiencing declining demand for their traditional services, built around the storage and dissemination of physical resources. At the same time, new demand for digital information services and collaborative learning spaces promise new areas of opportunity and engagement with patrons. A rapid and orderly transition to “the library of the future” requires difficult trade-offs, however, as no institution can afford to continue expanding both its commitment to comprehensive, local print collections as well as new investments in staff, technology, and renovations. This report illustrates how progressive academic libraries are evolving in response to these challenges, providing case studies and best practices in managing library space, staff, and resources.

Information technology for development of small and medium-sized exporters in Latin America and East Asia

Includes bibliography

The technical skills of information technology workers in Argentina

Includes bibliography

The software and information technology services industry: An opportunity for the economic autonomy of women in Latin America

The objective of this report is to understand the rationality that underpins public and business policies for promoting the IT and SIS industries and to determine whether they incorporate gender equality and/or provide incentives for women’s participation. The report also explores how this group of women is symbolically constructed within the firms, what issues are emphasized by the women themselves and what solutions or resources they propose for overcoming the problems. It then contrasts this discourse and intervention with the experiences, visions and demands of women leaders in the SIS sector. For this purpose, the policies, programmes and best practices of Europe are analysed and compared with instruments currently in place in Latin America and the Caribbean, in terms of their specific characteristics and degree of progress. Special attention is given to the cases of Argentina, Costa Rica and Colombia.

Towards a Model of Information Systems User Competency

The ability to utilize information systems (IS) effectively is becoming a necessity for business professionals. However, individuals differ in their abilities to use IS effectively, with some achieving exceptional performance in IS use and others being unable to do so. Therefore, developing a set of skills and attributes to achieve IS user competency, or the ability to realize the fullest potential and the greatest performance from IS use, is important. Various constructs have been identified in the literature to describe IS users with regard to their intentions to use IS and their frequency of IS usage, but studies to describe the relevant characteristics associated with highly competent IS users, or those who have achieved IS user competency, are lacking. This research develops a model of IS user competency by using the Repertory Grid Technique to identify a broad set of characteristics of highly competent IS users. A qualitative analysis was carried out to identify categories and sub-categories of these characteristics. Then, based on the findings, a subset of the model of IS user competency focusing on the IS-specific factors – domain knowledge of and skills in IS, willingness to try and to explore IS, and perception of IS value – was developed and validated using the survey approach. The survey findings suggest that all three factors are relevant and important to IS user competency, with willingness to try and to explore IS being the most significant factor. This research generates a rich set of factors explaining IS user competency, such as perception of IS value. The results not only highlight characteristics that can be fostered in IS users to improve their performance with IS use, but also present research opportunities for IS training and potential hiring criteria for IS users in organizations.

Authoring tools and management information systems: study of a generalizable architecture

The need to effectively manage the documentation covering the entire production process, from the concept phase right through to market realise, constitutes a key issue in the creation of a successful and highly competitive product. For almost forty years the most commonly used strategies to achieve this have followed Product Lifecycle Management (PLM) guidelines. Translated into information management systems at the end of the '90s, this methodology is now widely used by companies operating all over the world in many different sectors. PLM systems and editor programs are the two principal types of software applications used by companies for their process aotomation. Editor programs allow to store in documents the information related to the production chain, while the PLM system stores and shares this information so that it can be used within the company and made it available to partners. Different software tools, which capture and store documents and information automatically in the PLM system, have been developed in recent years. One of them is the ''DirectPLM'' application, which has been developed by the Italian company ''Focus PLM''. It is designed to ensure interoperability between many editors and the Aras Innovator PLM system. In this dissertation we present ''DirectPLM2'', a new version of the previous software application DirectPLM. It has been designed and developed as prototype during the internship by Focus PLM. Its new implementation separates the abstract logic of business from the real commands implementation, previously strongly dependent on Aras Innovator. Thanks to its new design, Focus PLM can easily develop different versions of DirectPLM2, each one devised for a specific PLM system. In fact, the company can focus the development effort only on a specific set of software components which provides specialized functions interacting with that particular PLM system. This allows shorter Time-To-Market and gives the company a significant competitive advantage.

Exploring the World's Largest ERP Implementation: the Role of ERP in Strategic Alignment

As one of the largest and most complex organizations in the world, the Department of Defense (DoD) faces many challenges in solving its well-documented financial and related business operations and system problems. The DoD is in the process of implementing modern multifunction enterprise resource planning (ERP) systems to replace many of its outdated legacy systems. This paper explores the ERP implementations of the DoD and seeks to determine the impact of the ERP implementations on the alignment of the DoD’s business and IT strategy. A brief overview of the alignment literature and background on ERP are followed by case study analysis of the DoD ERP development and current implementation status. Lastly, the paper explores the current successes and failures of the ERP implementation and the impact on the DoD’s goal of strategic alignment.

Professionalism and Information Technology: Positioning and Mediation

The starting point of this paper is the assumption that - on the one hand - information technology (IT) is increasingly shaping the professional knowledge base and on the other the relation between organisation and profession. IT is changing the role, responsibilities and practices of social workers and therefore it is important to deal with the impact of IT on social work (representative for many: Harlow and Webb 2003; Burton and van den Broek 2008). Hence, the general aim of this paper is to stimulate a basic discussion on “IT application in social work“, or rather, in a more general way, on „technology and professions“. Secondly, it is about an analytical differentiation of the process of informatisation, respectively formalisation. Thirdly we want to discuss the assumption and overall combination of efficiency, effectiveness and IT. Therefore this paper is arranged as follows: After some opening remarks (chapter 1) we outline case management systems as research object (2). Further on, we confront the approach of reflexive professionalism (3) with the process of formalization (4). Subsequently, we touch on the debate of “technologies of care” (5) and conclude with some short remarks on a research program (6).

The Houston Academy of Medicine--Texas Medical Center Library management information system.

A management information system (MIS) provides a means for collecting, reporting, and analyzing data from all segments of an organization. Such systems are common in business but rare in libraries. The Houston Academy of Medicine-Texas Medical Center Library developed an MIS that operates on a system of networked IBM PCs and Paradox, a commercial database software package. The data collected in the system include monthly reports, client profile information, and data collected at the time of service requests. The MIS assists with enforcement of library policies, ensures that correct information is recorded, and provides reports for library managers. It also can be used to help answer a variety of ad hoc questions. Future plans call for the development of an MIS that could be adapted to other libraries' needs, and a decision-support interface that would facilitate access to the data contained in the MIS databases.

The Evolution of Routines under flexible Information Technology

Many technological developments of the past two decades come with the promise of greater IT flexi-bility, i.e. greater capacity to adapt IT. These technologies are increasingly used to improve organiza-tional routines that are not affected by large, hard-to-change IT such as ERP. Yet, most findings on the interaction of routines and IT stem from contexts where IT is hard to change. Our research ex-plores how routines and IT co-evolve when IT is flexible. We review the literatures on routines to sug-gest that IT may act as a boundary object that mediates the learning process unfolding between the ostensive and the performative aspect of the routine. Although prior work has concluded from such conceptualizations that IT stabilizes routines, we qualify that flexible IT can also stimulate change because it enables learning in short feedback cycles. We suggest that, however, such change might not always materialize because it is contingent on governance choices and technical knowledge. We de-scribe the case-study method to explore how routines and flexible IT co-evolve and how governance and technical knowledge influence this process. We expect to contribute towards stronger theory of routines and to develop recommendations for the effective implementation of flexible IT in loosely coupled routines.

The Process of Starting a Business

Many students are inspired to start their own business venture after taking some courses in school or simply just taking an idea and turning it into a business. The beginning process is usually most difficult in terms of establishing a functioning business, getting the right connections, and avoiding discouragement to follow through with the business. That is why many businesses fall into the categories of starting, failing along the process, or failing to get started. There is a lot to be learned from the process of starting a business venture. In addressing this issue, some of the questions this research study aims to explore and study are how people go about their new venture efforts? Second, what steps they undertake? Third, from whom do they get information? And fourth, how do they use that information? This study will seek a variety of insights that can help answer these questions and improve our understanding of why some businesses fail, succeed, or never get started.

For-profit business safety interventions: A systematic, descriptive review of the literature

The purpose of this research was to determine if principles from organizational theory could be used as a framework to compare and contrast safety interventions developed by for-profit industry for the time period 1986–1996. A literature search of electronic databases and manual search of journals and local university libraries' book stacks was conducted for safety interventions developed by for-profit businesses. To maintain a constant regulatory environment, the business sectors of nuclear power, aviation and non-profits were excluded. Safety intervention evaluations were screened for scientific merit. Leavitt's model from organization theory was updated to include safety climate and renamed the Updated Leavitt's Model. In all, 8000 safety citations were retrieved, 525 met the inclusion criteria, 255 met the organizational safety intervention criteria, and 50 met the scientific merit criteria. Most came from non-public health journals. These 50 were categorized by the Updated Leavitt's Model according to where within the organizational structure the intervention took place. Evidence tables were constructed for descriptive comparison. The interventions clustered in the areas of social structure, safety climate, the interaction between social structure and participants, and the interaction between technology and participants. No interventions were found in the interactions between social structure and technology, goals and technology, or participants and goals. Despite the scientific merit criteria, many still had significant study design weaknesses. Five interventions tested for statistical significance but none of the interventions commented on the power of their study. Empiric studies based on safety climate theorems had the most rigorous designs. There was an attempt in these studies to address randomization amongst subjects to avoid bias. This work highlights the utility of using the Updated Leavitt's Model, a model from organizational theory, as a framework when comparing safety interventions. This work also highlights the need for better study design of future trials of safety interventions. ^

Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

The relationship between hospital financial performance and information technology integration strategy selection

In light of the new healthcare regulations, hospitals are increasingly reevaluating their IT integration strategies to meet expanded healthcare information exchange requirements. Nevertheless, hospital executives do not have all the information they need to differentiate between the available strategies and recognize what may better fit their organizational needs. ^ In the interest of providing the desired information, this study explored the relationships between hospital financial performance, integration strategy selection, and strategy change. The integration strategies examined – applied as binary logistic regression dependent variables and in the order from most to least integrated – were Single-Vendor (SV), Best-of-Suite (BoS), and Best-of-Breed (BoB). In addition, the financial measurements adopted as independent variables for the models were two administrative labor efficiency and six industry standard financial ratios designed to provide a broad proxy of hospital financial performance. Furthermore, descriptive statistical analyses were carried out to evaluate recent trends in hospital integration strategy change. Overall six research questions were proposed for this study. ^ The first research question sought to answer if financial performance was related to the selection of integration strategies. The next questions, however, explored whether hospitals were more likely to change strategies or remain the same when there was no external stimulus to change, and if they did change, they would prefer strategies closer to the existing ones. These were followed by a question that inquired if financial performance was also related to strategy change. Nevertheless, rounding up the questions, the last two probed if the new Health Information Technology for Economic and Clinical Health (HITECH) Act had any impact on the frequency and direction of strategy change. ^ The results confirmed that financial performance is related to both IT integration strategy selection and strategy change, while concurred with prior studies that suggested hospital and environmental characteristics are associated factors as well. Specifically this study noted that the most integrated SV strategy is related to increased administrative labor efficiency and the hybrid BoS strategy is associated with improved financial health (based on operating margin and equity financing ratios). On the other hand, no financial indicators were found to be related to the least integrated BoB strategy, except for short-term liquidity (current ratio) when involving strategy change. ^ Ultimately, this study concluded that when making IT integration strategy decisions hospitals closely follow the resource dependence view of minimizing uncertainty. As each integration strategy may favor certain organizational characteristics, hospitals traditionally preferred not to make strategy changes and when they did, they selected strategies that were more closely related to the existing ones. However, as new regulations further heighten revenue uncertainty while require increased information integration, moving forward, as evidence already suggests a growing trend of organizations shifting towards more integrated strategies, hospitals may be more limited in their strategy selection choices.^