Health information technology governance : a perspective on investment decision processes

Realizing value from IT investments continues to be a challenge for most healthcare organizations. IT governance (ITG) is envisaged to solve many of these challenges. ITG is the practice that establishes accountability framework for IT investments by allocating decision rights among major participants involved in IT decision processes. As ITG is relatively new in healthcare industry, it is expected that knowledge about how healthcare organizations govern their IT decisions is limited. This research aims to extend this knowledge and to assist both researchers and professionals by providing insights on how IT decisions are made and governed in healthcare organizations (HOs). This research adopts case-study methodology to investigate IT governance in two distinctly different HOs. The research findings indicate that HOs implement ITG to achieve alignment between business objectives and IT. Both HOs set up a five-stage IT decision process to identify, evaluate and prioritize IT investment ideas. They also established generic committee-structures that clearly defined roles and decision authorities to govern such process. It is suggested here that ITG in HOs is heavily influenced by strategic priorities, organizational structure, governance experience and governmental initiatives. Effective ITG in HOs is challenged by IT alignment, policy government, involvement of healthcare executives, and lack of business metrics to justify and evaluate decisions. The research proposes recommendations to address these challenges.

Healthcare professionals’ use of mobile phones and the internet in clinical practice

Background: Over the last few years mobile phone applications have been designed for healthcare professionals. However, little is known in regards to healthcare professionals’ use of and attitudes towards using smartphones (and applications) within clinical practice. Thus the aims of the present study were to enumerate the number of healthcare professionals that use mobile phones within clinical practice and their attitudes towards using them. Furthermore, given that the internet preceded smartphones, we also established healthcare professionals’ attitudes towards internet use in clinical practice as a comparison.

Method: Forty-three healthcare professionals from a range of disciplines and specialities who were predominantly working in Australia completed an anonymous online survey. 

National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults

Health literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy.

Energy performance of medium-sized healthcare buildings in Victoria, Australia- a case study

This paper investigates the energy performance of three medium-sized healthcare buildings in Victoria, Australia, that operate only during the daytime. The aim is to provide preliminary understanding of energy consumption in this particular typology in Australia in relation to the available benchmarks. This paper also identifies the differences of energy consumption between different functional areas within medium health facilities. Building features and operational characteristics contributing to the variations in healthcare energy performance are discussed. The total annual energy consumption data ranging from 167-306 kWh/m(2) or 42-72 kWh/m(3) were compared against international data from various climatic zones. Some of the drivers of energy consumption were determined and potentials for energy and water conservation were identified. Comparison with international standards shows a possibility to achieve lower energy consumption in Victorian healthcare buildings.

Interventions to improve cultural competency in healthcare: a systematic review of reviews

Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area.

Self-reported access to and quality of healthcare for diabetes : Do the severely obese experience equal access?

Background: Given reported pejorative views that health professionals have about patients who are severely obese, we examined the self-reported views of the quality and availability of diabetes care from the perspective of adults with type 2 diabetes (T2DM), stratified by body mass index (BMI). Methods: 1795 respondents to the Diabetes MILES - Australia national survey had T2DM. Of these, 530 (30%) were severely obese (BMI ≥35 kg/m2) and these participants were matched with 530 controls (BMI <35 kg/m2). Data regarding participants' self-reported interactions with health practitioners and services were compared. Results: Over 70% of participants reported that their general practitioner was the professional they relied on most for diabetes care. There were no betweengroup differences in patient-reported availability of health services, quality of interaction with health practitioners, resources and support for selfmanagement, or access to almost all diabetes services. Discussion: Participants who were severely obese did not generally report greater difficulty in accessing diabetes care.

Remote monitoring system enabling cloud technology upon smart phones and inertial sensors for human kinematics

Stroke is a common neurological condition which is becoming increasingly common as the population ages. This entails healthcare monitoring systems suitable for home use, with remote access for medical professionals and emergency responders. The mobile phone is becoming the easy access tool for self-evaluation of health, but it is hindered by inherent problems including computational power and storage capacity. This research proposes a novel cloud based architecture of a biomedical system for a wearable motion kinematic analysis system which mitigates the above mentioned deficiencies of mobile devices. The system contains three subsystems: 1. Bio Kin WMS for measuring the acceleration and rotation of movement 2. Bio Kin Mobi for Mobile phone based data gathering and visualization 3. Bio Kin Cloud for data intensive computations and storage. The system is implemented as a web system and an android based mobile application. The web system communicates with the mobile application using an encrypted data structure containing sensor data and identifiable headings. The raw data, according to identifiable headings, is stored in the Amazon Relational Database Service which is automatically backed up daily. The system was deployed and tested in Amazon Web Services.

Actor-Network Theory (ANT) based visualisation of socio-technical facets of RFID technology translation: an Australian hospital scenario

In the early 2000s, Information Systems researchers in Australia had begun to emphasise socio-technical approaches in innovation adoption of technologies. The ‘essentialist' approaches to adoption (for example, Innovation Diffusion or TAM), suggest an essence is largely responsible for rate of adoption (Tatnall, 2011) or a new technology introduced may spark innovation. The socio-technical factors in implementing an innovation are largely flouted by researchers and hospitals. Innovation Translation is an approach that purports that any innovation needs to be customised and translated in to context before it can be adopted. Equally, Actor-Network Theory (ANT) is an approach that embraces the differences in technical and human factors and socio-professional aspects in a non-deterministic manner. The research reported in this paper is an attempt to combined the two approaches in an effective manner, to visualise the socio-technical factors in RFID technology adoption in an Australian hospital. This research investigation demonstrates RFID technology translation in an Australian hospital using a case approach (Yin, 2009). Data was collected using a process of focus groups and interviews, analysed with document analysis and concept mapping techniques. The data was then reconstructed in a ‘movie script' format, with Acts and Scenes funnelled to ANT informed abstraction at the end of each Act. The information visualisation at the end of each Act using ANT informed Lens reveal the re-negotiation and improvement of network relationships between the people (factors) involved including nurses, patient care orderlies, management staff and non-human participants such as equipment and technology. The paper augments the current gaps in literature regarding socio-technical approaches in technology adoption within Australian healthcare context, which is transitioning from non-integrated nearly technophobic hospitals in the last decade to a tech-savvy integrated era. More importantly, the ANT visualisation addresses one of the criticisms of ANT i.e. its insufficiency to explain relationship formations between participants and over changes of events in relationship networks (Greenhalgh & Stones, 2010).

Healthcare costs associated with language difficulties up to 9 years of age: Australian population-based study

PURPOSE: This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children. METHOD: Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. RESULT: It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $AU206, 95% CI = $90, $321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $AU1.2-$AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties. CONCLUSION: Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

The use of a nursing informatics system as an exemplar to investigate business value of IT in healthcare

Researchers and decision makers in healthcare are taking great interest in clinical practices where there is a high potential to improve healthcare outcomes and reduce costs by incorporating a myriad of technology solutions. However, to date very few, if any of these IS/IT (information systems/information technology) solutions have realised the expected improvements to quality care with the expected cost reductions. This makes the need to evaluate the impact of IT on overall performance of clinical practices i.e. business value of IT a key strategic imperative in healthcare. To address this key need, we propose a comprehensive framework that conceptualises business value of IT in healthcare in different layers. To illustrate the proposed framework, a case study is used, which serves to examine the proposed conceptual model. The exemplar case study is an Australian-made nursing documentation system; an enterprise system that caters for multiple clinical users in acute healthcare contexts and hence provides appropriate richness to validate the proposed model.

A framework for cloud-based healthcare services to monitor noncommunicable diseases patient

Monitoring patients who have noncommunicable diseases is a big challenge. These illnesses require a continuous monitoring that leads to high cost for patients' healthcare. Several solutions proposed reducing the impact of these diseases in terms of economic with respect to quality of services. One of the best solutions is mobile healthcare, where patients do not need to be hospitalized under supervision of caregivers. This paper presents a new hybrid framework based on mobile multimedia cloud that is scalable and efficient and provides cost-effective monitoring solution for noncommunicable disease patient. In order to validate the effectiveness of the framework, we also propose a novel evaluation model based on Analytical Hierarchy Process (AHP), which incorporates some criteria from multiple decision makers in the context of healthcare monitoring applications. Using the proposed evaluation model, we analyzed three possible frameworks (proposed hybrid framework, mobile, and multimedia frameworks) in terms of their applicability in the real healthcare environment.

Courts as healthcare policy-makers: the problem, the responses to the problem and problems in the responses

This article starts by analysing healthcare litigation in Brazil by means of a literature review of articles that contribute with empirical findings on this phenomenon. Based on this review, I argue that health care litigation in Brazil makes the public health system less fair and rational. In the second part of this article, I discuss the three most overarching responses to control the level of litigation and its impact on the public health system: (i) the public hearing held by the Supreme Federal Court and the criteria the court established thereafter; (ii) the recommendations by the National Council of Justice aimed at building courts’ institutional capacity; and (iii) the enactment of the Federal Law 12.401/11, which created a new health technology assessment system. I argue that latter is the best response because it keeps the substantive decisions on the allocation of healthcare resources in the institution that is in the best position to make them. Moreover, this legislation will make the decisions about provision of health treatments more explicit, making easier for courts to control the procedure and the reasons for these decisions.

eHealth handbook for managers of healthcare services and systems

Prefacio de Alicia Bárcena y Luciano Sáez

Grander system: A new technology to reduce surface tension of adhesive systems in dentistry

Background. Reduced surface tension of liquids results in higher surface wetting ability and diffusivity by the substrate. Objectives. The objective of this study was to evaluate the influence of the Grander Technology in reducing the surface tension of adhesive systems. Methods. Two adhesive systems (self-etch and total-etch) were modified by physical contact with the Grander system Flexible unit to revitalize water, for 48 h. Surface tension of adhesive systems and water in normal and grander-modified conditions was measured with a goniometer. Results. The results showed a reduction of surface tension for all conditions grander-modified between 3-15%. Conclusions. Grander Technology was effective in reducing the surface tension of the Single Bond and Clearfil SE Bond adhesive systems. Clinical significance. Grander technology was employed to restructure the molecular structure of water-based adhesive systems, which can increase their wetness capacity and therefore ensure a greater diffusibility.

Data-driven healthcare: from patterns to actions

The era of big data opens up new opportunities in personalised medicine, preventive care, chronic disease management and in telemonitoring and managing of patients with implanted devices. The rich data accumulating within online services and internet companies provide a microscope to study human behaviour at scale, and to ask completely new questions about the interplay between behavioural patterns and health. In this paper, we shed light on a particular aspect of data-driven healthcare: autonomous decision-making. We first look at three examples where we can expect data-driven decisions to be taken autonomously by technology, with no or limited human intervention. We then discuss some of the technical and practical challenges that can be expected, and sketch the research agenda to address them.