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.^

Process orientation and information technology:customer engagement at Xerox (UK) Ltd

Xerox Customer Engagement activity is informed by the "Go To Market" strategy, and "Intelligent Coverage" sales philosophy. The realisation of this philosophy necessitates a sophisticated level of Market Understanding, and the effective integration of the direct channels of Customer Engagement. Sophisticated Market Understanding requires the mapping and coding of the entire UK market at the DMU (Decision Making Unit) level, which in turn enables the creation of tailored coverage prescriptions. Effective Channel Integration is made possible by the organisation of Customer Engagement work according to a single, process defined structure: the Selling Process. Organising by process facilitates the discipline of Task Substitution, which leads logically to creation of Hybrid Selling models. Productive Customer Engagement requires Selling Process specialisation by industry sector, customer segment and product group. The research shows that Xerox's Market Database (MDB) plays a central role in delivering the Go To Market strategic aims. It is a tool for knowledge based selling, enables productive SFA (Sales Force Automation) and, in sum, is critical to the efficient and effective deployment of Customer Engagement resources. Intelligent Coverage is not possible without the MDB. Analysis of the case evidence has resulted in the definition of 60 idiographic statements. These statements are about how Xerox organise and manage three direct channels of Customer Engagement: Face to Face, Telebusiness and Ebusiness. Xerox is shown to employ a process-oriented, IT-enabled, holistic approach to Customer Engagement productivity. The significance of the research is that it represents a detailed (perhaps unequalled) level of rich description of the interplay between IT and a holistic, process-oriented management philosophy.

Frontal Solutions: an Information Technology Transfer to Abstract Mathematics

The paper introduces a method for dependencies discovery during human-machine interaction. It is based on an analysis of numerical data sets in knowledge-poor environments. The driven procedures are independent and they interact on a competitive principle. The research focuses on seven of them. The application is in Number Theory.

Project Proposals Development – Entrepreneurship and Reflection in Teaching Information Technology

This work presents a model for development of project proposals by students as an approach to teaching information technology while promoting entrepreneurship and reflection. In teams of 3 to 5 participants, students elaborate a project proposal on a topic they have negotiated with each other and with the teacher. The project domain is related to the practical application of state-of-theart information technology in areas of substantial public interest or of immediate interest to the participants. This gives them ample opportunities for reflection not only on technical but also on social, economic, environmental and other dimensions of information technology. This approach has long been used with students of different years and programs of study at the Faculty of Mathematics and Informatics, Plovdiv University “Paisiy Hilendarski”. It has been found to develop all eight key competences for lifelong learning set forth in the Reference Framework and procedural skills required in real life.

Logisztikai folyamatok informatikai támogatottsága Magyarországon – fókuszban a disztribúciós logisztika = Backing logistics processes with information technology – current practice and improvement possibilities at Hungarian companies

Az elemzés egy, a Budapesti Corvinus Egyetem (BCE) Logisztika és Ellátási Lánc Menedzsment Tanszéke által végzett kérdőíves felmérés eredményeit foglalja össze. A kutatás alapvető célja, hogy felmérje és bemutassa a hazai vállalatok logisztikai, ezen belül is elsősorban disztribúciós logisztikai folyamatainak informatikai oldalról történő jelenlegi támogatottsági szintjét és a következő két-három év e téren várható fejlesztési irányait. A kutatás szisztematikusan kitért a logisztikai információs rendszer valamennyi alrendszerére, vizsgálta a különböző azonosítási megoldások elterjedtségét, a vállalatirányítási rendszer, illetve egyes moduljainak használatával kapcsolatban kialakult gyakorlatot, de a logisztika stratégiai döntéseinek informatikai támogatottságát és a használt kommunikációs technikákat is. Összességében megállapíthatjuk, hogy a logisztikai információs rendszerek fejlettségi szintje ma Magyarországon közepesnek mondható, fontos megjegyezni azonban, hogy a KKV szektor e téren is jelentős lemaradással rendelkezik. Ez természetesen azt is jelent, hogy az informatikai eszközök alkalmazásának kiterjesztésével még jelentős teljesítményjavulás érhető el. = The essay summarizes the results of a survey carried out by Corvinus University of Budapest, Department of Logistics and Supply Chain Management. Aim of the survey was to analyze and describe the actual Hungarian company practice regarding the IT support of logistics – and particularly distribution – processes, and the plans of developing it within the next 2-3 years. Survey has systematically covered all fields of logistics information system, analyzed the prevalence of different identification techniques and systems. On the whole we appoint that logistics information systems applied by Hungarian companies are on satisfactory level; however it is important to tell that SME companies are in huge lag. This means that improving logistics information system hides the possibility of considerable performance development.

Logisztikai folyamatok informatikai támogatottsága Magyarországon – Fókuszban a disztribúciós logisztika (Supporting logistics processes by information technology – current practice and improvement possibilities at Hungarian companies)

Az elemzés egy a Budapesti Corvinus Egyetem (BCE) Logisztika és Ellátási Lánc Menedzsment Tanszéke által végzett kérdőíves felmérés eredményeit foglalja össze. A kutatás alapvető célja, hogy felmérje és bemutassa a hazai vállalatok logisztikai, ezen belül is elsősorban disztribúciós logisztikai folyamatainak informatikai oldalról történő jelenlegi támogatottsági szintjét és a következő két-három év e téren várható fejlesztési irányait. A kutatás szisztematikusan kitért a logisztikai információs rendszer valamennyi alrendszerére, vizsgálta a különböző azonosítási megoldások elterjedtségét, a vállalatirányítási rendszer, illetve egyes moduljainak használatával kapcsolatban kialakult gyakorlatot, de a logisztika stratégiai döntéseinek informatikai támogatottságát és a használt kommunikációs technikákat is. Összességében megállapítható, hogy a logisztikai információs rendszerek fejlettségi szintje ma Magyarországon közepes, fontos megjegyezni azonban, hogy a kkv-szektor e téren is jelentősen lemaradt. Ez természetesen azt is jelenti, hogy az informatikai eszközök alkalmazásának kiterjesztésével még komoly teljesítményjavulás érhető el. ________ The essay summarizes the results of a survey carried out by Corvinus University of Budapest, Department of Logistics and Supply Chain Management. Aim of the survey was to analyze and describe the actual Hungarian company practice regarding the IT support of logistics – and particularly distribution – processes, and the plans to develop it within the next 2-3 years. Survey has systematically overviewed all fields of logistics information system, analyzed the prevalence of different identification techniques and systems. Generally the authors appoint that logistics information systems applied by Hungarian companies are on satisfactory level; however it is important to tell that SME companies are in huge lag. This means that improving logistics information system hides the possibility of considerable performance development.

Understanding the dynamics of information technology implementation: The case of clinical information systems

The ultimate intent of this dissertation was to broaden and strengthen our understanding of IT implementation by emphasizing research efforts on the dynamic nature of the implementation process. More specifically, efforts were directed toward opening the "black box" and providing the story that explains how and why contextual conditions and implementation tactics interact to produce project outcomes. In pursuit of this objective, the dissertation was aimed at theory building and adopted a case study methodology combining qualitative and quantitative evidence. Precisely, it examined the implementation process, use and consequences of three clinical information systems at Jackson Memorial Hospital, a large tertiary care teaching hospital.^ As a preliminary step toward the development of a more realistic model of system implementation, the study proposes a new set of research propositions reflecting the dynamic nature of the implementation process.^ Findings clearly reveal that successful implementation projects are likely to be those where key actors envision end goals, anticipate challenges ahead, and recognize the presence of and seize opportunities. It was also found that IT implementation is characterized by the systems theory of equifinality, that is, there are likely several equally effective ways to achieve a given end goal. The selection of a particular implementation strategy appears to be a rational process where actions and decisions are largely influenced by the degree to which key actors recognize the mediating role of each tactic and are motivated to action. The nature of the implementation process is also characterized by the concept of "duality of structure," that is, context and actions mutually influence each other. Another key finding suggests that there is no underlying program that regulates the process of change and moves it form one given point toward a subsequent and already prefigured end. For this reason, the implementation process cannot be thought of as a series of activities performed in a sequential manner such as conceived in stage models. Finally, it was found that IT implementation is punctuated by a certain indeterminacy. Results suggest that only when substantial efforts are focused on what to look for and think about, it is less likely that unfavorable and undesirable consequences will occur. ^

An Analysis of Information Technology Publications in Leading Hospitality Journals

In response to the recent wide-scale applications of lnformation Technology (I/T) in the hospitality industry, this study analyzed articles in leading hospitality research journals, including the International Journal of Hospitality Management, Cornell Hotel and Restaurant Administration Quarterly, and the Journal of Hospitality & Tourism Research published in the period 1985 to 2004. A total of 1,896 full-length papers were published in these journals during the study period. Excluding book reviews, research notes, and comments from editors and readers, 130 full-length IT-related papers were identified. These papers were then grouped into six defined categories of IT. The findings revealed that during the entire study period, the largest number of publications were in general business applications, whereas the highest growth rate from the first decade to the second decade were in articles on networking

Strategic positioning of Taiwan in the outsourcing market: Evidence from information technology services and electronic manufacturing outsourcing to China

In outsourcing relationships with China, the Electronic Manufacturing (EM) and Information Technology Services (ITS) industry in Taiwan may possess such advantages as the continuing growth of its production value, complete manufacturing supply chain, low production cost and a large-scale Chinese market, and language and culture similarity compared to outsourcing to other countries. Nevertheless, the Council for Economic Planning and Development of Executive Yuan (CEPD) found that Taiwan's IT services outsourcing to China is subject to certain constraints and might not be as successful as the EM outsourcing (Aggarwal, 2003; CEPD, 2004a; CIER, 2003; Einhorn and Kriplani, 2003; Kumar and Zhu, 2006; Li and Gao, 2003; MIC, 2006). Some studies examined this issue, but failed to (1) provide statistical evidence about lower prevalence rates of IT services outsourcing, and (2) clearly explain the lower prevalence rates of IT services outsourcing by identifying similarities and differences between both types of outsourcing contexts. This research seeks to fill that gap and possibly provide potential strategic guidelines to ITS firms in Taiwan. This study adopts Transaction Cost Economics (TCE) as the theoretical basis. The basic premise is that different types of outsourcing activities may incur differing transaction costs and realize varying degrees of outsourcing success due to differential attributes of the transactions in the outsourcing process. Using primary data gathered from questionnaire surveys of ninety two firms, the results from exploratory analysis and binary logistic regression indicated that (1) when outsourcing to China, Taiwanese firms' ITS outsourcing tends to have higher level of asset specificity, uncertainty and technical skills relative to EM outsourcing, and these features indirectly reduce firms' outsourcing prevalence rates via their direct positive impacts on transaction costs; (2) Taiwanese firms' ITS outsourcing tends to have lower level of transaction structurability relative to EM outsourcing, and this feature indirectly increases firms' outsourcing prevalence rates via its direct negative impacts on transaction costs; (3) frequency does influence firms' transaction costs in ITS outsourcing positively, but does not bring impacts into their outsourcing prevalence rates, (4) relatedness does influence firms' transaction costs positively and prevalence rates negatively in ITS outsourcing, but its impacts on the prevalence rates are not caused by the mediation effects of transaction costs, and (5) firm size of outsourcing provider does not affect firms' transaction costs, but does affect their outsourcing prevalence rates in ITS outsourcing directly and positively. Using primary data gathered from face-to-face interviews of executives from seven firms, the results from inductive analysis indicated that (1) IT services outsourcing has lower prevalence rates than EM outsourcing, and (2) this result is mainly attributed to Taiwan's core competence in manufacturing and management and higher overall transaction costs of IT services outsourcing. Specifically, there is not much difference between both types of outsourcing context in the transaction characteristics of reputation and most aspects of overall comparison. Although there are some differences in the feature of firm size of the outsourcing provider, the difference doesn't cause apparent impacts on firms' overall transaction costs. The medium or above medium difference in the transaction characteristics of asset specificity, uncertainty, frequency, technical skills, transaction structurability, and relatedness has caused higher overall transaction costs for IT services outsourcing. This higher cost might cause lower prevalence rates for ITS outsourcing relative to EM outsourcing. Overall, the interview results are consistent with the statistical analyses and provide support to my expectation that in outsourcing to China, Taiwan's electronic manufacturing firms do have lower prevalence rates of IT services outsourcing relative to EM outsourcing due to higher transaction costs caused by certain attributes. To solve this problem, firms' management should aim at identifying alternative strategies and strive to reduce their overall transaction costs of IT services outsourcing by initiating appropriate strategies which fit their environment and needs.

The social values of wireless technology in the institutional context

Despite growing attention, social values, compared to economic aspects, of information technology (IT) capture substantially less attention in the mainstream IT literature. In the context of mobile technology, social values might be as critical to help justify technology investment as the predominant economics perspective in the existing IT literature. As wireless networks and relevant mobile technologies continue to penetrate the global society and business world, an emerging social phenomenon rapidly reshapes how organizations interact with the technology and reposition themselves in their specific institutional context where organizations often develop networked alliance to compete against one another. This study thus seeks to shed light on how organizations make sense of the social aspects of wireless network implementation. Preliminary understanding derived from two higher education organizations' experiences is summarized. Implications for future research endeavor are suggested.

Exploring Auditors’ Perceptions of the Usage and Importance of Audit Information Technology

This study provides novel evidence on the extent to which auditors perceive the usage and importance of audit technology in an emerging market. It explores the types of audit technology tools used and factors influencing the use of these; it tests the association between the perceived use and importance of the tools and firm-specific/ auditor-specific characteristics. Using interviews and questionnaires from auditors at Big 4 and international non-Big 4 audit firms, the findings reflect the highly perceived importance of using audit technology in technical and administrative procedures, specifically to assess risk. We find that the perceived use and importance of audit technology is relatively higher for those in Big 4 firms, with less years of auditor experience and higher auditor technology expertise, and those in management positions. The results provide policy makers with guidance on the opportunities and challenges of using information technology in the audit process.