A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

Background: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-eff ectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months’ follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0∙58, 95% CI 0∙38–0∙89); a β blocker if they had asthma (0∙73, 0∙58–0∙91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0∙51, 0∙34–0∙78). PINCER has a 95% probability of being cost eff ective if the decision-maker’s ceiling willingness to pay reaches £75 per error avoided at 6 months. Interpretation: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. Funding: Patient Safety Research Portfolio, Department of Health, England.

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

Characterizing intuition in information systems research

The study of intuition is an emerging area of research in psychology, social sciences, and business studies. It is increasingly of interest to the study of management, for example in decision-making as a counterpoint to structured approaches. Recently work has been undertaken to conceptualize a construct for the intuitive nature of technology. However to-date there is no common under-standing of the term intuition in information systems (IS) research. This paper extends the study of intuition in IS research by using exploratory research to cate-gorize the use of the word “intuition” and related terms in papers published in two prominent IS journals over a ten year period. The entire text of MIS Quarterly and Information Systems Research was reviewed for the years 1999 through 2008 using searchable PDF versions of these publications. As far as could be deter-mined, this is the first application of this approach in the analysis of the text of IS academic journals. The use of the word “intuition” and related terms was catego-rized using coding consistent with Grounded Theory. The focus of this research was on the first two stages of Grounded Theory analysis - the development of codes and constructs. Saturation of coding was not reached: an extended review of these publications would be required to enable theory development. Over 400 incidents of the use of “intuition”, and related terms were found in the articles reviewed. The most prominent use of the term of “intuition” was coded as “Intui-tion as Authority” in which intuition was used to validate a research objective or finding; representing approximately 37 per cent of codes assigned. The second most common coding occurred in research articles with mathematical analysis, representing about 19 per cent of the codes assigned, for example where a ma-thematical formulation or result was “intuitive”. The possibly most impactful use of the term “intuition” was “Intuition as Outcome”, representing approximately 7 per cent of all coding, which characterized research results as adding to the intui-tive understanding of a research topic or phenomena. This research contributes to a greater theoretical understanding of intuition enabling insight into the use of intuition, and the eventual development of a theory on the use of intuition in academic IS research publications. It also provides potential benefits to practi-tioners by providing insight into and validation of the use of intuition in IS man-agement. Research directions include the creation of reflective and/or formative constructs for intuition in information systems research.

Transforming the English NHS using information technology: the story so far

The use of information and communication technologies (ICT) for transforming the way publicservices are delivered, has been an area of investment and focus in many countries in recentyears. The UK government envisioned moving from e-Government to transformationalgovernment by 2008, and initiatives such as the National Programme for IT (NPfIT) wereunderway towards this end. NPfIT was the largest civil IT programme worldwide at an initialestimated cost of £12.4bn over a ten-year period. It was launched in 2002 by the UKgovernment as part of its policy to transform the English NHS and to implement standardised ITsolutions at a national level. However, this top down, government led approach came underincreasing scrutiny, and is now being reconfigured towards a more decentralised mode of operations. This paper looks into the implementation of NPfIT and analyses the reasons behindits failure, and what effect the new NHS reforms are likely to have on the health sector. Wedraw from past studies (Weill and Ross, 2005) to highlight the key areas of concern in ITgovernance, using the NPfIT as an illustration

Beneath a learning management system: understanding the human information interaction in information systems

Studies on learning management systems have largely been technical in nature with an emphasis on the evaluation of the human computer interaction (HCI) processes in using the LMS. This paper reports a study that evaluates the information interaction processes on an eLearning course used in teaching an applied Statistics course. The eLearning course is used as a synonym for information systems. The study explores issues of missing context in stored information in information systems. Using the semiotic framework as a guide, the researchers evaluated an existing eLearning course with the view to proposing a model for designing improved eLearning courses for future eLearning programmes. In this exploratory study, a survey questionnaire is used to collect data from 160 participants on an eLearning course in Statistics in Applied Climatology. The views of the participants are analysed with a focus on only the human information interaction issues. Using the semiotic framework as a guide, syntactic, semantic, pragmatic and social context gaps or problems were identified. The information interactions problems identified include ambiguous instructions, inadequate information, lack of sound, interface design problems among others. These problems affected the quality of new knowledge created by the participants. The researchers thus highlighted the challenges of missing information context when data is stored in an information system. The study concludes by proposing a human information interaction model for improving the information interaction quality issues in the design of eLearning course on learning management platforms and those other information systems.

Evaluation of a multimedia online tool for teaching bronchial hygiene to physical therapy students

Background: Advances in information technology have been widely used in teaching health care professionals. The use of multimedia resources may be important for clinical learning and we are not aware of previous reports using such technology in respiratory physical therapy education. Objectives: Our approach was to evaluate a conventional bronchial hygiene techniques (BHTs) course with an interactive online environment, including multimedia resources. Methods: Previous developed audiovisual support material comprised: physiology, physiopathology and BHTs, accessible to students through the Internet in conjunction with BHTs classes. Two groups of students were compared and both attended regular classes: the on-line group (n=8) received access to online resources, while the control group (n=8) received conventional written material. Student's performance was evaluated before and after the course. Results: A preliminary test (score 0 to 10) was applied before the beginning of the course, showing that the initial knowledge of both groups was comparable [online, 6.75 (SD=0.88) vs. control, 6.125 (SD=1.35); p>0.05]. Two weeks after the end of the course, a second test showed that the online group performed significantly better than the control group [respectively, 7.75 (SD=1.28) vs. 5.93 (SD=0.72); p>0.05]. Conclusions: The use of a multimedia online resource had a positive impact on student's learning in respiratory therapy field in which instrumental and manual resources are often used and can be explored using this technology.

Green information technology

Quando si parla di green information technology si fa riferimento a un nuovo filone di ricerche focalizzate sulle tecnologie ecologiche o verdi rivolte al rispetto ambientale. In prima battuta ci si potrebbe chiedere quali siano le reali motivazioni che possono portare allo studio di tecnologie green nel settore dell’information technology: sono così inquinanti i computer? Non sono le automobili, le industrie, gli aerei, le discariche ad avere un impatto inquinante maggiore sull’ambiente? Certamente sì, ma non bisogna sottovalutare l’impronta inquinante settore IT; secondo una recente indagine condotta dal centro di ricerche statunitense Gartner nel 2007, i sistemi IT sono tra le maggiori fonti di emissione di CO2 e di altri gas a effetto serra , con una percentuale del 2% sulle emissioni totali del pianeta, eguagliando il tasso di inquinamento del settore aeromobile. Il numero enorme di computer disseminato in tutto il mondo assorbe ingenti quantità di energia elettrica e le centrali che li alimentano emettono tonnellate di anidride carbonica inquinando l’atmosfera. Con questa tesi si vuole sottolineare l’impatto ambientale del settore verificando, attraverso l’analisi del bilancio sociale ed ambientale, quali misure siano state adottate dai leader del settore informatico. La ricerca è volta a dimostrare che le più grandi multinazionali informatiche siano consapevoli dell’inquinamento prodotto, tuttavia non adottano abbastanza soluzioni per limitare le emissioni, fissando futili obiettivi futuri.

SMARTDIAB: a communication and information technology approach for the intelligent monitoring, management and follow-up of type 1 diabetes patients

SMARTDIAB is a platform designed to support the monitoring, management, and treatment of patients with type 1 diabetes mellitus (T1DM), by combining state-of-the-art approaches in the fields of database (DB) technologies, communications, simulation algorithms, and data mining. SMARTDIAB consists mainly of two units: 1) the patient unit (PU); and 2) the patient management unit (PMU), which communicate with each other for data exchange. The PMU can be accessed by the PU through the internet using devices, such as PCs/laptops with direct internet access or mobile phones via a Wi-Fi/General Packet Radio Service access network. The PU consists of an insulin pump for subcutaneous insulin infusion to the patient and a continuous glucose measurement system. The aforementioned devices running a user-friendly application gather patient's related information and transmit it to the PMU. The PMU consists of a diabetes data management system (DDMS), a decision support system (DSS) that provides risk assessment for long-term diabetes complications, and an insulin infusion advisory system (IIAS), which reside on a Web server. The DDMS can be accessed from both medical personnel and patients, with appropriate security access rights and front-end interfaces. The DDMS, apart from being used for data storage/retrieval, provides also advanced tools for the intelligent processing of the patient's data, supporting the physician in decision making, regarding the patient's treatment. The IIAS is used to close the loop between the insulin pump and the continuous glucose monitoring system, by providing the pump with the appropriate insulin infusion rate in order to keep the patient's glucose levels within predefined limits. The pilot version of the SMARTDIAB has already been implemented, while the platform's evaluation in clinical environment is being in progress.

From the Vice President for Library and Information Technology: Spring 2012

Param Bedi discusses technology adoption by students and its impact on teaching and learning.

A communication and information technology infrastructure for real time monitoring and management of type 1 diabetes patients

This paper is focused on the integration of state-of-the-art technologies in the fields of telecommunications, simulation algorithms, and data mining in order to develop a Type 1 diabetes patient's semi to fully-automated monitoring and management system. The main components of the system are a glucose measurement device, an insulin delivery system (insulin injection or insulin pumps), a mobile phone for the GPRS network, and a PDA or laptop for the Internet. In the medical environment, appropriate infrastructure for storage, analysis and visualizing of patients' data has been implemented to facilitate treatment design by health care experts.

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).

Using Moodle as a support tool for teaching in Higher Education in Portugal: an exploratory study

The use of virtual learning environments in Higher Education (HE) has been growing in Portugal, driven by the Bologna Process. An example is the use of Learning Management Systems (LMS) that translates an opportunity to leverage the use of technological advances in the educational process. The progress of information and communication technologies (ICT) coupled with the great development of Internet has brought significant challenges to educators that require a thorough knowledge of their implementation process. These field notes present the results of a survey among teachers of a private HE institution in its use of Moodle as a tool to support face-to-face teaching. A research methodology essentially of exploratory nature based on a questionnaire survey, supported by statistical treatment allowed to detect motivations, type of use and perceptions of teachers in relation to this kind of tool. The results showed that most teachers, by a narrow margin (58%), had not changed their pedagogical practice as a consequence of using Moodle. Among those that did 67% attended institutional internal training. Some of the results obtained suggest further investigation and provide guidelines to plan future internal training.

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.