Creator of Knowledge
Information Resources Management Association
Advancing the Concepts & Practices of Information Resources Management in Modern Organizations

Handbook of Research on Information Technology Management and Clinical Data Administration in Healthcare

Handbook of Research on Information Technology Management and Clinical Data Administration in Healthcare
Author(s)/Editor(s): Ashish N. Dwivedi (University of Hull, UK)
Copyright: ©2009
DOI: 10.4018/978-1-60566-356-2
ISBN13: 9781605663562
ISBN10: 1605663565
EISBN13: 9781605663579


View Handbook of Research on Information Technology Management and Clinical Data Administration in Healthcare on the publisher's website for pricing and purchasing information.


Advances in information technology have brought about a revolution in healthcare, enabling medical personnel to have round-the-clock access to clinical data regardless of geographic location.

The Handbook of Research on Information Technology Management and Clinical Data Administration in Healthcare provides researchers, educators, students, and industry practitioners with new research, practical experiences, challenges, and opportunities within healthcare data management. A comprehensive reference source within the medical technology field, this Handbook of Research presents tools and techniques in all aspects of IT management and clinical data administration in healthcare.

Table of Contents



    The whole of science is nothing more than a refinement of everyday thinking.

    -Albert Einstein

There is widespread agreement that the very nature of healthcare has been unalterably changed within the last fifty years. The cause of this massive revolution in the nature of healthcare can be traced to the coming together of the twin revolutions of Information Technology and Telecommunications, revolutions which together have synergistically opened new vistas for healthcare. The comparison between the evolution of the information handling ability between humanity and information technology is an indicator that reveals the impact of the high growth rates of Information Technology (IT) on the quality of life. It has been pointed out that the rate of growth in the information handling capacity in computers has been approximately ten million times faster in comparison to the evolution of the information handling capacity in mankind (Dwivedi, Wickramasinghe, Bali, & Naguib, 2008). This statistic becomes truly astounding in light of the fact that the origins of the Information technology revolution can be traced to the onset of the 20th century and can thus be stated to be less then a century old. The changes in information technology described above and in particular in the telecommunications technology have brought about fundamental changes throughout the healthcare process (Applebaum & Wohl, 2000). An approximation of the change process that the healthcare industry has undergone in the recent years is confirmed by a research that has stated that in the period 1997-2000, 85% of healthcare organizations have gone through some sort of transformation (Sherer, 1995).

One of the most important technological changes in electronics has been the ability to convert signals from an analogue to a digital medium (images or signals are converted into digital code by using an analogue-to-digital conversion device) – a process referred to as Digitization. Digitization in healthcare has meant that it is now possible to take healthcare related information in different formats (audio, video, sound) and deliver the same at high speeds in the same basic format. Simultaneously there has been a change in technology (from simple copper wires to optical fibres) via which information is transmitted. This in turn has exponentially increased the bandwidth (the quantity of data that can be transmitted in a specified time-period). The phenomenon of Multimedia has made possible to exchange information – information that can be combined from different formats (sound, video, animation, text and graphics) and presented in an interactive manner. This in turn is fast making multimedia technology the “technology of choice” for the delivery of information (Wallace, 1997; Dwivedi, Bali, James, Naguib, & Johnston, 2002; Dwivedi et al., 2008).

In the healthcare sector different information technology applications such as clinical information systems, electronic patient records and telemedicine have been used successfully, thereby demonstrating their potential to greatly improve the standard of medical care and healthcare administration (Rao, 2001; Dwivedi, Bali, Naguib, & Nassar, 2006; Dwivedi, Bali, & Naguib, 2007). In recent years advances in information technology applications have resulted in an “accelerated pace of innovations” (Johns, 1997). These innovations have resulted in the creation of new opportunities and healthcare concepts such as health-care information – a term indicating the combined synergistic application of “a science of information, technology, and knowledge…to ‘health care” (Johns, 1997). With advances in technologies, (telecommunications, multimedia and IT healthcare applications) telemedicine has the potential to transform the delivery of healthcare permanently. Countries like Malaysia have already integrated telemedicine with the electronic health record concept and there is a national telemedicine strategy in place. Teleconsultations are being carried out on a regular basis in Malaysia. In Sweden, telemedicine is being used to reduce the stay of children in hospital. This is being achieved by using local telecommunications to connect to the health monitoring equipment (for heart rate, rhythm and blood pressure) and is installed at the residence of the child (patient) (Dwivedi et al., 2006; Dwivedi et al., 2007).

Advances in technology have been the hallmark of the healthcare sector, particularly with regard to advances in biomedical sciences. Today there are “10,000 known diseases, 3,000 drugs, 1,100 lab tests, 300 radiology procedures, 1,000 new drugs and biotechnology medicines in development and 2,000 individual risk factors” (Pavia, 2001; Dwivedi et al., 2008). This has had an enormous impact on healthcare and in particular has rendered the concept of an expert in a particular domain in healthcare irrelevant, simply because, as shown above it is just not possible for one human being to have all the relevant knowledge in his domain of speciality (Rockefeller, 1999; Pavia, 2001; Dwivedi et al., 2008). For example today, “Organ and tissue scanning speed is doubling every 26 months, making tests both faster and cheaper…Image resolution is doubling every 12 months…the increase in computer power (four-fold over the next 20 years) and the availability of inexpensive bandwidth”. All of the above is likely to change our own perception of what information is available and even possible for one human being to acquire. Advances in modern day genetic sciences have increased the number of potential drug compositions from a mere 400 to over 4,000 (Pavia, 2001; Dwivedi et al., 2008). This has happened despite the fact that the rate of adoption of computer applications in healthcare is slower in comparison to other industries (Johns, 1997; Dwivedi et al., 2008). The pace of discovery of new drugs may well undergo an exponential leap when the above observation is seen in context of the forecasted increase in computing power. Perhaps the biggest tragedy in the history of modern science was the fact that the announcement regarding the completion of the Human Genome project (mapping of the entire human genetic code) did not create any ripples in the mindset of healthcare decision-makers and academics or propel a new wave of healthcare discoveries. The impact of the completion of the Human Genome project will profoundly change the concept of healthcare itself within the next 25 years (Jones, 2001). Most dramatic of all is the statistic that a majority of physicians practicing in US community hospitals are not able to understand the impact of biomolecular sciences as they have been “trained in the germ theory of disease, not molecular medicine… and that in a recent nationwide survey, it was found that of all the incidents of advice on genetics given by primary care physicians, the advice was wrong 85 % of the time” (Jones, 2001; Dwivedi et al., 2008).

In this book, an attempt has been made to bring to the forefront these important technologies and processes in healthcare, and consider the implications of their advances. It is contended that if the impact of these healthcare technologies and processes are seen together, then the conclusion from a healthcare informatics perspective is clear. Twenty first century clinical practitioners have to acquire proficiency in understanding and interpreting clinical information so as to attain knowledge and wisdom whilst dealing with large amounts of clinical data – clinical data that will be dynamic in nature and would call for the ability to interpret context-based healthcare information. This challenge cannot be met by an IT led solution. The solution has to come from a domain that supports all the three integral healthcare system components (i.e. people, processes and technology) of the future. This book is an attempt in this direction.

Chapter 1 (The Use and Evaluation of IT in Chronic Disease Management) by Adler-Milstein and Linden describes the broad array of information technologies currently used in programs that manage individuals with chronic diseases and discusses evaluation strategies to assess the impact of implementing programs that incorporate such technologies. Chapter 2 (E-Health Technology for Detecting and Managing Chronic Disease) by Lehmann, Scott and Giacini presents an overview of the health and economic challenges that healthcare infrastructures are experiencing and the growing concern of providing healthcare to increasing numbers of individuals age 60 and above. It discuss how comprehensive disease management programs that combine e-health technology with community-based health and/or social services can support the long distance diagnosis and clinical monitoring of chronic disease states such as cardiovascular disease among communities with poor access to quality healthcare. By sharing lessons learned from their prior work and studies found in the literature, they discuss e-health projects that improve access to healthcare and disease management among home-bound chronically ill seniors by introducing mobile units to service rural communities in non-traditional settings. It is argued that e-health technology must remain in the forefront of global thinking in order to better serve the health needs of an aging world population, reduce costs and alleviate a dwindling healthcare workforce.

Chapter 3 (Novel Data Interface for Evaluating Cardiovascular Outcomes in Women) by Villablanca, Anderson and Baxi discusses critical success factors in the design, implementation, and utility of a new construct and interface for data transfer with broad applicability to clinical data set management. In the context of a Data Coordinating Center for Evaluating Cardiovascular Outcomes in High-Risk Women, we detail and provide a framework for bridging the gap between Extensible Markup Language (XML) and XML Schema Definition file (XSD) in order to provide greater accessibility using Visual Basic for Applications (VBA) and Excel. Chapter 4 (A Telehealth Technology Model for Information Science in Rural Settings) by Miller, Morgan and Wood examines the application of telehealth technology in a rural community clinical and educational system.

Chapter 5 (Health Technology Assessment and Health Economics) by Simoens examines health technology assessment and health economics as a tool for decision makers to allocate scarce resources in the healthcare sector. It argues that information about the safety; efficacy and effectiveness; organizational implications; social and ethical consequences; legal considerations; and health economic aspects of the application of a health technology needs to be taken into account with a view to informing decisions about the registration and reimbursement of a health technology. Chapter 6 (Electronic Patient Monitoring in Mental Health Services) by Stritzke and Page reviews advances in electronic patient monitoring in mental health service delivery. The first part focuses on interactive-voice-response (IVR) technology and its dual role of enhancing the efficient and reliable access to vital patient information and reducing the need for human resources in using that information to guide patient care.

Chapter 7 (The role of subjective computer training and management support to use computers in community health centers) by Yaghmaei and Jayasuriya argues that there have been many changes to information systems in the last decade. Changes in information systems requires users to constantly up-date their computer knowledge and skills. The authors present the results of a study which shows that trained health staff as computer users had more favorable attitude, less computer anxiety and more attention to others expectation (managers and policies of organizations) to use computers than untrained users. Chapter 8 (Health Information Standards: Towards Integrated Health Information Networks) by Spyrou, Bamidis and Maglaveras presents an abstract view of the regional health information networks A list of case studies from the implementation of RHN in Health Systems in European, as well as, non-European countries such as US, Canada, New Zealand and Australia are demonstrated. It is argued that that the abstract view of RHN would assist in the understanding of the key areas upon establishing regional health networks.

Chapter 9 (Context-Based Intelligent Service for Healthcare Applications) by Smirnov, Levashova and Shilov presents an approach to implementation of an intelligent service for decision support in healthcare logistics taking an advantage of the knowledge logistics idea. The approach is based on synergistic integration of knowledge acquired from distributed sources in order to obtain new or complement insufficient knowledge. Chapter 10 (Multicriteria Models for e-health Service Evaluation) by Buyukozkan and Bilsel presents an overview of how the use of advanced telecommunications and information technologies has been investigated for in context of improving healthcare services. The study uses several different discrete alternative methods; namely, AHP, Borda Count, LINMAP and PROMETHEE are utilized to prioritize different e-health services and to evaluate preferences of both users and practitioners. Chapter 11 (Blo-Behavioral Medicine and Information Technology) by Carr contemplates on how research advances in behavioral medicine have prompted increasing recognition of the importance of behavioral and social science factors in health care, resulting in calls for the greater incorporation of the behavioral sciences in medical education and of behavioral interventions in health care. This chapter notes that these recent developments have underscored the need for research on the mechanisms of bio-behavioral interaction and the conceptual limitations of the traditional biomedical model.

Chapter 12 (DRGs and the Professional Independence of Physicians) by Frisina and Cacace examines the effects of Diagnosis Related Groups (DRGs) on the professional independence of physicians in three distinct cases of healthcare systems: the US private insurance system, where DRGs were first developed and subsequently implemented in the public Medicare program in 1983; the British National Health Service (NHS), which adopted an analogous version of DRGs referred to as Health Resource Groups (HRGs) in 1992; and the German social insurance system, which adopted its own DRG version (G-DRGs) based on a refined version of the Australian model, the Australian Refined-DRGs (AR-DRGs), that is to be fully phased into the hospital system by 2009. Chapter 13 (Smoking Assessment through Information Technology ) by Gremigni introduces a proposal for the role of information technology as a means of completing a comprehensive assessment of smoking behaviour. Smoking cessation is an important goal both in primary care and in healthcare settings. Results of the literature encourage the utilisation of self-report questionnaires to assess individual differences that could assist to develop stage-matched-intervention for smoking cessation. It also notes that reliable and valid measurement tools are available in this area, but comprehensive assessment procedures are not yet standardized.

Chapter 14 (Benefits and Barriers to Adoption of Information Technology in U.S. Health Care) by Anderson emphasises that Information technology such as electronic medical records (EMRs), electronic prescribing and clinical decision support systems are recognized as essential tools in all developed countries. However, the U.S. lags significantly behind other countries that are members of the Organization for Economic Cooperation and Development (OECD). The authors conclude that overcoming these barriers will require subsidies and performance incentives by payers and government; certification and standardization of vendor applications that permit clinical data exchange; removal of legal barriers; and convincing evidence of the cost-effectiveness of these IT applications. Chapter 15 (Evidence on the Efficacy of Integrated Care) by Larsen considers how fragmented delivery of healthcare and social services was put on the agenda as a major problem by WHO in 2002. The authors argue that for Early Home-Supported Discharge (EHSD) of stroke patients combining efficacy with net savings represents a prototype of integrated care (IC) or overlapping services for better clinical continuity. The authors state that a SWOT analysis of IC emphasizes: Strengths are 1) economic dominance, 2) benefits to a majority of the population and 3) psychological motivators for the patient (Hawthorne effect) Weaknesses are 1) moderate improvements on a day-to-day basis, 2) some lack of RCT and 3) lack of trust across settings Opportunities are 1) job enrichment to health professionals, 2) low-tech improvements affordable to low and middle income countries and 3) organisational quality Threats are 1) fragmented financial conditions, 2) defensive specialists and 3) Mediocre implementations.

Chapter 16 (Information Technology and Data Systems in Disaster Preparedness for Healthcare and the Broader Community) by Quiram, Pennel and Carpender observes that in the healthcare and public health community, information technology and data management tools are indispensable in preventing, preparing for, responding to and recovering from public health emergencies, both natural and man-made. The authors conclude with a model that has been implemented to integrate and train the broader group of community stakeholders, including healthcare organizations and providers, in disaster preparedness and response. Chapter 17 (The use of interactive voice response systems to improve the quality and safety of ambulatory care) by Oake and Forster highlights how an interactive voice response system (IVRS) may be used to improve quality of care problems associated with ambulatory care. The authors provide examples of quality problems, related to access, effectiveness, and safety, and describe how an IVRS may be used to reduce them. The authors also discuss how potential implementation issues, including technological requirements of the IVRS, project management, and scalability of the IVRS.

Chapter 18 (Improving the Quality of Healthcare Services through Information and Quality Interrelation) by Kostagiolas and Kaitelidou argues that the ongoing information revolution calls for the exploitation of new information services that may set to support the traditional quality management approaches in healthcare. The authors address the following issues: What might be an approach for quality management considering the rapid advances of information technology and the growth of the “new economy”? and What might be the contribution of library and information services in the improvement of the healthcare services quality? The design of library and information services for the support of quality is an interesting and innovative area of research within healthcare services.

Chapter 19 (Improving the Quality of Healthcare Research Data Sets) by Ghosh notes that the goal of many healthcare research projects and evidence based medicine programs within healthcare organizations is to support clinical care team members by mining evidence from patient outcomes to support future treatment recommendations. In these research studies, the data is often extracted from secondary sources such as patient health records, benefits systems and other non research data sources. Good data is important to facilitate a good research study and to support clinical decisions using the results. The author attempts to develop an understanding of how the quality of data for healthcare research data sets can be established and improved when using secondary data sources such as clinical or benefits databases, which were created without primary intentions for research use. Chapter 20 (The implementation of innovative technologies in health care: barriers and strategies) by Adang emphasises that proven cost-effectiveness of innovative technologies is more and more a necessary condition for implementation in clinical practice. The author addresses the usefulness of cost-effectiveness for decision making considering the potential discrepancy between long run and short run efficiency of innovative technologies in healthcare, the potential consequences for implementation in daily clinical practice, explores diseconomies of scale in Dutch hospitals and makes suggestions what strategies might help to overcome hurdles to implement innovations due to that short run-long run efficiency discrepancy.

Chapter 21 (Case Management: The Global Emergence of a Contemporary Practice) by Carr introduces case Management as a principal cornerstone in the delivery of cost effective, quality health care. Through identification and definition of its principles and standards of practice, and through discussion of the role and function of case management professionals, the author hopes to demonstrate that the implementation of such strategies can optimize the success of clinical operations and help ensure fiscal viability in the global health care market place. Chapter 22 (Practical Action and Mindfulness in Health Information Security) by Collmann and Cooper notes that although it is sometimes tempting to treat information security as a domain of its own, this approach will inevitably yield failures of information security and failures for the organization. The authors present analysis with two case studies that demonstrate the limitations of focusing only on good information security practices. These case studies help explain the mutual interaction between health information security programs and their wider organizational context by introducing key concepts about organizational performance, and examining them at the individual, group, organizational and cross domain levels of organizational life.

Chapter 23 (A Care Informatics Approach to Telehomecare Applications) by Glascock and Kutzik argue in this chapter that Telehomecare is comprised of three separate components: 1) the technology that collects and transfers the data; 2) the informatics that transforms the data into information and then stores and displays it; and 3) the care component that actually delivers the care. The authors conclude that the future success of Telehomecare is largely based on making the care needs of individuals the starting point, rather than an afterthought, and viewing the technology and informatics as tools not solutions.

Chapter 24 (Shared Healthcare in a Regional Ehealth Network) by Harno notes that healthcare information exchange is transforming the practice and structure of healthcare delivery. This chapter introduces the building of a regional eHealth network between public healthcare providers as well as the necessary legal foundation and governance for this successful deployment in a Finnish Hospital District. The authors detail the roadmap to a national eHealth network is paved on the premises of these experiences and lessons learned are transferred to described concepts when migrating to a national eHealth network. Chapter 25 (Physicians and the Utilization of Information Technology) by Holsinger examines the role of physicians in the delivery of healthcare has continued to evolve over the past fifty years. During this period a growing divergence of professionalism and personal expectations has occurred for physicians, often resulting in their inability to meet them. The authors note that a variety of factors have encroached on physician autonomy which has long been the ascendant professional value of physicians. As the underlying and practical realities of health care systems have changed, the professional values and practices of physicians have failed to adapt in a corresponding manner.

Chapter 26 (The Development and Implementation of Patient Safety Information System (PSIS)) by Kim presents the overview of the current status and developmental stages of the PSIS technology and consensus around the patient safety issues as they emerge, grow, and mature globally. The first section gives the general description of the patient safety reporting system (PSRS), and then provides the brief summary of 23 patient safety information classifications and terminologies to date. In the next section, the development of the International Classification of Patient Safety (ICPS) is overviewed, which evolved from the local to an international level by the joint initiatives of WHO. The essential elements of the PSIS and the Clinical Decision Support System (CDSS) functionalities are explained to make the future goals of PSIS clearer. The Patient Safety Indicator (PSI) is explained in a separate section, which provides the opportunity to assess the incidence of adverse events and in-hospital complications using administrative data found in the typical discharge record. The ultimate goals of PSIS and PSI are to improve the quality of healthcare and ensure patient safety.

Chapter 27 (Planning Successful Telemedicine and e-Health Systems) by Mackert, Whitten and Krol notes that elemedicine and e-health applications have the potential to improve healthcare organizations’ ability to provide advanced services in a cost-effective manner. The authors state that given the failure rate of Information Technology projects in general (25%), successfully launching a new telemedicine or e-health system can be a daunting prospect – especially for organizations without experience with these new technologies. The authors provides examples of important aspects of pre-project planning that can help set the stage for success in implementing new telemedicine and e-health applications; importantly, the lessons provided in this chapter are provided by discussing both systems that have achieved success and others that have faced significant difficulties.

Chapter 28 (The Graphic Display of Labour Events) by Oladapo introduces the partograph as an essential tool of labour management. It describes the concept of the partograph from its historical perspective and highlights its benefits, practical application in contemporary clinical practice and current challenges to its universal implementation. It also explores the feasibility of design and incorporation of electronic partograph into teleobstetrics to facilitate remote but skilled birth attendance as one of the ways to tackle the problems of prolonged labour resulting from inequitable distribution of maternity specialists in underserved populations. Chapter 29 (Anesthesia Information Management Systems) by Toplosky, Egger-Halbeis and Riskin discusses the critical role of Anesthesia Information Management Systems (AIMS) in clinical tracking and operating room information management. It begins by reviewing the history and implementation of such systems and examines their current abilities and utilities. The current known benefits of AIMS, as documented by peer-reviewed literature, are examined. Possible additional benefits, both future and current, and the potential role of AIMS in future healthcare information management are discussed.

Chapter 30 (Understanding Computerised Information Systems Usage in Community Health) by Yaghmaei introduces factors that affect computer usage. Discussions of computer systems effectiveness or system success frequently focus on questions of which factors provide better system usage. As there are many factors that affect computer system usage, measuring the influence of the factors is necessary. The objective of the current study was to gain a further understanding of some factors that affect the use of computerised information systems. Most studies have been in business and few studies have been conducted in the health sector and specifically in community health.

Chapter 31 (Knowledge Workers, Librarians and Safety: Opportunities for Partnership) by Zipperer advocates for the involvement of librarians in safety initiatives to mitigate risk and improve reliability of performance. Its primary focus is the clinical environment. The author suggests research concepts to be considered to empirically identify areas where the expertise of librarians can contribute to patient safety. Examples are included to illustrate how that expertise can be applied through knowledge service design and use of evidence delivery via information technologies. The value of a systems approach to developing information programs is highlighted. Chapter 32 (Current Challenges in Empowering Clinicians to Utilise Technology ) by Roberts This chapter is designed to outline the current situation and challenges to successful deployment of technologies to support clinical activities. It utilises action research and cooperative enquiry within the community of practice. It is grounded in UK experiences but will have international resonance in many key areas. Increasingly members of the public are joining the clinical professions in using health data to maintain and improve health status of the individual; however this chapter predominantly focuses on catalysts and inhibitors to professional use. The authors discuss the opportunities presented by emerging technologies, and restrictions to effective deployment such as cultural reluctance, ethical issues and privacy concerns.

Chapter 33 (IAM: A Comprehensive and Systematic Information Assessment Method for Electronic Knowledge Resources) by Pluye, Grad, Repchinsky, Farrell, Johnson-Lafleur, Bambrick, Dawes, Bartlett, Rodriguez, Jovaisas, Fortin, Tufts-Conrad, Salsberg, Macaulay, Légaré and Loiselle focuses on the methods used to systematically document the health professionals’ perspective on relevance, cognitive impacts, use, and health outcomes of information items, which delivered by or retrieved in electronic knowledge resources (EKR) may enhance evaluation of these resources, continuing education, and two-way knowledge exchange between information users and providers. The author’s aim to present an overview seven years of research and development pioneering a comprehensive and systematic Information Assessment Method (IAM), which has been validated for information delivery networks, information retrieval technology and decision support systems. Chapter 34 (The role of information technology for knowledge exchange amongst health care stakeholders) by Robinson summarizes the current state of practice in the application of information technology (IT) for knowledge exchange amongst key health care stakeholders: health care consumers, health service providers and researchers. The objectives are to review the practices that facilitate collaboration amongst stakeholders, the role of new technologies in facilitating exchange of information amongst key stakeholders and the role of three key stakeholders as creators, consumers and/ or translators of information. The emphasis is on exploring an increasingly collaborative exchange of knowledge online.

Chapter 35 (Strategies to Meet Knowledge Transfer Needs) by Roemer, Bigelow and Borsato introduces strategies to meet knowledge transfer needs. The clinical knowledge repository infrastructure and tools developed at Intermountain Healthcare are described. The Knowledge Repository (KR) is a database with services housing knowledge assets. The process for knowledge asset development is described, and four project-specific case studies are presented describing asset development incorporating the infrastructure and tools. The value added by knowledge engineers to the knowledge transfer process is discussed.

Chapter 36 (Integration Issues in the Healthcare Supply Chain) by Kitsiou, Matopoulos, Vlachopoulou and Manthou emphasises that the efficacy, quality, responsiveness, and value of healthcare services provided is increasingly attracting the attention and the questioning of governments, payers, patients, and healthcare providers. Investments on integration technologies and integration of supply chain processes, has been considered as a way towards removing inefficiencies in the sector. The authors provide an in depth analysis of the healthcare supply chain and to present core entities, processes, and flows. Moreover, the authors explores the concept of integration in the context of the healthcare sector, and indentifies the integration drivers, as well as challenges. Chapter 37 (Researching health service information systems development) by Shahtahmasebi states that information is considered the currency within health systems. Numerous reorganisations and restructuring, coupled with many buzz words (e.g. evidence-based practice) and the various advancements in ICT (information and communication technology) are apparently designed to improve the utilisation of this currency. However, what constitutes information appears to vary between health professionals. The author concludes that although we have been eager to embrace technological advancements and change, we have failed to monitor the impact and consequences of change on our behaviour and thus on health outcomes.

Chapter 38 (Art and Technology for Health) by Davis, Moar, Jacobs, Watkins, Shackford, Oppermann and Capra describes the development of a prototype digital game which was designed to make players more aware of the health consequences of their behaviours. The emphasis was on enabling players to become more aware of the performance of their heart – but without setting them targets, prescribing fitness programmes or in any other way making them feel that they were doing ‘work’ or ‘exercise’. Since few projects have been based on live heart-rate, the authors also introduce some of the problems and the potential of exploiting this aspect of behaviour in digital play. Chapter 39 (Appreciative Inquiry: Research for Action) by Reed, Nilsson and Holmberg describes the ways in which Appreciative Inquiry research has developed outlining its links to Action Research. Both share an emphasis on research for change, developing knowledge through an exploration of current practice, and an application of findings in informing strategies for the future. Where Appreciative Inquiry is distinct, however, is in the way that it focuses on positive aspects of practice rather than problems, thus facilitating participation in projects. This chapter gives some more details of the Appreciative Inquiry process and then an overview of related healthcare and IT research is presented. Following this some examples of the use of Appreciative Inquiry in IT research are given, and the chapter points to ways in which the use of Appreciative Inquiry can contribute to IT development.

Chapter 40 (Systems Thinking as the Model for Educating Future Healthcare Managers in Information Technology) by Goodman and Selcer explores the individual competencies presented by various healthcare executive organizations as being important for healthcare leaders to emulate in the exchange of information and knowledge. These competencies provide a set of tools that healthcare leaders can use to make their organizations successful in the healthcare systems and Knowledge Management (KM) environment. Several possible ways these can be instilled within the academic setting are presented. Systems and KM paradigms, such as organizational learning and memory, are superordinate metaphors that provide an approach to analyzing organizational capability through an understanding of processes occurring in healthcare organizations.

Chapter 41 (Social Marketing in Healthcare) by Mah argues that social marketing is a way to influence the behaviors of stakeholders in the healthcare system. This chapter will define the traditional transaction marketing concepts of exchange, segmentation, competition, the marketing mix, and audience orientation. The authors then describe the current paradigm shift to relationship marketing with its logic of collaboration and the co-creation of value. Relationship marketing is enhanced by the arrival of internet-based “social media” such as blogs, file sharing sites, and social networking sites that place creativity and communication channels under “audience” control. These developments in marketing strategy and social software will profoundly affect the next generation of social marketing programs. Chapter 42 (Ageing, Learning, Technology and Health Management) by Boulton-Lewis, Buys, Sylvia and Partridge state that as the world’s population is ageing rapidly, ageing has an impact on all aspects of human life, including social, economic, cultural and political. Understanding ageing is therefore an important issue for the twenty-first century. The authors consider the active ageing model. This model is based on optimising opportunities for health, participation and security in order to enhance quality of life.

Chapter 43 (Methodology to Set Regulations for Safe Reuse of Wastewater and Sludge for Agriculture in Developing Countries Based on A Scientific Approach and Following the New WHO Guidelines) by Jiménez and Navarro describes, using the quantitative microbial risk assessment (QMRA) methodology proposed by WHO, how to set affordable standards for reuse of wastewater or sludge in agriculture using helminth eggs (Ascaris lumbricoides) as an example. Additionally, this work shows that intervention methods, other than wastewater and sludge treatment as suggested by WHO, can play an important role in controlling health risks. Chapter 44 (Psychological Guidelines in Cardiac Rehabilitation and Prevention) by Sommaruga states that a large number of evidence-based guidelines are drawn up all over the world to improve standards of health care and to reduce inequalities in access to effective treatment. Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences. Despite widespread circulation and publicity of these guidelines, often they are not implemented effectively.

Chapter 45 (Health-Related Quality of Life Measures in the Information Age) by Warrian and Spaeth investigates the role of medical history which is one of the oldest and most fundamental assessments performed by health care providers is the medical history. The medical history can be described as a discussion concerning one’s health that takes place between a health care professional and a patient. The authors note that to date, over ninety thousand peer reviewed articles are indexed on MEDLINE under the key words “Quality of Life” and this body of research stands as a testament to their importance. The authors provide an introduction to a variety of essential issues concerning QoL instruments, to the scope of their employment in the field of health care will be introduced and several important limitations of QoL instruments are discussed. Chapter 46 (Health Technology Assessment: Development and Future) by Håheim and Mørland observes that scientific publications in medical fields are rapidly increasing and are overwhelming in numbers. This poses a challenge to health authorities, and health professionals who need knowledge to make informed decisions in finding the best evidence for treatment and practice in the health provision to the public. They need an accessible system that handle the information flow using a systematic approach. This applies to developing and industrialized countries alike. The rapid development of health technologies with the introduction of new drugs, devices and complex treatment modalities to achieve better health outcomes increases the need for evaluation of the treatment effect. The authors illustrates how the health service handles the information flow utilizing information technology, and the great benefit that is gained by this methodology.

Chapter 47 (Informational priorities in health information system) by Kisilowska presents the model of a wide health information system, designed in accordance with information science theories and requirements. The model, based on modern ICT solutions, reflects the idea of information processes (collection, indexing, transfer) as seen in an information science perspective. It concentrates on optimal answering information needs of different categories of patrons, including adaptation of information-retrieval tools to their competencies. The author discusses different types of information indispensable in healthcare practice, analyzes methods of knowledge representation in health information system, proposes methodology of surveying information needs of health professionals, and describes challenges of linguistic tools used in information systems. The author hopes that such a model will emphasis the need of cooperation among ICT, health, and information professionals in designing information structures and processes. Chapter 48 (The Role of IT in Global Health Disparities and Human Rights) by Kershaw argues that in a global environment, a key challenge of health care and information technology (IT) management involves learning how to protect human rights and addressing the health disparities that result when human rights are violated. The author aims to promote the awareness and protection of basic human rights as a 21st century imperative.

Chapter 49 (IT benefits in Healthcare performance and safety) by Bolsin and Colson postulates that carefully designed IT solutions enhance the capture of performance and critical incident reporting data in clinical environments. The authors examine the effectiveness of recent initiatives in this area and the value of the information that can be generated. While outlining the proposed savings to Healthcare systems that can be anticipated by improved performance monitoring and incident reporting the authors will also explore the additional value that the IT solutions can offer to clinicians in terms of improved learning experiences and ethical behaviour. Extensions of these applications are discussed, with the necessary prerequisites (eg ease of data entry, single data entry/multiple data use, speed of data collection, rapid and accessible feedback of results etc) that underpin these advances. The authors also discuss the potential barriers (eg technophobia, fear of performance monitoring, poor ethical standards) to successful uptake and implementation in Healthcare. Chapter 50 (Paediatric Telepsychiatry as Innovation in Health Care Delivery) by Boydell ,Volpe and Pignatiello notes that although a great deal has been written about the potential for telemedicine to increase access to care, applications in paediatrics are sparse. The authors detail how one paediatric telepsychiatry program has facilitated the creation of integrated healthcare solutions in patient psychiatric care for children and youth in remote and rural communities. The authors demonstrate how the telepsychiatry model of healthcare service delivery has improved access, enhanced capacity, and promoted knowledge exchange in rural communities.

Chapter 51 (Interactive Communication Tool for Health Education) by Suka and Yoshida introduces an interactive communication tool, the ‘HRA System’. The authors note that the recent rapid penetration of the Internet has made it a leading mode for gathering and sharing health information, and that people who access information on the Internet differ considerably in their ‘health literacy’ or the ability to understand and act on health information. The authors provide some ideas regarding how to apply interactive communication technology to health education successfully. Chapter 52 (Accelerometer-based actimetry as technology applied to health care) by Tendero ,Martín and Laín reviews new quantification possibilities for the assessment of physical activity, a variable intimately related to good health. First, a variety of existing instruments are described with regard to their validity and functionality. Then, their applications are analyzed and categorized into two broad branches: sedentary lifestyle prevention and applications in special population segments. The authors’ intention is to make existing possibilities for assessment of physical activity known to researchers and public health professionals, as it is important for the achievement and promotion of active and healthy lifestyles in the population.

Chapter 53 (Designing Medical Research Websites) by Grady ,Spring and Rotondi discusses the design of websites to be used as the basis of medical research. The authors discuss: (a) the various issues that have to be addressed in the design of a website that will be used to assess some intervention based on the website, (b) the design of such a website and the development of a tool to facilitate this process, and (3) present the results of preliminary usability analysis for the tool to assist medical researchers in constructing websites that can meet the needs and requirements of medical intervention studies. The results of the preliminary interviews, prototype walkthroughs and preliminary usability studies are presented laying the groundwork for future development and more formal usability studies. Chapter 54 (Critical Systematic Review) by Wilby discusses the process of systematic review and the critique of the design of such processes and their research questions and contexts, whether in the natural or social science arenas. The methodology proposed for critical systematic review extends the remit of systematic review, moving beyond extensive literature searching, the application of pre-determined inclusion and exclusion criteria to the retrieved literature, quality assessment, evaluation, synthesis and review of the data, to a process that is self- and process-critical and reflective, and iterative in that critique.

I have managed to solicit chapters, which we hope validates the coming of age of Information Technology application in the healthcare diagnosis and prognosis. I hope that academics, clinical and non-clinical practitioners, managers, and students will find some issues of interest and value, to take our discipline forward.

Ashish. N. Dwivedi, Ph.D.
04 March 2009


Reviews and Testimonials

"This book brings to the forefront important technologies and processes in healthcare, and consider the implications of their advances."

– Ashish. N. Dwivedi, University of Hull, UK

Author's/Editor's Biography

Ashish Dwivedi (Ed.)
Ashish Dwivedi is the Deputy Director, Centre for Systems Studies at Hull University Business School, UK. Previously, he was the Deputy Graduate Research Director at Hull University Business School, and was also associated with the management of the high-tech Management Learning Laboratory). His primary research interests are in knowledge management (in which he obtained his PhD), supply chain management healthcare management and information and communication technologies. He has published 4 books and over 50 journal and conference papers. He has served as an Invited reviewer and Guest Editor for several journals, including the IEEE Transactions on Information Technology in Biomedicine.


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