Journal of Systems and Information Technology

Sophie Cockcroft

2009 Journal of Systems and Information Technology

doi: 10.1108/13287260910983605

Purpose – The purpose of this paper is to evaluate electronic health record (EHR) initiatives at the national/external level. Governments are investing large amounts of money in national EHR systems. These systems are socially and politically complex and a variety of stakeholders (e.g. at the individual, organisational or national level) have an interest in evaluating such systems from technical, economic or patient outcome perspectives. In cognisance of academic research in the area, this paper presents an approach which uses the perspective of one particular type of professional critic, the media, to identify issues and evaluate their impact at a national level. Design/methodology/approach – The work is conducted using an established evaluation framework and formal content analysis of selected relevant articles from the quality press of three selected countries. Findings – Different issues take prominence in centralised vs decentralised EHR approaches. In countries with a decentralised approach issues of standards and interoperability take the fore. Where there is a more centralised approach the media focus is more on project management, budgetary and financial aspects. In all coverage political and economic aspects are emphasised over technical or patient outcome issues. Originality/value – The paper represents the application of the content‐context‐process framework. It contributes to the information systems evaluation literature at the national/external level.

Janne Lahtiranta

2009 Journal of Systems and Information Technology

doi: 10.1108/13287260910983614

Purpose – Health care has come to a turning point. Particularly due to aging societies and economic pressure placed on health care system, health is rapidly becoming one's own responsibility. This fundamental paradigm shift does not only affect the way health care services that will be provided in the near future but it also places enormous health information management demands on the laypeople. The purpose of this paper is to look into this emerging phenomenon, its current challenges and available solutions. Design/methodology/approach – In order to identify different kinds of solutions used for personal health information management (PHIM) and related challenges, a bibliographical review is conducted using five online databases. The review focuses on articles that emphasize personal nature of the health information management. The bibliographical review is also extended to some of the articles cited in the original review. To support discoveries from the bibliographical review, the results are compared to free electronic personal health records of different types. Findings – The paper identifies some of the most current challenges in the field of PHIM and provides an outline for overcoming them. Proposed guidelines include a concept of citizen pathways (CPs) that can be used for complementing the currently available solutions from a citizen‐centric perspective. Research limitations/implications – The paper points out near‐future development directions for the PHIM solutions in the form of identified and relevant challenges and characterized CPs. However, the forward‐looking conclusions are based on a bibliographical review and analysis of existing systems, and therefore their functionality and applicability are not tested in practice. Originality/value – The findings of this paper can be used in shaping PHIM solutions of the near future. The described challenges can also be used to identify potential problems of the internet and new media on a larger scale in the context of health and medical informatics.

Tsipi Heart; Philip O'Reilly; David Sammon; John O'Donoghue

2009 Journal of Systems and Information Technology

doi: 10.1108/13287260910983623

Purpose – The limited success of electronic health records (EHRs) implementation in the healthcare services in general, and a national EHR in particular, requires better understand and documentation of the current drivers and inhibitors of EHR adoption, together with a definition of a national EHR. This paper aims to address these issues. Design/methodology/approach – Factors affecting EHR adoptions are elicited from extant literature and the stakeholder/actor framework is used as the theoretical framework. The multiple case study approach is used as the research method, and data are collected in Ireland and Israel by interviews and analysed using text coding methods. Findings – Factors elicited in the literature are generally corroborated, yet the salient factor on the localized perspective appears to be the degree of centralization of the healthcare services; while different factors affect the national perspective. In summary, it seems that Israel is more ready for national EHR implementation than Ireland due to the high level of computerization and high levels of integration of primary and secondary care patient data. Research implications – Contribution to research is in the definition of a national EHR, the illustration of various levels of analysis and their relative impacts on EHR adoption, the analysis framework, and by showing that EHR adoption is a top‐down, change management process. Practical implications – EHR adoption should be driven by a powerful actor in the healthcare sector addressing the need for a high level of integration within and between care levels, while focusing on clinicians' requirements. Technological and legislative infrastructures are mandatory for establishing a national EHR. Originality/value – Data for this study are collected in two countries that represent different healthcare structures, one being highly centralized while the other is just the opposite. These differences provide an additional interesting lens through which factors affecting EHR adoption can be assessed. As far as we know, not many previous studies have compared EHR adoption across two diverse healthcare systems.

Shamshul Bahri

2009 Journal of Systems and Information Technology

doi: 10.1108/13287260910983632

Purpose – The purpose of this paper is to present a model of radio frequency identification (RFID) implementation process in a hospital. The model is developed to fill the lack of models on RFID implementation in a hospital setting. Design/methodology/approach – The case study research and grounded theory approaches are combined. The data are collected through repeat interviews with the hospital's RFID manager and the IT vendor. The data are analysed using the grounded theory approach. Findings – The main finding of the paper is the RFID implementation process model in a hospital. The model consists of key activities that have occurred during the unfreezing, moving and refreezing stages of the implementation. Research limitations/implications – The generalisability of the model may be limited because it is based only on a single hospital's RFID implementation. Practical implications – RFID managers in hospitals need to be aware that the technology's implementation is no different to other types of information systems implementation. However, they also need to be aware of the contextual differences in their hospitals before the model can be adapted. Originality/value – The RFID implementation process model could guide existing and future RFID managers in hospitals. The three stages of the model will enable the managers in identifying the different emphasis needed in each stage.

Jorma Jokela; Shengnan Han; Ville Harkke; Markku Kallio; Leena Lindgren; Maaret Castrèn

2009 Journal of Systems and Information Technology

doi: 10.1108/13287260910983641

Purpose – The purpose of this paper is to present the results of a comparison study of using a mobile medical information system between civilian medical students and physicians undergoing military service in Finland. Special emphasis is on differences in system usage, and perceptions towards the mobile medical system. Other points of interest are the important features of the mobile medical system, advantages and disadvantages of using the system in actual emergency situations and use of the device to search for general information. Design/methodology/approach – The study is conducted between two groups of users, medical students and physicians undertaking military service. Findings – The two groups are found to have similar behaviors toward the mobile system in different contexts. This study helps develop an understanding of how the two groups of users use a mobile medical information system while also providing insights of some behavioral differences between them. Not all of the differences are significant; indicating the possibility of developing a universal tool for both military and civilian contexts, but more contents of military medicine should be supplemented for military physicians. Originality/value – This paper addresses an area of increasing research interest, i.e. mobile medical informatics.

Eva Söderström; Rose‐Mharie Åhlfeldt; Nomie Eriksson

2009 Journal of Systems and Information Technology

doi: 10.1108/13287260910983650

Purpose – Regardless of who or where we are and when we get sick, we expect healthcare to make us well and to handle us and our information with care and respect. Today, most healthcare institutions work separately, making the flow of patient information sub‐optimal and the use of common standards practically unheard of. The purpose of this paper is to emphasise the use for standards to improve information security in process‐oriented distributed healthcare. Design/methodology/approach – The paper introduces a real‐life case which is analysed to highlight how and where standards can and should be used in order to improve information security in process‐oriented distributed healthcare. Findings – In total, 11 flaws or problems in information security and process‐orientation are identified. From these, six changes are suggested which address how information is handled, and how organizational routines should be standardized. Research limitations/implications – The case setting is Swedish healthcare, but problems can be shared across international borders. The purpose is to highlight the issues at hand. Practical implications – If suggested changes are implemented, healthcare processes will be more streamlined and focused on patients. Routines will be standardized and uncertainties thus removed in terms of how to act in certain situations. Originality/value – Healthcare and academia has yet to address both document and process issues concerning standardization in distributed healthcare. There are also few actual cases from a patient perspective. This paper provides lessons learned from a real‐life case, where results may impact how standardization is addressed in healthcare organizations.