Dissertations / Theses on the topic 'Health information system development'

Abstract The main focus of this study is the identification of factors influencing the use and effectiveness of information system development methodologies (Le., systems development methodologies) in health information systems. In essence, it can be viewed as exploratory research, utilizing a conceptual research model to investigate the relationships among the hypothesised factors. More specifically, classified as behavioural science, it combines two theoretical models, namely the Unified Theory of Acceptance and Use of Technology and the Expectancy Disconfirmation Theory. The main aim of behavioural science in information systems is to assist practitioners (Le., social actors) in improving business processes and competitiveness, thus the effective use of information systems. A wider view of behavioural science incorporates other social actors (e.g., end users) and organisational actors (e.g., executives). In health information systems, the effective use of information systems is especially relevant Health information systems are vital in the area of health care, since only by having access to pertinent health information, can the correct decisions relating to diagnostics and curative procedures be made. The use of systems development methodologies in health information systems development is therefore crucial, since they can make the development process more effective, while improving software quality. By empirically evaluating the conceptual research model, utilizing a survey as the main research method and structural equation modelling as the main statistical technique, meaningful results were obtained. Focussing on the factors influencing the individual's behavioural intent, it was found that the compatibility of systems development methodologies to the developer's pre-existing software development style is vital. Furthermore, performance expectancy, self-efficacy, organisational culture, policies, customer influence, voluntariness and facilitating conditions, all directly influenced the use of systems development methodologies, with policies and customer influence playing a significant role, especially in relation to health information systems. No significant direct effects or indirect effects could be established for the factors effort expectancy, personal innovativeness and social influence. It appears that individuals working in the health care software development discipline are more autonomous, less influenced by others. Also, the lack of support for the factor effort expectancy may indicate that systems development methodologies have entered a mature state, with less concern on the effort required for use. Furthermore, with regard to effectiveness and the continued use of information systems methodologies, satisfaction had a significant direct effect, with confirmation having a significant indirect effect. Keywords: behavioural science; conceptual research model; direct effect; exploratory research; Expectancy Disconfirmation Theory; indirect effect; Unified Theory of Acceptance and Use of Technology; structural equation modelling; survey; systems development methodologies.
Thesis (Ph.D. (Computer Science))--North-West University, Potchefstroom Campus, 2010.

China is moving towards a market economy. The greater use of market forces has made China richer, accelerated modernisation and increased productive efficiency but has created new problems, including, in the health sector, problems of inequity and allocative inefficiency. From 1997, the Chinese government committed to a national policy of regional health planning (RHP), as part of a broader commitment to harmonising social and economic development. However, RHP has been slow to impact on the equity and efficiency problems in health care. Planning requires information; better health decision-making requires better health information. Information systems constitute a resource that is vital for the health planning and the management of the health system. Properly developed, managed and used, health information systems are a highly cost-effective resource for the nation and its regions. Bureaucratic resistance, one of critical reasons is that regional health planners gained insufficient support from information system. Health information needs to adopt into the new way of government health management. The objective of the study is to contribute to the development of China�s health information system (HIS) over the next 5-10 years, in particular to suggest how provincial health information systems could be made more useful as a basis for RHP. The existing HIS is examined in relation to its support for and relevance to RHP, including policy framework, institutional structures and resources, networks and relationships, data collection, analysis, quality and accessibility of information as well as the use of information in support of health planning. Data sources include key informant interviews, a questionnaire survey and various policy documents. Qualitative (questionnaire survey on provincial HIS) and quantitative (key informant interviews) approaches are used in this study. Document analysis is also conducted. The research examines information for planning within the macro and historical context of health planning in China, in particular having regard to the impacts and implications of the transition to a market economy. It is evident that the implementation of RHP has been retarded by poor performance of information system, particularly at the provincial level. However, the implementation of RHP has also been complicated by fragmented administrative hierarchies, weak implementation mechanisms and contradictions between different policies, for example, between improved planning and the encouragement of market forces in health care. To support RHP which is needs based, has a focus on improving allocative efficiency and is adapted to the new market development will require new information products and supports including infrastructure reform and capacity development. Provincial HIS needs to move from being data generators and transmitters to becoming information producers and providers. Health planning has moved to greater use of population-based benchmark and demand-side control. Therefore, information products should be widened from supply side data collection (in particular assets and resources) to include demand-side collection and analysis (including utilisation patterns and community surveys of opinion and experience). The interaction between users (the planners) and producers (the HIS) should be strengthened and regional networks of information producers and planners should be established.

Includes bibliographical references.
Waste management generally in South Africa is poorly defined and practised, and the inadequate management of health care waste (HCW) has been recognised by the South African government as a significant environmental and public health risk. The literature revealed that an integrated health care waste information system (IHCWIS) serves as an important intervention to address the issue of poor health care waste management (HCWM). The overall key research question which this research asked was: "How does an IHCWIS develop and become institutionalised among health care waste generators?" The aim of the research was to gather empirical data to understand how the development and institutionalisation of an IHCWIS contributes to effective HCWM.

Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2009.
Includes bibliographical references (p. 133-153).
Postmarket data on prescription medical product performance has historically been incomplete, underutilized, and mismanaged to inform safety and comparative clinical effectiveness. Congress has tasked the Food and Drug Administration to build a public health information infrastructure for drug safety. It also has allotted $1.1 billion dollars in new spending for comparative effectiveness research. A singular, shared, multi-purpose public health information infrastructure can be built to serve both these needs and others. It can be used by multiple public health agencies under a coordinating framework. A new independent public health authority is best positioned to manage that framework and to negotiate the security, legal, proprietary, and privacy barriers that accompany requests to access large amounts of patient data. Such a design protects privacy, avoids duplication, leverages investment, and promotes sustainability in what is truly a "greenfield" opportunity in the United States. Consequently, the policy window to influence the system design is now. Personal health data is the scarce resource needed to constitute this infrastructure. Citizens have a right and responsibility to re-examine how postmarket data is used to measure safety and comparative clinical effectiveness. A public process to establish new classification schemes that set benefit-risk targets for classes of prescription medical products is needed. Such schemes would differentiate products according to therapeutic need, expected length of treatment, expected patient population, novelty of treatment, and availability of substitutes.
(cont.) These classes would prompt different postmarket requirements according the needs and values of the affected patient population. Data collection, data analysis, risk management strategies, and reimbursement strategies would logically follow from this classification. In this paper, inadequate historical postmarket data generation mechanisms and risk management plans are reviewed. Specific attention is given to the failed use of "carrots" and "sticks" to elicit desired behavior. Next, an analysis of stakeholder interests and desired public health outcomes is performed. Policy goals for a public health information infrastructure are outlined along with strategies to achieve those goals.
by Judith C. Maro.
S.M.in Technology and Policy

This study examines the challenges, issues and complexities surrounding the construction of information for a South Texas Internet-based, health information gateway. It explores the collaborative and negotiated power dimensions and partnerships that supported this effort and the implications of online technological innovation for women's health choices. The context of the study is the online South Texas Health Information Gateway, a health information and communications-based effort that emerged in response to a stated community need to improve access to local, relevant and time-sensitive health information, resources and support for women and their families.

Software development with limited resources is a challenge encountered by most developers at one time or another. The limited resources in question can involve many things like: Time, money, manpower, knowledge etc. Developing countries, due to their general lack of resources are particularly well suited as arenas for the study of this concept The research questions we aim to explore are: 1) How can limited resources affect one’s work organizationally? 2) How can technological decisions affect the resource pool? Our case involves a study of the effects of limited resources on the development process of a person-based family health system in India. Our results indicate that a lack of most specific resources often manifests itself into a more general lack of the resource: Time. Technological decisions can influence time through alteration of the resource pool. Making a technological decision in a limited resource environment should therefore be motivated by the management of time for facilitating the execution of critical tasks.

Master of Public Health - MPH
One hundred and fifty two (152) countries in the world can be classified as developing or low-resourced countries (LR Cs) according to the World Bank. 1 In the majority of these countries the Gross Domestic Product (GDP) is below $1000. Given these limited resources it stands to reason that there is less money available to spend on healthcare and health research

Abstract 1 – A Geographic Information System for Evaluating Residential Pesticide Exposure and Prostate Cancer Incidence Agricultural pesticide exposure is hypothesized to be a risk factor for prostate cancer, and such exposures are of particular concern for men living in farming communities where large-scale pesticide applications occur. Prostate cancer incidence data were obtained from the State Health Registry of Iowa for the years 1996 through 2006, and county and census tract level age-adjusted incidence rates were calculated. Historical crop-specific land use records and pesticide sales data for the state of Iowa during 1990 were integrated into a geographic information system (GIS), where estimates of predicted exposure to the four most commonly used pesticides in Iowa (atrazine, metolachlor, cyanazine, alachlor) were produced. Ecological correlation between pesticide exposure and prostate cancer incidence was evaluated using Spearman’s (rank) correlation coefficient and linear regression analysis. Statistically significant associations between prostate cancer incidence and percent of acres of corn and soybean crops were found at both the county (r=0.22, p=.031 and r=0.33, p=.001, respectively) and census tract (r=0.10, p=.007 and r=0.13, p<.001, respectively) level. The associations between percent of land exposed to the specific pesticides and prostate cancer were not statistically significant. Our findings suggest that residential proximity to corn and soybean fields, and by association the pesticides used on those crops, is correlated with increased prostate cancer risk, but that the increase in risk is not correlated with exposure to the four most commonly used pesticides in Iowa in 1990. Findings from this study underscore the need for continued investigation of the association between agricultural exposures and prostate cancer incidence. Abstract 2 – Spatial Analysis of Prostate Cancer Incidence and Residential Pesticide Exposure in Iowa A statistically significant positive association between prostate cancer incidence and residential proximity to corn and soybean fields in Iowa exists. Research suggests that exposure to pesticides used on these crops increases prostate cancer risk. The objective of this study was to investigate clustering of prostate cancer risk in the presence of potential exposure to pesticides in Iowa. Prostate cancer incidence data (1996-2006) were obtained from the State Health Registry of Iowa. Using SaTScan software, clusters of high and low prostate cancer risk were identified. Ecological correlation between exposure to the four most commonly used pesticides (atrazine, metolachlor, cyanazine, alachlor) in Iowa during 1990 and residence in a cluster of relatively high or low prostate cancer incidence was evaluated using Pearson’s chi-square test statistic and logistic regression analysis. Clusters of increased prostate cancer risk were associated with a greater percentage of land used for all crops of interest (i.e., corn and soybean farming (p <0.001), corn farming (p <0.001), soybean farming (p <0.001)) and low exposure to alachlor (p =0.032) than did clusters with decreased risk of prostate cancer. After adjustment for percent of land used for each crop type, no association between pesticide exposure and prostate cancer risk was observed. Residence in or near agricultural communities increases prostate cancer risk. Our findings suggest that residential proximity to exposures specific to corn and soybean farming increases prostate cancer risk. Evaluation of exposure to less commonly used pesticides and those used in lower quantities is needed.   Abstract 3 – Multilevel Analysis of Residential Pesticide Exposure and Prostate Cancer Incidence An association between residential exposure to factors specific to corn and soybean farms in Iowa exists. The objectives of this study were to statistically assess spatial autocorrelation in prostate cancer incidence in Iowa and to evaluate the effect of residential exposure to the most commonly used pesticides for corn and soybean farms in Iowa in 1990 on prostate cancer incidence. Prostate cancer incidence data were obtained from the State Health Registry of Iowa for the years 1996 through 2006. Spatial patterning of age-adjusted incidence rates was assessed via Moran’s I global index of spatial autocorrelation. A hierarchical regression modeling approach with an assumed Poisson distribution was used to characterize the relationship between census tract level prostate cancer incidence and exposure to pesticides. Statistically significant spatial patterning of prostate cancer incidence, corn and soybean fields and pesticide use (p<.001 for all variables) was observed. After adjustment for individual and area level characteristics, prostate cancer risk increased by approximately 25% for each percentage point increase in percent of land used for corn and soybean crops. Prostate cancer risk was approximately 25% higher for Black men exposed to corn and soybean fields compared to white men exposed to corn and soybean fields. Results from this study support the need for further evaluation of residential exposure to environmental hazards specific to corn and soybean farming.

Philosophiae Doctor - PhD
A review of the literature has shown that there is a lack of mental health information on which to base planning of mental health services and decisions concerning programme development for mental health services. Several studies have indicated that the use of an evidence-based health information system (HIS) reduces inappropriate clinical practices and promotes the quality of health care services. This study was aimed at developing a framework for a district-based mental health information management system, utilising the experiences of health care providers and caregivers about a district mental health information system (DMHIS). Activity Theory was used as the philosophical foundation of the information system for the study. A qualitative approach was employed using semi-structured individual interviews, Focus Group Discussions (FGDs), systematic review and document analysis. The intervention research design and development model of Rothman and Thomas (1994) was used to guide the study, which was conducted in the Cape Town Metropole area of the Western Cape. A purposive, convenient sampling method was employed to select study participants. Ethical clearance for the study was obtained from the University of the Western Cape, and permission to use the health facilities from the Department of Health. The data collection process involved 62 individual interview participants, from mental health nurses to district health managers, health information clerks, and patient caregivers/families and persons with stable mental conditions. Thirteen caregivers took part in the FGDs. Document review was conducted at three community mental health centres. The data were analysed manually using content analysis. Core findings of the interviews were lack of standardized information collection tools and contents for mental health, information infrastructure, capacity building, and resources. Information processing in terms of collection, compiling, analysing, feedback, access and sharing information were the major problems. Results from document analysis identified inconsistencies and inaccuracies of information recording and processing, which in turn affected the quality of information for decision making. Results from the systematic review identified five functional elements: organizational structure; information infrastructure; capacity building; inputs, process, output and feedback; and community and stakeholders’ participation in the design and implementation of a mental health information system (MHIS). The study has contributed a framework for a DMHIS based on the findings of the empirical and systematic review. It is recommended that there is a need to establish a HIS committee at district health facility level for effective implementation of the framework and quality information processing. There is a need to ensure that staffs have adequate knowledge and skills required for effective implementation of an information system. It is recommended that higher education institutions include a course on HISs in their curriculum. It is suggested that the South African Mental Health Policy be reviewed to include an MHIS and ensure involvement of the community and stakeholders in this system as well as adequate budget allocation.

The convergence of political and technical challenges is demonstrated in a case study on a collaborative initiative to develop a pan-Canadian Electronic Health Record (EHR) system. It is argued that the juxtaposition of different domains, procedures, knowledge bases, and entities involved in establishing a pan-Canadian EHR has resulted in the development of a new, hybrid form of collaboration.
Cette étude de cas d'un projet collaboratif de développement d'un dossier de santé électronique (DSE) pan-canadien démontre que le déroulement de ce projet a donné lieu à une convergence d'enjeux politiques et techniques. La juxtaposition de différents domaines, procédures, bases de connaissances, et entités impliqués dans l'établissement d'un DSE pancanadien a ainsi abouti à l'élaboration d'une nouvelle forme hybride de collaboration.

eHealth has been adopted by many countries across the globe in response to cut down cost and improve the quality of life. Sweden has been engaged in providing web-based health care services for its citizens for the past decade and county councils have the responsibility to develop them. The main aim of this thesis is to present answers to the following research questions:What strategies (formal and informal) guide the development of web-based health care services provided by the Swedish county councils?What barriers exist in relation to the development and usage of web-based health care services provided by the county councils from the viewpoint of their IT leaders?From the perspective of IT leaders in the county councils and in their capacity to develop, manage and monitor their organizations‘ website content, which web-based health care services are mostly accessed by users and what age group utilize the services most?The thesis is an exploratory research conducted through a survey based on a mail questionnaire that was posted to all 21 county councils in Sweden with 18 councils responding. The results show that all county councils have formally adopted the National eHealth Strategy to guide the development of web-based health care services and some have other informal strategies as well. Technological barriers, resistance to use the web-based services and changing business process to integrate ICTs have been identified by IT leaders as major challenges that impede the development of web-based health care services in Swedish county councils. Swedish citizens more frequently access prescription renewal and booking and cancellation of appointments than other available web-based health care services which depicts a trend towards the use of advanced interactive services than basic information seeking, and people in the ages of 46 to 55 have been identified as the frequent users of web-based health care services according to IT leaders from the county councils.

This thesis represents over five years of research focusing on the development and implementation of information systems within the National Health SefV1ce. It aims to contribute towards a better understanding of the information systems development process from inception through to system evaluation and review. Five long-term interventions have been undertaken in a range of National Health Service sites, examining different aspects of information provision. The length of the interventions ranged from nine months to almost two years. The five sites were all at different stages of system development. The research has been carried out using a combination of participant observation and action research. This has meant working with National Health Service staff on a series of system projects. The aim of the research is to try and help National Health Service (NHS) organisations deal more successfully with their information provision. The research question asks, "how can NHS organisations think about, and hence go about their information provision in such a way that successful information systems are introduced'!". Information systems development has generally been regarded as a technical discipline. This has led to a narrow view being taken of a number of areas that may affect the success or otherwise of system projects. Historically, the system development process has been concentrated in the hands of a small number of experts even though the implementation of systems can have far-reaching consequences for the organIsation. The output of the research is a set of issues that should be addressed when introducing information systems within the NHS. These have been translated into the OASES materials which form the appendices. OASES is not a prescriptive methodology but a set of principles and guidelines to try and improve the way that information systems are developed within the NHS. It IS hoped that the outcome of the research will be a situation in which effective information systems are developed that take account of the behavioural, cultural, and organisational issues that are important within complex organisations.

Regular physical activity, timely medication, controlled diet, and blood glucose monitoring is crucial for any diabetic patient. Laxity on following these treatment regimens can cause severe health complexity. Moreover, A physician’s surveillance on a patient, based on the patient’s real-time progress is difficult with the existing health care system. This research aims to provide a more accurate objective data in real-time to the physicians to help both patients and providers. The data being generated is mined later to investigate interesting questions regarding diabetic care. The resultant system is a mobile healthcare monitoring system for type – 2 diabetic patients that traces patients daily progress. Although many mobile apps provide self-monitoring tools for the patient, an interactive platform for monitoring all relevant parameters of diabetes where patients and physicians both are end users is unique. The Android app is designed with 3 major modules and two submodules: 1. Carb Intake Tracker (CIT), 2. Blood Glucose Tracker (BGT), 3. Physical Activity Tracker (PAT), 4. Medicine and 5. Blood Glucose (BG) reading reminder. Since Carb is an important factor for a diabetic patient’s meals, the CIT provides a platform to record daily meals from which the patient can see the total carb intake. Through BGT, patients can record their fasting or non-fasting blood glucose reading. The PAT collects a patient’s movement data via Bluetooth from a pair of wearable insole devices, and processing the data identifies and records the current activity. The PAT can detect if the patient is active in sedentary, as well as the type of exercise done by the patient. Using BG reminder and medicine reminder, the patient can set reminders which supports the apps self-monitoring aspect. All the data collected by CIT, BGT, and PAT are stored in Microsoft Azure cloud database, an authorized physician can access the database and see graphical statistics of a patient’s diet, physical activity, and glycemic index level. The app portrays statistics of carbs taken over a period, calories burned, and Glucose level trends through graphical representation. This has two advantages: 1. Patients can improve lifestyle observing records and following reminders, 2. Physicians can prescribe actions perceiving a patient’s trends over time. This research presents unique collaborative interaction between diabetic patients and physicians to create a real time patient portal based on android APIs and wearable devices.

A geographic information system was used to measure geographical access to general surgical services in the Champlain Local Health Integration Network. An origin-destination matrix approach was used with discharge data for Champlain residents using the Ontario Road Network file and OC Transpo trip planner for public transportation trips with in the city of Ottawa. GIS showed that adding surgical services to the Renfrew Victoria Hospital would be the best location to achieve the goal of reduced drive times for Champlain LHIN residents. However, this hospital was ill suited to take on additional surgeries due to high occupancy rates, a lack of space and surgeons. Differences in neighbourhoods' geographical access (drive and transit time) to the General Campus of the Ottawa Hospital were found. However, it was the more affluent neighbourhoods and neighbourhoods with lower percent of recent immigrants that had longer drive times and transit times.

A novel, interactive Android app has been developed that monitors the health of type 2 diabetic patients in real-time, providing patients and their physicians with real-time feedback on all relevant parameters of diabetes. The app includes modules for recording carbohydrate intake and blood glucose; for reminding patients about the need to take medications on schedule; and for tracking physical activity, using movement data via Bluetooth from a pair of wearable insole devices. Two machine learning models were developed to detect seven physical activities: sitting, standing, walking, running, stair ascent, stair descent and use of elliptical trainers. The SVM and decision tree models produced an average accuracy of 85% for these seven activities. The decision tree model is implemented in an app that classifies human activity in real-time.

Thesis (MPhil)--Stellenbosch University, 2001.
ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a profession. The focus ranges depending on issues at hand - it may be on the educational, training, humanistic, economic, professional ethics and legal aspects. One area of medicine that is under the spotlight around the world is that of the maintenance of clinical competency, followed very closely and almost linked to professional ethics. This study follows the introduction of a system of Continuing Professional Development (hereinafter also referred to as CPD), in South Africa and an overview of how it has been introduced in a few other countries. The main areas of focus being the extrication of inherent values of CPD, relating this aspect to quality improvement in medical health care. The medical profession as well as most of the interested parties, has different perspectives regarding the fact that the system is regulated through legislation. There is also the doubt whether the CPD system will be effective in achieving the goals that it has been set to achieve. Although a system of Continuing Medical Education has been a tradition in all countries, which implies that the CPD system is not totally new as far as the educational principles are concerned, the values accruable need to be exploited. It is the possible success of this kind of evaluations that may foster more understanding of the inherent values in this CPD system.
AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot belangstelling gelok. Die fokus verskuif na gelang van die onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding, humanisme, ekonomie, en professionele etiek tot regsaspekte. Dwarsoor die wêreld word daar gefokus op die handhawing van kliniese vaardighede, gevolg deur professionele etiek wat ook daarin verweef is. Hierdie studie bespreek die instelling van 'n stelsel van Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO) in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar ander lande ingestel is. Die klem lê op die inherente waardes met betrekking tot die verbetering gehalte in mediese gesondheidsorg. Die mediese beroep, asook meeste van die belangegroepe het verskillende opvattings oor die feit dat die stelsel deur wetgewing gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy vooropgestelde doelwitte sal slaag. Wat die opvoedkundige beginsels betref, is die VPO-stelsel nie totaal en al nuut nie. Alhoewel VPO in ander lande tradisie is, is dit nodig om die totstandkoming van waardes te ontgin. Die moontlike sukses van hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die inherente waardes in die VPO-stelsel bevorder.

The factors that influence the ultimate level of success or failure of systems development projects have received considerable attention in the academic literature. Two particularly significant areas of interest have been the importance of applying best practice during systems development and the need to explicitly consider organisational issues to ensure a positive organisational impact. However, despite the existence of a well developed best practice literature and an emergent organisational issues literature, many projects still fail. The record of the NHS has been particularly poor in terms of the successful development and implementation of information systems and it was thought that this area would provide a fertile domain for information system research. Whilst the use of information systems in community healthcare has increased greatly over the last ten years the majority of existing research has been conducted in acute hospital environments with little attention devoted to the community sector. Consequently, this research project has two main aims: To identify the key best practice variables and areas of organisational impact associated with the development, implementation and use of a Community Information System (CIS) in National Health Service Trusts; and to examine the relationships between these two sets of variables and the system's resultant level of effectiveness. This research project has a number of positive methodological attributes in that it studies a homogenous organisational sector using a common type of information system and so minimises the potentially confounding influences of sector and system. In addition, the research design involves a three stage approach, combining both quantitative and qualitative research approaches. The research project has produced several key findings. A positive relationship was identified between the adoption of best practice and system effectiveness and similarly, there was a positive relationship between the level of organisational impact and system effectiveness. In order to ensure a positive organisational impact it was found that the successful treatment of key organisational issues is required. In addition, two new variables have been identified, user ownership and positive user attitudes, that play an important mediating role in ensuring system effectiveness. Finally, it was also recognised that the adoption of best practice variables had a dual role, directly influencing the level of perceived system effectiveness but also as a method of effectively managing organisational issues, user ownership and user attitudes. In summary, this study has emphasised the importance of adopting best practice and assessing and managing organisational impact during a community information system development project to ensure system success. These results will be of particular interest to practising IM&T Managers in the NHS and to the wider academic community. A series of practical recommendations are presented at the end of the thesis.

This study investigates whether the cultural differences, that are known to exist between countries, affect the attitudes of professionals in health towards the development and use of information systems. The study was motivated by the perceived failure of health information systems to deliver expected benefits, in particular in international developments, and also by the perception that attitudes of health sector professionals, who are current and potential users of the systems, can have an impact on the success or failure of these systems. Both structured group discussions and a self completion questionnaire were used in this investigation. As well as drawing on previous research on attitudes, a participative approach was taken to the development of the questions to be used, to reduce ethnocentricity in the design. Participants in the study were professionals working in the health sector in Georgia, Tajikistan, Uganda and UK, and professionals in other countries assisted in the study design and group discussions. Preparatory work for rolling out the research has also been carried out in other countries. As well as highlighting cross country differences, the results identified some significant issues in relation to the attitudes of health sector professionals towards information systems developments, common to all countries. The investigation has also led to the development of approaches, suitable for use in a cross cultural setting, that facilitate the identification of the attitudes of users towards information systems. These approaches can help to address the real-world problems faced when implementing health information systems by assisting in understanding the views of stakeholders to the systems, and how these views vary between different groups of staff or different countries.

This study evaluates monograph acquisition decisions at an academic health sciences library using circulation and acquisitions data. The goal was to provide insight regarding how to allocate library funds to support research and education in disciplines of interest to the library user base. Data analysis revealed that allocations in 13 subject areas should be reviewed as the cost of circulation was greater than the average cost of circulation of the sample and the average cost of monographs was higher in these subject areas than the average cost of monographs in the sample. In contrast, 13 subjects returned cost of circulation rates lower than the average cost of circulation of the sample. These subjects merit stable budget allocation or increased allocation depending upon collection needs. Overall, this study found that this library is allocating a majority of resources to subjects with above average rates of use.

For communities in urban and rural areas, access to healthcare facilities is a very significant concern of service delivery to both public policy makers and urban planners. Many healthcare systems set one of their primary objectives to achieve equity and ease of access to healthcare facilities for the populations that they serve. Spatial distribution of population, transport infrastructure, as well as spatial distribution of healthcare facilities are key characteristics that influence the disparities in spatial accessibility to healthcare facilities. Regardless of the permanent interest in transport accessibility, it is often uncertain how different types of accessibility measures relate to one another and which conditions are best for applications. In general, the current study undertakes a statistical comparison among three spatial accessibility measures (representing the main categories of spatial accessibility models) to determine whether they are comparable and/or interchangeable. Specifically, this study aims to use a geographical information system based approach combined with spatial accessibility measures, in a case study, derived from fine spatial resolution datasets, to characterise and divulge spatial variations in individual’s access to healthcare facilities and identify deprived locations/local communities in a selected District Municipality of the Western Cape, South Africa. Results indicate that the main categories of spatial accessibility measures provide different interpretations of accessibility that cannot be reproduced by each other. However, the accessibility measures show a significant similar trend in variations of individual’s accessibility to healthcare services for the communities of Cape Winelands District Municipality. The study establishes that within the Cape Winelands there exist spatial variations in the distribution of accessibility to healthcare and characterises these variations.

Today's new technology provides endless opportunities to automate and digitize operations. An increasing number of companies replace manual tasks with new technologies, aiming at increasing efficiency and productivity. This master thesis project was made in corporation with Essity Hygiene and Health AB at Falkenberg. In order for Essity to continue to be one of the leading manufacturers and maintain their financial ability, they need to take a step in the right direction towards a more modern production.   The purpose with the project is to propose ways to reduce the amount of manual non-value adding work performed by operators, with focus on time losses, ergonomic and safety. The project shall deliver realistic concepts that reduce manual tasks performed by operators through automation, and find new ways to quality-proof the material.   The project has worked according to an iterative work process where the cycle was repeated, until the outcome satisfied the needs. The project started with mapping the current state where Fenix 2, one of the machines, was selected for the mapping. Two weeks was spent in the production to gain understanding of the operators work tasks and working environment. The project did, among other things, observations, interviews, surveys, ergonomic analysis, flowcharts and spaghetti diagrams. The result from the current state shows that the refill of material is the most time-consuming task for the operators. It was also made clear, based on step counters and spaghetti diagrams that the operators walk a lot. The result from the mapping formed the basis for the development areas. The project chose to proceed with the material refill, walking and the quality and made requirement specifications for each area.   An ideation process was used to generate as many ideas as possible for the chosen areas. The ideas then became early concepts, which were evaluated with weighted matrixes and feedback from employees. The concepts were then further developed into three final concepts, Ground Floor, Second Floor and Integration. The concepts shows that it is possible to reduce the manual working time with 4,5 hour per shift and decrease the walking with better information system.   Further recommendation is that Essity proceed with the results, both the mapping and the concepts. The recommendation is to do another evaluation and include the operators in the process and after that use the results in this thesis as the basis for future implementations.
Dagens teknik medför oändligt med möjligheter till att automatisera och digitalisera verksamheter. Allt fler företag ersätter manuellt arbete med ny teknik, i syfte att öka effektiviteten och produktiviteten. Det här examensarbetet har genomförts i samarbete med Essity Hygiene and Health AB i Falkenberg. För att fortsätta vara ledande inom deras bransch och behålla sin konkurrenskraftighet behöver Essity ta ett steg i rätt riktning och modernisera sin produktion.   Syftet med projektet är att föreslå sätt att minska mängden manuellt, icke värdeskapande arbete hos operatörerna med fokus på tid, ergonomi och säkerhet. Projektet ska leverera realistiska koncept som minskar mängden icke värdeskapande arbete hos operatörerna genom att automatisera manuella arbetsmoment och finna nya sätt att kvalitetssäkra materialet.   Projektet har arbetat efter en iterativ arbetsprocess där processen upprepats tills resultatet uppfyllde behoven. Projektet startades med en kartläggning över nuläget där Fenix 2, en av maskinerna valdes ut. Två veckor spenderades i produktionen för att få förståelse för operatörernas arbetsuppgifter och arbetsmiljö. Projektet gjorde bland annat observationer, intervjuer, enkäter, ergonomiska analyser, flödesscheman och spagetti diagram. Resultatet från nuläget visade på att det är påfyllnaden av material som tar mest tid för operatörerna under ett skift. Baserat på spagettidiaramen och stegräknarna blev det tydligt att operatörerna går mycket. Resultatet från kartläggningen utgjorde grunden för vilka områden som projektet vidareutvecklade. Projektet valde att gå vidare med materialpåfyllnad, gående och kvalitet och för dessa områden så upprättades en kravspecifikation.   En ide generering användes för att skapa så många idéer som möjligt för de olika områdena. Idéerna blev sedan till tidiga koncept som i sin tur utvärderades med hjälp av viktningsmatriser och feedback från anställda. Koncepten utvärderades ytterligare till tre slutliga koncept, Första Våningen, Andra Våningen och Integrations koncept. Koncepten visar att det är möjligt att minska arbetstiden med 4,5 timmar samt gåendet genom bättre informationssystem.   Vidare rekommendationer är att Essity fortsätter arbeta med resultaten från både kartläggningen och slutliga koncepten. Rekommendationen är att göra ytterligare en utvärdering och inkludera operatörerna i utvecklingsprocessen. Efter det bör resultatet i den här rapporten användas som grund för vidare implementering och framtida projekt.

Prologue is a health information system developed for underserved communities in Bihar, India. It is aimed at helping people living in poverty and with low literacy to take the right steps to manage their and their family’s health. Bihar suffers from one of the worst healthcare records in the country. This is as much due to the lack of access to the right information as it is due to the economic condition of the region. The inaccessibility of information is aggravated by the complex social set up in these communities, for e.g. women aren’t allowed to leave their homes and community has the strongest influence on an individual’s decision making. To make sure that right information permeates even to the most inaccessible user groups, especially women and to uplift community’s awareness as a whole, two different communication channels were designed-an interactive radio show and a public installation.

The greatest wealth is health. It is sometimes said your health is a function of what you are not doing, not what you are currently doing. The degree to which individuals can attain, process, and comprehend the necessary health information and services they need to make proper health decisions is vital for optimal health and well-being. This project documents the analysis, design, development, and implementation of a prototype web-based data-driven health & wellness system targeted for college students. The architecture for this system uses business intelligence to develop a smart online platform for real-time analysis based on inputs entered by its users. The objective is to develop modules that can be used to provide meal plan options that dietitians can recommend to students, while also providing a standard wellness health check. This also promotes constant awareness for students with specialized health diets. User-health and wellness history of each Student is collected and stored for generating progress and wellness reports for end users. The dietitian can monitor the user in real time through the data collected and stored in the data server. Users can monitor their own progress. The system incorporates user context and feedback to personalize each user's lifestyle. Implementation of this system provides a complete and easy to use integrated system that promotes the process of analyzing wellness and improving the user’s overall health. The system is designed to be in a non-clinical setting and hence more lifestyle-oriented compared to other health-oriented systems. It is thus more relevant and convenient to student’s everyday life context.

Information System development involves various activities; the process of developing information systems is considered to be the production of a series of documents. The information derived from the activities of the life cycle needs to be stored in a way that will facilitate the carrying out of subsequent activities. That is, information must be stored with a consistent, semantically rich, flexible, and efficient structure that will make it accessible for use by various tools employed in carrying out the development process. In this research, knowledge base management system (KBMS) to manage the information created by the information system development process was designed and implemented. Several contemporary popular knowledge representation schemes can be managed conveniently by this KBMS, which utilized efficient database techniques to facilitate fast retrieval and traversal of the underlying semantic inheritance net and frame knowledge structure. Inference and logic deduction capability was made a part of the static knowledge structure to further extend the functionality of the KBMS. Furthermore, a specially designed relational database management system was implemented and interfaced with the KBMS to alleviate the possibility of a storage saturation problem and to facilitate the storage of detailed exclusive information of terms defined in the knowledge base. Models that are applicable to various information system development activities were identified and stored in the knowledge base. The aggregation of those models is, in fact, a conceptual non-procedural language that provides a concise descriptive framework to help the user gather and manage information derived from various activities during the information system development process. The knowledge base, the language, and several knowledge-base related tools were used by more than seventy graduate students in a case study for a system analysis and design course. An information system methodology specifically tailored for this knowledge base supported environment was proposed and applied in a simplified case to illustrate the process of how a database-centered information system can be derived from the initial strategic planning phase. The methodology explored and made use of the storage structure of the closely coupled knowledge base and database. Finally, future research direction was identified.

Contexto: A morbimortalidade por causas externas constitui um dos mais graves problemas de saúde pública global. Dentre as estratégias preventivas primárias, a educação para a segurança é uma das áreas em que é mais nítida a influência das concepções das pessoas sobre as atitudes e determinantes de vulnerabilidades e resiliências. Especialistas da disciplina do controle de injúrias físicas, no âmbito da língua inglesa, hegemônica, advogam pela proscrição do termo acidente, pelo menos do léxico acadêmico, mas também evitando o seu emprego na promoção da saúde, por conta de um potencial efeito negativo de suas alegadas acepções pré-científicas de imprevenibilidade nas ações educativas. Essa questão, ainda polêmica entre os pesquisadores de língua inglesa, nunca foi estudada na língua portuguesa. Seu estudo tem grande relevância para a inserção da pesquisa brasileira nas iniciativas em andamento, no âmbito mundial, para a normalização terminológica nesse campo de conhecimento. Observa-se uma tendência crescente na utilização do termo injúria, nos textos acadêmicos originais em português, com definição equivalente à dos textos em inglês, fenômeno que merece um olhar mais atento. Objetivos: Promover a inserção da discussão terminológica no campo das ciências médicas, por meio do olhar crítico sobre o impacto da passagem de falantes do português por cursos de graduação selecionados sobre suas concepções dos vocábulos acidente e injúria, principalmente quanto à associação com noções de causalidade, intencionalidade, previsibilidade e prevenibilidade. Métodos: Estudo observacional, transversal, com coleta de informações quantitativas por meio de enquete autoadministrada realizada integralmente pela internet. A amostra alvo compreendeu estudantes de primeiro e último ano de medicina, direito, comunicação e educação de todas as escolas da cidade de Porto Alegre, Brasil. Desenvolvemos um aplicativo original, capaz de recrutar respondentes, enviar convites pessoais por e-mail, armazenar as respostas e exportar os dados. O software e os dados foram hospedados em um site específico do projeto, com acesso permanente pela internet. As variáveis preditoras foram os seguintes atributos dos sujeitos: idade, sexo, estágio do curso, curso, inclinação política, espiritualidade, arrojo, hábito de ler instruções sobre produto de limpeza, fonte de orientação sobre segurança, uso do cinto de segurança, uso de assento infantil de segurança, uso de capacete de ciclista, modo de armazenar arma de fogo, experiência com perda de ente querido por causas externas, experiência de hospitalização por causas externas e conhecimento de causas de morte de crianças e de adolescentes. As variáveis de desfecho foram as seguintes concepções dos sujeitos acerca dos termos acidente, injúria e lesão: tipo de dano; associações de ideias com as três palavras; noções de fatalidade, intencionalidade, previsibilidade e prevenibilidade associadas à palavra acidente; associação de traumatismo cranioencefálico com injúria, acidente ou lesão; grau de prevenibilidade atribuído a cada uma das três palavras e culpabilidade da vítima num caso definido de acidente com criança. Para investigar a associação entre atributos e concepções submetemos os dados à análise de correspondência simples e ao teste qui-quadrado com análise de resíduos. Resultados: A taxa de resposta à enquete foi de 34,5%. Metade dos sujeitos responderam até o segundo dia, 66,3% durante a primeira semana. 4,2% dos sujeitos se recusaram a revelar sua religião e 19,2% se recusaram a revelar sua inclinação política, enquanto apenas 2,8% se recusaram a responder questões sobre concepções e atitudes. Não houve diferença significativa entre os que responderam cedo ou tarde, quanto a atributos e concepções selecionados. Estudantes de medicina se distinguiram dos demais pelas associações com a arreligiosidade, com o conhecimento de que a mortalidade de crianças e jovens se dá principalmente por causas externas e com o hábito de buscar orientação sobre segurança em fontes especializadas. Os sujeitos revelaram percepção preponderante de que os chamados acidentes são preveníveis e tal percepção não mudou se a palavra usada na pergunta foi injúria ou lesão. A palavra acidente evocou noções de prevenibilidade em 85,1% dos sujeitos, previsibilidade em 50,3%, fatalidade em 15,1%, e intencionalidade em 2,3%. Religiosidade apresentou correspondência com noções de não previsibilidade e fatalidade atribuídas à palavra acidente. Calouros associaram a palavra acidente a noções de não previsibilidade, enquanto formandos foram significativamente distintos em considerar que acidentes podem ser previstos. Os sujeitos associaram injúria com dano moral, de modo quase unânime e, em menor grau, com noções de calúnia e difamação; uma porção limitada associou injúria com dano físico e ferimento. Associaram mais a palavra lesão com dano físico, mas também revelaram concepções igualitárias de dano físico, moral e material. Estudantes de cursos e estágios diferentes variaram significativamente em suas concepções de acidente e injúria. Estudantes de medicina se colocaram em franca oposição aos de todos os demais cursos no tangente à associação de injúria com danos físicos. Estudantes de direito associaram acidente com noções de negligência, dano moral e difamação. Estudantes de educação associaram acidente com noções de não prevenibilidade e fatalidade. Conclusões: A enquete online para investigar concepções de estudantes universitários acerca de injúrias físicas é factível e produz taxas de resposta similares às da literatura. Um período de acompanhamento superior a três semanas não é recomendável; limitar os esforços de recrutamento de respondentes a esse tempo restrito permite uma concentração mais racional de recursos. A enquete online é efetiva na abordagem de questões sensíveis, como atitudes em segurança, inclinação religiosa e política. A análise geométrica de dados é eficaz em evidenciar correspondências entre um grande número de modalidades de variáveis categóricas e denota de modo apropriado as suas associações estatisticamente significativas. A análise de resíduos ajustados mais ratifica do que enfraquece a análise geométrica. O currículo médico promove a terminologização da palavra injúria. Um modelo conceptual da injúria como entidade nosológica tem que respeitar o fato da terminologização da palavra injúria no âmbito médico, assim como conceder que a significação leiga da palavra acidente é um evento antecedente não intencional e prevenível, potencialmente gerador de injúria. No âmbito da linguagem médica, há uma definição de espaços semânticos específicos para os termos lesão (com acepção de dano anatomopatológico sem causação externa) e injúria (com acepção de dano físico, com ou sem lesão). Noções populares vinculadas à palavra acidente têm mais sutilezas do que sustentam os que propugnam pelo seu banimento do léxico acadêmico.
Background: Morbidity and mortality due to external causes constitute one of the most serious public health problems worldwide. Among primary preventive strategies, safety education is one of the areas in which people's conceptions are more likely to influence both attitudes and determinants of vulnerability and resilience. Injury control experts, within the hegemonic English language, advocate for proscribing the term accident at least from the academic vocabulary, but also for avoiding its use in health promotion, due to a potential deleterious effect of its alleged pre-scientific notion of nonpreventability upon educative actions. Such issue, which is an ongoing controversy among English speaking researchers, has never been studied within the Portuguese realm. Its study bears great relevance towards introducing Brazilian research into the current worldwide initiatives pursuing terminology normalization within this field of knowledge. There is a growing trend of original academic texts written in Portuguese to use the term injury with an equivalent meaning to that used in English; this phenomenon deserves a harder look. Objectives: To promote the introduction of terminology discussion in the field of medical sciences, by means of a critical gaze upon how the passage of Portuguese speakers through selected undergraduate university courses may have an impact on their conceptions of the words accident and injury, mainly as to associations with notions of causality, intent, foreseeability and preventability. Methods: A cross-sectional observational study, which collected quantitative information by means of a self-administered web-based questionnaire. The target sample comprised first-year and last-year students of medical, law, communication and education schools in Porto Alegre, Brazil. We devised an original software application, which was capable of organizing the recruited information concerning prospective respondents, sending out customized e-mail invitations, gathering and housing response data in an online database, and exporting data to statistical softwares. All softwares and data were hosted in a project specific site with continuous Internet access. Predictor variables were the following subjects' attributes: age, sex, course stage, political and religious persuasion, risk-taking proclivity, habit of reading cleaning products' package insert instructions, source of safety orientation, safety belt wearing habits, use of child safety seat, cycling helmet wearing habits, gun storing, personal (or close relation) injury history, and knowledge about child and adolescent causes of death. Outcome variables were the following conceptions of the terms accident, injury and lesion: type of damage; associations of some ideas with the three words; notions of fatality, intent, foreseeability and preventability associated with the word accident; association of head trauma with accident, injury and lesion; degree of preventability attributed to each of the three words; and victim culpability in a case of child accident. We investigated associations between attributes and conceptions by means of simple correspondence analysis and chi-square test with residual analysis. Results: The response rate was 34.5%. Half of the subjects responded by the second day, 66.3% during the first week. 4.2% subjects refused to disclose religious persuasion, and 19.2% refused to disclose political persuasion, whereas only 2.8%, on average, refused to answer questions on conceptions and attitudes. There was no significant difference between early and late respondents in respect to selected attributes and conceptions. Medical students were distinguished from the rest due to their associations with nonreligiosity, knowledge that most child and youth deaths have external causes, and searching safety orientation in specialized sources. Subjects showed preponderant perception that so-called accidents are preventable, and such perception did not change whether the question used the word injury or lesion. The word accident evoked the notion of preventability to 85.1% of the subjects, foreseeability to 50.3%, fatality to 15.1%, and intentionality to 2.3%. Religiosity showed correspondence with notions of nonprevisibility and fatality being attributed to the word accident. First-year students associated the word accident with notions of nonprevisibility, while last-year students were significantly distinct as they considered that accidents can be foreseen. Subjects unanimously associated injury with moral damage, and to a lesser degree with notions of calumny and defamation; a limited portion associated injury with physical damage and wound. They mainly associated the word lesion with physical damage, but also revealed equivalent conceptions of physical, moral, and material damage. Students from different courses and stages significantly varied in their conceptions of accident and injury. Medical students were in stark opposition to those from the other courses as to their association of injury with physical damage. Law students associated accident with notions of negligence, moral damage, and defamation. Education students associated accident with notions of nonpreventability and fatality. Conclusions: Web surveying university students' conceptions about injuries is feasible and yields response rates similar to those found in the literature. A follow-up period longer than three weeks is not warranted; restricting recruiting efforts to such period of time allows a more rational allocation of resources. A web survey is effective in tackling sensitive issues, such as safety attitudes, religious and political persuasion. Geometric data analysis is efficacious in evincing correspondences among a great number of categorical variable modalities, and appropriately denotes their statistically significant associations. The adjusted standardized residual analysis ratifies more than weakens the geometric analysis. Medical curriculum promotes the terminologization of the word injury. A conceptual framework of injury as a nosologic entity must acknowledge the fact of terminologization of the word injury in the medical realm, as well as concede the lay signification of the word accident as an anteceding, unintentional, and preventable event, which potentially causes injury. Within the realm of medical language, there is a definition of specific semantic spaces for the terms lesion (with the acception of anatomopathological damage without external causation) and injury (with the acception of physical damage, with or without lesion). Lay notions of the word accident carry more subtleties than those who advocate for banning it from the academic lexicon maintain.

Advanced information technologies promise a massive influx of individual-specific medical data. These rich sources offer great potential for an increased understanding of disease mechanisms and for providing evidence-based and personalized clinical decision support. However, the size, complexity, and biases of the data pose new challenges, which make it difficult to transform the data to useful and actionable knowledge using conventional statistical analysis. The so-called “Big Data” era has created an emerging and urgent need for scalable, computer-based data mining methods that can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. The goal of my Ph.D. research is to address some key challenges in current clinical deci-sion support, including (1) the lack of a flexible, evidence-based, and personalized data mining tool, (2) the need for interactive interfaces and visualization to deliver the decision support knowledge in an accurate and effective way, (3) the ability to generate temporal rules based on patient-centric chronological events, and (4) the need for quantitative and progressive clinical predictions to investigate the causality of targeted clinical outcomes. The problem statement of this dissertation is that the size, complexity, and biases of the current clinical data make it very difficult for current informatics technologies to extract individual-specific knowledge for clinical decision support. This dissertation addresses these challenges with four overall specific aims: Evidence-Based and Personalized Decision Support: To develop clinical decision support systems that can generate evidence-based rules based on personalized clinical conditions. The systems should also show flexibility by using data from different clinical settings. Interactive Knowledge Delivery: To develop an interactive graphical user interface that expedites the delivery of discovered decision support knowledge and to propose a new visualiza-tion technique to improve the accuracy and efficiency of knowledge search. Temporal Knowledge Discovery: To improve conventional rule mining techniques for the discovery of relationships among temporal clinical events and to use case-based reasoning to evaluate the quality of discovered rules. Clinical Casual Analysis: To expand temporal rules with casual and time-after-cause analyses to provide progressive clinical prognostications without prediction time constraints. The research of this dissertation was conducted with frequent collaboration with Children’s Healthcare of Atlanta, Emory Hospital, and Georgia Institute of Technology. It resulted in the development and adoption of concrete application deliverables in different medical settings, including: the neuroARM system in pediatric neuropsychology, the PHARM system in predictive health, and the icuARM, icuARM-II, and icuARM-KM systems in intensive care. The case studies for the evaluation of these systems and the discovered knowledge demonstrate the scope of this research and its potential for future evidence-based and personalized clinical decision support.

In Saudi Arabia, medical errors are at an alarming level. Lack of a Health Information Exchange (HIE) system is one the greatest reasons for medical errors in the Kingdom. Health care in many countries has evolved with the invention of electronic health information exchange system, henceforth HIE. This research paper purposes to implement HIE in Saudi Arabia, which entirely does not have a system of the sort. It is imperative instill HIE in the health care system in Saudi to allow physicians, nurses, health care facilities as well as patients to electronically share medical information in a safe and secure manner. Many countries such as United States, New Zealand and Germany have had great success with the HIE system and have reported vast benefits. Benefits of HIE are such as reduction of health care cost as well as decreasing medical errors. For Saudi Arabia to reach the same heights, many stakeholders will be involved in the triumph of the HIE system in the Kingdom of Saudi Arabia. The biggest contributor will be the Ministry of Health, which will be in charge of implementing as well as making the system mandatory in the main four hospitals in the country: Shomasy, Kind Saud University Hospital, Ministry of interior Hospital and Ministry of Defense Hospital. Each hospital having their own current medical information recording system, will now have one universal system that is made sure to be secure and safe for patients as well as other participating organizations who have access to the HIE system. The main concentration of the HIE system in Saudi Arabia will be in the emergency care of these four hospitals. It is crucial to have an organized and controlled way of recording as well as accessing patient medical records electronically, in a fast and effective way. This paper proposes that an HIE system in Saudi Arabia will reduce the cost of medical care and decrease medical errors. Through the use of Lean thinking and the use of quality tools, the HIE system will be able to change and increase the reliably as well as effectiveness of Urgent Care in the country and therefore have consequent benefits as well. Also, understanding who is going to play a great role in the triumph of the HIE system, such as the Ministry of Health and knowing what stakeholders will need to be affiliated and contribute will lead the project to a better success.

Mestrado em Engenharia de Computadores e Telemática
Os sistemas de informação na web assumem-se cada vez mais como um recurso indispensável para os que estudam as ciências biomédicas. Uma das áreas de estudo destas ciências incide na cavidade oral e nas proteínas que nela residem. Existem variadas plataformas online que permitem a pesquisa de dados específicos a microorganismos e a proteínas associadas, mas estes dados são genéricos e não são desenhados para casos de estudo específicos. Este trabalho tem como objectivo desenvolver uma estratégia e um protótipo para o armazenamento de informação relacionada com a cavidade oral, visando a sua utilização em investigação. Uma preocupação diferenciadora prende-se com o objectivo de integrar dados obtidos experimentalmente com referências existentes na web e estudadas por outras entidades. O protótipo desenvolvido permite aos investigadores na área das ciências biomédicas, sem conhecimentos específicos em bases de dados, pesquisar proteínas, doenças e genes, e integrar novos resultados de ensaios na base de dados existente.
Information systems on the web are becoming important resources for those studying biomedical sciences. One area of study of these sciences focuses on the oral cavity and on proteins that reside in it. Several online platforms provide specific knowledge on multiple microorganisms and associated proteins, but these are generic and are not designed for specific case studies. This work aims to develop a strategy and a prototype for the storage of information related to the oral cavity, aiming their use in research. It will integrate data collected from experimental results with existing references on the web and explored by other entities. The prototype allows researchers in the biomedical sciences, without particular expertise in databases, searching for proteins, genes and diseases, and integrating new test results in the existing database.

Bibliography: leaves 120-127.
The literature relating to women's health in Africa focuses on health information seeking needs. It rarely focuses on how women's health information needs link to the development of the continent. The dissertation examines the interrelationships between women's health information needs and development. The study sought to establish the significance of information to women's health and development. In order to validate this link the study employed three data collection techniques - documentary research, interviews and electronic mail questionnaires. In illustrating that there is a relationship between women's health and development, the study argues that women's empowerment can only be achieved where sufficient information is provided for women to make informed independent decisions concerning health issues that affect them. This relates especially to when to have children; how to protect themselves against AIDS, what the early warning signals of breast and cervical cancer are, and how best to look after their children and the community at large. The study further argues that these types of challenges can only be met with an efficient and effective health information service that is both gender sensitive and context specific to the African continent.

The Patient Protection and Affordable Care Act (PPACA) is slowly transforming the U.S. Health Care System from a fee-for-service structure, which reimburses providers based on the quantity of patient encounters, to a new structure that emphasizes the value of care. Since value can be interpreted differently among various stakeholders, quality measures have been established by government and nonprofit sources. These quality measures serve as agreed-upon criteria by which to measure the achievement of value in health care. While these measures help to improve the quality of health care, they can also be burdensome to physicians and health care organizations. Implementation of quality measurement programs requires the involvement of highly intelligent people who think about what to measure, what to focus on, and how to accomplish outcomes. Thus, the process of selecting measures and compiling recommendations (reports) can be time consuming, complicated, and expensive. Applying SELP coursework fundamentals, key process activities outlined by INCOSE, and the DoD Architectural Framework, a quality measure information system was developed. The primary business objective (top level requirement) of the project was to reduce the cost and improve the quality of the measure selection and report generation processes. First, fundamental systems engineering principles were applied to understand the problem, conduct a lean analysis, identify stakeholders' needs, and derive a set of requirements to meet the primary business objective. Subsequently, five alternative solutions were evaluated to identify a preferred solution that could best meet the primary business objective while minimizing risk. The DoD Architectural Framework and course material from Integration of Hybrid Hardware and Software Systems (SELP 560) was then applied to develop, represent, and understand the information system architecture. Finally, leveraging Management Information Systems Coursework (MBAA 609), a system prototype was created utilizing Microsoft Access. The system prototype demonstrated a capability to reduce the cost and improve the quality of the health care quality measure selection and report generation processes. Utilizing pre-selected associations between various quality measures and categories of care, comprehensive quality measure reports can be generated in a matter of seconds for many categories of medical care. These comprehensive reports serve to educate users about various quality measures and to aid administrators in the development of comprehensive quality measurement programs. In one particular example, health care organizations will utilize the generated quality measure reports for the purpose of redesigning compensation and incentive pay for physicians and health care executives. In this particular example, estimates show that the system prototype is expected to reduce the labor associated with measure research and selection by approximately 49%, resulting in thousands of dollars of estimated savings. Additionally, the system will automate complicated measure search processes, which will increase the quality and consistency of the reported data.

Public health decision making is critically dependant on accurate, timely and reliable information. There is a widespread belief that most of the national and sub-national health information systems fail in providing much needed information support for evidence based health planning and interventions. This situation is more acute in developing nations where resources are either stagnant or decreasing, coupled with the situations of demographic transition and double burden of diseases. Literature abounds with publications, which provide information on misguided health interventions in developing nations, leading to failure and waste of resources. Health information system failure is widely blamed for this situation. Nevertheless, there is a dearth of comprehensive evaluations of existing national or sub-national health information systems, especially in the region of South-East Asia. This study makes an attempt to bridge this knowledge gap by evaluating a regional health information system in Sri Lanka. It explores the strengths and weaknesses of the current health information system and related causative factors in a decentralised health system and then proposes strategic recommendations for reform measures. A mix methodological and phased approach was adopted to reach the objectives. An initial self administered questionnaire survey was conducted among health managers to study their perceptions in relation to the regional health information system and its management support. The survey findings were used to establish the presence of health information system failure in the region and also as a precursor to the more in-depth case study which was followed. The sources of data for the case study were literature review, document analysis and key stake holder interviews. Health information system resources, health indicators, data sources, data management, data quality, and information dissemination were the six major components investigated. The study findings reveal that accurate, timely and reliable health information is unavailable and therefore evidence based health planning is lacking in the studied health region. Strengths and weaknesses of the current health information system were identified and strategic recommendations were formulated accordingly. It is anticipated that this research will make a significant and multi-fold contribution for health information management in developing countries. First, it will attempt to bridge an existing knowledge gap by presenting the findings of a comprehensive case study to reveal the strengths and weaknesses of a decentralised health information system in a developing country. Second, it will enrich the literature by providing an assessment tool and a research method for the evaluation of regional health information systems. Third, it will make a rewarding practical contribution by presenting valuable guidelines for improving health information systems in regional Sri Lanka.

The focus of this study was to understand how health system employees define Data Governance (DG), how they perceive its importance and effectiveness to their role and how it may impact strategic outcomes of the organization. Having a better understanding of employee perceptions will help identify areas of education, process improvement and opportunities for more structured data governance within the healthcare industry. Additionally, understanding how employees associate each of these domains to strategic outcomes, will help inform decision-makers on how best to align the Data Governance strategy with that of the organization.

This research is intended to expand the data governance community’s knowledge about how health system employee demographics influence their perceptions of Data Governance. Very little academic research has been done to-date, which is unfortunate given the value of employee engagement to an organization’s culture juxtaposed to the intent of Data Governance to change that culture into one that fully realizes the value of its data and treats it as a corporate asset. This lack of understanding leads to two distinct problems: executive resistance toward starting a Data Governance Program due to the lack of association between organizational strategic outcomes and Data Governance, and employee, or cultural, resistance to the change Data Governance brings to employee roles and processes.

The dataset for this research was provided by a large mid-west health system’s Enterprise Data Governance Program and was collected internally through an electronic survey. A mixed methods approach was taken. The first analysis intended to see how employees varied in their understanding of the definition of data governance as represented by the Data Management Association’s DAMA Wheel. The last three research questions focused on determining which factors influence a health system employee’s perception of the importance, effectiveness, and impact Data Governance has on their role and on the organization.

Perceptions on the definition of Data Governance varied slightly for Gender, Management Role, IT Role, and Role Tenure, and the thematic analysis identified a lack of understanding of Data Governance by health system employees. Perceptions of Data Governance importance and effectiveness varied by participants’ gender, and organizational role as part of analytics, IT, and Management. In general, employees perceive a deficit of data governance to their role based on their perceptions of importance and effectiveness. Lastly, employee perceptions of the impact of Data Governance on strategic outcomes varied among participants by gender for Cost of Care and by Analytics Role for Quality of Analytics. For both Quality of Care and Patient Experience, perceptions did not vary.

Perceptions related to the impact of Data Governance on strategic outcomes found that Data Quality Management was most impactful to all four strategic outcomes included in the study: quality of care, cost of care, patient experience, and quality of analytics. Leveraging the results of this study to tailor communication, education and training, and roles and responsibilities required for a successful implementation of Data Governance in healthcare should be considered by DG practitioners and executive leadership implementing or evaluating a DG Program within a healthcare organization. Additionally, understanding employee perceptions of Data Governance and their impact to strategic outcomes will provide meaningful insight to executive leadership who have difficulty connecting the cost of Data Governance to the value realization, which is moving the organization closer to achieving the Triple Aim by benefiting from their data.