Magister Commercii (Information Management) - MCom(IM) / Health information systems (HIS) have much to offer in managing healthcare costs and in improving the quality of care for patients. However, the adoption of HIS can cause problems to health professionals in terms of efficiency as well as to the entire health organization in terms of acceptability and adaptability. The development of a national Information and Communication Technology (ICT) policy in Zambia was initiated in 2001 through an extensive consultation process which involved academics and civil society organizations. The aim of using ICT is to improve the quality of health service delivery at local levels. Maramba and Mahatma Gandhi Clinics are the largest primary health care (PHC) clinics in Livingstone and have been prioritized for the implementation of an electronic medical record (EMR) system. The current study explored health care workers' perceptions and experiences of the use of ICTbased EMR and factors that could determine acceptability of EMR at Maramba and Mahatma Gandhi clinics to feed into future program improvement.

The aim was to explore experiences and needs of information following a prenatal diagnosis of congenital heart defect, and to assess the quality of publicly available information websites about congenital heart defects. Study I was a qualitative interview study that explored experiences among 11 parents to prenatally diagnosed children. Respondents tried to grasp the facts today while reflecting on the future, and personal contact with medical specialists was valued. The analysis showed that the Web contained an overwhelming amount of information. Study II was a qualitative interview study that explored experiences among 26 females and males 5-15 weeks after a prenatal diagnosis. Respondents hunted for information in a confusing reality, with a need for information about various topics and methods for information delivery. Although high satisfaction with the specialist information was described, the information was considered overwhelming and complex. Supplemental information was sought via the Web. Insufficient information about induced abortions was described. Study III was a quantitative study that explored content and quality of 67 English websites about congenital heart defects. Few websites included information about prenatal aspects, such as pregnancy termination. The overall quality was poor, especially reliability and information about treatment choices. Study IV was a mixed methods study that explored the quality of 10 Swedish websites about congenital heart defects, from the perspectives of 9 assessors with personal experience of a prenatal diagnosis. Quantitative Likert scale assessments were followed by written open-ended questions and focus group discussions. Quantitative assessments represented unfulfilled quality criterion for treatment choices, and partially fulfilled quality criteria for appearance, details, relevance, suitability and overall quality. Websites had significantly different scores for all investigated quality criteria. Various issues were highlighted in the responses to the open-ended questions and during the discussions, including inappropriate advertisements, biased information, poor illustrations, complex language and poor trustworthiness. In conclusion, expectant parents faced with a prenatal diagnosis of congenital heart defect in the fetus try to grasp the unexpected, an attempt that involves difficulties in relation to information. These are present during the consultation with health professionals and when searching for web-based information.

This study attempts to answer the research question ‘Can a novel model of health information system strengthen process for conducting research to understand the effects of air pollution on CVD in developing countries?’ There is limited research output from Asia and in particular, from India on studies of the deleterious effects of air pollution on CVD. This research aimed to investigate the barriers in developing countries and proposed the use of a spatiotemporal methodology to assess the effects of air pollution on CVD by developing an application based on a GIS platform. Choosing Bangalore as a case study area, secondary data from various governmental departments that included demographic data, air pollution data and mortality data were obtained. An Environmental Health Information system application based on GIS platform was developed specifically for Bangalore and with the characteristics of the datasets available. Data quality assessment was carried out on these datasets that resulted in the recommendation of a generalisable data quality framework to enable better data collection that will aid in strengthening health development policies. The data was analysed using spatial and non-spatial techniques. Results showed that levels of PM10 were of concern to the city with all areas having either high or critical levels of pollution. CVD deaths also were of concern contributing to almost 40% of total mortality. The potential years of life lost (PYLL), which is an estimate of the average years a person would have lived if he or she had not died prematurely was calculated for the years from 2010 to 2013; this revealed that 2.1 million person years were lost in Bangalore due to CVD alone. These potential years lost is an important factor to consider, as preventive measures taken by the Government will result in a significant economic impact on the city. The limitations of few monitoring stations were overcome by using spatial interpolation techniques such as Inverse Distance Weighted interpolation technique. The performance of the interpolation was tested using cross-validation techniques and the results revealed that Bangalore city would benefit from increased measuring stations for PM10. The logistic regression conducted showed that pollution especially PM10 was a likely predictor of CVD in the city. Spatial analysis was conducted and included buffering, overlay maps, queries and Hotspot analysis highlighting the zone hotspots. The results from the research guided the development of the novel 5-I model that would assist other similar developing cities to assess the effects of air pollution on CVD. The impetus is that based on evidence, intervention policies and programs may be implemented to inform research and practice which will ultimately have social, economic and health impact on the population. On implementation of the model, hotspots will be identified in order to roll out interventions to priority areas and populations most at risk that will ultimately prevent millions of deaths and enhance overall quality of life.

Class of 2014 Abstract / Specific Aims: Assess the change in efficiency and accuracy of healthcare in provider access to HIE for medication profiles at the PCADC. Methods: Adults detainees admitted from October 22, 2012 to July 31, 2013 were enrolled in this study. A completed Intake Medical Screening form with self-reported/correction facility staff verified medication list will (the old method) be compared to the medication list obtained by querying the medication HIE (the new method). Descriptive statistics will describe the patients. Statistical significance will be calculated using the McNemar chi-square test for comparing the proportions of omissions (medications and strengths) on the 765PI to the HIE with an a priori alpha of 0.05. Main Results: In progress. Conclusion: HIE has the potential to be a valuable tool for healthcare providers operating at an adult detention facility.

Class of 2016 Abstract and Report / Objectives: To evaluate the successes and failures of the recent implementation of the Arizona Health-e Connection (AzHeC) health information exchange (HIE) at the Pima County Adult Detention Center (PCADC); to identify a generalized infrastructure and draft recommendations for implementing HIE at other correctional facilities. Methods: Participants pertinent to the implementation by current staff at the PCADC were identified through snowball sampling. Interviews were conducted in-person or by telephone using a semi-structured interview guide. Demographics regarding roles and responsibilities during implementation were collected during each interview. Participants were asked for input regarding key aspects and lessons learned from the implementation. Interviews were audio-recorded, transcribed verbatim, and then analyzed with Atlas.ti software for common themes. Results: A total of 12 individuals were interviewed, providing a comprehensive set of perspectives. Six common themes were identified: impact of being a novel implementer; challenges surrounding implementation; problems during implementation; what was done well; benefits of the system; and communication during implementation. Potential barriers that were successfully anticipated were establishing the value of the HIE through pilot studies to obtain early stakeholder buy-in, and addressing legal/privacy issues for the at-risk population in the corrections system. Problems that arose during implementation often involved information technology issues. Conclusions: Despite challenges faced throughout the HIE implementation, improvements in patient care, workflow, and time-savings made a tremendous impact for those involved. The lessons learned and advice given by the participants of this study can provide guidance for other correctional health systems wishing to implement a HIE at their facility.

Magister Public Health - MPH / Background: The factors that underlie teenage pregnancies are complex and multifactorial. The prevailing perception is that teenage pregnancies are increasing in South Africa. However, the empirical extent and trends in teenage births in the Western Cape Province are not well understood. A systematic analysis of routine health information for the data element.Delivery in facility to women under 18 years for the period 1 April 2000 to 31 March 2012 is presented in order to contribute to documenting and understanding how this problem manifests in the Western Cape Province.Objectives:The objectives of the study were to describe the trends in the number of deliveries for women under the age of 18 years in the Western Cape Province for the period 1 April 2000 until 31 March 2012, and to compare the trends within and between districts. A secondary aim was to explore the quality and usefulness of Routine Health Information in the Western Cape Province focusing on the dataset for deliveries for women under the age of 18 years.Methods:The data for the Province extracted from the Sinjani system (the data repository for health information management in the Western Cape Department of Health) was subjected to a trend analysis at the Provincial, District and Sub-District level. The absolute numbers of all deliveries, and deliveries for women under the age of 18 years as well as proportions of deliveries for women under the age of 18 years were compared across districts, years and seasons. Results were discussed with senior managers in the Department of Health as compared to performance indicators presented in workshop settings to triangulate and help interpret findings.Findings The key finding is that both the absolute number of deliveries for women under the age of 18 years and the deliveries for women under the age of 18 years relative to all deliveries have declined steadily since 2007, while 8 absolute numbers of deliveries in 2012 were only slightly higher than in 2000-2001, despite an increase of 19.4% in the total population of the Province between 2002 and 2011. Despite the decline in the number of deliveries for women under the age of 18 years, the number of deliveries remains high. Seasonal increases in numbers of deliveries coincide with school holidays in most districts. The data analysis also revealed challenges with the quality of the data, and that it is not possible to determine the age distribution of deliveries across women under 18 years from the provincial data set. Routinely collected data do not permit analysis or comparison of births at the ward level where significant socio-economic variations are likely to influence fertility.Conclusions and Recommendations:The data did not support widespread perceptions of rapidly increasing teen births. The declining birth rates and relatively stable proportion of under 18 births relative to all births suggest that adding new indicators throughout the entire routine information system is not justified on public health or economic grounds. However, more detailed and disaggregated evidence is needed to inform locally tailored interventions and could be obtained from alternate sources of information such as point prevalence surveys, annual surveys, or data collection at sentinel sites. While teenage birth rates are not increasing, they remain high. It is recommended that additional service delivery models be explored to ensure that sexual reproductive health services are strengthened and delivered in a manner that would be acceptable to young people. Further, it is recommended that programmatic interventions that target the sexual reproductive health choices made by young people be scaled up in partnership with intersectoral partners and communities in order to mitigate against seasonal increases in the number of deliveries for women under 18 years of age.

Philosophiae Doctor - PhD / A phenomenological philosophy underlies this research study which attempts to understand clinicians’ perception and understanding of an electronic patient record (EPR) system currently operational at a hospital in the Western Cape Province in South Africa (SA). Healthcare is a human right, thus patient records contain critical data and mostly paper-based in many SA hospitals. Clinicians are the EPR primary users and their attitude in its use is important for its success. This study explores, identifies and determines clinicians’ cognitive attributes towards EPR with a technology use framework developed. An initial quantitative approach was applied but unsuccessful due to low sample size. A pilot study was then conducted using 11 respondents. Purposive sampling was first initiated then snowball introduced later to improve the sample size qualitatively. Interviews were administered to 15 clinicians and tape recorded. Narrative content analysis was used as the preferred analysis technique because of the advantage of gaining direct information from study participants, unobtrusive and a nonreactive way to study the phenomenon of interest. Research findings tested 12 propositions and found high impact relationships between attitude (ATT) and each listed theme namely: perceived usefulness (PU), perceived ease of use (PEOU), complexity (COM), facilitating condition (FC), use behaviour (USE). Use behaviour had high impact relationships with storage (STO) and retrieval (RET). There were moderate impact relationships between PU and USE; PEOU and PU; RA and ATT; job fit (JF) and ATT; USE and share (SHA). The implication here is that any EPR system to be implemented should be tested using this framework to ascertain its usefulness and fit with a hospital's objectives and users expectations. By so doing, anticipated problems can be mitigated against and resolved before implementation. The study contributes to the information system (IS) body of knowledge through the technology use framework. The framework is for adoption by hospital management and its use by clinicians where EPR is operational. Traditional IS frameworks can be adopted for hospitals about to implement EPR because of the relevance of the "intent to use" theme.

Appropriate e-services as well as revenue generation capabilities are key to the deployment and the sustainability for ICT installations in poor areas, particularly common in developing country. The area of e-Health is a promising area for e-services that are both important to the population in those areas and potentially of direct interest to National Health Organizations, which already spend money for Health campaigns there. This thesis focuses on the design, implementation, and full functional testing of HealthAware, an application that allows health organization to set up targeted awareness campaigns for poor areas. Requirements for such application are very specific, starting from the fact that the preparation of the campaign and its execution/consumption happen in two different environments from a technological and social point of view. Part of the research work done for this thesis was to make the above requirements explicit and then use them in the design. This phase of the research was facilitated by the fact that the thesis' work was executed within the context of the Siyakhula Living Lab (SLL; www.siyakhulaLL.org), which has accumulated multi-year experience of ICT deployment in such areas. As a result of the found requirements, HealthAware comprises two components, which are web-based, Java applications that run in a peer-to-peer fashion. The first component, the Dashboard, is used to create, manage, and publish information for conducting awareness campaigns or surveys. The second component, HealthMessenger, facilitates users' access to the campaigns or surveys that were created using the Dashboard. The HealthMessenger was designed to be hosted on TeleWeaver while the Dashboard is hosted independently of TeleWeaver and simply communicates with the HealthMessenger through webservices. TeleWeaver is an application integration platform developed within the SLL to host software applications for poor areas. Using a core service of TeleWeaver, the profile service, where all the users' defining elements are contained, campaigns and surveys can be easily and effectively targeted, for example to match specific demographics or geographic locations. Revenue generation is attained via the logging of the interactions of the target users in the communities with the applications in TeleWeaver, from which billing data is generated according to the specific contractual agreements with the National Health Organization. From a general point of view, HealthAware contributes to the concrete realizations of a bidirectional access channel between Health Organizations and users in poor communities, which not only allows the communication of appropriate content in both directions, but get 'monetized' and in so doing becomes a revenue generator.

The Kimball methodology, often referred to as dimensional modelling, is well established in data warehousing and business intelligence as a highly successful means for turning data into information. Yet weaknesses exist in the Kimball approach that make it difficult to rapidly extend or interrelate dimensional models in complex business areas such as Health Care. This Thesis looks at the development of a methodology that will provide for the rapid extension and interrelation of Kimball dimensional models. This is achieved through the use of techniques similar to those employed in the semantic web. These techniques allow for rapid analysis and insight into highly variable data which previously was difficult to achieve. / Graduate

The fragmented nature of modern health care provision makes it increasingly difficult to achieve continuity of care. This is equally true in the context of the South African healthcare landscape. This results in a strong emphasis on the informational dimension of continuity of care which highlights the importance of the continuity of medical records. Paper-based methods of record keeping are inadequate to support informational continuity of care which leads to an increased interest in electronic methods of record keeping through the adoption of various Health Information Technologies (HITs). This research project investigates the role that various HITs such as Personal Health Records (PHRs), Electronic Medical Records (EMRs), and Health Information Exchanges (HIEs) can play in improving informational continuity of care resulting in the development of a standards-based technological model for the South African healthcare sector. This technological model employs appropriate HITs to address the problem of informational continuity of care in the South African healthcare landscape The benefits that are possible through the adoption of the proposed technological model can only be realized if the proposed HITs are used in a meaningful manner once adopted and implemented. The Delphi method is employed to identify factors that need to be addressed to encourage the adoption and meaningful use of such HITs in the South African healthcare landscape. Lastly, guidelines are formulated to encourage the adoption and meaningful use of HITs in the South African healthcare landscape to improve the continuity of care. The guidelines address both the technological requirements on a high level, as well as the factors that need to be addressed to encourage the adoption and meaningful use of the technological components suggested. These guidelines will play a significant role in raising awareness of the factors that need to be addressed to create an environment conducive to the adoption and meaningful use of appropriate HITs in order to improve the continuity of care in the South African healthcare landscape.