This work investigates the uses of the Internet and email in health care and specifically focuses on the use of these technologies in the management and support of patients following kidney transplantation. Health information websites are recognised to differ widely in quality and reliability of their content. This has led to the development of various codes of conduct and rating tools to assess the quality of health websites. However, the validity and reliability of these rating tools and their applicability to different health websites also varies. In principle, rating tools should be available to consumers, require a limited number of elements to be assessed, be assessable in all elements, be readable and be able to gauge the readability and consistency of information provided from a patient's view point. This study addresses the design and evaluation of a patient-centred transplant online service consisting of a website and e-mail communication. The website focuses on providing health education to patients so that they can conveniently obtain useful clinical information, as needed in home or workplace settings. The online service was assessed for its acceptability and usefulness from patient's perspectives and for its efficacy in reducing patient's needs to contact primary or secondary care services regarding day-to-day health issues. The online service was purpose built, informed by a framework developed during this study. The framework can be used by transplant clinicians to develop and maintain their websites. Work to inform the framework included an evaluation of the quality of information found in kidney and liver transplantation websites. This evaluation used both expert reviews, based on a weighted hformation Scoring (IS) system and involving clinicians in the assessment, and user evaluations where patient's Internet use, and their suggestions about, and interest in, transplant websites were elicited. The use of email in answering health related questions in the group of the patients who took part in the study was also evaluated. Whilst the hflernet has made it possible for patients and their families to access vast quantities of information that previously would have been difficult for anyone but a physician or librarian to obtain, an important finding of the research is the existence currently of many poor quality websites. The results indicate overall that readily accessible Internet websites for liver or kidney transplantation patients provide a large quantity of, but poor quality, material. Based on surveys of patients needs, the study reported in this thesis highlights the fact that transplant websites should include information about life style in addition to purely medical-related topics. Incorporation of web tools, like email, is shown to effectively help solve many of the daily health problems of patients with organ transplantation. The transplant online service developed as a part of this study showed high levels of patient acceptability and effectively helped reduce the need for patients to access primary or secondary care. The results of this research support the potential of online services as an innovative approach for patient-centred care in organ transplantation.

This research builds upon a body of work on the development and introduction of information systems in the UK National Health Service following the implementation of the White Paper 'Working for Patients'. None of the earlier studies examined the use of the information from those systems for costing health care services, the methodologies used by hospitals for costing their products or the comparability of the output from the costing methodologies used, thereby making this study different from prior work. Costing methodologies cited in the literature are described from the perspective of single organisations. This research analyses the development of an aggregated costing approach, focusing on the issues laced when trying to develop a costing methodology that will be applied to a group of autonomous organisations. The research provides a comparison of health care costing methodologies in both the United Kiiigdom and Ontario, Canada. Collected through interviews and a postal survey tool, data from NHS hospital care providers are analysed to identify both the conformity of the approach and the results of the costing methodologies eniployed. Information from an extended field study is used to review the development of a micro-costing framework in Ontario for radiation therapy services. These findings are then synthesised into a generic framework applicable within other health care organisations seeking to implement a comparative costing methodology. This lramcwork is used to identify possible causes of variance in health care costing approaches. Elements of the framework requiring modification to account for local conditions, such as salary rates or provider availability, are identified and suggestions are made for further work resulting from this research to increase understanding about variability in health care costing methodologies and test the implementation of the generic costing methodology.

This research builds upon a body of previous research on health informatics in developing countries. Early research on this area was motivated by a desire to understand the role of different health informatics applications for an effective and efficient health care delivery in developing countries. These applications range from the use of medical expert systems for clinical diagnosis to epidemiological systems at the central level. None of these looked at health information systems at the district level, especially in relation to the information needs of district health staff. Therefore, this research differs from earlier studies in three aspects. First, it looks at the planning and decision-making processes at the district level and how information support could play a crucial role in these processes. Second, it provides a critical evaluation of the existing vertical reporting systems, and through action-research demonstrates the use of an integrated health information system at the district level. Third, it applies multiple perspectives to analyse the research findings in relation to information support for district health care planning and decision making. These three perspectives are the functional perspective, organisational perspective, and the political perspective. To achieve this, the research: • uses a systemic approach to examine the health care system in The Gambia; • uses action-research to design, develop and implement an integrated district health information system in The Gambia; • uses an interpretive evaluation framework to evaluate the impact of the system development efforts in this research; • uses the theory of contextualism to reflect on the research findings over the three year period. Various themes emerged during the research. These themes would be introduced here as the contributions to knowledge arising from the completion of this research project. These include: • a demonstration of the suitability of using a systemic approach for the design, development and implementation of an integrated information system for district health care planning and decision making; • the development of a conceptual implementation framework suitable for the unique characteristics of developing countries; • a manifestation of the implications of an integrated information system for management development, decentralisation, intersectoral coordination and community participation at the district level; • suggestions for further work especially on the need to evaluate the socio-political impact of this research on the existing political and cultural structures in The Gambia.