ABSTRACT Due to the continuous variation of medical policies, the competition of healthcare services markets are even more drastic and face more challenges. Among them, the advantage in competition for each hospital and clinic is information service, as a result, the superintendent of information unit in hospitals must obtain not only knowledge about information specialty but also general disposition of healthcare system; the superintendent of routine interactions between authorized superior officials and the subordinates with academic technique, under the huge pressure of heavy responsibility with minor power, how can women leaders overcome obstacles and which kinds of career development philosophy they adopt to distinguish themselves and achieve success; in the other hand, they choose to be a housewife. This study mainly explores the reasons for their choice of either working or not working. The purpose of this study is revealing the insight of the pressures and the strategies of career development as a female supervisor in healthcare information unit. Research topics focus on the roleplay under the tradictional social expection, the pressures from both family and workplace, and the strategies of career planning. I employ the depth interview as the data collection method. The research results are summarized in three parts, they are: (1). In the concept of tradictional value: the tradictional value affects the attitude of the gender roleplay; the stablilty becomes the most critcal critera of career evaluation; the traditional gender roleplay affects the development of strategy of career development; (2). The adjustment between family and workplace pressur: the conflict is derived from the tradictional value; the lower the conflict the higher the accomplishment they achieve; (3). Strategies of career development: looking for the support from family; create the opportunity of competion advantage; self-promotion; receiving advice from friends and advisors. Keywords: Healthcare Information Unit, Female Information Supervisor

The overall aim of the research was to produce a validated framework for a Malaysian integrated and distributed telemedicine system. The framework was constructed so that it was capable of being useful in retrieving and storing a patient’s lifetime health record continuously and seamlessly during the downtime of the computer system and the unavailability of a landline telecommunication network. The research methodology suitable for this research was identified including the verification and validation strategies. A case study approach was selected for facilitating the processes and development of this research. The empirical data regarding the Malaysian health system and telemedicine context were gathered through a case study carried out at the Ministry of Health Malaysia (MOHM). The telemedicine approach in other countries was also analysed through a literature review and was compared and contrasted with that in the Malaysian context. A critical appraisal of the collated data resulted in the development of the proposed framework (MyTel) — a flexible telemedicine framework for the continuous upkeep of patients’ lifetime health records. Further data were collected through another case study (by way of a structured interview in the outpatient clinics/departments of MOHM) for developing and proposing a lifetime health record (LHR) dataset for supporting the implementation of the MyTel framework. The LHR dataset was developed after having conducted a critical analysis of the findings of the clinical consultation workflow and the usage of patients’ demographic and clinical records in the outpatient clinics. At the end of the analysis, the LHR components, LHR structures and LHR messages were created and proposed. A common LHR dataset may assist in making the proposed framework more flexible and interoperable. The first draft of the framework was validated in the three divisions of MOHM that were involved directly in the development of the National Health ICT project. The division includes the Telehealth Division, Public and Family Health Division and Planning and Development Division. The three divisions are directly involved in managing and developing the telehealth application, the teleprimary care application and the total hospital information system respectively. The feedback and responses from the validation process were analysed. The observations and suggestions made and experiences gained advocated that some modifications were essential for making the MyTel framework more functional, resulting in a revised/final framework. The proposed framework may assist in achieving continual access to a patient’s lifetime health record and for the provision of seamless and continuous care. The lifetime health record, which correlates each episode of care of an individual into a continuous health record, is the central key to delivery of the Malaysian integrated telehealth application. The important consideration, however, is that the lifetime health record should contain not only longitudinal health summary information but also the possibility of on-line retrieval of all of the patient’s health history whenever required, even during the computer system’s downtime and the unavailability of the landline telecommunication network.

Introducing an information system is an organizational learning process, during the process of development an information system , organizational members learn how to introduce information technology into an enterprise. While learning, however, most of individuals always act defensively without any awareness, when solving their problems. For the purpose of Organizational learning, these defensive behaviors will bring counterproductive or unintended consequences or limited learning, and result in the information system which cannot completely meet the business needs or cause project¡¦s schedule delay. In this research, we use the process research model methodology which developed by D. Robey and M. Newman in 1992 year and 1996 year, identify the 16 sequences event process in the case of healthcare information project of E hospital, and define them as either encounters or episodes. From the view of organizational defense, we analyze these events base on the theories of defense mechanism from Argyris and documents about organizational defense from information management. The analyzing results show that there indeed exist many defensive behaviors during the development of project of E hospital, and thus cause negative effect. This research offers these defensive phenomenon for the CIO and project managers to take precaution against same mistake while implementing information project, and help organizational members learning effectively while introducing an information system, in order to reduce risk of project failure and improve control of information project¡¦s cost, quality and schedule.

Healthcare information systems (HISs), as a class of systems, are not currently addressed in the MIS literature. This is in spite of a sharp increase in use over the past few years, and the uniquely qualified role that MIS has in the development of, impact and general understanding of HISs. In this project the design science paradigm frames the development of a set of design principles derived from the synthesis of the design literature, ethics literature, and professional guidelines, from both the medical and computing professions. The resulting principles are offered to address the design of healthcare information systems. Action research, a widely accepted methodology for testing design principles derived from the design science paradigm, is employed to test the HIS principles and to implement change in a healthcare organization through the use of an HIS. The action research project was a collaborative effort between a Central Florida hospice and the researcher, the result of which was an advanced directives decision support system. The system was design to meet a number of organizational goals that ranged from tracking compliance with federal regulations to increasing the autonomy of the patients that used the system. The result is a set of tested design principles and lessons learned from both anticipated and unanticipated consequences of the action research project.

No description available.

In this study, the continuous use of knowledge-based clinical decision support systems (KB-CDSS) is examined. KB-CDSS not only provides advice to clinicians, but also integrates guidelines with patient information and provides clinicians with tools that facilitate the application of guidelines in patient care. Studying KB-CDSS as a continuous application is important because continuity is a prerequisite to the success of KB-CDSS implementations and is considered as an important motivator for knowledge translation. Previous research in the area of health information systems (HIS) use has focused on the acceptance of these systems through the use of mostly information systems related constructs. Therefore, the theoretical models that explain the use of HIS have been limited and they obfuscated other phases of HIS such as continuous use. Moreover, extant research has not, to a large extent, considered the influence of KB-CDSS use on knowledge translation, the application of clinical guidelines in practice. This study seeks to fill these gaps in the literature by first integrating context-related factors with IS factors. This supports the study of antecedents of continuous use of KB-CDSS systems, exploring the relationship between continuous use and knowledge translation, and exploring changes in system dynamics (how usage patterns change with time). In order to achieve these research objectives, a literature review of healthcare and IS research was conducted, resulting in a comprehensive theoretical model that explains the antecedents of continuous use and its relationship to knowledge translation. To validate this model, data were collected from different sources, including: A questionnaire deployed to 118 physicians using the McMaster Pain Assistant KB-CDSS in three academic clinics in South Western Ontario, followed by five focus groups to further explain the context of using the systems and antecedents of its use, and the analysis of system use through data obtained from system logs and patient charts. The findings of this study show that: (i) Threats to physician professional identity surpasses intention to continue using KB-CDSS, thus influencing its use by physicians in the first six months; (ii) The relationships between factors influencing continuous system use change with time; (iii) System use has a strong relationship with knowledge translation after 6 months of use, but this relationship diminishes after 12 months of use; and (iv) How patients are affected by the system positively influences physician satisfaction with the system and hence their use of the system. This study helps in explaining the theory of physicians’ continuous use of KB-CDSS and how the antecedents of use change with time. Methodologically, this study has discovered several techniques that can be used to improve HIS research and physician acceptance of IS methods. Finally, in practice this study presents several suggestions for improving the development and deployment of KB-CDSS to enhance its use during the knowledge translation process. / Thesis / Doctor of Philosophy (PhD)

This research study explores how the nature and type of usability failures impact task performance in a healthcare organization. Healthcare organizations are composed of heterogeneous and disparate information systems intertwined with complex business processes that create many challenges for the users of the system. The manner in which Information Technology systems and products are implemented along with the overlapping intricate tasks the users have pose problems in the area of usability. Usability research primarily focuses on the user interface; therefore, designing a better interface often leaves security in question. When usability failures arise from the incongruence between healthcare task and the technology used in healthcare organizations, the security of information is jeopardized. Hence, the research problem is to understand the nature and types of usability-related security failures and how they can be reduced in a Healthcare Information System. This research used a positivist single case study design with embedded units, to understand the nature and type of usability-related information systems security failures in a Healthcare context. The nature and types of usability failures were identified following a four-step data analysis process that used terms that defined (1) user failures in a large healthcare organization, (2) Task Technology Fit theory, (3) the Confidentiality Integrity and Availability triad of information protection that captured usability-related information system security failures, and (4) by conducting semi-structured interviews with users of the Healthcare Information System capturing and recording their interactions with the usability failure. The captured reported usability-related information system security failures dated back five years within a healthcare organization consisting of a network of 128 medical centers. The evaluation of five years of data and over 8,000 problems reported by healthcare workers allowed this research to identify the misalignment of healthcare task to the technology used, and how the misalignment impacted both information security and user performance. The nature of usability failures were centered on technical controls, however, the cause of the failures was predominately information integrity failures and the unavailability of applications and systems. Usability-related information system security failures are primarily not recognized due to the nature of healthcare task along with the methods healthcare workers use to mitigate such failures by employing workarounds to complete a task. Applying non-technical security controls within the development process provides the clearest path to addressing throughout the organization the captured usability-related information system security failures.

Estudos relacionados ao aperfeiçoamento na gestão de saúde descrevem casos de sucesso com soluções utilizando a implementação de Data Warehouse (DW) como um recurso para facilitar e melhorar a qualidade dos dados para gestão na área de saúde pública. O Mapa de Saúde consiste na descrição da distribuição geográfica de recursos humanos, de ações e de serviços de saúde ofertados pelo SUS e pela iniciativa privada, considerando-se o desempenho aferido a partir dos indicadores de saúde do sistema. A gestão em saúde pública carece de recursos que auxiliem efetivamente os processos de análise e tomada de decisão. O objetivo deste trabalho é contribuir para sanar esta carência, a partir do desenvolvimento de um ferramental de apoio à decisão fundamentado em bases de dados de indicadores de saúde determinados pelo Mapa de Saúde. Este ferramental consiste no planejamento e na implementação de um ambiente de Data Warehousing para integração de bases de dados legadas, oriundas dos documentos gerados pelas Redes Regionais de Atenção à Saúde (RRAS) e coletadas pela Secretaria de Saúde do Estado de São Paulo, fornecendo aos usuários gestores os recursos necessários para a geração de consultas ad-hoc complexas com flexibilidade e rapidez sobre os dados contemplados pelo Mapa de Saúde. As fases do processo de desenvolvimento são sete, a saber: (1) Análise dos dados definidos pelo Mapa de Saúde e disponibilizados pelas fontes públicas; (2) Modelagem e implementação de um banco de dados integrador; (3) Modelagem dimensional e implementação do DW; (4) Criação do processo de extração, transformação e carga; (5) Geração dos metadados e configuração do servidor de análises; (6) Análises; (7) Testes. Como resultado, todas as fases de desenvolvimento do ambiente de Data Warehousing foram cumpridas, bem como o procedimento de avaliação junto aos gestores. De acordo com a avaliação, o sistema cumpre de forma satisfatória o seu objetivo de tomar o processo de gestão de saúde mais efetivo, flexível e produtivo. / Studies related to the enhancement on health management describe instances of success with solutions concerning the Data Warehouse (DW) implementation as a resource to facilitate and improve data quality for management on health public area. The Health Map consists of the geographical description of human resources, actions and services distribution of health offered by the Brazilian National Health System and by the private sector, taking into account the existent installed capacity, the investment, and the performance assessed from system\'s health indicators. The goal of this project is to develop a decision support toolset based on health indicators databases defined by the Health Map. This toolset consists of the planning and the Data Warehousing environrnent implementation for the integration of legacy databases, arising from documents generated by the Regional Health Care Networks and collected by the São Paulo State Health Department, hence providing for users a necessary suite of tools for complex ad-hoc queries generation with flexibility and celerity over the data contemplated by the Health Map. Development process steps are seven, namely: (1) Analysis of data defined by the Health Map and available by public sources; (2) Integrator Database modeling and implementation; (3) DW dimensional modeling; (4) Creation of the extraction, transformation and load process; (5) Metadata generation and analysis server configuration; (6) Analysis; (7) Tests. As a result, the Data Warehousing environment development process steps were completely fulfilled, as well as tests and evaluation steps along with the health managers.

A internet passa a ter uma grande importância na comunicação em odontologia e a qualidade da informação é um dos aspectos fundamentais para a sua correta utilização. O objetivo desse trabalho foi avaliar a qualidade da informação na Internet em websites de clínicas e consultórios odontológicos. O trabalho foi dividido em duas etapas. A primeira consistiu em realizar um estudo hermenêutico da legislação e documentos pertinentes. A segunda etapa teve por objetivo verificar a qualidade da informação disponível nos websites selecionados. Para realizar a análise hermenêutica foram elaboradas 39 (trinta e nove) questões com dúvidas sobre a divulgação de assuntos odontológicos. O questionário foi enviado ao Conselho Regional de Odontologia do Estado de São Paulo. Foi revisada a legislação pertinente sobre o assunto. Para avaliar a qualidade da informação foi realizado um estudo transversal. A População do estudo foi composta por 100 websites de clínicas e consultórios odontológicos da região da Grande São Paulo. Tomou-se por base os critérios estabelecidos pela Agency for Healthcare Research and Quality (AHRQ) em conjunto com o Health Information Technology Institute (HITI) e o Código de Ética Odontológica (2006), resultando em 25 (vinte e cinco) questões que avaliaram a qualidade da informação nos websites de clínicas e consultórios odontológicos. A qualidade da informação nos websites se mostrou regular, com 53,68% do total de pontos possíveis, apresentando baixa qualidade principalmente nos indicadores de atualização (ausência da data de atualização), hierarquia de evidência (ausência de referências bibliográficas), avisos institucionais (ausência de alertas sobre limitação da informação), perfil do site (ausência dos termos de sigilo e privacidade das informações), ausência de mecanismo de busca interno, ausência de fóruns de discussão e ausência do número de inscrição no Conselho dos profissionais mencionados, que contribuíram para a redução de credibilidade dos websites. Dessa forma, a avaliação indica que os websites de clínicas e consultórios precisam ser melhorados e que os órgãos competentes devem dar mais atenção para a qualidade da informação apresentados na Internet. Sugere-se para futuras pesquisas a avaliação da qualidade da informação a partir da importância dada por pacientes, cirurgiões-dentistas e desenvolvedores de websites com os critérios apresentados no trabalho. O objetivo é gerar uma contínua melhoria desse importante sistema de informação, contribuindo para o desenvolvimento do relacionamento entre pacientes e cirurgiões-dentistas. / Nowadays, the Internet has a great importance in communication in dentistry and quality of information is a fundamental for its correct use. The objective of this study was to evaluate the information quality on the Internet, in websites of clinics and dental offices. The work was divided into two stages. The first one was to perform a hermeneutic study of legislation and relevant documents. The second step was to verify the information quality available in selected websites. At the hermeneutic analysis, 39 (thirty nine) issues with questions were made based on the disclosure of dental subjects. The questionnaire was sent to the São Paulo Regional Council of Dentistry. It was reviewed the relevant legislation about the subject. To evaluate the information quality, a cross-sectional study was made. The study population consisted of 100 clinic websites and dental offices in the metropolis of São Paulo. It was based on the criteria established by the Agency for Healthcare Research and Quality (AHRQ) in with the Health Information Technology Institute (HITI) and the Code of Ethics in Dentistry (2006), resulting in 25 (twenty five) questions that evaluated quality of information on the websites of clinics and dental offices. The quality of information on websites showed regular, with 53,68% of the total possible points, with low quality indicators, especially in the update (no date of update), hierarchy of evidence (references absence), institutional warnings (alerts absence about limitation of information), the site profile (absence of the information confidentiality and privacy terms), no internal search engine, no discussion forums and absence of the registration number of the professionals mentioned in the Council, which contributed to the reduction of websites credibility. So, the evaluation indicates that the clinics websites and dental offices need to be improved and that the competent institutions should give more attention to the information quality presented on the Internet. It is suggested for future researches to evaluate the information quality from the importance given by patients, dentists and website developers with criteria presented into this study. Its objective is to improve continuously this important system of information, contributing with the development of the relationship between patients and dentists.

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