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.

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.

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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.

Magister Commercii (Information Management) - MCom(IM) / In the past, the Western Cape Department of Health had no formal or technologically enabled system for patient administration. This resulted in an administrative burden, increased waiting times for patients and doctors who needed results back from other sections, and missing patient files within the community health institutions such as clinics and hospitals. The Primary Healthcare Information System (PHCIS) was developed to solve this problem. However, it was later discovered that even though the PHCIS had been installed across the Western Cape clinics, there was a limited adoption and use of the PHCIS. Hence, the aim of this study was to investigate the factors that hinder the adoption and use of PHCIS by healthcare workers in the public healthcare clinics in the Khayelitsha sub-district in the Western Cape Province

Information Systems (IS) innovations in healthcare sector are seen as panacea to control burgeoning demand on healthcare resources and lack of streamlining in care delivery. Two particular manifestations of such innovations are telehealth and electronic records in its two forms: the electronic medical records and the electronic health records. Deployment efforts concerning both of these IS-innovations have encountered a rough terrain and have been slow. Problems are also faced while evaluating the effectiveness of innovations on health and care delivery outcomes through strategies such as randomised controlled trials- particularly in case of telehealth. By taking these issues into account, this research investigates the issues that affect IS innovation deployment and its evaluation. The strategy adopted in this research was informed by recursive philosophy and theoretical perspectives within IS that strived to expound this recursive relationship. It involved conducting two longitudinal case studies that are qualitative in nature. The first study involved telehealth deployment and its evaluation in the UK, while the second case study involved the deployment of electronic medical/health records in the US. Data was collected through focus group discussions, interviews and online discussion threads; and was analysed thematically. The results of this research indicate that there are nine issues that arise and affect the deployment and evaluation of IS innovation in healthcare; and these are design, efficiency and effectiveness, optimality and equity, legitimacy, acceptance, demand and efficacy, expertise, new interaction patterns, and trust. These issues are attributes of relationships between the IS innovation, context of healthcare and the user. The significance of these attributes varies during the deployment and evaluation process, and due to iterative nature of IS innovation. This research further indicates that all the attributes have either direct or indirect impact on work practices of the user.

Os processos de gestão do Sistema Único de Saúde (SUS) são apoiados por um conjunto de sistemas de informação de abrangência nacional, com funcionalidades para as áreas epidemiológicas, ambulatoriais, hospitalares e administrativas. Trabalhos na literatura descrevem pontos fracos nessas aplicações, tais como a falta de integração entre sistemas e bases de dados, fragmentação de informações, baixa cobertura, incertezas quanto à confiabilidade dos dados mantidos e deficiências no apoio ao gestor para planejamento e tomada de decisões. Nesse contexto, foi identificada uma lacuna para pesquisar e discutir qualidade e avaliação dessas aplicações. Este trabalho propõe um modelo para avaliação de características de qualidade de sistemas de informação em saúde que possa ser aplicado aos sistemas do SUS. É descrito o processo de pesquisa, análise e classificação dos indicadores de avaliação para o modelo. Os indicadores foram obtidos por meio de pesquisa em bases bibliográficas e classificados segundo os atributos de qualidade da norma ISO/IEC 25010, adotada como modelo de qualidade no estudo. Como resultado, 57 indicadores foram identificados e mapeados, abrangendo todas as características de qualidade do modelo. A avaliação dos indicadores foi instrumentalizada por meio do desenvolvimento de questionários e procedimentos de inspeção de software, orientados aos diversos stakeholders envolvidos: profissionais de saúde, gestores de saúde, profissionais de tecnologia da informação e usuários do sistema de saúde. A aplicabilidade do modelo proposto foi avaliada para o Sistema de Informações sobre Mortalidade (SIM). A factibilidade dos procedimentos de inspeção foram analisados pelos mantenedores da aplicação e o SIM foi avaliado em um processo que envolveu profissionais de saúde de 18 municípios paulistas e 10 gestores de saúde que atuam nos níveis locais, regionais e estadual. Este trabalho poderá contribuir como mais uma referência para estudos que envolvam processos de avaliação da qualidade de softwares em saúde e auxiliar na normatização de planos de avaliação e monitoramento de qualidade de sistemas e dados em saúde pública no Brasil e em projetos de melhoria de software. / The management processes of the Unified Health System (SUS) are supported by a set of information systems with national scope, having features for the epidemiological, ambulatory, hospital, and administrative areas. Papers in the literature describe weaknesses in these applications, such as the lack of integration between systems and databases, fragmentation of information, low coverage, uncertainties regarding the reliability of data held and weaknesses in supporting managers in planning and decision making. In this context, we identified a gap for quality research and discuss and review these applications.This work proposes a model for evaluating health information systems that may be applied to the systems of SUS. It describes the research, analysis, and classification process of evaluation indicators for the model. The indicators were obtained by search in bibliographic databases and they were classified according to the quality attributes of the standard ISO/IEC 25010, adopted as quality model in the study. As a result, 57 indicators were identified and mapped, covering all quality features of the model. The evaluation of the indicators was instrumentalized by developing questionnaires and inspection procedures of software, oriented to the various stakeholders involved: health professionals, health managers, information technology professionals and users of the health system. The applicability of the proposed model was evaluated for the Information System on Mortality (SIM). The feasibility of the inspection procedures were analyzed by the maintainers of the application and the SIM has been reported in a case involving health professionals from 18 cities and 10 health managers working in local, regional and state levels. This work will be able to contribute as a further reference for studies involving quality assessment processes for softwares in health and to assist in the standardization of plans for assessing and monitoring the quality of systems and data on public health in Brazil and in projects for improving softwares

Os processos de gestão do Sistema Único de Saúde (SUS) são apoiados por um conjunto de sistemas de informação de abrangência nacional, com funcionalidades para as áreas epidemiológicas, ambulatoriais, hospitalares e administrativas. Trabalhos na literatura descrevem pontos fracos nessas aplicações, tais como a falta de integração entre sistemas e bases de dados, fragmentação de informações, baixa cobertura, incertezas quanto à confiabilidade dos dados mantidos e deficiências no apoio ao gestor para planejamento e tomada de decisões. Nesse contexto, foi identificada uma lacuna para pesquisar e discutir qualidade e avaliação dessas aplicações. Este trabalho propõe um modelo para avaliação de características de qualidade de sistemas de informação em saúde que possa ser aplicado aos sistemas do SUS. É descrito o processo de pesquisa, análise e classificação dos indicadores de avaliação para o modelo. Os indicadores foram obtidos por meio de pesquisa em bases bibliográficas e classificados segundo os atributos de qualidade da norma ISO/IEC 25010, adotada como modelo de qualidade no estudo. Como resultado, 57 indicadores foram identificados e mapeados, abrangendo todas as características de qualidade do modelo. A avaliação dos indicadores foi instrumentalizada por meio do desenvolvimento de questionários e procedimentos de inspeção de software, orientados aos diversos stakeholders envolvidos: profissionais de saúde, gestores de saúde, profissionais de tecnologia da informação e usuários do sistema de saúde. A aplicabilidade do modelo proposto foi avaliada para o Sistema de Informações sobre Mortalidade (SIM). A factibilidade dos procedimentos de inspeção foram analisados pelos mantenedores da aplicação e o SIM foi avaliado em um processo que envolveu profissionais de saúde de 18 municípios paulistas e 10 gestores de saúde que atuam nos níveis locais, regionais e estadual. Este trabalho poderá contribuir como mais uma referência para estudos que envolvam processos de avaliação da qualidade de softwares em saúde e auxiliar na normatização de planos de avaliação e monitoramento de qualidade de sistemas e dados em saúde pública no Brasil e em projetos de melhoria de software. / The management processes of the Unified Health System (SUS) are supported by a set of information systems with national scope, having features for the epidemiological, ambulatory, hospital, and administrative areas. Papers in the literature describe weaknesses in these applications, such as the lack of integration between systems and databases, fragmentation of information, low coverage, uncertainties regarding the reliability of data held and weaknesses in supporting managers in planning and decision making. In this context, we identified a gap for quality research and discuss and review these applications.This work proposes a model for evaluating health information systems that may be applied to the systems of SUS. It describes the research, analysis, and classification process of evaluation indicators for the model. The indicators were obtained by search in bibliographic databases and they were classified according to the quality attributes of the standard ISO/IEC 25010, adopted as quality model in the study. As a result, 57 indicators were identified and mapped, covering all quality features of the model. The evaluation of the indicators was instrumentalized by developing questionnaires and inspection procedures of software, oriented to the various stakeholders involved: health professionals, health managers, information technology professionals and users of the health system. The applicability of the proposed model was evaluated for the Information System on Mortality (SIM). The feasibility of the inspection procedures were analyzed by the maintainers of the application and the SIM has been reported in a case involving health professionals from 18 cities and 10 health managers working in local, regional and state levels. This work will be able to contribute as a further reference for studies involving quality assessment processes for softwares in health and to assist in the standardization of plans for assessing and monitoring the quality of systems and data on public health in Brazil and in projects for improving softwares