There is substantial evidence concerning the inability to achieve desired results and impact through what are commonly described as IS or IT projects, or implementation. The UK health sector provides a fertile ground for research, at a time of unprecedented investment, but with what is perceived to be a relatively poor record of achievement. Mental health services are held to be particularly problematic. This thesis explores the part played by technical, informational, organisational and human aspects, the relationship between these, and how in practice they are interpreted within what is defined as IS implementation. The aims were, a) definitional, concerning the specification of IS implementation, b) context appraising, to examine the impact of the host (mental health) context on both process and results, and through these c) problem solving, to propose an approach to IS implementation based on theory and practice. Drawing from interpretive theory, soft systems methodology and social cognitive theory an in-depth, longitudinal comparison study was performed, principally focussing on a single UK mental health Trust, and a directorate within that Trust. A multi-method approach included document review, questionnaire, structured and semi-structured interview, definitional exercises, focus groups, and action research. Findings concern the inability of organisations to manage the complexity of the process of implementation within challenging, multi-faceted contexts. To address the causes rather than symptoms of this difficulty it is necessary to re-interpret implementation itself, and its human element. A broad definition was proposed as a basis for an inclusive and balanced approach, and an Interface Management toolkit was produced. It is proposed that implementation should be considered and approached in practice as a dialectical situation, interpreting implementation as change within an organisation which encompasses technology. Alternative existing and proposed ideologies of change are suggested to frame a productive relationship between theory and practice.

Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 82-87).

Thesis (M.S.) University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file viewed on (June 26, 2007) Includes bibliographical references.

Thesis (M.S.P.H.)--University of Michigan, 1939.

Thesis (M.S.P.H.)--University of Michigan, 1939.

The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for action / an Information System that can be used to advocate and influence decisions and policies for the rights of these children / an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo / Ideal Speech Situation&rsquo / , informed the methodology chosen and were used to analyse the research undertaken. <br /> <br /> Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull / determination of the community&rsquo / s own indicators / &bull / changes in data collection forms / &bull / creation of forums for analysis and reflection, and / &bull / changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo / Critical Social Theory, to the empirical context of South Africa / addressing the gap of Community-Based Information Systems in Information System design / extending the debate on participation and communication in Information Systems to &rsquo / developing&rsquo / countries, and developing generalisations from a qualitative case study.

The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for action / an Information System that can be used to advocate and influence decisions and policies for the rights of these children / an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo / Ideal Speech Situation&rsquo / , informed the methodology chosen and were used to analyse the research undertaken. <br /> <br /> Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull / determination of the community&rsquo / s own indicators / &bull / changes in data collection forms / &bull / creation of forums for analysis and reflection, and / &bull / changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo / Critical Social Theory, to the empirical context of South Africa / addressing the gap of Community-Based Information Systems in Information System design / extending the debate on participation and communication in Information Systems to &rsquo / developing&rsquo / countries, and developing generalisations from a qualitative case study.

Made available in DSpace on 2015-05-14T12:36:38Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 4150986 bytes, checksum: 67f3a9455b63f5424ab2c9a531cf5090 (MD5) Previous issue date: 2012-05-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Several Governments and countries have shown great interest in defining public policies to reduce spending on health services. In this way, several researchers have sought to develop solutions that reduce such costs. Among these solutions are the remote monitoring systems of the State of health of critical patients, those suffering from heart disease, chronic diseases or elderly who need continuous care. These systems allow the identification of risk situations and the adoption of preventive procedures, reducing health spending. In addition, they allow an improvement in quality and lifetime of your users. Several approaches to the construction of these systems. Generally, they are divided into two main groups: the home care and the furniture. The approach used in this paper advocates the use of mobile monitoring systems can be more efficient, since the health monitoring will be carried out regardless of locale or patient drive. The work presented here makes use of pervasive devices for monitoring of the health status of patients with cardiovascular diseases, which are the biggest cause of death in the world. In this sense, this dissertation contributes with an application for use in mobile phones that act as an intelligent agent to the preventive monitoring of cardiovascular diseases, using a rules-based intelligence engine. This application, which has received the name of MonitorPrevIntel, based on the continuous reading of five physiological signals, detect abnormal situations of danger for the health of your server, and emits alarm procedures. To detect anomalous situations the application uses a mechanism fully embedded intelligence on the mobile phone, with custom knowledge base for each user. The alarms emitted by the system warn the user about the detection of abnormal situations and advise, via SMS messages, or trigger, via phone call, a medical center about this situation. The MonitorPrevIntel operation is controlled by your intelligence mechanism, based on the State of health of the user, allowing the same run autonomously, independently of the user activation. / Vários governos e países têm demonstrado bastante interesse em definir políticas públicas para reduzir os gastos com os serviços de saúde. Dessa maneira, diversos pesquisadores têm procurado desenvolver soluções que reduzam tais custos. Entre essas soluções, estão os sistemas de monitoramento remoto do estado de saúde de pacientes críticos, aqueles que sofrem de doenças cardíacas, doenças crônicas ou idosos que precisam de atendimento contínuo. Esses sistemas permitem a identificação de situações de risco e a adoção de procedimentos preventivos, o que reduz os gastos com saúde. Além disso, eles permitem uma melhoria na qualidade e no tempo de vida de seus usuários. Várias são as abordagens para construção desses sistemas. De maneira geral, elas se dividem em dois grandes grupos: os home care e os móveis. A abordagem utilizada nesse trabalho defende a utilização de sistemas de monitoramento móveis pode ser mais eficiente, uma vez que o acompanhamento da saúde será realizado independentemente da localidade ou da movimentação do paciente. O trabalho aqui apresentado faz uso de dispositivos pervasivos para monitoramento do estado de saúde de pacientes com doenças cardiovasculares, que são a maior causa de morte no mundo. Nesse sentido, esta dissertação contribui com um aplicativo para uso em telefones móveis que atue como um agente inteligente personalizado para o monitoramento preventivo de doenças cardiovasculares, utilizando um mecanismo de inteligência baseado em regras de produção. Esse aplicativo, que recebeu o nome de MonitorPrevIntel, com base na leitura contínua de cinco sinais fisiológicos, detecta situações anormais, de perigo para a saúde de seu usuário, e emite procedimentos de alarme. Para detectar as situações anômalas o aplicativo utiliza um mecanismo de inteligência totalmente embutido no telefone celular, com base de conhecimento personalizada para cada usuário. Os alarmes emitidos pelo sistema avisam ao usuário sobre a detecção de situações anormais de saúde e avisam, através de mensagens SMS, ou acionam, através de chamada telefônica, uma central médica sobre essa situação. O funcionamento do MonitorPrevIntel é controlado por seu mecanismo de inteligência, com base no estado de saúde do usuário, permitindo que o mesmo execute de maneira autônoma, independentemente da ativação pelo usuário.

Doctor of Philosophy (PhD) / This thesis describes a study of the utilisation of computers by individual general practitioners (GPs) in Australia, and compares the practice behaviour of GPs who use a computer as a clinical tool, either by prescribing, ordering tests, or storing patient data in an electronic medical record format, with those who do not use a computer for these functions. A survey of individual GP’s use of computers was conducted among 1,336 GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) program between October 2003 and March 2005. The GPs were then assigned to groups according to their clinical use (or not) of a computer, and were compared on a range of variables including the characteristics of the GPs themselves, their practices, their patients, the morbidity they managed for their patients, and the managements they provided. Their behaviour was also compared, using a set of quality indicators designed for use with the BEACH data, and applicable in a primary care setting, to determine whether the clinical use of a computer has an affect on the quality of care GPs provide to their patients. Finally, GPs who use clinical software with embedded pharmaceutical advertising were compared with GPs not exposed to advertisements via this media, to determine whether such advertising influences the prescribing behaviour of GPs to favour advertised brands. From 44 quality indicators examined, clinical computer users performed ‘better’ on four and ‘worse’ on four. For the remaining 36 they exhibited no difference. Exposure to pharmaceutical advertising embedded in clinical software did not influence the prescribing behaviour of the GPs so exposed. Despite the belief espoused in the literature that computer use will improve the quality of patient care, I have found no evidence to demonstrate that the use of a computer for clinical activity has (as yet) affected, either positively or negatively, the quality of care GPs provide to their patients. The current push to computerise general practice will mean that this method of assessment will be difficult to replicate in the future, given the absence of control groups. Other research methods will need to be developed.

Doctor of Philosophy (PhD) / This thesis describes a study of the utilisation of computers by individual general practitioners (GPs) in Australia, and compares the practice behaviour of GPs who use a computer as a clinical tool, either by prescribing, ordering tests, or storing patient data in an electronic medical record format, with those who do not use a computer for these functions. A survey of individual GP’s use of computers was conducted among 1,336 GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) program between October 2003 and March 2005. The GPs were then assigned to groups according to their clinical use (or not) of a computer, and were compared on a range of variables including the characteristics of the GPs themselves, their practices, their patients, the morbidity they managed for their patients, and the managements they provided. Their behaviour was also compared, using a set of quality indicators designed for use with the BEACH data, and applicable in a primary care setting, to determine whether the clinical use of a computer has an affect on the quality of care GPs provide to their patients. Finally, GPs who use clinical software with embedded pharmaceutical advertising were compared with GPs not exposed to advertisements via this media, to determine whether such advertising influences the prescribing behaviour of GPs to favour advertised brands. From 44 quality indicators examined, clinical computer users performed ‘better’ on four and ‘worse’ on four. For the remaining 36 they exhibited no difference. Exposure to pharmaceutical advertising embedded in clinical software did not influence the prescribing behaviour of the GPs so exposed. Despite the belief espoused in the literature that computer use will improve the quality of patient care, I have found no evidence to demonstrate that the use of a computer for clinical activity has (as yet) affected, either positively or negatively, the quality of care GPs provide to their patients. The current push to computerise general practice will mean that this method of assessment will be difficult to replicate in the future, given the absence of control groups. Other research methods will need to be developed.