The countries within the Caribbean region are pursuing the development of national integrated health information systems (iHIS). The model of the Belize Health Information System (BHIS) is referenced as the implementation guide. There are no established standards to facilitate independent evaluation of these types of systems. This study utilizes existing knowledge to determine the common approaches for evaluating health information systems (HIS) and applies these findings to formulate an evaluation approach for these regional systems. This approach is intended to strengthen the regional capacity for evaluating national iHISs by examining the contextual factors and providing an evaluation tool, CHEATS+, for systems lifecycle evaluation.

In the light of an ageing society with shrinking economic resources, deinstitutionalization of elderly care is a general trend. As a result, homecare is increasing, and increasingly shared between different health and social care organizations. To provide a holistic overview about the patient care process, i.e. to be patient-centred, shared homecare needs to be integrated. This requires improved support for information sharing and cooperation between different actors, such as care professionals, patients and their relatives. The research objectives of this thesis are therefore to study information and communication needs for patient-centered shared homecare, to explore how integrated information and communication technology (ICT) can support information sharing, and to analyze how current standards for continuity of care and semantic interoperability meet requirements of patient-centered shared homecare. An action research approach, characterized by an iterative cycle, an emphasis on change and close collaboration with practitioners, patients and their relatives, was used. Studying one specific homecare setting closely, intersection points between involved actors and specific needs for information sharing were identified and described as shared information objects. An integration architecture making shared information objects available through integration of existing systems was designed and implemented. Mobile virtual health record (VHR) applications thereby enable a seamless flow of information between involved actors. These applications were tested and validated in the OLD@HOME-project. Moreover, the underlying information model for a shared care plan was mapped against current standards. Some important discrepancies were identified between these results and current standards for continuity of care, stressing the importance of evaluating standardized models against requirements of evolving healthcare contexts. In conclusion, this thesis gives important insights into the needs and requirements of shared homecare, enabling a shift towards patient-centered homecare through mobile access to aggregated information from current feeder systems and documentation at the point of need.

<p>How can we develop usable and work process-oriented ICT systems for shared homecare?</p><p>Shared homecare involves different professionals, consists of mobile work and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process.</p><p>This thesis presents a new collaborative design method for user needs analysis and requirements specification in the context of health information systems development; the Multi-disciplinary Thematic Seminar (MdTS) method. The thesis also describes the MdTS method’s application and two different usability evaluations of the developed system.</p><p>The MdTS addresses a significant problem with health information technologies; they tend to support collaborative work of healthcare professionals poorly, sometimes leading to a fragmentation of workflow and disruption of healthcare processes. Based on human-computer interaction methods, MdTS implies a multiple-user needs analysis by thorough investigation of the entire interdisciplinary cooperative work and its transformation into technical specifications in order to develop appropriate information and communication technology (ICT) for the users’ differing work situations.</p><p>Application of the MdTS resulted in a prototype, the OLD@HOME Virtual Health Record (VHR), adapted to the specific demands in shared homecare. Through mobile devices each care professional accessed patient information in profession-specific views from an integrated platform.</p><p>This thesis provides an interesting case, illustrating how mobile ICT can support shared homecare, thereby bridging health and social care activities and improving knowledge about joint work processes.</p><p>Results from the usability evaluations were overall positive. Information needed at point of care was available on mobile devices and presented in an understandable manner. However, the evaluations also indicated that it is difficult to transfer results from one homecare setting to another due to differences in operational routines.</p><p>In conclusion, application of the MdTS method, in this study, succeeded in elicitation of correct user needs and in transferring correct requirements specifications to system developers for implementation.</p>

How can we develop usable and work process-oriented ICT systems for shared homecare? Shared homecare involves different professionals, consists of mobile work and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process. This thesis presents a new collaborative design method for user needs analysis and requirements specification in the context of health information systems development; the Multi-disciplinary Thematic Seminar (MdTS) method. The thesis also describes the MdTS method’s application and two different usability evaluations of the developed system. The MdTS addresses a significant problem with health information technologies; they tend to support collaborative work of healthcare professionals poorly, sometimes leading to a fragmentation of workflow and disruption of healthcare processes. Based on human-computer interaction methods, MdTS implies a multiple-user needs analysis by thorough investigation of the entire interdisciplinary cooperative work and its transformation into technical specifications in order to develop appropriate information and communication technology (ICT) for the users’ differing work situations. Application of the MdTS resulted in a prototype, the OLD@HOME Virtual Health Record (VHR), adapted to the specific demands in shared homecare. Through mobile devices each care professional accessed patient information in profession-specific views from an integrated platform. This thesis provides an interesting case, illustrating how mobile ICT can support shared homecare, thereby bridging health and social care activities and improving knowledge about joint work processes. Results from the usability evaluations were overall positive. Information needed at point of care was available on mobile devices and presented in an understandable manner. However, the evaluations also indicated that it is difficult to transfer results from one homecare setting to another due to differences in operational routines. In conclusion, application of the MdTS method, in this study, succeeded in elicitation of correct user needs and in transferring correct requirements specifications to system developers for implementation.