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Health Informatics

Health Informatics by Sarmad Alshawi
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Computer based information systems represent an ever-growing component within healthcare organisations. There is now more than ever a high demand to develop effective systems that will manage healthcare information. Parallel to that there is even greater need to develop more reliable and efficient ways to use information to assist in making viable decisions. The adoption of computer based information systems – largely termed health informatics – offers many healthcare organisations potential abilities to cope with the overwhelming demand for healthcare services and deals with a number of strategic and tactical issues. Health informatics is increasingly employed in a wide variety of forms, such as supporting managerial decision making, monitoring patients’ progress through the system, and enhancing clinical practice. The debate around health informatics is how to use reliable information systems to manage healthcare systems and in establishing how to use efficient systems to manage healthcare information. The introduction and use of technologies may, however, have its drawbacks, such as the debate surrounding ethical issues and the costs of re-engineering, together with a general lack of understanding of the impact of using technology as decision aids. Political and cultural issues may also be affected by the use of technology.

This special issue is intended to stimulate this debate within the healthcare management arena. Logistics Information Management was identified as an appropriate platform to launch such a debate and generate meaningful conclusions. Logistics Information Management covers a wide audience ranging from academics to industrial managers, all of who would benefit from – and could contribute to – this debate. This double issue explores the current state-of-the-art applications of health informatics by highlighting potential benefits of its application but also by stressing the importance of appropriate – rather than bandwagon – implementation. The special issue attracted 30 submissions, resulting in 11 papers being finally selected following a rigorous reviewing process. The articles included in this issue represent international experiences and give, a flavour of the current research issues in the public sector and academe. The Guest Editors of this special issue are more than willing to collaborate further with anyone who might be interested in carrying out further research. Summaries of the articles in the special issue now follow, along with some editorial views on potential debating issues.

Pemberton et al. draw upon previous research to chart the technological developments that have taken place within primary health care during the last 20 years. Their survey reveals that 96 per cent of UK practices use a clinical computer system, with repeat and acute prescribing, the collation of annual data and audits/searches being the most well used applications. The authors discuss how improvement of computing skills appears to be a major determinant of successful integration of technology within a medical practice. They argue that there is a need to develop a social architecture and learning environment that allows GPs to provide good quality health care with clinical computer systems.

Pelletier and Weil study regional health care planning deals with the regional healthcare resource location-allocation, posed to each public healthcare administration, and argue that currently the models designed to support this kind of decision fail in their application. The article produces a set of attributes meeting each dimension underlying the choice of the regional healthcare plan. More precisely, by using Keeney’s method, the authors propose a formulation in simpler terms of the overall objective of the regional health facility systems planning. Pain et al. discuss the problem of adverse drug events and medication errors that can occur because of decisions made during prescribing. The authors examine the perceptions of doctors regarding adverse drug events/reactions and their views on how they may or may not be avoided with the use of a clinical decision support system (CDSS) in a prescribing environment. The article concludes that doctors welcomed the use of a CDSS for prescribing and stated three critical factors for their use of such a system – time constraints, limited knowledge and misreading.

Ambrose et al. use medical genetics as the research context to examine how Internet technologies are useful in managing thin (amount of knowledge is low) and thinly distributed (density of expertise is low) medical knowledge. The article specifically focuses on highlighting the usefulness of the Internet in managing such knowledge and draws attention to the need to examine the semiotic process management while designing Internet-enabled solutions for managing thin and thinly distributed knowledge. Khalfan and Alshawaf discuss the concept of IS/IT outsourcing in the context of health care, and present an overview of a case study exploring the IS/IT outsourcing phenomenon in the public sector of Kuwait. The article seeks to develop a conceptual contingency model for the successful implementation of IS/IT outsourcing arrangements in the context of Kuwait. The presented model addresses many interacting variables, from national culture and social factors through to contractual issues, and argues that it is necessary to take account of all these variables to ensure successful implementation of IS/IT outsourcing arrangements.

Akber and Gough highlight the problems that still prevail in the telecommunications sector of the healthcare industry, and emphasise the need for an effective solution in this rapidly evolving technological environment. The authors define the problem within healthcare delivery worldwide and theoretically explore a typical medical scenario in Kuwait, utilising the grounded theory method. The article also describes the pay-per-use concept, and discusses the appropriateness of such a concept for the healthcare industry, and proposes a conceptual framework that is characterised by being platform and application independent for healthcare delivery. Shapiro and Shapiro discuss how in the past operational researchers used their expertise in dealing with the problems of ‘‘multi-organisations’’ to influence government policy concerning the National Health Service (NHS), itself a ‘‘multiorganisation’’. They argue that effective management of a shared system requires the commitment of all stakeholders to an agreed agenda, and that recent organisational changes and liberalised funding schemes frustrate the co-operative efforts of those working to provide good healthcare. The authors consider this work as a prompt for effective policy structures that allow informed collaboration of all NHS stakeholders. Klischewski and Wetzel discuss how exploding expenditure has led to new reimbursement regulations forcing healthcare providers to conduct their organisations as business concerns. In order to be competitive, providers have started to build networks that allow the delivery of interrelated health services in a well-adjusted and uniform manner. They argue that besides strategic agreement, successful networking requires the support of information systems in order to deliver efficient day to day service, and advocate that service flow management supports organisations in jointly delivering services that cross provider boundaries. The authors provide a general concept that is based on the exchange of XMLrepresentations of process knowledge and data between service providers. Wang et al. explore the development of a knowledge base within the European Public Health and Environment Network. The study aims to provide some insight to managers, group members within EPHEN as to how this development can bring about changes to service delivery and practice that empowers service users and involves them in the process. It seeks also to identify possible difficulties that might be anticipated.

Han and Lee describe how the public health sector in South Korea introduced district health information systems (DHIS). The authors describe how district health information systems are being implemented, and how the information generated and collected through the systems is to be used by local authorities to plan and manage health services in their areas, and further by the central government to make a health plan at the national level. The article presents the development of DHIS for health centres in Korea, and evaluates the project focusing on the problems found in implementing the systems.

Alshawi et al. discuss the problems associated with data utilisation and propose a multi-layer framework for evaluating the quality and integration of patient data for CRM applications in the health care sector. In doing so, a range of potential business benefits is highlighted. The proposed framework presents a platform and software independent architecture for data evaluation and integration operations. The authors conclude that further research needs to be carried out to refine this framework, through model testing and case study evaluation.

Acknowledgments
The Guest Editors of this special issue have been pleased by the response for the call for papers on health informatics for Logistics Information Management. Each paper was reviewed by the guest editors and at least two other referees. The Guest Editors gratefully acknowledge the support and assistance provided by Zahir Irani – the Editor-in-Chief of the journal, and the 30 anonymous referees that reviewed the manuscripts received following the call for papers. Finally, much credit goes to Mrs Carolyn Bailey, whose outstanding effort and administrative support made this issue possible and ensured it was on time.

Sarmad Alshawi
Tillal Eldabi
Ray J. Paul

Previously published in: Logistics Information Management, Volume 16, Number 3/4, 2003

Emerald Group Publishing Limited; January 2003
124 pages; ISBN 9781845445447
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Title: Health Informatics
Author: Sarmad Alshawi; Tillal Eldabi
 
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