Cynthia LeRouge

Healthcare information systems research, revelations and visions

European Journal of Information Systems(2007) 16, 669–671.doi:10.1057/palgrave.ejis.3000712Information technology (IT) is no longer perceived as just a supportingtool, but has become a strategic necessity for developing an integratedhealthcare IT infrastructure that can improve services and reduce medicalerrors (Mantzana et al., 2007). Correspondingly, IT investments in thehealth sector have increased dramatically (Carpenter, 2005) and areexpected to rise further over the near term (HIMSS Analytics, 2007).Yet the current focus on IT infrastructure describes only part of thetransformation of healthcare information systems (HIS) that will benecessary to achieve service quality goals. It has long been accepted inthe information systems (IS) discipline that effective developmentcombines understanding of the people who use it and the processesthrough which organizations apply IT, as well as the IT infrastructure itself.Because of this multi-faceted perspective, we propose that IS researcherswill be able to contribute to future advances in HIS in a number of waysthat transcend a simplistic focus on technology.The objective of this special issue is to demonstrate how the IS disciplinecan aid in shaping the future of HIS through empirical and theoreticalresearch. Healthcare organizations face multiple future hurdles that ISresearchers are well-equipped to study (Wilson & Lankton, 2004; Chiassonet al., 2007). Prominent among these hurdles are: applying IT to improvethe quality of healthcare processes and reduce medical errors; developinge-services to connect healthcare stakeholders, including government,insurers, healthcare administrators, clinical staff, and patients; identifyingobstacles to acceptance and continued use of HIS; adapting user-centereddesign principles to healthcare settings; assessing financial and otherorganizational impacts of IT in healthcare; and managing HIS effectively.In addition, the healthcare sector provides a largely unexplored settingfor IS researchers to develop, refine, and extend IS theories. Recent reviewsof the IS literature suggest there are substantial opportunities for new HISresearch. Chiasson & Davidson (2004) reviewed 17 leading IS journals from1985 to 2003 to identify contributions to HIS research, finding a total of165 papers. As presented in Table 1, Cho (2007) has updated their review toinclude the period from 2004 to 2006.Chiasson & Davidson (2004) established four categories to organizepublished HIS studies based on how IS theory and the healthcare contextwere addressed. IS-Only papers focus on generalizable theory withoutspecific consideration of the healthcare context. IS theories may beapplied, but these papers do not explore how the healthcare context mightinfluence theoretical constructs or assumptions. Healthcare-Only papersfocus on describing the design, development, implementation, and use ofinformation-intensive technologies in healthcare without significantapplication of IS theories. IS-Healthcare papers primarily focus on develop-ing or testing IS theories with secondary consideration given to interac-tions with the healthcare context. Healthcare-IS papers more systematicallyconsider the influence of context by applying IS theory to analyze

Exploring the Systems Analyst Skill Set: Perceptions, Preferences, Age, and Gender

Information systems (IS) workers need an appropriate skill set to effectively exploit technology innovations. Social constructivist theory would indicate that some aspect of a systems analysts job evolution is attributable to the nature of both their perceptions of importance for various job skills and preferences toward using their professional job skills. Self-report survey data gathered from 124 systems analysts reveal analysts collectively recognize all skill dimensions explored have some degree of importance to their role. Systems analysts seem to perceive their role as a socio-technical function and desire this functional duality as they rank interpersonal skills and system development skills significantly higher than political skills and knowledge, technology skills, and business task knowledge for both preferences to use and perceptions of importance. Results show differences exist in perceptions and preferences among the sexes and age groups studied. Findings will add to the existing body of IS human resources research, and provide job development and career planning.

Quality attributes in telemedicine video conferencing

Video conferencing is used increasingly in many telemedicine applications, including medical personnel education, peer consultation, patient education, and direct patient care. Advances in technology and changes in medical care delivery have enhanced the ability to develop effective telemedicine video conferencing systems. Measures of effectiveness for technology systems rely on identified requirements,for system quality. In this research, we propose a comprehensive model of quality attributes for telemedicine video conferencing systems. The quality attribute model is developed from an extensive literature review, direct observations of telemedicine encounters, and structured interviews with telemedicine experts. The model contains four quality attribute groups: Technical, Usability, Physical Environment, and Human Element. Interview citations are used to justify the importance of these individual quality attributes. Both researchers and practitioners can make use of the model to understand, design, and evaluate telemedicine video conferencing systems.

Downsizing Effects on Survivors: Layoffs, Offshoring, and Outsourcing

In a representative sample of 13,683 U.S. employees, we compared survivors of layoffs, offshoring, outsourcing, and their combinations to a group who experienced no downsizing. Survivors of layoffs perceived lower organizational performance, job security, affective attachment, calculative attachment, and had higher turnover intentions. Offshoring survivors perceived lower performance, fairness, and affective attachment, but outsourcing survivors generally did not have more negative outcomes than the no-downsizing group. Layoffs generally had more negative outcomes than other downsizing forms.

Baby Boomers’ Adoption of Consumer Health Technologies: Survey on Readiness and Barriers

Background As they age, baby boomers (born 1946-1964) will have increasing medical needs and are likely to place large demand on health care resources. Consumer health technologies may help stem rising health care needs and costs by improving provider-to-patient communication, health monitoring, and information access and enabling self-care. Research has not explored the degree to which baby boomers are ready for, or are currently embracing, specific consumer health technologies This study explores how baby boomers’ readiness to use various technologies for health purposes compares to other segments of the adult population. Objective The goals of the study are to (1) examine what technologies baby boomers are ready to use for health purposes, (2) investigate barriers to baby boomers’ use of technology for health purposes, and (3) understand whether readiness for and barriers to baby boomers’ use of consumer health technologies differ from those of other younger and older consumers. Methods Data were collected via a survey offered to a random sample of 3000 subscribers to a large pharmacy benefit management company. Respondents had the option to complete the survey online or by completing a paper-based version of the survey. Results Data from 469 respondents (response rate 15.63%) were analyzed, including 258 baby boomers (aged 46-64 years), 72 younger (aged 18-45 years), and 139 older (age >64 years) participants. Baby boomers were found to be similar to the younger age group, but significantly more likely than the older age group to be ready to use 5 technologies for health purposes (health information websites, email, automated call centers, medical video conferencing, and texting). Baby boomers were less ready than the younger age group to adopt podcasts, kiosks, smartphones, blogs, and wikis for health care purposes. However, baby boomers were more likely than older adults to use smartphones and podcasts for health care purposes. Specific adoption barriers vary according to the technology. Conclusions Baby boomers have commonalities with and distinctions from both younger and older adults in their readiness to adopt specific consumer health technologies and the barriers they experience to adoption. Baby boomers’ nuances regarding readiness to adopt and the barriers associated with the various forms of consumer health technology should be taken into account by those interested in promoting consumer health technologies use among baby boomers when developing applications, choosing technologies, preparing users for use, and in promotional tactics.

Crossing the telemedicine chasm: have the U.S. barriers to widespread adoption of telemedicine been significantly reduced?

Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks.

Focus groups and critical social IS research: How the choice of method can promote emancipation of respondents and researchers.

Critical social research in information systems has been gaining prominence for some time and is increasingly viewed as a valid research approach. One problem with the critical tradition is a lack of empirical research. A contributing factor to this gap in the literature is the lack of agreement on what constitutes appropriate methodologies for critical research. The present paper contributes to this debate by exploring the role that focus group research can play in the critical approach. This paper outlines the main characteristics of critical research with an emphasis on its emancipatory faculties. It then reviews the focus group method from the perspective of critical approach and provides a critical account of two research projects that used focus groups as a method of data collection. The paper presents the argument that focus groups, if designed and executed in light of a critical approach, can contribute to the emancipation of researchers and respondents. This argument is built upon the critical theories of the two most influential theorists in critical social information systems research, namely Jürgen Habermas and Michel Foucault. Critically oriented focus groups have the potential to improve communication and move real discourses closer to Habermass ideal speech situation. At the same time, they can contribute to challenging the prevailing orthodoxy and thereby overcome established regimes of truth in the Foucauldian tradition. The paper ends by developing a set of guiding questions that provide a means for researchers to ensure that the emancipatory potential of focus group research can be achieved.

Telemedicine: Technology mediated service relationship, encounter, or something else?

PURPOSE Service interactions between service providers and health care consumers happen daily in health care organizations, and can occur face-to-face or through mediating technology. We use the demanding and rich environment of telemedicine to better understand the nature of the real time service-encounter interactions among the human and technology actors engaged in the process and to inform telemedicine providers about key factors to consider in telemedicine design. METHODS We conducted a case study of medical video conferencing (MVC) for the delivery of patient healthcare (a form of telemedicine) using multiple data collection and analysis techniques involving a range of telemedicine stakeholders. RESULTS The research reveals that telemedicine requires a new kind of service relationship, an Advanced Encounter, with unique relationships between the telemedicine service providers, presenters, patients, and technology. Seven facilitating factors for the Advanced Encounter of telemedicine are identified and discussed, including the telemedicine servicescape: a set of supporting structures that are critical to telemedicine success. CONCLUSIONS Key contributions are a deep understanding of the relationships between telemedicine actors, and the organizational actions needed to deploy a technology-mediated telemedicine service.

The Business of Telemedicine: Strategy Primer

There is some tacit understanding that telemedicine can provide cost efficiency along with increased access and equality of care for the geographically disadvantaged. However, concrete strategic guidance for healthcare organizations to attain these benefits is fragmented and limited in existing literature. Telemedicine programs need to move from a grant-funded to a profit-centered status to sustain their existence. This article extends work presented at a recent American Telemedicine Association Business and Finance Special Interest Group course to provide a conceptual framework for strategic planning and for effectively implementing telemedicine programs. An expert panel of telemedicine coordinators provides insight and recommendations.

IT Adoption and Evaluation in Healthcare: Evolutions and Insights in Theory, Methodology, and Practice

This article focuses on the evolution of theory, methodology, and practice regarding the role of adoption, implementation, diffusion, and evaluation factors, and the interaction of these factors at various levels, to healthcare system success. These topics continue to present challenges to organizations, the research community, and to society in general. The first place that new waves of thought are often aired is at conferences. This article explores the evolution taking place in this domain by looking back through the years over work presented at the longest standing conference track focused on adoption, implementation, diffusion, and evaluation factors in e-health and the interaction of these factors at various levels to healthcare system success.