IT in Health Care

Patient care information systems (PCISs) can be extremely beneficial in a health care system. Some of the pros of PCISs include patient records becoming electronic, “eliminating illegible orders, improving communication, improving the tracking of orders, and reminding professionals of actions to be undertaken” (Ash, Berg, & Coiera, 2004, p. 104). On the other hand, PCISs can cause unintended errors and problems in a health care system that may affect workflow and patient care. The authors (Ash et al., 2004) identify two main categories of problems with the user interface of the PCIS: entering and retrieving information and communication and coordination (p. 106). While entering information, errors may occur due to choices being too close to one another on the screen; doctors may get distracted in conversation with a patient and mistakenly select the wrong choice. Even worse than choosing the incorrect response, an order may be placed for the wrong person. User interfaces may also require the user to enter information in a structured format which is much different than the normal “free text” format and the information then loses the “personal touch” of the user (Ash et al., 2004, p. 106).

Problems with communication and coordination include loss of communication and inflexibility and inability to detect urgency. “Physicians may assume that ‘entry’ into the computer system replaces their previous means of initiating and communicating their plans, and that orders will be carried out without further action on their part” (Ash et al., 2004, p. 109). The result is a loss in direct communication between doctors, nurses, and lab technicians and an increased reliance on the PCIS. The inflexibility of the system can be seen when an order is placed that makes sense on paper, but the information system tries to be “smart” and make a correction to the order. In a health care environment, a system must be dynamic and open to manual overrides. Urgency is also an important part of the health care atmosphere; a nurse may give medication to a patient without the doctor’s orders because it is necessary at that moment. The nurse then tries to enter the information, but the information system will not accept the entry because a doctor did not previously order it.

As problems can occur in the exchange of information between personnel in a health care system, they can also occur in transactions. “A transaction consists of an exchange of a product or service for money. Consequently, there is always a risk that something might go wrong in the exchange” (Post & Anderson, 2006, p. 209). Risks for the vendor include not receiving a payment, a fraudulent payment, or the government might invalidate the transaction (Post & Anderson, 2006, p. 209). The customer must be concerned about being charged the proper amount, receiving the product they purchased and whether the transaction is legal (Post & Anderson, 2006, p. 210).

In my mind, one solution to create an efficient and effective PCIS would be to create a nationwide (or even worldwide) standard. This way, each health care entity could contribute to the design by giving comments and using the software in trial runs. Health care organizations would be working together to design a final product that allows everyone to perform their jobs using PCIS with the least amount of negative impact. Is this single application solution too ambitious?

Ash, J. S., Berg, M., & Coiera, E. (Mar/Apr 2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104-112.

Post, G. V., & Anderson, D. L. (2006). Management Information Systems: Solving business problems with Information Technology. New York: McGraw-Hill/Irwin.

Knowledge Management Systems and Teamwork

This article explains why knowledge management systems (KMS) are important for knowledge management. Before describing the ways in which Information Technology impacts knowledge management, the authors (Alavi, M. & Leidner, D. E., 2001) list the various perspectives of knowledge: a state of mind, an object, a process, a condition of having access to information, and a capability (p. 109). Details are given about how each perspective revolves around a knowledge management system. Knowledge as a state of mind would require IT “to provide access to sources of knowledge rather than knowledge itself” (Alavi, M. & Leidner, D. E., 2001, p. 111). In this case, an individual could read company manuals in electronic form or employee handbooks to gain knowledge to meet organizational needs. Gathering, storing, and transferring knowledge is the key to IT when knowledge is viewed as an object “to be stored and manipulated” (Alavi, M. & Leidner, D. E., 2001, p. 111). This would involve knowledge that was previously acquired to be entered into a system for storage and retrieval. Providing a way for knowledge to easily flow between individuals is required by IT when viewing knowledge as a process (Alavi, M. & Leidner, D. E., 2001, p. 111). In this case, discussion forums, knowledge bases, websites, and email would be an efficient solution. Access to information is the fourth view of knowledge and requires IT to “provide effective search and retrieval mechanisms for locating relevant information” (Alavi, M. & Leidner, D. E., 2001, p. 111). Database queries would be the most effective way for search and retrieval. The idea of knowledge being a capability can be best described as having the capacity to use information (Alavi, M. & Leidner, D. E., 2001, p. 110). Pertaining to capability, the “role of IT is to enhance intellectual capital by supporting development of individual and organizational competencies” (Alavi, M. & Leidner, D. E., 2001, p. 111).

Similarly to Information Technology being an integral part of knowledge management, it also plays a key role in helping teams of workers communicate. There are many IT tools to aid communication, and some of them are e-Mail, instant messaging, web pages and blogs, electronic calendars, project management tools, video conferencing, and mobile devices (Post, G. V. & Anderson, D. L., 2006, pp. 319-321). These tools are not necessary for a team to use, but if the team chooses to take advantage of these available features, it will find communication between members much easier and more common.

Since knowledge is a powerful tool for an employee to have, how can an employee be convinced of the importance to share his knowledge with other team members and not simply keep it to himself?

Alavi, M., & Leidner, D. E. (2001, March). Knowledge management and knowledge management systems: Conceptual foundations and research issues. MIS Quarterly, 25(1), 107-136.

Post, G. V., & Anderson, D. L. (2006). Management Information Systems: Solving business problems with Information Technology. New York: McGraw-Hill/Irwin.

Ch. 4 & 5 and Database Mgmt

The authors (Wenger, McDermott, & Snyder, 2002) explain that there are “five stages of community development: potential, coalescing, maturing, stewardship, and transformation” (p. 68). Each stage has unique issues to address, some straightforward and some are time and labor intensive. When a community is in the first stage, the potential stage, it is necessary to “find enough common ground among members for them to feel connected and see the value of sharing insights, stories, and techniques” (Wenger et al., 2002, p.71). It is important for the organization to recognize the community of practice, so in this stage, members need to build a case to defend the value of the community (Wenger et al., 2002, p.77). The second stage, coalescing, should involve many events in which members would be enticed to “build relationships, trust, and an awareness of their common interests and needs” (Wenger et al., 2002, p.82). Activities could include monthly meetings, attending professional conferences, or participation in online forums. Maturing, which is the third stage of community development, involves “clarifying the community’s focus, role, and boundaries” (Wenger et al., 2002, p.97). In the beginning stages of life, a community is more focused on showing the organization and members that there is great value in the community, but now the community must focus on building a solid infrastructure for itself. In the next stage, stewardship, a community must figure out “how to sustain its momentum through the natural shifts in its practice, members, technology, and relationship to the organization” (Wenger et al., 2002, p.104). The transformation stage can be recognized if a community is losing members and energy, when its members are meeting socially instead of meeting to exchange information about the community’s issues, or when a community begins to dissolve and separate into other groups (Wenger et al., 2002, p.109).

One of the ways that a community can create value for itself is to create a list of issues and the solutions that have been agreed upon my members. If a new member has the exact same question, he will simply go to the created list for his answer. This list would most easily be maintained in a database. An input form would be created for users to enter data and members can then use SQL to retrieve information. Database systems have tools that make it “relatively easy to create input forms and reports” (Post & Anderson, 2006, p. 142). If members are not familiar with SQL, it may be easier to create a query form; using this method, a member would enter search parameters into the form and the results would be presented in a formatted, readable report.

If a community is on the verge of extinction, would it be feasible for a brand new member to step in and take control? I was recently on a community group forum that seems to be fading fast, and I was wondering if I could pose questions to the group to see if there would be any interest in continuing communication.

Post, G. V., & Anderson, D. L. (2006). Management Information Systems: Solving business problems with Information Technology. New York: McGraw-Hill/Irwin.

Wenger, E., McDermott, R., & Snyder W. M. (2002). Cultivating communities of practice: A guide to managing knowledge. Boston: Harvard Business School Press.

Technology for Communities

In the report Technology for communities, the authors introduce a person who takes the role of maintaining, supporting, and introducing technology to a community; the authors refer to this person or group as the technology steward (Wenger, White, Smith, & Rowe, 2005, p. 3). If a community is small, there may be only one or two people necessary to support the community’s technology, but if the community is larger in size, it may need a small group of people to maintain the technology. A technology steward has three major items to address: identify and understand new technologies that the market introduces, select community relevant technologies for use in the community’s everyday activities, and finally, monitor the ways a community does or does not utilize the tools and also monitor the uses that members discover for the chosen technologies that were not previously introduced to them (Wenger et al., 2005, p. 3).

There are millions of technologies to choose from, but almost every single one of them involves a network. The technology steward must make sure that all members have access to a network that is sufficient for the technology he wants to incorporate. For example, a web-based meeting may work great for someone in the United States who has access to high bandwidth links, but for someone in a second world country, they may not be as fortunate to have access to high speed Internet and the meeting would be worthless. Since the bandwidth is low, the member on the other side of the world would have to wait for an extremely long time for voice and video to update and appear. This would take the effectiveness out of the meeting. Other items that are built around a network are web sites, newsgroups, chat rooms, e-mail, calendars and scheduling, and centralized storage; these are all important features necessary for a healthy distributed community (Wenger, McDermott, & Snyder, 2002, pp. 76-80).

To keep a distributed community healthy, there is a great dependence on technology and equipment. Would the technology steward support, update, and maintain the technology or would the community rely on the organization's infrastructure? For example, would it be more practical for the community to have its own database vice sharing one with the organization?

Wenger, E., McDermott, R, & Snyder W. M. (2002). Cultivating communities of practice: A guide to managing knowledge. Boston: Harvard Business School Press.

Wenger, E., White, N., Smith, J. D., & Rowe, K. (2005). Technology for communities.