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Although it is widely acknowledged that health care delivery systems are complex adaptive systems, there are gaps in understanding the application of systems engineering approaches to systems analysis and redesign in the health care domain. Commonly employed methods, such as statistical analysis of risk factors and outcomes, are simply not adequate to robustly characterize all system requirements and facilitate reliable design of complex care delivery systems. This is especially apparent in institutional-level systems, such as patient safety programs that must mitigate the risk of infections and other complications that can occur in virtually any setting providing direct and indirect patient care. The case example presented here illustrates the application of various system engineering methods to identify requirements and intervention candidates for a critical patient safety problem known as failure to rescue. Detailed descriptions of the analysis methods and their application are presented along with specific analysis artifacts related to the failure to rescue case study. Given the prevalence of complex systems in health care, this practical and effective approach provides an important example of how systems engineering methods can effectively address the shortcomings in current health care analysis and design, where complex systems are increasingly prevalent.

The adoption of electronic health records (EHRs) and digitization of health data over the past decade is ushering in the next generation of digital health tools that leverage artificial intelligence (AI) to improve varied aspects of health system performance. The decade ahead is therefore shaping up to be one in which digital health becomes even more at the forefront of health care delivery – demanding the time, attention, and resources of health care leaders and frontline staff, and becoming inextricably linked with all dimensions of health care delivery. In this chapter, we look back and look ahead. There are substantive lessons learned from the first era of large-scale adoption of enterprise EHRs and ongoing challenges that organizations are wrestling with – particularly related to the tension between standardization and flexibility/customization of EHR systems and the processes they support. Managing this tension during efforts to implement and optimize enterprise systems is perhaps the core challenge of the past decade, and one that has impeded consistent realization of value from initial EHR investments. We describe these challenges, how they manifest, and organizational strategies to address them, with a specific focus on alignment with broader value-based care transformation. We then look ahead to the AI wave – the massive number of applications of AI to health care delivery, the expected benefits, the risks and challenges, and approaches that health systems can consider to realize the benefits while avoiding the risks.

Digital healthcare once again emerges due to pandemic (Covid-19). Digital healthcare can be minimising the issue of accessibility, availability, accuracy and affordability of healthcare service during a pandemic. Digital healthcare playsa significant role to provide healthcare equity during the pandemic. This article presents the current trends and scenario of digital healthcare with a focus on health equity. The main objective of this chapter is to review the four aces of health equity in the digital healthcare literature. The scope and challenges faced by the policymakers to implementation of digital healthcare to improve health equity. This chapter considers the hybrid literature review based on the bibliometric and the systematic literature based on the various theme, sub-theme, concept and context-related health equity through digital healthcare. This study provides the previous and current research trends and preposition for the future researcher, healthcare professional, policymakers and digital healthcare innovators to invent the tool which leads the health equity through the digital healthcare in the healthcare.

This chapter discusses the potential role of geographic information systems (GIS) for infection control within the hospital system. The chapter provides a brief overview of the role of GIS in public health and reviews current work applying these methods to the hospital setting. Finally, it outlines the potential opportunities and challenges for adapting GIS for use in the hospital setting for infection prevention. A targeted literature review is used to illustrate current use of GIS in the hospital setting. The discussion of complexity was compiled using the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Challenges and opportunities were then extracted from this exercise by the authors. There are multiple challenges to implementation of a Hospital GIS for infection prevention, mainly involving the domains of technology, organization, and adaptation. Use of a transdisciplinary approach can address many of these challenges. More research, specifically prospective, reproducible clinical trials, needs to be done to better assess the potential impact and effectiveness of a Hospital GIS in real-world settings. This chapter highlights a powerful but rarely used tool for infection prevention within the hospital. Given the importance of reducing hospital-acquired infection rates, it is vital to identify relevant methods from other fields that could be translated into the field of hospital epidemiology.

Purpose – Health information exchange (HIE), the process of electronically moving patient-level information between different organizations, is viewed as a solution to the fragmentation of data in health care. This review provides a description of the current state of HIE in seven nations, as well was three international HIE efforts, with a particular focus on the relation of exchange efforts to national health care systems, common challenges, and the implications of cross-border information sharing.

Design/methodology/approach – National and international efforts highlighted in English language informatics journals, professional associations, and government reports are described.

Findings – Fully functioning HIE is not yet a common phenomenon worldwide. However, multiple nations see the potential benefits of HIE and that has led to national and international efforts of varying scope, scale, and purview. National efforts continue to work to overcome the challenges of interoperability, record linking, insufficient infrastructures, governance, and interorganizational relationships, but have created architectural strategies, oversight agencies, and incentives to foster exchange. The three international HIE efforts reviewed represent very different approaches to the same problem of ensuring the availability of health information across borders.

Originality/value – The potential of HIE to address many cost and quality issues will ensure HIE remains on many national agendas. In many instances, health care executives and leaders have opportunities to work within national programs to help shape local exchange governance and decide technology partners. Furthermore, HIE raises policy questions concerning the role of centralized planning, national identifiers, standards, and types of information exchanged, each of which are vital issues to individual health organizations and worthy of their attention.

Big Data analysis is one of the key challenges to the provision of health care to emerge in the last few years. This challenge has been spearheaded by the huge interest in the “4Ps” of health care (predictive, preventive, personalized, and participatory). Big Data offers striking development opportunities in health care and life sciences. Healthcare research is already using Big Data to analyze the spatial distribution of diseases such as diabetes mellitus at detailed geographic levels. Big Data is also being used to assess location-specific risk factors based on data of health insurance claims. Other studies in systems medicine utilize bioinformatics approaches to human biology which necessitate Big Data statistical analysis and medical informatics tools. Big Data is also being used to develop electronic algorithms to forecast clinical events in real time, with the intent to improve patient outcomes and thus reduce costs.

Yet, this Big Data era also poses critically difficult ethical challenges, since it is breaking down the traditional divisions between what belongs to public and private domains in health care and health research. Big Data in health care raises complex ethical concerns due to use of huge datasets obtained from different sources for varying reasons. The clinical translation of this Big Data is thus resulting in key ethical and epistemological challenges for those who use these data to generate new knowledge and the clinicians who eventually apply it to improve patient care.

Underlying this challenge is the fact that patient consent often cannot be collected for the use of individuals’ personal data which then forms part of this Big Data. There is also the added dichotomy of healthcare providers which use such Big Data in attempts to reduce healthcare costs, and the negative impact this may have on the individual with respect to privacy issues and potential discrimination.

Big Data thus challenges societal norms of privacy and consent. Many questions are being raised on how these huge masses of data can be managed into valuable information and meaningful knowledge, while still maintaining ethical norms. Maintaining ethical integrity may lack behind in such a fast-changing sphere of knowledge. There is also an urgent need for international cooperation and standards when considering the ethical implications of the use of Big Data-intensive information.

This chapter will consider some of the main ethical aspects of this fast-developing field in the provision of health care, health research, and public health. It will use examples to concretize the discussion, such as the ethical aspects of the applications of Big Data obtained from clinical trials, and the use of Big Data obtained from the increasing popularity of health mobile apps and social media sites.

Citizens are substantial stakeholders in every e-government system, thus their willingness to use and ability to access the system are critical. Unequal access and information and communication technology usage, which is known as digital divide, however has been identified as one of the major obstacles to the implementation of e-government system. As digital divide inhibits citizen’s acceptance to e-government, it should be overcome despite the lack of deep theoretical understanding on this issue. This research aimed to investigate the digital divide and its direct impact on e-government system success of local governments in Indonesia as well as indirect impact through the mediation role of trust. In order to get a comprehensive understanding of digital divide, this study introduced a new type of digital divide, the innovativeness divide.

The research problems were approached by applying two-stage sequential mixed method research approach comprising of both qualitative and quantitative studies. In the first phase, an initial research model was proposed based on a literature review. Semi-structured interview with 12 users of e-government systems was then conducted to explore and enhance this initial research model. Data collected in this phase were analyzed with a two-stage content analysis approach and the initial model was then amended based on the findings. As a result, a comprehensive research model with 16 hypotheses was proposed for examination in the second phase.

In the second phase, quantitative method was applied. A questionnaire was developed based on findings in the first phase. A pilot study was conducted to refine the questionnaire, which was then distributed in a national survey resulting in 237 useable responses. Data collected in this phase were analyzed using Partial Least Square based Structural Equation Modeling.

The results of quantitative analysis confirmed 13 hypotheses. All direct influences of the variables of digital divide on e-government system success were supported. The mediating effects of trust in e-government in the relationship between capability divide and e-government system success as well as in the relationship between innovativeness divide and e-government system success were supported, but was rejected in the relationship between access divide and e-government system success. Furthermore, the results supported the moderating effects of demographic variables of age, residential place, and education.

This research has both theoretical and practical contributions. The study contributes to the developments of literature on digital divide and e-government by providing a more comprehensive framework, and also to the implementation of e-government by local governments and the improvement of e-government Readiness Index of Indonesia.

Purpose – The purpose of the chapter is to provide an analytical overview of information research in the United Kingdom and of the role of the Research Assessment Exercises (RAE) in shaping the form and structure of that research.

Design/methodology/approach – The approach adopted is a detailed content analysis of the submissions made to the last UK RAE. This analysis is carried out in relation to four broad subject categorisations, and specific analysis of accounts of research carried out in the departments and research groups.

Findings – The RAE have played a key role in promoting research specialisms in library and information studies (LIS) research in the United Kingdom. The former general approach to research in information studies has been replaced by more focused research activities carried out in a variety of research groups spread across a diverse range of disciplines and departments, from LIS, to business and management, information systems, and computing and engineering.

Research implications – The prospects for general LIS research departments may be increasingly limited, as research becomes concentrated in sub-groups within larger organisational structures, subverting both departmental lines and conventional subject boundaries.

Originality/value – This overview provides a novel synthesis of information research in the United Kingdom in relation to four broad categories of research in information studies and information science, information management and social informatics, information systems and information interaction, and social computing and computational informatics. The account brings together a fragmented field of research in a compact and intelligible form.