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Advanced Electronic Medical Records (EMR) provide many potential benefits to hospitals. However, because of their broad scope, many stakeholders deal with the EMR and a continuous effort has to be made to keep up with internal and external change. Therefore, hospitals need to deliberately shape their organizational competencies considering the pursuit of alignment, i.e. making sure that the EMR remains optimally aligned with strategies, goals and needs of the hospital and its stakeholders. This paper aims to investigate the evolutionary paths of these alignment competencies and their drivers, from a theoretical perspective of co-evolutionary information systems alignment (COISA).

This paper reports on a longitudinal multiple case study of three Dutch hospitals which each recently implemented an advanced EMR system. The authors conducted 35 in-depth interviews in 2 phases (before and after go-live of the EMR), and studied documentation related to the EMR implementations.

The findings show that each hospital's COISA capability shows a different evolutionary path. However, two of the three case hospitals ended up coordinating part of their COISA capability to an ecosystem level, i.e. they incorporated other hospitals using the same EMR system to coordinate their alignment efforts, either from an operational perspective, or in terms of orchestration and strategy. The found evolutionary paths' key drivers include “stakeholder initiative”, “accumulating experience”, “driving events” and “emerging issues”.

The findings help healthcare practitioners to deliberately shape their organization's COISA capability in pursuit of EMR alignment. Furthermore, the authors add to the knowledge base on co-evolutionary approaches to alignment through the longitudinal approach.

The purpose of the article is to assess the effectiveness, compliance, adoption and lessons learnt from the pilot implementation of a data integration solution between an acute care hospital information system (HIS) and a long-term care (LTC) home electronic medical record through a case report.

Utilization statistics of the data integration solution were captured at one-month post implementation and again one year later for both the emergency department (ED) and LTC home. Clinician feedback from surveys and structured interviews was obtained from ED physicians and a multidisciplinary LTC group.

The authors successfully exchanged health information between a HIS and the electronic medical record (EMR) of an LTC facility in Canada. Perceived time savings were acknowledged by ED physicians, and actual time savings as high as 45 min were reported by LTC staff when completing medication reconciliation. Barriers to adoption included awareness, training efficacy and delivery models, workflow integration within existing practice and the limited number of facilities participating in the pilot. Future direction includes broader staff involvement, expanding the number of sites and re-evaluating impacts.

A data integration solution to exchange clinical information can make patient transfers more efficient, reduce data transcription errors, and improve the visibility of essential patient information across the continuum of care.

Although there has been a large effort to integrate health data across care levels in the United States and internationally, the groundwork for such integrations between interoperable systems has only just begun in Canada. The implementation of the integration between an enterprise LTC electronic medical record system and an HIS described herein is the first of its kind in Canada. Benefits and lessons learnt from this pilot will be useful for further hospital-to-LTC home interoperability work.

Open source software (OSS) communities devoted to the development of electronic medical records (EMRs) have grown in recent years. The purpose of this paper is to focus on the challenge the leaders of these communities face in terms of building perceptions of psychological ownership among community members.

Surveys (n = 50) and brief interviews (n = 56) with individual members of an open source EMR community (most of whom are based in African nations) were used.

Among community members, normative commitment (in comparison to extrinsic motivation and affective commitment) was the strongest predictor of psychological ownership. Interviews revealed that community members tended to feel a greater sense of ownership toward the end user (i.e. hospitals and clinics) than toward the community itself.

To foster engagement and retention – and enhance the worldwide impact of their community on healthcare practices – leaders of open source EMR communities can offer incentives related to certifications and status-based rewards, hold annual meetings to allow members to develop a better understanding of the community and encourage members to “pay it forward” by involving end users (i.e. hospital and clinic employees) within the community, thus furthering public health initiatives.

OSS communities experience unique challenges compared to traditional organizations. This necessitates a reconsideration of the applicability of commonly accepted principles, tenets and recommendations from the management literature.

The purpose of this study is to examine the state of research into adoption of machine learning systems within the health sector, to identify themes that have been studied and observe the important gaps in the literature that can inform a research agenda going forward.

A systematic literature strategy was utilized to identify and analyze scientific papers between 2012 and 2022. A total of 28 articles were identified and reviewed.

The outcomes reveal that while advances in machine learning have the potential to improve service access and delivery, there have been sporadic growth of literature in this area which is perhaps surprising given the immense potential of machine learning within the health sector. The findings further reveal that themes such as recordkeeping, drugs development and streamlining of treatment have primarily been focused on by the majority of authors in this area.

The search was limited to journal articles published in English, resulting in the exclusion of studies disseminated through alternative channels, such as conferences, and those published in languages other than English. Considering that scholars in developing nations may encounter less difficulty in disseminating their work through alternative channels and that numerous emerging nations employ languages other than English, it is plausible that certain research has been overlooked in the present investigation.

This review provides insights into future research avenues for theory, content and context on adoption of machine learning within the health sector.

The quality of asthma care may be affected if asthma management is overlooked, thus needing frequent clinical audits to identify areas for improvement. The purpose of this paper is to evaluate the quality of the process (e.g. documentation of asthma-specific information), the structure (e.g. availability of resources) and the outcome (e.g. proportion of patients prescribed with asthma medications) at a university-based primary care clinic. The associated clinical factors for non-documentation of asthma control at the last visit were also examined.

This retrospective study involved auditing medical records and the pharmacy data system of 433 adult patients with asthma to evaluate 18 quality indicators. The standard target for the indicators of process and structure was 80 percent and the standard target for the indicators of outcome was 100 percent.

All the indicators failed to reach the standard targets. Documentation of asthma-specific information and availability of resources were deficient. The non-documentation of asthma control was significantly associated with presence of acute complaint(s) unrelated to asthma, presence of other issues and number of the documented parameters for asthma control. Although the prescription rates of inhaled reliever and preventer were substandard, they were reasonably high compared to the targets.

In this study, evaluation of the quality of care was limited by absence of asthma register, use of paper-based medical records and restricted practice capacity. Besides, the asthma-specific assessments and management were only audited at one particular time. Furthermore, the findings of this study could not be generalised to other settings that used other methods of record keeping such as patient-held cards and electronic medical records. Future studies should sample asthma patients from a register, evaluate more reliable quality indicators (e.g. over-prescription of short-acting β-2 agonist and underuse of inhaled corticosteroid) and assess asthma management over a duration of time.

This study provides quality information on all aspects of asthma care (process, structure and outcome) which can be a basis for clinical improvement. It is hoped that the study could assist the stakeholders to plan strategies for improvement of the asthma care. A more strategic and reliable system of documentation is needed, such as the use of a simple template or structured form, which should not jeopardise the provision of personalised and comprehensive care. With complete documentation, thorough investigational audits can be continuously performed to determine the quality of asthma care.

This study could provide useful findings to guide healthcare providers in developing a more strategic model of asthma care that can ensure asthma patients to receive a personalised, comprehensive, holistic and continuous care. Through this approach, their physical and psychosocial well-being can be optimised.

Even though our healthcare has advanced, the quality of asthma care is still suboptimal which requires further improvement. However, it could be considered assuring due to high outcome levels of asthma care despite having limited resources and practice capacity.

Mumbai needs to be transformed into a world-class city as stated in the 2005–2025 development plan of Municipal Corporation. For this initiative, hospital management information system (HMIS) has to be implemented across 400+ health facilities in the city.

A case study methodology was adopted to study HMIS implementation. Wave 1 of Phase 1 implementation of HMIS is carried out as a pilot project at Film City’s Hospital, Mumbai, which “go-live” on 21st June 2018. The work for hardware and software implementation was awarded to HardSystems and Solutions Limited and SoftSolutions India Private Limited, respectively, through e-tender.

Provision of inadequate quantity of hardware, slowness of network or system, non-satisfactory training after observation confirmation and sign-off process, lack of data entry operators, mismatch in numbering systems in blood bank and many other challenges concerned with the specific departments had become a major impediment in the efforts to maximize number of patients registered into HMIS.

Even after providing many clinical and managerial benefits, being the first cloud-based centrally located HMIS in any of the hospitals in the city, it imposes a major challenge for the management in terms of resistance of employees toward technology and need for the adoption of theoretical models for implementing change for the overall organizational development.

To the best of the authors’ knowledge, no other teaching case study is conducted to study the HMIS implementation in large-scale public health-care services. This is a dummy case study for teaching exercises. The identity of the stakeholders, organizations and events has been masked to maintain confidentiality.

The study aims to analyze the previous literature on government initiatives to implement health information systems (HISs).

Proknow-C (Knowledge Development Process-Constructivist) was used in the selection of the literature and in the bibliometric and systematic analysis.

The research identified a portfolio composed of 33 articles aligned with the research theme and with scientific recognition, as well as periodicals, authors, papers and keywords that stood out the most. Amongst the government initiatives in the 24 identified countries, England has been the most studied nation, and there is a certain prominence of research arising from developed countries. Electronic health records (EHRs) have been the most explored technology. Efficiency and safety of health care delivery, integration of information and among health organizations, cost reduction and economicity are the most expected benefits from government programs. The difficulties found are related to the broader context in which the system is inserted, to the management of the program, to technology itself and to individuals. The most emphasized difficulties identified in most countries were previous context marked by a lack of standardization/interoperability, acceptance of providers and users and project financing. The findings of the present article provide a theoretical framework for future studies, in addition to yielding a replicable process for future use.

This research may be considered original as it analyzes – through a constructivism-structured process (Proknow-C) – the phenomenon under investigation by gathering bibliometric and systematic review data concomitantly. The countries and technologies reported emerge from the process itself.

The purpose of this paper is to develop a new method to extract medical temporal information from online health communities.

The authors trained a conditional random-filed model for the extraction of temporal expressions. The temporal relation identification is considered as a classification task and several support vector machine classifiers are built in the proposed method. For the model training, the authors extracted some high-level semantic features including co-reference relationship of medical concepts and the semantic similarity among words.

For the extraction of TIMEX, the authors find that well-formatted expressions are easy to recognize, and the main challenge is the relative TIMEX such as “three days after onset”. It also shows the same difficulty for normalization of absolute date or well-formatted duration, whereas frequency is easier to be normalized. For the identification of DocTimeRel, the result is fairly well, and the relation is difficult to identify when it involves a relative TIMEX or a hypothetical concept.

The authors proposed a new method to extract temporal information from the online clinical data and evaluated the usefulness of different level of syntactic features in this task.

Despite many calls to strengthen connections between health systems and communities as a way to improve primary healthcare, little is known about how new collaborations can effectively alter service provision. The purpose of this paper is to explore how a health authority, municipal leaders and physicians worked together in the process of transforming primary healthcare.

A longitudinal qualitative case study was conducted to explore the processes of change at the regional level and within seven communities across Northern British Columbia (BC), Canada. Over three years, 239 interviews were conducted with physicians, municipal leaders, health authority clinicians and leaders and other health and social service providers. Interviews and contextual documents were analyzed and interpreted to articulate how ongoing transformation has occurred.

Four overall strategies with nine approaches were apparent. The strategies were partnering for innovation, keeping the focus on people in communities, taking advantage of opportunities for change and encouraging experimentation while managing risk. The strategies have bumped the existing system out of the status quo and are achieving transformation. Key components have been a commitment to a clear end-in-view, a focus on patients, families, and communities, and acting together over time.

This study illuminates how partnering for primary healthcare transformation is messy and complicated but can create a foundation for whole system change.

The purpose of this paper is to provide an analysis of the studies about workaround behavior in the Information Systems (IS) area, addressing its positive and negative aspects and raising the key related issues.

A systematic literature review was conducted to verify how workaround behavior has been approached in IS studies. A qualitative method was adopted and implemented in two stages: selection of articles from the time period 2007-2017 in the databases Web of Science, ScienceDirect and Scopus and analysis of the selected articles.

The results showed that many studies have been concerned with identifying the principal reasons for the manifestation of workaround behavior and the measures taken to reduce its impacts. Many studies from international journals examined the implementation of an ERP along with the workaround behavior. The need to expand the national studies on workaround behavior is emphasized, because the majority of the identified studies are international.

The key limitation is related to the period of analysis, because only articles published since 2007 were selected.

This paper contributes to both theory and practice, bringing relevant concepts about workaround behavior, and corroborating the importance of the studies on workaround in the IS area. The literature review of the 20 articles analyzed reveals the main features in each article, such as theoretical and methodological aspects that support the research. Based on this analysis, a conceptual map was developed presenting the most relevant points about workaround behavior, where the causes, the negative and positive consequences, the types of solutions and the organizational and individual impacts are presented.

Research into workaround behavior has increased in recent years, however very few studies have been conducted in Brazil. To the best of the authors' knowledge, no articles regarding Brazil and this subject were published between 2007 and 2017. Thus, this paper seeks to redress this imbalance.