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This paper aims to discover and analyze the challenges hampering blockchain technology’s (BT’s) implementation in the Indian health-care sector. A total of 18 challenges have been prioritized and modeled based on an extensive literature search and professional views.

An integrated multi-criteria decision-making approach has been used in two phases. Best worst method (BWM) is used in the first phase to prioritize the challenges with sensitivity analysis to validate the findings and eliminate a few challenges. In the second phase, interpretive structural modeling is applied to the remaining 15 challenges to obtain relative relationships among them with cross-impact matrix multiplication applied to classification analysis for their categorization.

The study’s results reveal that limited knowledge and expertise, cost and risk involved, technical issues, lack of clear regulations, resistance to change and lack of top management support are the top-ranked or high-intensity challenges according to the BWM. Interpretive structural modelling findings suggest that the lack of government initiatives has been driving other challenges with the highest driving power.

This work has been conducted in the Indian context, so careful generalization of the results is needed.

This work will give health-care stakeholders a better perspective regarding blockchain’s adoption. It will help health-care stakeholders, service providers, researchers and policymakers get a glimpse of the strategies for eradicating mentioned challenges. The analysis will help reduce the challenges’ impact on blockchain’s adoption in the Indian health-care sector.

The adoption of BT is a novel concept, especially in developing countries such as India. This is one of the few works addressing the challenges to BT adoption in the Indian health-care sector.

Sharing patient health information (PHI) among hospitals has been much slower than the adoption of health record systems. This paper aims to investigate if privacy regulation (PR) or security measures (SMs) influence hospitals’ use of health information exchange (HIE) to share PHI with other providers (e.g. physicians, labs, hospitals). The study specifically focuses on how multiple PRs can impede and a strong national security infrastructure (NSI) can support HIE.

The study uses secondary data from a multi-national and multi-hospital survey administered by the European Union. The multi-level structure of the cross-sectional panel data is used to test the influence of both hospital-level (e.g. PR) and national-level variables (e.g. NSI) on HIE. A total of nine types of HIE, three types of PRs, nine SMs and other relevant control variables are considered. This study uses a two-level random intercept generalized linear model to test the hypothesis proposed in the study.

The study finds that national-level PRs (NLPR) have the strongest positive influence on HIE in comparison to regional (RLPR) and hospital-level (HLPR) PRs. Moreover, the study finds evidence that the presence of RLPR and HLPR, on average, decreases the positive impact of NLPR by 264%. The SMs also have a significant and positive impact on HIE. Adoption of an additional SM can increase the odds of engaging in a certain type of HIE between 21% and 61%. On the other hand, a strong NSI can also amplify the positive impact of SM on certain types of HIE.

This study extends prior research on the role of PRs in enabling HIE by considering the complexities brought up by adopting multiple PRs. NLPRs have the strongest impact on HIE in comparison to RLPRs or HLPRs. Moreover, public infrastructure initiatives such as those related to secure communications can also complement SMs adopted by the providers by encouraging HIE.

The purpose of this study was to examine consumer data acquired by branded prescription drug websites and the ethics of privacy related to the interconnected web of personal information accessed, packaged and resold by tracker technologies.

The research used the DMI Tracker Tool to collect data on the top 17 branded prescription drug websites, with a specific interest in the tracker technologies embedded in those websites. That data was analyzed using Gephi, an open-source data visualization tool, to map the network of trackers embedded in those branded prescription drug websites.

Findings visualize the interconnections between tracker technologies and prescription drug websites that undergird a system of personal data acquisition and programmatic advertising vehicles that serve the interests of prescription drug marketers and Big Tech. Based on the theory of platform ethics, the study demonstrated the presence of a technostructural ecosystem dominated by Big Tech, a system that goes unseen by consumers and serves the interests of advertisers and resellers of consumer data.

The 17 websites used in this study were limited to the top-selling prescription drugs or those with the highest ad expenditures. As such this study is not based on a random sampling of branded prescription drug websites. The popularity of these prescription drugs or the expanse of advertising associated with the drugs makes them appropriate to study the presence of tracking devices that collect data from consumers and serve advertising to them. It is also noted that websites are dynamic spaces, and some trackers within their infrastructures are apt to change over time.

Branded prescription drug information has over the past three decades become part of consumers’ routine search for information regarding what ails them. As drug promotion moved from print to TV and the Web, searching for drug information has become a part of everyday life. The implications of embedded trackers on branded prescription drug websites are the subject of this research.

This study has significant social implications as consumers who are searching for information regarding prescription medications may not want drug companies tracking them in a way that many perceive to be an invasion of privacy. Yet, as the Web is dominated by Big Tech, web developers have little choice but to remain a part of this technostructural ecosystem.

This study sheds light on branded prescription drug websites, exploring the imbalance between the websites under study, Big Tech and consumers who lack awareness of the system that operates backstage.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

The study aims to address a critical gap in existing healthcare payment schemes and care service pricing by recognizing the influential role of patients' decisions on self-management efforts. These decisions not only impact health outcomes but also shape the demand for care, subsequently influencing care costs. Despite the significance of this interplay, current payment schemes often overlook these dynamics. The research focuses on investigating the implications of a novel behavior-based payment scheme, designed to align incentives and establish a direct connection between patients' decisions and care costs. The primary objective is to comprehensively understand whether and how this innovative payment scheme structure influences key stakeholders, including patients, care providers, insurers and overall social welfare.

In this paper, we propose a game-theoretical model to incorporate the performance of self-management with the demand for healthcare service, compare the patient's effort decision for self-management and provider's price decision for healthcare service under a behavior-based scheme with that under two implemented widely payment schemes, that is, co-payment scheme and co-insurance scheme.

Our findings confirm that the behavior-based scheme incentives patient self-management more than current schemes while reducing their possibility of seeking healthcare service, which indirectly induces the provider to lower the price of the service. The stakeholders' utility under various payment schemes is sensitive to the cost of treatment and the perceived health utility of patients. Especially, patient health awareness is not always benefited provider profit, as it motivates patient self-management while diminishing the demand for care.

We provide a novel framework for characterizing behavior-based payment schemes. Our results confirm the need for modification of the current payment scheme to incentivize patient self-management.

In developing countries, how risk management technologies influence management accounting and control (MAC) practices is under-researched. By drawing on insights from institutional studies, this study aims to examine the multiple institutional pressures surrounding an entity and influencing its risk-based management control (RBC) system – that is, how RBC appears in an emerging market attributed to institutional multiplicity.

The authors used qualitative case study research methods to collect empirical evidence from a privately owned Egyptian insurance company.

The authors observed that in the transformation to risk-based controls, especially in socio-political settings such as Egypt, changes in MAC systems were consistent with the shifts in the institutional context. Along with changes in the institutional environment, the case company sought to configure its MAC system to be more risk-based to achieve its strategic goals effectively and maintain its sustainability.

This research provides a fuller view of risk-based management controls based on the social, professional and political perspectives central to the examined institutional environment. Moreover, unlike early studies that reported resistance to RBC, this case reveals the institutional dynamics contributing to the successful implementation of RBC in an emerging market.

The ecosystem concept has attracted attention in information system research to explain business competition, innovation and many other emerging phenomena. Existing studies focus more on a single ecosystem type or a single ecosystem goal and pay little attention to the ecosystem’s evolution. The objective of the study is to investigate the factors that impact the evolution of the information ecosystem (IE) to gain a better understanding of strategic thinking.

The IE involves many actors, so the multi-case study approach is conducted with purposeful sampling to recruit all the significant ecosystem actors. The collected qualitative data are analyzed by coding data, exploring data relationships and structuring pattern steps; institutional theory is used as a theoretical framework.

The results demonstrate that industry practices, laws and regulations, new actors and the mimetic pressure of outsourcers drive the growth of the ecosystem. Strategy intention, cost pressure and normative pressure all contribute to the IE’s evolution.

The concept of ecosystems has attracted attention in information system research. The study investigates the factors contributing to the evolution of the IE from an institutional theory perspective. Our suggestion is that new players can find a niche in offering information technology (IT)/ information services (IS)-related solutions to survive in the ecosystem; however, they need to pay attention to the normative pressure.

This study aimed to investigate the sensemaking strategies employed by early-career employees working within organizationally constrained environments.

Grounded in the sensemaking-as-accomplishment framework, a longitudinal multi-case study was conducted, involving three early-career employees. These participants were interviewed multiple times concerning tasks they themselves identified as anomalous and ambiguous.

The study's findings illuminate how early-career employees utilize sensemaking strategies to accomplish anomalous-ambiguous tasks. These strategies are interwoven with deliberate efforts to mitigate organizational constraints that exist in the organization or arise during the execution of complex tasks.

Notable limitation pertains to the time gap between task completion and the interviews. Conducting real-time interviews concurrently with task execution or immediately afterward was not feasible due to constraints in participant availability. This research has implications for organizational learning initiatives, particularly those encompassing employee-driven self-learning components. Insights derived from studies like this can inform the development of effective self-learning schemes within organizations.

Previous sensemaking research focused on what takes place in high-reliability organizations. This study explored sensemaking strategies in workplaces that are organizationally constrained.