International Journal of Healthcare Technology and Management (6 papers in press)

• Reducing Non-Operative Time: Methods and Impact on Operating Room Economics
  by Dan Krupka, Shashikant Sathaye, Warren Sandberg 
  Abstract: Improving operating room Throughput is a perennial objective, but only incremental gains have been reported in the past. Recently, however, in situations characterized by short Operative Times, several teams have reported substantial increases in Throughput by addressing Non-Operative time rather than just its component, Turnover Time. The methods employed fall into five categories. Reviewing published results, we deduce the potential impact of each category on the reduction of Non-Operative Time. Next, we estimate the reduction in Non-Operative Time that must be achieved to reliably add cases to a “full” operating room schedule, given a variety of Operative Times. Finally, we calculate potential incremental margin contributions of several of the reviewed perioperative systems when implemented in a typical U.S. hospital. We conclude that the benefits of introducing the methods outweigh their costs, but caution that hospitals need to increase their caseload of short procedures to realize these benefits.
  Keywords: perioperative systems; perioperative systems design; operating room efficiency; operating room throughput; hospital revenue; non-operative time; cost savings; opportunity cost; healthcare process redesign; healthcare process effectiveness.
   
• The Use of Knowledge Management in Telemedicine and Perceived Effects on Patient Care Activities
  by Jami DelliFraine, Kathryn Dansky, Jill Rumberger 
  Abstract: This study investigates the relationship between types of knowledge management activities used in telemedicine and nurses’ perceived efficiency and effectiveness of telemedicine systems in home health agencies. Drawing from knowledge management concepts, we propose that nurses who engage more frequently in telemedicine knowledge management activities will perceive the telemedicine system to contribute to overall efficiency and effectiveness of patient care delivery. Primary data were collected from 29 home health agencies and 917 nurses from 2004-2005. The results of the analysis indicate a strong and significant association between the use of combined explicit and tacit knowledge management activities using the telemedicine system and nurses’ perceived efficiency and effectiveness of the telemedicine system. We conclude that using telemedicine for knowledge management activities has a positive impact on the perceived efficiency and effectiveness of patient care delivery in home health agencies.
  Keywords: telemedicine; telehomecare; home health; knowledge management; patient care.
   
• A Specification Process for Communicating Security Policies to Trusted e-Health Information Systems
  by Lakshmi Narasimhan, Peter Croll, William Caelli 
  Abstract: E-Health systems must be capable of adhering to clearly defined security policies based upon legal requirements, regulations and ethical standards while catering for dynamic healthcare and professional needs. Further, such security policies, incorporating enterprise level principles of privacy, integrity and availability, coupled with appropriate audit and control processes, must be able to be clearly defined by enterprise management with the understanding that such policy will be reliably and continuously enforced. The ability, then to map such e-Health policies into mandatory access control structures for next generation secure computer systems is an essential requirement for the future. This paper provides some principles for addressing these issues and provides a solution space that tackles the technical challenges involved in their implementation.
  Keywords: e-Health systems, security policies, security Standards, data privacy, information architecture.
   
• Involving stakeholders in policy research should not imply that they control the problem definition. Lessons from a case study on new analgesics
  by Margriet Moret-Hartman, Gert Jan van der Wilt, John Grin 
  Abstract: The Dutch Health Care Insurance Board (HCIB), an advisory body to the Ministry of Health commissions research to guide their policy recommendations. However, the studies commissioned conducted did not always yield relevant information. This may result from differences in problem definitions held by the HCIB and by target populations. To compensate for these problems, researchers were asked to analyse problems from the perspective of the policy maker and the policy's target populations. We monitored and analysed this HCIB’s commissioning approach when used in a tender that was issued for research proposals on a new type of analgesics. The HCIB considered off label use of these new drugs to be problematic. Our analysis showed that researchers seemed to be reluctant to adopt the HCIB's problem definition, questioning whether it would be shared by 'the field'. Although most physicians did not consider their prescribing patterns to be problematic, one of the new drugs had to be withdrawn from the market because of severe side effects. The results of this case study emphasize that involving target populations in policy research should not imply that target populations control the problem definition and identification of solutions.
  Keywords: Policy analysis, qualitative research, participatory methodology, cox-2-selective inhibitors
   
• Healthcare Web Privacy Policy Management - A UK to USA Comparison
  by Darren Mundy 
  Abstract: As we move towards fully computerised healthcare institutions with a web presence, ethical challenges of e-health come increasingly to the fore. One of those ethical challenges; that of privacy protection is of principal importance for our patients when using services for ehealth. This paper investigates practices in the UK and USA related to web privacy policy. The study presents a unique perspective on the similarities and differences between healthcare and healthcare related organisations in the two countries. In particular it is useful to look at how privacy policies have changed post the introduction of HIPAA as an indication to the challenges faced by UK organisations over the next few years. The hope is that raising awareness of these results will drive forward changes in UK privacy policy management, similar to those experienced with information quality.
  Keywords: Privacy; Goal Oriented Analysis; Data Protection; Privacy Protection Goals; Privacy Vulnerability Goals; Cookies; Security; Healthcare; WWW, International Comparison
   
• Key Success Factors in the Implementation of an Automated Dispensing System in Community Pharmacy
  by Lesley White 
  Abstract: This research project was undertaken to determine the factors which influence the success of an implementation of a disruptive technology in a small business context. The technology studied was automated dispensing systems (ADSs) which are at an early stage of adoption and represent a major innovation in community pharmacy. Twenty interviews were conducted with owners, managers and 10 dispensary assistants from all 11 pharmacies in Australia where ADSs have been installed to date. Two main themes were identified from the interviews; pharmacy organisational characteristics and factors associated with the new technology, the ADS itself. Pharmacy organisational characteristics include factors associated with the leadership, the planning undertaken, employees, the pharmacy and its processes. Factors associated with the ADS included the machine itself, the software, the installation and the vendor.
  Keywords: Key Success Factors; Innovation; Pharmacy; Community Pharmacy; Automated Dispensing System; New Technology Implementation