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	<title>Information Science Today &#187; information technology</title>
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		<title>Educational data mining</title>
		<link>http://infosciencetoday.org/document-management/educational-data-mining.html</link>
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		<pubDate>Wed, 10 Mar 2010 05:17:45 +0000</pubDate>
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				<category><![CDATA[Document management]]></category>
		<category><![CDATA[data minign process]]></category>
		<category><![CDATA[data mining]]></category>
		<category><![CDATA[EDM]]></category>
		<category><![CDATA[information technology]]></category>

		<guid isPermaLink="false">http://infosciencetoday.org/?p=995</guid>
		<description><![CDATA[Today, as in other areas of society, information technology and communications have entered the field of education. It is possible to capture and compile a very simple and low cost all kinds of information: administrative data enrollment in schools, colleges or universities, computerized academic records of students, logging in educational portals (e-learning platforms ), collaborative [...]]]></description>
			<content:encoded><![CDATA[<p>Today, as in other areas of society, information technology and communications have entered the field of education. It is possible to capture and compile a very simple and low cost all kinds of information: administrative data enrollment in schools, colleges or universities, computerized academic records of students, logging in educational portals (e-learning platforms ), collaborative learning systems guided by the computer (computer-supported collaborative learning systems, etc.).<br />
<span id="more-995"></span><br />
Educational data mining (Educational Data Mining, EDM) is the process of transforming raw data collected by national education systems into useful information that can be used to make informed decisions and answer research questions [Cecily Heiner, Ryan Baker and Kalina Yacef, Proceedings of the Workshop on Educational Data Mining at the 8th International Conference on Intelligent Tutoring Systems (ITS 2006). Jhongli, Taiwan]. </p>
<p>In short, EDM is simply the application of data mining in the area of education, in order to gain a better understanding of the learning process of students and their overall involvement in the process, aimed at improving quality and profitability of the educational system. </p>
<p>In EDM can identify three types of objectives: educational objectives (assistance in the design of educational content, improvements in student academic performance), management objectives (optimizing the organization and maintenance of education infrastructure, areas of interest, more courses requested) and commercial objectives (market segmentation allows and facilitates the capture of pupils, particularly important in the case of private education). </p>
<p>EDM is an emerging discipline at the intersection of data mining and pedagogy. On the one hand, pedagogy provides the intrinsic knowledge of the learning process. Furthermore, data mining techniques provides modeling and analysis of information. EDM, like data mining itself, this is a technology that integrates multidisciplinary techniques, information retrieval from the database using simple SQL queries to use machine learning algorithms from the field of artificial intelligence. Among the most common techniques in education are the automatic grouping (clustering) and analysis of partnerships and common patterns in sequences.</p>
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		<title>Beyond Convenience and Competition : The Impact of Personalized Information Technology on the Way Communities Work</title>
		<link>http://infosciencetoday.org/type/research-type/beyond-convenience-and-competition-the-impact-of-personalized-information-technology-on-the-way-communities-work.html</link>
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		<pubDate>Wed, 23 Dec 2009 22:10:48 +0000</pubDate>
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				<category><![CDATA[Articles]]></category>
		<category><![CDATA[Information systems]]></category>
		<category><![CDATA[Marketing]]></category>
		<category><![CDATA[Research]]></category>
		<category><![CDATA[information science]]></category>
		<category><![CDATA[Electronic Data Transfer]]></category>
		<category><![CDATA[European Common Market]]></category>
		<category><![CDATA[information technology]]></category>
		<category><![CDATA[North American Free Trade Agreement]]></category>

		<guid isPermaLink="false">http://infosciencetoday.org/?p=865</guid>
		<description><![CDATA[Abstract:
Having already transformed business beyond recognition in barely two decades, information technology is now further expanding into the general culture and transforming society at an equally rapid rate due to the growth and popularity of personal and personalized computing.  While the computer was once only a factor in the production of other goods, it is [...]]]></description>
			<content:encoded><![CDATA[<p style="text-align: justify;"><span style="text-decoration: underline;"><strong>Abstract:</strong></span></p>
<p style="text-align: justify;">Having already transformed business beyond recognition in barely two decades, information technology is now further expanding into the general culture and transforming society at an equally rapid rate due to the growth and popularity of personal and personalized computing.  While the computer was once only a factor in the production of other goods, it is now a commodity in itself being tailored to the demands and desires of the consumer. Businesses have always been innovating to gain a competitive edge, but no commercial tool, from the wheel to the airplane, has affected the way we live, as well as the way we do business, as much as information technology.</p>
<p style="text-align: justify;">Today, increasingly, political campaigns are organized, social activism is waged, and consumer populations are identified and targeted, through no other means than the use of information technology.  This paper will examine the nature of this trend and possible implications of its expansion.  For as the growth of the Internet and personalized information technology is rapidly creating and strengthening some communities at the local, state, national, and international level, it is simultaneously undermining others on an equally large scale.</p>
<p style="text-align: justify;">When the Stranger says: &#8220;What is the meaning of this city?&#8230;What will you answer?  &#8220;We all dwell together to make money from each other&#8221; ? or &#8220;This is a community&#8221;?  And the Stranger will depart and return to the desert. O my soul, be prepared for the coming of the Stranger, Be prepared for him who knows how to ask questions. &#8211; T.S. Eliot Choruses from &#8220;The Rock&#8221;</p>
<p style="text-align: justify;"><strong>INTRODUCTION</strong></p>
<p style="text-align: justify;">This dialogue probes central questions of quality of life that communities have been asking themselves for ages, and ones which we have tried successively to respond to with answers in the form of new ways of thinking, scientific advancements and technological developments.  What is the purpose and definition of communities?  How are they strengthened?  How may individual standards of living and quality of life be raised?  The Agrarian Age provided many answers to these questions and profoundly altered the productivity and lifestyle of human societies.  The Industrial Age has had an even greater impact on communities, personal fortunes and human potential but at the same time has brought on enormous unintended and unforeseen social and environmental side effects.  The Information Age promises to do the same.</p>
<p style="text-align: justify;">For the purposes of this examination, personalized information technology is defined as the increasing range of products on the border between consumer electronic devices and computing equipment.  So many of these items, only recently, were high-priced tools of business efficiency but have now become everyday household items.    This includes, but is not limited to, the Internet, pagers, personal digital assistants, e-mail, world wide web homepages, and even fax machines; all of which now use the most cutting-edge satellite, fiber optic and microwave transmission capability.</p>
<p style="text-align: justify;">In a breathtakingly short period of time, personalized information technology through the media of communications devices, electronic data transfer capabilities, and personal computers, has profoundly altered every field of business manufacturing and services imaginable as well as education, government and labor.  As these are all components of communities, how then, are communities being affected by this force which is said to be making life easier? In looking at scholarship on the subject of communities themselves, it seems clear that there are negative trends underway even in the absence of universal information technology.  Some scholars [16,18] identify the very same phenomena echoed in the quotation by T. S. Eliot above.  Our communities are fragmented and lacking in a rich common cultural life.  They are lacking in commitment and solidarity on the part of the governing elite or the public.  Our cities are not built around the shared enterprise of building a common set of values, but rather they are &#8220;economic sites for the combining and recombining of atoms&#8221; in which modernism and technology have failed to provide substantive answers to the age-old motivations which are the primary purpose of communities.</p>
<p style="text-align: justify;">This same sense of anxiety clearly still exists today as to whether we will be able to meet the needs and challenges of our communities.  The meteoric rise of personalized IT has provided some answers during this interim time, but their long term impact remains to be seen.  The nearly unbridled influence that IT will have on our lives is often examined in the media by its primary drivers [11,12]. We can see from these discussions how digital information is without boundaries and how, having revolutionized the computer industry, it is now turning to the communications industry and will soon be felt by the media, health care and education industries as well.</p>
<p style="text-align: justify;"><strong>Where is IT Taking Us ?</strong></p>
<p style="text-align: justify;">What these changes will be, however, is far from certain.  In many ways, this is a reality which is being shaped on a daily basis.  It is almost axiomatic that the changes taking place in these many fields are not only industry-wide, but worldwide.  Almost single handedly, Information Technology, and specifically Electronic Data Transfer, is responsible for the relatively new phenomenon which is now a household word: Globalization. As it is currently conceived, the impact upon communities of the process of globalization is little more than a promise that life will be easier for everyone once access among world markets is greater.  We have seen the strong opinions on both sides of the North American Free Trade Agreement (NAFTA) and the European Common Market, both of which could be seen as trial runs for what IT promises to enable on a global scale.  Economic opportunities are widened for a few, many others are displaced, and financial ripples in one country send shock waves throughout the region at an accelerated and intensified rate.  Witness the ongoing global economic crisis sparked initially by the fiscal misbehavior of a few small Asian nations.  The effect is summed up in the words of one observer [2] to the effect that globalization now encompasses economic interaction, ideas and information technology, culture and even the labor force.  The potential is exciting, provided that democratically-mandated governments, in cooperation with business, fulfill their role; if they do not, the gap between the developing and the developed world as well as within societies will widen.</p>
<p style="text-align: justify;">To be sure, many companies are trying to demonstrate the positive social and community effects of the information technology which they provide to the developing world to facilitate and encourage capitalist free markets and even democratic elections and political institutions [23].</p>
<p style="text-align: justify;">To look further at the impact of personalized Information Technology on communities it is important to become familiar with definitions of community and then, to examine what groups are benefiting, and suffering, from these developments.  Following the generally recognized definitions of community, [6,13] the term refers either to a locality such as a neighborhood or town, or to a relational group, typically networks of like-minded people within formal or informal organizations.  An individual&#8217;s sense of membership and belonging to either one often depends upon the influence, sense of belonging and personal investment one has in the community, among other factors.  If it is true [9] that communities need not be committed to a geographical dimension, that they may be &#8220;communities without propinquity&#8221;, [25] then this indeed portends a profound impact on the social institutions we rely upon in our day-to-day lives.  People who have their own means of communication and thus form independent networks are precisely the types of communities that corporations want to encourage, identify and exploit by way of data mining and other forms of IT-driven marketing.  The primary consideration of this paper is this question: which communities stand to gain from developments in IT, which ones stand to lose, and in what ways?</p>
<p style="text-align: justify;"><strong>BENEFICIARY COMMUNITIES OF INFORMATION TECHNOLOGY</strong></p>
<p style="text-align: justify;">Corporations are the first group to look at who will benefit from the shift from geographical to relational communities.  There are many reasons for this, not the least of which is the fact that a major portion of corporate expenses come from identifying far-flung groups of potential clients and customers, advertising to them through various media, placing branch stores and offices in their physical communities to service their needs and storing goods for sale in these many locations.  All of these activities and their associated costs can potentially be eliminated through the use of information technology.  Physical location, natural resources and availability of domestic capital are no longer constraints on business. [22]</p>
<p style="text-align: justify;">But how exactly do firms see the growth of personalized information technology and how do they expect to be able to use it?  The current vision is essentially limited to advertising products and sponsors on the Web in the hope that viewers will buy something.  An enhanced and value-added approach to on-line communities will come from satisfying people&#8217;s multiple social needs in a way that will create stronger customer loyalty which  will in turn generate strong economic returns. [4]</p>
<p style="text-align: justify;">Or so companies believe.  A crucial but as yet unaddressed issue regards the long-term effects of replacing geographical communities with virtual ones. Even the computing industry itself has had to confront the implications of this trend.  Ironically, in the face of the mounting trend toward telecommuting, virtual networking and the elimination of the centralized workplace, people in the  computer and software industries still realize the importance of propinquity and face to face contact. [20]  This does not mean, however, that the decentralizing effects of these developments will cease.  No major transformation of the workplace has ever been without social consequences, from the dissolution of the feudal system of trade and agriculture to the industrial revolution to the  movement for greater participation by women in the workplace.  The advent of universal and personalized IT is no less of a revolution and it will easily spur as many changes to current social structures.  Whether we welcome these changes or not, we must be aware of the fact that all of the current developments in technology today have this in common: they reduce the degree to which we are dependent upon one another.  At the very least, they reduce the degree to which we perceive ourselves to be dependent on our neighbors, which may be even more dangerous, for it creates a false sense of security.  People are no longer dependent on their neighbors for company or social interaction, shoppers are no longer dependent on local stores for the things they want to buy, and businesses are not even dependent anymore on regional banks to finance their growth and expansion.  Corporations themselves are trying to accelerate this trend with the promise of greater choice, convenience and freedom for consumers.  These may indeed be legitimate goals by which they hope to satisfy consumers and thus increase market share, but equally important are the motivations to cut costs, segment the marketplace and dilute collective consumer bargaining power.  A good example of the dynamics of IT&#8217;s influence on the workplace and on communities is in the banking industry.  Long gone are the days of the savings account passbook and face-to-face recognition of customers with local branch employees.  A degree of security has already been lost in that transition, as anonymous electronic banking is much more susceptible to fraud than is truly personal banking.  There is a kind of snowball effect going on now in the banking, insurance and investment industries.  Mergers and acquisitions are taking place almost monthly and takeover bids in the $30-$50 billion range are not uncommon.</p>
<p style="text-align: justify;"><strong>The PC Banking Revolution</strong></p>
<p style="text-align: justify;">Banks are at the forefront of this move and conceivably could do away with branch offices entirely in a matter of a few years.  While touting it as a convenience to account holders, banks are increasingly pressuring consumers, through advertising and increased user fees, to perform their transactions on line rather than at a physical location which requires the presence of trained and paid employees.  Additional advantages are easily identifiable:  as awareness and use of the World Wide Web continues to grow exponentially, companies will be able to market their products and services to hundreds of thousands of potential consumers without the high cost of television, print or even radio advertisement.  To establish a permanent web page can be a mere fraction of the tens of thousands of dollars necessary for a one-time television ad.  A conglomeration on the scale of the merger between NationsBank and BankAmerica, which will create a bi-coastal behemoth of over 4,300 branches in 21 contiguous states would be utterly inconceivable without the enabling power of information technology.</p>
<p style="text-align: justify;">Electronic data transfer will make possible the combination of each bank&#8217;s account and transaction systems and unification of their different software systems.  Even with the awesome data computing and transmission power of current hardware and networks, enormous complications remain.  Nations Bank is still in the process of assimilating the accounts of previously acquired banks and the merger with Bank America will greatly complicate the efforts of each at Y2K compliance. [5]  Nevertheless, these and other companies see such expansion as desirable avenues for almost unlimited future growth.</p>
<p style="text-align: justify;"><strong>The New Populism</strong></p>
<p style="text-align: justify;">Another major group which stands to benefit significantly from the growth and personalization of IT is public policy interest groups. Political Action Committees and the many various minority advocacy organizations benefit from the same reduction in advertising costs that the World Wide Web brings to corporations.  Both small, unknown groups as well as large, established and highly recognizable non-profit organizations alike can gain a  sort of technological leverage from IT which can greatly magnify their message and access to the public.  As far back (in technological time-scale) as 1989, organizers of the democratic uprising in Beijing&#8217;s Tiananmen Square relied extensively on fax machines and other forms of electronic communication to coordinate leaders and followers of the uprising and to maintain contact with the outside world.  The spread of personalized IT is not only facilitating communication in countries where these products have leap-frogged over older generations of devices to become the fastest growing technology sector.  In the fully modernized, Information Age economies, as well, this phenomenon is beginning to determine the content, shape and volume of the communication itself.  This has profound implications for community and political activism.  It is not difficult to envision a kind of electronic democracy or &#8220;Technocracy&#8221; in which individuals and interest groups flood their elected representatives with petitions far out of proportion from their actual numbers in the population. Even the information technology industry itself is beginning to see the necessity of becoming politically active in order to influence governmental policies. [7]  It is not difficult to project this trend forward to a greater degree in which there is a return to direct participatory democracy by electronic means. [1]  Informed (or uninformed) voters could cast ballots on-line for various pieces of legislation and lobby for or against in the same manner.  This might one day appear attractive to the public for the immediacy and interactivity of it, and even the potential to create, once again, greater &#8216;independence&#8217;.  In this case it would be a perceived independence from legislators and vastly expensive election and issue advocacy campaigns.  Inevitably, however, such a process would quickly deteriorate into a myopic popularity contest of issues in which the public was even more susceptible to manipulation by interest groups and the controllers of the electronic networks on which our communications travel in much the same way that on-line opinion polls and surveys already have done today.  There are also significant implications for international government and diplomacy.  Crises have arisen out of the content or propaganda that some liberal countries allow to be electronically broadcast from their territory, such as pornographic or pro-Nazi material, which can be viewed in countries that prohibit these materials, such as Saudi Arabia or Germany. Alternatively, the growth of information technology is thought to hold great promise for international business opportunities and democratization.  [19]</p>
<p style="text-align: justify;">The growth of on-line participation in public policy debates will not necessarily increase the degree to which people become involved in their communities.  It may actually diminish the amount of local activity in a certain causes as national activist groups are increasingly able to apply pressure on certain issues at even the lowest political levels.   This appears to be an area in which the expansion of personalized IT works both to the benefit and to the detriment of communities.  Certainly there are interest groups that are incompatible with the preservation of a healthy and supportive community which will benefit from the same technological leverage of IT that businesses and other groups seek.  Among the most high profile of these are groups engaged in the distribution of pornography and other offensive or incendiary materials.  This has posed new challenges to the guarantees of free speech that the government seeks to preserve for communities as a whole because the rapidly changing and nearly unregulable</p>
<p style="text-align: justify;">Internet creates even greater potential for criminal activity. [10]  One the other hand, great potential in personalized IT for philanthropic and civic minded individuals and groups as well.  The very same networks providing greater communication potential for would-be criminals can enhance policing and community activism efforts.  Everyone from Neighborhood Watch groups to supporters of international humanitarian efforts can be identified, contacted and organized for social and political purposes with greater efficiency and less expense through information technology.</p>
<p style="text-align: justify;">The example of socially conscious communities of interest is a fascinating one which is presently evolving at a very rapid rate. Historically it has been especially difficult for human rights organizations to overcome the geographical and economic barriers to their attempts at connecting concerned citizens spread around the world with the people at risk for human rights violations in other countries.  Two prominent recent examples illustrate the impact that information technology is having on communities of conscience which previously had to go door-to-door in order to generate grass-roots support.</p>
<p style="text-align: justify;"><strong>Changing the World with IT</strong></p>
<p style="text-align: justify;">The 1997 Nobel Prize for Peace was awarded to Jody Williams, a woman whose tactics epitomize the model of Information Age organization and activism.  Beginning  in 1991 at the Vietnam Veterans of America Foundation, she worked to assemble a coalition of more than 1,000 non-governmental organizations in more than 60 countries into the International Campaign to Ban Landmines (VVAF, 1997)  Ms. Williams conducted much of this organizational work by e-mail and by raising public and legislative awareness through the use of the Internet and the World Wide Web.  Without the leverage provided by information technology,  it would have been almost prohibitively expensive to mount a communication and organizational effort on the scale of the International  Campaign to Ban Landmines.  And yet, as the awarding of the Nobel Peace Prize indicates, her efforts have been invaluable to the cause of the human rights community worldwide.  The organization eventually led to the signing of the International Treaty to Ban Landmines by over 100 nations.</p>
<p style="text-align: justify;">A second example comes from a 15-year old Toronto native named Craig Kielburger.  After becoming concerned about the issue of child labor exploitation primarily in Third-World countries, he began to become active in raising awareness about the conditions that children his age are subjected to around the globe.  After founding Free the Children, a children&#8217;s rights advocacy organization, Kielburger has focused especially on consumer responsibility in purchasing, trying to pursuade middle-class consumers in the industrialized nations to demand that manufacturing companies such as Toys &#8216;R&#8217; Us and Reebok guarantee that their products are child-labor free.  Like Jody Williams, Kielburger has used the Internet extensively to broadcast and coordinate his message.  Like-minded members of such communities of interest would have extremely limited means of contacting each other and bringing significant pressure to bear on corporations without the empowering effect of personalized information technology.</p>
<p style="text-align: justify;">These, however, are some of the winners in the IT revolution that has moved so rapidly from the boardroom to the living room.  It is inevitable that a social transformation on such a scale will leave many members of our communities permanently worse off.  Can we identify those who will suffer from these changes and what the cost will be to them and to the culture at large ?</p>
<p style="text-align: justify;">COMMUNITIES AT RISK</p>
<p style="text-align: justify;">There  are those who have been displaced or left in a compromised and lower position as the result of every technological development which had any social implications, and the growing influence of IT in our daily lives will no doubt have the same effect.  As we know, many communities stand to gain from continued advances.  It is clear that corporations hope to cut costs and redundancies while increasing their market share and customer loyalty through the use of information technology.  Minority interest groups can gain an added voice beyond their immediate constituencies and municipal and non-profit organizations will have their jobs made much easier by the communication power and simplification of logistics that are offered by the Internet and electronic data transfer.  It is essential, however, to examine what negative impacts can be foreseen for communities as a result of these changes in the way we work and communicate.</p>
<p style="text-align: justify;">One of the primary goals of applied technology today is to make people less dependent upon one another.  Therefore, there will very likely be a severing within communities of many of the social links which have for generations been a natural by-product of the way people do business.  Businesses which have been more relationship-oriented are shifting to a more transaction-oriented focus.  Again, banks are a perfect example: while publicly insisting upon their commitment to service and to personalized attention for every account holder, banks are growing ever larger and preventing such promises from becoming a reality.  They are simultaneously cutting back services and dis-incenting customers from using or expecting personal service at a physical branch.</p>
<p style="text-align: justify;">Clearly the most at-risk individuals and communities in this evolving new way of work will be those who do not &#8220;jump on the bandwagon&#8221;, so to speak.  That is, those who do not align themselves with technologically sophisticated partners or have independent support networks of their own.  The elderly come to mind first in such a scenario, but many other groups will be at risk as well.  Employees in virtually every major corporation increasingly must sacrifice privacy as their work files, letters, daily activity schedules and all inter- and intra-office communications become subject to electronic supervision and consumers are subject to greater surveillance by advertisers and marketers when they use on-line services (Kennedy, 1996).  Ironically,  corporations themselves are losing a measure of independence and control over the workplace when managers do not respond to the changing climate of technology.  For example, employees can create &#8220;virtual unions&#8221; to organize for certain issues without ever holding physical meetings, leading to unexpected challenges to management.  Additionally, IT departments must act as facilitators of technology use within various companies, rather than simply dictating what kinds of computing their employees will have access to and what they will do with it.  [3]</p>
<p style="text-align: justify;">As the changes brought on by successive waves of IT revolutions filter into the workplace and society, the true measure of their long term effect on community health will be in the resulting quantity and quality of careers to be had.    Employees in almost every industry may suffer from expanded information technology is simply in the amount of jobs available to be had.  It is a clearly stated goal of most companies implementing IT systems that they hope to cut costs by doing so, and one of the greatest cost centers is personnel and the benefits that they expect.  It is difficult to imagine any trade or profession that could not operate more efficiently and more cheaply with the use of computers, and therefore nearly all tradesmen and professionals are theoretically at risk of losing their jobs to computers.  In a most supreme of ironies, IT specialists have even put their own jobs at risk.  In what is truly a phenomenal and possibly unique dynamic in the realm of business, the cycle of IT innovation has become a self-perpetuating process which feeds upon itself and even on its practitioners. Studies have shown that information-sensitive industries tend to bring with them a proportionate increase in low-wage labor.  Furthermore, advances in software capabilities can rapidly turn highly skilled programming, coding and image manipulation into simplified drudgery.  In such an environment, it is very likely that the more advances are realized by those in high technology fields, the more they will fuel the tendency of business to transfer as much programming and technical design as possible to low-wage employment.  [20]</p>
<p style="text-align: justify;">Although a great deal of the work done already by computers is repetitive detail or drudgery, we can see that whole classes of work are being converted into simple grunt work.  Jobs which previously required a broad range of technical, analytical and interpersonal skills now require only a narrow range of &#8220;computer skills&#8221;. In the process, the sum total of positions available in the workforce and the range of skills needed are significantly reduced.  Hospitals, architectural design firms, securities brokerage houses, travel agencies and businesses in almost every other industry conceivable are employing IT not only to cut costs and perform labor-intensive tasks, but also frequently to handle the day-to-day interaction with their customers through auto-mated, voice-recognition response systems, for example.  In the process, many companies have reduced their staffing needs by 50 percent.  Overall, tens of thousands of employable positions have  been eliminated by IT redesign efforts.  [17]  In the BankAmerica/NationsBank merger, president David Coulter of BankAmerica estimated that the two banks would cut between 5,000 and 8,000 jobs when joined.  [5]  Studies have clearly shown that even the customers of merging banks often do not benefit from lower fees in the long run.  [8]  Economists have long debated the true long-term impact of technology related shifts in the labor market and what can or should be done about them.  To take one of the classic examples, we can look at the demise of the horse and buggy trade.  Neither government nor the private sector should have fought this inevitable trend, they would argue, or subsidize horse and buggy manufacturers to help them compete with the automobile industry.  The workers in this dying trade will simply be retrained and will go to work elsewhere in newly created industries, they would argue.  But can anyone truly believe that tens or hundreds of thousands of bank tellers, travel agents, stock brokers, assembly line workers, car salesmen, telephone operators, teachers, pharmacists and miscellaneous office workers can all be relocated once everyone can buy airline tickets, mutual funds and prescription drugs on line?  Or that computer and related industries can absorb them all and provide them the same quality of life and job satisfaction?  Such a forecast may be said to be overly pessimistic, but the vast majority of the duties performed by every one of those individuals could be performed more efficiently or simply eliminated by the greater use of information technology.</p>
<p style="text-align: justify;"><strong>CONCLUSION</strong></p>
<p style="text-align: justify;">Geographical communities everywhere are at risk in this process of technological change, even as greater opportunities are being created for some individuals. While personalized IT is creating greater independence for some of its beneficiaries, it must also be noted that &#8220;Liberty is the strongest force leading to isolation; fraternity and equality typically sit waiting on the sidelines.  We have to get them on the field so that these three elements can work together&#8221;.  [18]  We must be aware of the long-term affects of these changes on communities and decide which capabilities made possible by IT are ones that we want to live with.  It has been noted that &#8220;People no longer really live their lives in neighborhoods; and professionals are the most transient and least connected of all.  If the housekeeping details of the area where they lived were properly taken care of and if security were adequate, they could scarcely care less about neighboring or social contacts with others in the area&#8221;.  [13]</p>
<p style="text-align: justify;">Andrew Grove predicts that  &#8220;What can be done, will be done.  Like a natural force, technology is impossible to hold  back.  It finds its way no matter what obstacles people put in its place.&#8221;  [12]  Whether you subscribe to this extraordinary statement or not, it is clear now that there is no Digitopia of ahead on the horizon to justify the wholesale re-engineering of the workplace and society for no reason other than simply that &#8220;it can be done&#8221;.  Certainly not if we define &#8220;progress&#8221; as an improved work quality of life as measured by individual job satisfaction, security and productivity.</p>
<p style="text-align: justify;">It is likely that very few people would agree that everything that is now or will soon be technologically feasible will also be conducive to strong human communities.  Many such developments will in fact be detrimental and corrosive to them.  The primary threat, of course, is not the technologies and capabilities themselves, but rather the ways in which we choose to employ them and the degree to which we lose sight of our ultimate objectives in the process: to make life and work not simply easier, but better, more fruitful and more fulfilling.  If technological advances are simply a self-perpetuating cycle and cannot ultimately provide these objectives, then should not the resources being plowed into them be directed elsewhere?</p>
<p style="text-align: justify;">These universal and immutable goals will not be furthered by the creation of a world in which we conduct a greater and greater percentage of our transactions and exchanges with just ourselves and hosts of computerized enablers.  We are now, in the developed world, awash in social transformations brought on by the Information Age, with little or no time to take stock or measure of the consequences brought on by the last 20 years of IT revolutions.  We are extremely close to a utility frontier of sorts in terms of measuring actual additional qualitative benefits gained by each successive wave of technological change.  Professionals today must invest greater  amounts of education and experience and dedicate to their careers larger amounts of time more efficiently than ever before in order to maintain the same quality of life and purchasing power of their parent&#8217;s generation.  It was no coincidence President Clinton&#8217;s 1992 campaign mantra that Americans were &#8220;working harder for less&#8221; found such resonance beyond just the working class.  Whether there will be a consumer backlash in favor of more community-building business practices rather than ones that segment society further and further remains to be seen.  If not, we may pass through a permanent technological perestroika of our own after which we will look back and wonder if the outcomes could have been better.</p>
<p style="text-align: justify;">Henry David Thoreau anticipated e-mail and satellite video- conferencing by more than a century and a half when he observed: &#8220;We are in great haste to construct a magnetic telegraph from Maine to Texas;  but Maine and Texas, it may be, have nothing important to communicate.&#8221;  [21]  As we have seen in the case of Jody Williams, not only Maine and Texas, but Saskatoon and Sarajevo may indeed have a great deal of importance to say to each other, but the point is validly made that content must precede capacity as a rationale for development in the Information Age.  Threats to community must be addressed, for the purported aim of expanding information technology into every workplace and every home is clearly to strengthen and facilitate the activities that are most important to preserving a high quality of life, not to weaken these forces.  To address these issues will require the informed participation of government,  industry and civic organizations to ensure that the forces fueling the Information Age revolution are harnessed for the greatest possible good.</p>
<p style="text-align: justify;"><strong>REFERENCES</strong></p>
<p style="text-align: justify;">[1] ABC News.  (1998).  &#8220;E-democracy ?&#8221;  Homepage at www.abcnews.com November 2, 1998.</p>
<p style="text-align: justify;">[2] Ahtisaari, Martti.  (1997).  Globalization and its implications for Europe.  In Vital Speeches of the Day, Vol.64, Iss.4, 104-107.</p>
<p style="text-align: justify;">[3]  Anderton, Paula (1997).  Forrester takes run at the IT department.  In Computing  Canada, Vol. 23, Iss. 7. 15.</p>
<p style="text-align: justify;">[4]  Armstrong, Arthur and John Hagel III (1996).  The Real Value of On-Line Communities. In Harvard Business Review, May/June.  143.</p>
<p style="text-align: justify;">[5]  Block, Sandra (1998).  &#8220;Banks to merge; will be USA&#8217;s largest&#8221;.  In USA Today,  April 14. A1.</p>
<p style="text-align: justify;">[6]  Chavis, David M., et al. (1986).  Sense of Community Through Brunswik&#8217;s Lens: A First Look.  In Journal of Community Psychology, Vol. 14, January.  24-25.</p>
<p style="text-align: justify;">[7]   Dennis, Kathryn  (1997).  &#8220;Brother can you spare    some time?&#8221;  In MC Technology Marketing  Intelligence, Vol. 17, Issue 8. 12, 16.</p>
<p style="text-align: justify;">[8]  Dugas, Christine (1998).  &#8220;Customers aren&#8217;t sold on convenience, cost savings&#8221;.  In USA Today, April 14. A1.</p>
<p style="text-align: justify;">[9]  Florin, Paul and Abraham Wandersman.  (1990).    An Introduction to Citizen Participation,  Voluntary Organizations, and Community Development.  In American Journal of Community Psychology, Vol. 18, No. 1.  41-55</p>
<p style="text-align: justify;">[10]  Gallant, John  (1996).  Free trade of ideas.  In Network World, Vol. 13, No.2. 36.</p>
<p style="text-align: justify;">[11]  Gates, Bill.  (1996)  The Road Ahead.  New York: Viking Penguin, Inc.</p>
<p style="text-align: justify;">[12]  Grove, Andrew.  (1996).  What can be done, will be done.  In Forbes, December 2, 193.</p>
<p style="text-align: justify;">[13]  Heller, Kenneth. (1989). The Return to Community. In American Journal of Community Psychology.Vol.17, No. 1.1-15</p>
<p style="text-align: justify;">[14]  Kennedy, Shirley D.  (1996).  Internet commercialization vs. privacy. In Information Today, Vol. 13, No. 9.  46-47.</p>
<p style="text-align: justify;">[15]  Kielburger, Craig (1996).  &#8220;Stop child exploitation  by shopping with a conscience!&#8221; In Chicago Tribune, December 15.</p>
<p style="text-align: justify;">[16]  Long, Norton.  (1986).  The City as a Political Community.  In Journal of Community Psychology, 14,  January, 72-73.</p>
<p style="text-align: justify;">[17]  Lucas, Henry C.  (1995).  Information Technology for Management.  New York: The McGraw-Hill Companies, Inc. 68, 86, 107.</p>
<p style="text-align: justify;">[18]  Newbrough, J.R.  (1995).  Toward Community: A Third Position.  In American Journal of Community Psychology, Vol.23 No.1, 9-27.</p>
<p style="text-align: justify;">[19]  Rosa, Jerry (1997).  Road map to Latin America.  In Computer Reseller News, Issue 718, January 13. 109-110.</p>
<p style="text-align: justify;">[20]  Ross, Andrew (1998).  The Case of Silicon Alley.  In 21C, October 27, 1998.</p>
<p style="text-align: justify;">[21]  Thoreau, Henry David.  (1854)  Walden.  New York: Penguin Classics, 1960.  40</p>
<p style="text-align: justify;">[22]  Thurow, Lester C.  (1996).  The Future of Capitalism.  New York:William Morrow and Company, Inc.1-42.</p>
<p style="text-align: justify;">[23]   Unisys Corporation  (1998).  Company web page at www.unisys.com, April 16.</p>
<p style="text-align: justify;">[24]  Vietnam Veterans of America Foundation  (1997).  Web page at www.vvaf.org.</p>
<p style="text-align: justify;">[25]  Webber, M. (1964).  Order in diversity: Community without propinquity. In L. Wingo, Jr.(Ed.),  Cities and Space: The future use of urban land. Baltimore: Johns Hopkins University Press.</p>
<p style="text-align: justify;">
<p align="center">Robert M. Hollister, Jr.</p>
<p align="center">The University of Memphis</p>
<p align="center">(901) 272-3896</p>
<p align="center">email: rhollstr@memphis.edu</p>
<p align="center">
<p align="center">Dr. Mark N. Frolick</p>
<p align="center">The University of Memphis</p>
<p align="center">Fogelman College of Business</p>
<p align="center">Memphis, TN 38152</p>
<p align="center">(901) 678-4945</p>
<p align="center">email: mfrolick@memphis.edu</p>
<p><span style="text-decoration: underline;"> </span></p>
<p style="text-align: justify;">
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		<title>Using Electronic Medical Records To Improve Patient Care:  The St. Jude Children&#8217;s Research Hospital Case</title>
		<link>http://infosciencetoday.org/type/articles/using-electronic-medical-records-to-improve-patient-care-the-st-jude-childrens-research-hospital-case.html</link>
		<comments>http://infosciencetoday.org/type/articles/using-electronic-medical-records-to-improve-patient-care-the-st-jude-childrens-research-hospital-case.html#comments</comments>
		<pubDate>Sun, 22 Nov 2009 22:22:59 +0000</pubDate>
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		<category><![CDATA[PROBLEMS WITH PAPER MEDICAL RECORDS]]></category>

		<guid isPermaLink="false">http://infosciencetoday.org/?p=497</guid>
		<description><![CDATA[BY
Mark N. Frolick
Xavier University
mark@frolick.net
Abstract
Information technology is proving to be a vital element in the administration of healthcare. Specifically, most healthcare institutions in the United States are adopting information systems that provide more accurate and timely information regarding patient care. This paper explores the implementation of an electronic medical record system at St. Jude Children&#8217;s Research [...]]]></description>
			<content:encoded><![CDATA[<p style="text-align: justify;">BY</p>
<p style="text-align: justify;">Mark N. Frolick<br />
Xavier University<br />
mark@frolick.net</p>
<p style="text-align: justify;"><strong>Abstract</strong></p>
<p style="text-align: justify;">Information technology is proving to be a vital element in the administration of healthcare. Specifically, most healthcare institutions in the United States are adopting information systems that provide more accurate and timely information regarding patient care. This paper explores the implementation of an electronic medical record system at St. Jude Children&#8217;s Research Hospital in Memphis, Tennessee. St. Jude Hospital is primarily dedicated to the treatment of children with catastrophic illnesses and the performance of research studies to improve the clinical outcomes of such diseases. Appropriate patient care requires the use of clinical procedures as well as applied research protocols. Information must be accurate and immediately available to individuals involved in the care of patients. An electronic medical record system was introduced as a way to facilitate a centralized patient information repository. Benefits realized by this system included improvements in patient care, clinical research, and patient service and satisfaction. The ultimate goal of this project was to provide a paperless patient medical record that linked research and clinical data.</p>
<p align="center"><strong>INTRODUCTION</strong></p>
<p>Although technological advancements in science have greatly improved medical care in recent decades, improvements in the management of patient information have been languid. Many healthcare institutions continue to rely on paper-based medical records as the primary source of patient medical and demographic information. Medical care decisions are based on the information stored in these charts.</p>
<p>While most health care institutions employ information systems to manage some aspects of patient care, the systems are often disjointed. Many times each department in a hospital has its own information system. In such cases, communication between departments is reduced to printing the information from one system and sending that output to the other department. Ultimately, these paper records are transferred to the patient medical record. Delayed or inappropriate patient treatment is often due to miscommunication, lost or destroyed records, and the overall inefficiency of the paper system.</p>
<p>Substantial improvements in patient care can be realized through the use of electronic medical records. These electronic medical records provide the ability to capture, organize, and present relevant clinical information in a manner superior to the physical records currently in use. In addition, unlike the paper-based record, electronic medical records allow all caregivers to access the patient record at the same time.</p>
<p>St. Jude Children&#8217;s Research Hospital (SJCRH) in Memphis, Tennessee is dedicated to the treatment of children with catastrophic illnesses. Defined protocols exist for the treatment of leukemia, solid tumors, specific genetic disorders, and some infectious diseases. The criteria for each protocol of treatment are carefully defined. Patients who meet the criteria of a protocol and are enrolled on that protocol are monitored closely for both clinical and research purposes. In order to accurately assess the effects of treatment protocols, patients must be followed from referral to the end of treatment. Many patients are followed for several years. Complete and accurate documentation of all clinical details and variances in treatment must be maintained. The ability to link protocol-defined treatments with the effects of those treatments on patients improves medical care for future patients.</p>
<p>While undergoing treatment at SJCRH, most patients receive treatment in the outpatient clinic. The fact that the majority of patients are ambulatory introduces another factor into patient care. In order to provide the best patient care, hospital visits must be well-managed so that patients receive all the care needed but are not required to spend excessive amounts of time at the hospital due to an inefficiency of institutional processes. Patient scheduling must be well coordinated. Orders for treatment, medications, and diagnostic testing must be legible, complete, and accessible. In addition, test results must be reported accurately in order to provide the best and most efficient patient care.</p>
<p>This case study examines the implementation of an electronic medical records system at St. Jude Children&#8217;s Research Hospital. It addresses the problems that existed with the paper-based medical record and explores the advantages of electronic medical records. In addition, this paper explains the issues that SJCRH explored before choosing the Cerner HNA Millenium system. As a result of this implementation effort, all active patients at the hospital have a paperless medical record that provides both demographic and medical information. This electronic medical record provides a single point of access for all employees seeking information both for clinical treatment of patients and for research data collection.</p>
<p align="center"><strong>PROBLEMS WITH PAPER MEDICAL RECORDS</strong></p>
<p>Providing excellent medical care for a patient requires an accurate and organized record of the patient&#8217;s medical history. While SJCRH had previously implemented a computerized information system to manage a limited amount of patient information such as demographics, clinical laboratory results, diagnostic imaging results, and pharmacy records, the records in this system still lacked a vast amount of information. All manually generated paperwork and printouts generated by individual department&#8217;s information systems were ultimately stored in the paper medical record. Thus, the paper medical record represented the only complete source of a patient&#8217;s medical history.<br />
<strong><br />
The Medical Record as a Source of Information</p>
<p></strong>The typical paper medical record contained nine sections including information on admissions, discharge summaries, progress notes, protocols, laboratory results, radiology results, surgical and pathology reports, orders for treatment, and nursing notes (I.T.S. steering committee, 1999). Most documentation regarding treatment of a patient was written directly in the patient&#8217;s medical chart. However, some additional paperwork items such as consent forms and transfusion records were also stored in the chart.</p>
<p>Appointment scheduling, treatment plans, and record keeping were performed manually in departments such as physical therapy, respiratory therapy, social services, and psychology. Patient care activities in these departments produced another set of paperwork that had to be stored in the patients record.</p>
<p>Patient medical records were stored in the Health Information Management Services (HIMS) department and were retrieved for use when a patient was admitted for inpatient care or returned to the outpatient clinic for treatment.</p>
<p><strong>Computerized Information<br />
</strong><br />
While all patient information was stored in the paper record, SJCRH had previously installed a computer information system in order to automate some of the record-keeping processes required for patient care. This original information system at SJCRH consisted of two separate systems. One system was used to manage patient scheduling and registration. Information collected in this system was transferred to a second system that provided record-keeping and test-resulting capabilities for the clinical laboratory, pharmacy, and diagnostic imaging departments (Rogers, October, 1999). While this record-keeping system was used to order, enter, and review clinical test results, printouts of all test results were ultimately placed in the paper medical record.</p>
<p><strong>Accessibility of the Medical Record</strong></p>
<p>On any given day, physicians, nurses, medical residents, health information management personnel, data managers, and hospital unit coordinators needed to access the information in the medical record. Typically, charts were pulled from HIMS the day before a patient&#8217;s scheduled return, transported to the outpatient clinic where the patient would be seen, and then returned to HIMS at the end of the day to be filed again (Milli-our system, 1999). In addition, data managers, who collected information for clinical protocol review and research studies, retrieved the medical charts from HIMS and manually extracted data several times during a patient&#8217;s enrollment on a protocol (Milli-our system, 1999).</p>
<p>It was necessary for the medical record to follow the patient throughout their visit. Thus, if the patient was seen in one clinic where orders were written, it was necessary to physically transport the record when the patient moved to the medicine room for treatment. Inpatient charts were kept at the appropriate nursing station until the patient was discharged.</p>
<p>While the record-keeping system was available to review test results, the information available in this system was limited. Information such as physicians&#8217; notes, transfusion records, and dietary notes could not be accessed through the computer system. Thus, it was necessary, under most circumstances, to have access to the patient&#8217;s medical chart in addition to the computerized records.</p>
<p><strong>The Medical Record as a Form of Communication</strong></p>
<p>The information added to a patient&#8217;s medical record was regularly reviewed to determine adherence to protocol standards and to monitor a patient&#8217;s progress. In addition, attending physicians used the charts to review the previous attending physician&#8217;s notes in order to provide the best care for their patients. For example, notes that detailed an adverse reaction to a specific medication could be used to prevent that medication from being prescribed in the future. Nurses beginning their shifts reviewed their patients&#8217; charts to determine how the patients had progressed through the day as well as to follow up on any orders that had not been filled. Dietary personnel and psychology staff used the chart to determine if particular medications had been prescribed that would alter a patient&#8217;s eating habits or behavior patterns. Needless to say, caregivers relied on the information in the record to be accurate and complete.</p>
<p>In addition, departments such as the blood bank and pharmacy were obligated to have a physician&#8217;s signature attached to any order they filled. Thus, a copy of the original order for medication or transfusion was faxed to the appropriate department. Unfortunately, faxes were not always legible nor were they always sent to the correct department. Patients&#8217; wait times were unnecessarily lengthened because orders were illegible or sent to the wrong department and had to be faxed again when the mistake was discovered.</p>
<p><strong>Disadvantages of the Paper Medical Record</strong></p>
<p>While the tasks of retrieving patient records, extracting and adding information, and returning these records to their appropriate place of storage each day was burdensome, managing the information in the records was even more tedious. Patients who had been followed for years often had medical records consisting of several large volumes. Any of these volumes might have contained the information necessary to properly care for the patient. As a result, all of the volumes had to be accessible to caregivers.</p>
<p>Since the medical record consisted of many individual pages from many different sources, pages could easily be misfiled or even misplaced entirely. In some cases, if information could not be located in the record, tests and procedures were simply repeated. For example, patients or their guardians were required to sign medical consent forms that were then placed in the medical record. If a signed consent form could not be found, a new form was completed and added to the chart. Of course, such actions led to redundant information being filed in the patient record. Most institutions find that such extensive documentation is often incomplete, inaccurate, illegible, and difficult to access when needed (Protti, et al., 1998). The risk of improper patient care or misinterpretation of research protocols increases when data is illegible or inaccurate.</p>
<p align="center"><strong>SOLVING THE PAPER CHART PROBLEM: ELECTRONIC MEDICAL RECORDS</strong></p>
<p>While the first attempt at computerizing medical records helped with records management, it was little more than a storage mechanism for a very limited amount of patient information. As a result, SJCRH undertook the development of an electronic medical records system.</p>
<p>The introduction of electronic medical records at SJCRH afforded the possibility for records to be created, processed, stored, retrieved, and cross-referenced more efficiently. The electronic records of SJCRH patients include all of the information stored in the paper-based medical record. It allows caregivers with appropriate security clearance to access patient&#8217;s electronic medical records from any personal computer in the hospital. This feature eliminates having to locate the patient chart in order to obtain information necessary for treatment.</p>
<p>In addition, information can be easily sorted or grouped according to certain criteria such as the date on which the test was performed. The electronic medical record also allows the user to graph a set of results over time. For example, a patient&#8217;s blood glucose level can be graphed over a time period of ten days, thus allowing the caregiver to notice trends that might be important for proper patient care.</p>
<p>Not only does the electronic medical record system provide a central location for storing patient information, it provides several powerful functions that allow for better patient care. These functions were facilitated by the various components of the electronic medical records system.</p>
<p><strong>The Components of the Electronic Record: OCF, PowerChart, and Discern Expert</strong></p>
<p>The electronic medical record system at SJCRH has several components. The Open Clinical Foundation (OCF) is the repository at the center of the new electronic medical record. The OCF is an Oracle database that stores clinical and administrative information. This new database functions as a data warehouse and has the ability to group information based on any one particular patient parameter. For example, patient clinical outcomes with regard to a particular protocol can easily be grouped and presented by the electronic medical records system, thus eliminating the need for data managers to collect the information manually (Rogers, October, 1999).</p>
<p>PowerChart is the graphical user interface that caregivers access at the clinical workstation. It is composed of two parts: the Organizer and the Chart. The Organizer allows the user to quickly check for new patient test results immediately after logging onto the system. In addition, it allows the user to indicate which test results they have reviewed.</p>
<p>The Chart is the electronic form of the patient medical record. It is through this interface that the user can review clinical lab results, nurses&#8217; notes, physicians&#8217; notes, and patient demographics. Features that are available in the Chart such as the problem list, visit list, and growth chart also allow caregivers to track a patient&#8217;s medical progress. This electronic medical record makes gathering patient information more efficient because it automatically groups similar data together.</p>
<p>PowerChart will act as the foundation for more advanced patient care applications to be installed in the future (Milli project scope document, 1998).</p>
<p>Discern Expert is a program that evaluates best clinical practice criteria and monitors events in the system for compliance. It is part of a decision support system that assists healthcare providers at the point of care by linking historical patient data with current clinical data and assessing that data based on built-in clinical rules. Historically, work in clinical decision support systems has been concentrated on designing alerts and reminders for physicians, however more recent systems are focused on overall compliance with patient care plans (Broverman, 1999). A &#8220;starter set&#8221; of rules was developed in Discern Expert for the lab, radiology, pharmacy, PowerChart, admitting/registration, and the Chart modules (Milli project scope document, 1998). Managing patient care through the use of decision support systems ultimately means that a patient&#8217;s quality of care improves.</p>
<p><strong>Benefits of the Electronic Medical Record</strong></p>
<p>The benefits of the electronic medical record system at SJCRH includes information that is more accessible and improved communications.</p>
<p>Information that is more accessible. All clinical laboratory and patient demographic information is a part of the electronic medical record and can be viewed at any computer terminal in the hospital as long as the employee has security clearance. Data retrieval is more accurate and efficient due to automated clinical documentation and protocol information being electronically linked to clinical data reports (Milli project scope document, 1998).</p>
<p>Information systems that collect and deliver information efficiently are only the forerunners to more sophisticated systems. Ultimately, electronic medical records systems will not only deliver the correct information, they will actively assist in the treatment of patients through the use of that information. The electronic medical records system will act as an assistant to the healthcare provider in addition to its role as a storage device for patient information. The ultimate success of these systems, however, ultimately depend on healthcare providers&#8217; willingness to &#8220;change the way they have traditionally recorded, retrieved, and utilized clinical data&#8221; (Anderson, 1999, p. 62).</p>
<p>Improved communication. Communication between departments in a healthcare organization can also be improved when all healthcare providers have access to the same information. For example, an electronic medical record that provides ready access to patient scheduling, test ordering confirmation, and completed test results allows healthcare providers in every department to clarify orders and assess patients more efficiently (Barsukiewicz, 1998). Essentially, the quality of patient care depends on the collection of detailed clinical information and the timely delivery of that information to the appropriate healthcare provider (Chan, et al., 1999).</p>
<p>Clinical decision support systems can improve patient care, reduce costs, support clinical diagnosis and treatment-plan processes, manage patients on research and chemotherapy protocols, monitor the need for follow-up care, and manage administrative details (Perreault, et al., 1999). Essentially, SJCRH&#8217;s new electronic medical record provides a link between clinical treatment and adherence to research protocols.</p>
<p>The benefits realized by the implementation of an electronic medical record include &#8220;increased efficiency in managing clinical information and improved quality of care and cost savings through decision support and management of patient care&#8221; (Anderson, 1999, p. 62). In addition, orders placed through the use of an information system are legible, free of transcription errors and can be directly routed to all departments that need access to the order (Teich, 1999). Improvements in the manner used to capture and store patient information and then relate the information to clinical treatment and research protocols has lead to much better patient care.</p>
<p align="center"><strong>ISSUES TO CONSIDER WHEN IMPLEMENTING AN ELECTRONIC MEDICAL RECORD</strong></p>
<p>While SJCRH had previously installed an information system to manage some aspects of patient care, it was not a substitute for the paper medical record. Most businesses have determined that information systems can greatly reduce errors, increase customer satisfaction, and provide better employee time management. Likewise, healthcare providers have discovered that information systems can improve patient satisfaction as well as employee performance. In an effort to improve patient care and satisfaction, SJCRH implemented their electronic medical records system. While implementing this system, SJCRH discovered several important issues that should be considered prior to implementing an electronic medical records system.</p>
<p><strong>Determine Objectives</strong></p>
<p>In an effort to support institutional objectives, Information Technology Services at SJCRH identified the implementation of an advanced clinical information system as one of its goals. The mission of the electronic medical records software implementation was &#8220;to provide immediate access to clinical information, to enhance patient care and accelerate clinical research&#8221; (Milli project scope document, 1998, p. 1). The implementation of the new system resulted in improvements in the following areas:<br />
patient care, patient service and satisfaction, clinical research, and access to both clinical and research data (Milli project scope document, 1998).</p>
<p><strong>Determine Who Should Evaluate the System</strong></p>
<p>A system selection committee was formed that consisted of a representative from each hospital department including physicians, nurses, pharmacists, and clinical lab personnel (Rogers, December, 1999). In addition, process-improvement teams were formed that consisted of a process improvement consultants, a SJCRH application analyst, an application analyst, and a SJCRH departmental subject matter expert (Milli project scope document, 1998). Process improvement teams were responsible for documenting and analyzing the former processes and recommending the goals to be achieved by the new system. Leadership teams comprised of SJCRH senior management representatives were assigned to each of the process improvement teams (Milli project scope document, 1998).</p>
<p>Once these process and leadership teams made their recommendations, a Steering Committee that was comprised of senior management representatives reviewed the recommendations of the process improvement teams. The proposal was then presented to the SJCRH board of directors for approval (Rogers, December, 1999).</p>
<p><strong>Determine Which Software To Implement</strong></p>
<p>Several clinical software packages were reviewed. Three packages appeared to meet the desired criteria. Final vendor selection was based on the clinical functionality of the software, the stability and market position of the vendor company, the product strategy, the implementation and follow-up support provided by the vendor, and the cost and business terms of the agreement (Rogers, December, 1999). Since the Cerner platform was already in place at SJCRH, the system selection committee felt that conversion to a newer Cerner system would be easier than introducing an unfamiliar system. In the end, the Cerner HNA Millennium (Milli) package was chosen.</p>
<p>An Oracle database that housed research data was already in place at the hospital. The Cerner system also provided an integrated system in which all information would be stored in a single database (Oracle) thus eliminating redundancy (Rogers, December, 1999). In addition, data from the research database could be easily transferred to the new system.</p>
<p><strong>Determine Risks and Advantages of the New System</strong></p>
<p>Risks involved with choosing this particular software package, however, included the fact that very few clinical products had been written to this particular platform. In an effort to influence the final product design, SJCRH entered into a developmental partnership with Cerner. This agreement ensured that the specific criteria defined by SJCRH would be incorporated into any new software that Cerner developed (Rogers, December, 1999).</p>
<p align="center"><strong>CONCLUSION</strong></p>
<p>Electronic medical records provide healthcare workers with an extensive option for improving patient care. Not only can electronic records not be misplaced as paper records can, but the information in the record is more accurate as well as legible. St. Jude Children&#8217;s Research Hospital has implemented a paperless medical record in order to improve care for both current patients and future patients. Successfully linking clinical treatment plans with research protocol information provides valuable information when assessing the effectiveness of particular treatment plans. Research efforts can move forward more rapidly when data is collected in an efficient manner as is provided by the electronic record. In addition, human error is less of a factor than it was when data was collected manually from paper charts.</p>
<p>St. Jude Children&#8217;s Research Hospital&#8217;s goal was to implement a system that not only met the organization&#8217;s current needs, but would also provide support for a growing number of protocols and clinical treatment plans. Not only does the new electronic medical records system maintain and organize all the information necessary to support clinical and research efforts, but it also guides healthcare providers in their daily treatment of patients. All in all the new system is at the center of providing the best possible patient care and advancing treatment for future patients.</p>
<p><strong>References</strong></p>
<p>Anderson, J. D. (1999). Increasing the Acceptance of Clinical Information Systems. MD Computing, 16 (1), 62-65.</p>
<p>Barsukiewicz, C. K. (1998). Managing care Through Managing Information:<br />
Are We Headed in the Right Direction. Journal of Healthcare Information Management,<br />
12 (4), 67-77.</p>
<p>Broverman, C. A. (1999). Standards for Clinical Decision Support Systems. Journal of Healthcare Information Management. 13 (2), 23-31.</p>
<p>Chan, W., Centiu, C., &amp; Morris, J. A. (1999). Uniform Data Standards for Capturing Patient Medical Record Information at the Point of Care. Journal of Healthcare Information Management, 13 (3), 85-95.</p>
<p>I.T.S. Steering Committee Strategic Planning [Slide Presentation]. (1999, June). (Available from St. Jude Children&#8217;s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105).</p>
<p>Milli &#8212; Our System for Advanced Patient Care and Research [Slide Presentation]. (1999). (Available from St. Jude Children&#8217;s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105).</p>
<p>Perreault, L. E. &amp; Metzger, J. B. (1999). A Pragmatic Framework for Understanding Clinical Decision Support. Journal of Healthcare Information Management. 13 (2), 5-21.</p>
<p>Protti, D., &amp; Peel, V. (1998). Critical success Factors for Evolving a Hospital toward an electronic Patient Record System: A Case Study of Two Different Sites. Journal of Healthcare Information Management, 12 (4), 29-38.</p>
<p>Rogers, J. (Director of Patient Care Systems). (1999, October). [Interview]. St. Jude Children&#8217;s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105.</p>
<p>Rogers, J. (Director of Patient Care Systems). (1999, December). [Interview]. St. Jude Children&#8217;s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105.</p>
<p>St. Jude Children&#8217;s Research Hospital. (1998, January). Milli Project Scope Document (Document No. unknown). Memphis: No Author.</p>
<p>Teich, J. M. (1999). Inpatient Order Management. Journal of Healthcare Information Management, 13 (2), 97-110.</p>
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		<title>Networking of Agricultural Information Systems in Bangladesh (BD-AGRINET): A  Model</title>
		<link>http://infosciencetoday.org/type/articles/networking-of-agricultural-information-systems-in-bangladesh-bd-agrinet-a-model.html</link>
		<comments>http://infosciencetoday.org/type/articles/networking-of-agricultural-information-systems-in-bangladesh-bd-agrinet-a-model.html#comments</comments>
		<pubDate>Mon, 27 Jul 2009 15:17:49 +0000</pubDate>
		<dc:creator>Hanif Uddin</dc:creator>
				<category><![CDATA[Articles]]></category>
		<category><![CDATA[Featured]]></category>
		<category><![CDATA[information science]]></category>
		<category><![CDATA[Agricultural information]]></category>
		<category><![CDATA[agricultural information systems in Bangladesh]]></category>
		<category><![CDATA[agricultural university libraries]]></category>
		<category><![CDATA[DRAWBACKS OF THE EXISTING SYSTEM]]></category>
		<category><![CDATA[INADEQUATE FUNDS]]></category>
		<category><![CDATA[information explosion]]></category>
		<category><![CDATA[information professionals in Bangladesh]]></category>
		<category><![CDATA[information services]]></category>
		<category><![CDATA[information technology]]></category>
		<category><![CDATA[INSUFFICIENT READING MATERIALS AND INEFFECTIVE SERVICES]]></category>
		<category><![CDATA[LACK OF TRAINED MANPOWER]]></category>
		<category><![CDATA[Library Network]]></category>
		<category><![CDATA[library resources]]></category>
		<category><![CDATA[LOCAL AREA NETWORK (LAN)]]></category>
		<category><![CDATA[National Commission on Libraries and Information Science]]></category>
		<category><![CDATA[NETWORK DEFINITIONS]]></category>
		<category><![CDATA[TOPOLOGY]]></category>
		<category><![CDATA[TYPES OF NETWORKS]]></category>
		<category><![CDATA[WIDE AREA NETWORK (WAN)]]></category>

		<guid isPermaLink="false">http://infosciencetoday.org/?p=131</guid>
		<description><![CDATA[Bangladesh is mainly an agricultural country. Agriculture is the mainstay of the economy. Agricultural sector contributes 32% GDP in the country. Agricultural information supply is vital for the development of agriculture. The rapid growth of publications, decreasing ability of libraries to go for comprehensive acquisition of documents, escalation of prices, regular increase in foreign currency [...]]]></description>
			<content:encoded><![CDATA[<p style="text-align: justify;">Bangladesh is mainly an agricultural country. Agriculture is the mainstay of the economy. Agricultural sector contributes 32% GDP in the country. Agricultural information supply is vital for the development of agriculture. <span id="more-131"></span>The rapid growth of publications, decreasing ability of libraries to go for comprehensive acquisition of documents, escalation of prices, regular increase in foreign currency value with reference to Bangladesh currency, growing demands of increasing number of users in the agricultural libraries and multi-faceted user requirements are a few challenges presently facing the library and information professionals in Bangladesh. Resource sharing/networking would help smooth library management and enrich resources and provide better services to the library users. In this present age of information explosion, no library is self-sufficient to provide comprehensive services to (he users. To overcome these shortcomings sharing of resources through networks assumes greater importance these days. The use of information technology has added new dimensions to the concept of networking in the agricultural libraries. This paper highlights the need and importance of networking in the agricultural libraries and describes a plan for developing a network of the libraries of agricultural universities, agricultural colleges and research institutes in Bangladesh (BD-AGRINET). The functions and objectives of the network and how it can help in strengthening the development of skills, the design of appropriate information products, exchange of information and document supply is described.</p>
<p style="text-align: justify;"><strong>I INTRODUCTION</strong></p>
<p style="text-align: justify;">Library and Information Centres are institutions responsible for meeting information needs of the agricultural scientists and researchers. The proper performance of this function requires well organized library services supported by an infrastructure comprising an administrative authority in the form of legislation, an organizational structure and adequate finance. As no library can be self sufficient, it is difficult to fulfil all the users demands relating to their information needs. Networking of libraries is thus essential for sharing of library resources.</p>
<p style="text-align: justify;"><strong>1.</strong> The library network aims at providing materials, information and services by different types of libraries to the needy users. These libraries may be in different jurisdictions but agree to serve one another on the same basis as each service to its own constituents. Computer and telecommunication may be among the tools used for facilitating communication among them.</p>
<p style="text-align: justify;"><strong>2.</strong> However, with the growth of agricultural information, there are very often delays in &#8216;providing service to the end users. The cost of providing service is also rising, mainly because of adoption of manual methods and duplication of investments in library holdings. On the other hand, the costs of valuable books and journals are rising day-by-day.</p>
<p style="text-align: justify;"><strong>3.</strong>The above have made it imperative to share library resources and to go in for networking of agricultural information systems in Bangladesh. This may he possible only on the application of modern information technology in the agricultural libraries of Bangladesh. The need of networking of agricultural information system for Bangladesh has been well recognized but the technology options available till now are limited. Considering the above factors, the authors are proposing a Network in Agricultural Sector of Bangladesh. The proposed network may be called <strong>BD-AGRINET</strong>.</p>
<p style="text-align: justify;">The BD-AGRINET covers two Agricultural University Libraries, three College Libraries, ten NARS Institute Libraries, AIC. BADC and Department of Agricultural Extension Library in Bangladesh.</p>
<p style="text-align: center;"><img class="size-full wp-image-281  aligncenter" title="netfig8" src="http://infosciencetoday.org/wp-content/uploads/2009/07/netfig8.jpg" alt="netfig8" width="257" height="171" /></p>
<p><strong>2.0 </strong><strong>DRAWBACKS OF THE EXISTING SYSTEM</strong></p>
<p style="text-align: justify;">In the present set-up, the services of several agricultural libraries have been found to be far from satisfactory. The shortcomings observed mainly relate to three aspects. They are:</p>
<p style="text-align: justify;">(a) Insufficient reading materials and ineffective services.</p>
<p style="text-align: justify;">(b) Inadequate funds.</p>
<p style="text-align: justify;">(c) Lack of trained manpower.</p>
<p style="text-align: justify;"><strong>2. INSUFFICIENT READING MATERIALS AND INEFFECTIVE SERVICES</strong></p>
<p style="text-align: justify;">Most of the complaints received from the users are about less access to information. The problem of providing the required reading materials as sources of information to the readers, with limited financial resources of libraries, is now almost universal.</p>
<p style="text-align: justify;"><strong>2.2 INADEQUATE FUNDS</strong></p>
<p style="text-align: justify;">Almost all agricultural libraries in Bangladesh are facing financial constraints. Due to lack of sound financial position of the libraries, they can not provide the required information to the users. The escalating cost of the reading materials on one hand and huge cost of the infrastructure on other have made the agricultural libraries to suffer from insufficient flow of funds.</p>
<p style="text-align: justify;">The various information services that can be deployed in libraries are also dependent on sound financial position of the libraries. The existing information services available in agricultural libraries of Bangladesh are not adequate. To improve the existing condition of the agricultural libraries effectively, it is necessary to design a networking proposal model for agricultural libraries, situated in various places in the country.</p>
<p style="text-align: justify;"><strong>2.3 LACK OF TRAINED MANPOWER</strong></p>
<p style="text-align: justify;">There are non-professional library personnel working in agricultural libraries of Bangladesh. As a result, they can not provide proper services to the researchers and scientists. For this reason, there should be a programme in BD-AGRINET for training of the library personnel so that it may reduce the lack of trained manpower in agricultural libraries.</p>
<p style="text-align: justify;"><strong>3</strong> <strong>NETWORK DEFINITIONS</strong></p>
<p style="text-align: justify;">Library network may be defined as &#8220;a distribution system composed of two or more libraries and/or other organizations engaged in a common pattern of information exchange, through communications for some functional purpose&#8221;.</p>
<p style="text-align: justify;"><strong>4 .</strong>The National Commission on Libraries and Information Science (NCLIS) in its National Program Document (1975) defined a network as: &#8220;Two or more libraries and/or other organizations engaged in a common pattern of information exchange, through communications for some functional purpose. A network usually consists of a formal arrangement whereby materials, information and services provided by a variety of libraries and other organizations are available to all potential users. Libraries may be under different jurisdictions but agree to serve one another on the same basis as each serves its own constituents. Computers and telecommunications may be among the tools used for facilitating communication among them.&#8221;</p>
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