Integrated IT System Research Articles

Development of an integrated and sustainable rural service for people with diabetes in the Scottish Highlands

The number of people with diabetes is increasing leading to a greater burden on health care services. The impact of the growing prevalence is accentuated by remote and rural demographic and geographic characteristics. Highland is a sparsely populated remote and rural area in the north of Scotland, characterised by poor access to health-care services and pockets of marked deprivation. Centralised policy developments demanding local implementation compounded the pressures on a system that already had waiting times of over 90 weeks for some people with diabetes. A regional review of services, engaging stakeholders from all disciplines and geographical locations was required to develop acceptable and sustainable solutions. This article describes the extensive mapping process involved, how solutions were derived, and suggests a new service structure to encompass remote health-care issues. Health-care professionals with an interest in diabetes were identified and workshops were organised to include the remote areas of Highland. Patient and carers views were ascertained through workshops and supplemented by written submissions. Using the redesign methodology the patient pathway was mapped, noting service deficiencies and good practice. The information gathered was constructed into a service-level map representing the patient journey. A conference was organised to develop solutions to the issues raised during the mapping process. From these solutions a new service configuration was constructed. Over 300 health-care professionals patients and carers contributed. Fourteen workshops were held across the region including the remote areas, providing 15 local maps of the patient pathways subsequently amalgamated into a service-level map. The current patient pathway in Highland follows a traditional and dichotomous cycle of care in the primary and secondary care setting, partly reflecting the rural nature of healthcare in the Highlands. Four main areas for service improvement were identified: a reduction in waiting times for secondary care out patients; an improvement in communication between health-care professionals; further education for both health-care professionals and patients; and the use and role of allied health professionals. Seventeen solutions were recommended, including the introduction of a managed clinical network, use of an integrated IT system, use of a remote access consultation clinic, and web-based peer education and group sessions for allied health professionals. A new service configuration was proposed with the patient at the centre of a non-hierarchical system using standardised referral letters with a seamless flow of information. Local processes for the implementation of government directives are imposing pressures on relatively smaller organisations. These pressures develop as a result of attempts to ensure local ownership and in overcoming the difficulties unique to the remote and rural setting. Further evaluation of the implementation of initiatives to solve the issues of service planning in remote areas is needed to clarify their level of effectiveness.

Nurses' Perceptions of Using a Pocket PC for Shift Reports and Patient Care

Nurses working in hospitals with paper-based systems often face the challenge of inefficiency in providing quality nursing care. Two areas of inefficiency are shift-to-shift communication among nurses and access to information related to patient care. An integrated IT system, consisting of Pocket PCs and a desktop PC interfaced to a hospital’s mainframe system, was developed. The goal was to use mobile IT to give nurses easier access to patient information. This paper describes the development of this system and reports the results of a pilot study: a comparison of time spent in taking and giving shift reports before and after the study and nurses’ perceptions of the mobile IT system. Results showed significant difference in taking shift reports and no significant difference in giving shift reports. Nurses stated that quick and easy access to updated patient information in the Pocket PC was very helpful, especially during mainframe downtime.

Protected Area Systems and Project Management in Protected Area Systems

Applications of information technology and systems engineering in the management of protected areas range from simple 'off the shelf project management and work scheduling software, to complex bespoke distributed management systems in which project management is just one element of an integrated IT system encompassing virtually every function (including administration and finance) of a large organisation. The Countryside Management System is a relatively successful system conceived 'bottom up' as a modest experiment by site managers to solve their immediate problems of project control but has significant limitations. The National Trust's Property Management and Information System in the UK is, by contrast, the most ambitious attempt to date of any conservation organisation to computerise its activities and was abandoned prior to full implementation. It seems likely to be some time before the full potential of information technologies such as Geographical Information Systems can be harnessed to the management of protected sites and landscapes, yet it is a promising prospect.

Project management in protected areas—a tale of two systems

This paper examines the application of information technology to project management in the context of the implementation of management plans for protected areas which now cover some 20% of the land surface of developed countries. CMS, an ‘off the shelf’ system intended for use on any conservation site, is compared with PMIS, an organizationally based bespoke system in which site and property management was merely one aspect of an integrated IT system encompassing virtually every function of a large organization, the National Trust. CMS was conceived “bottom up” as a modest experiment by site managers to solve their immediate problems of project control, has been highly successful to date and is in use in over 350 sites within the UK as well as in a number of other countries. PMIS, initiated ‘top down’ as probably the most ambitious attempt to date of any conservation organization to computerize its activities has failed to fulfil early hopes, proving unwieldy and expensive and development was curtailed in late 1995. The implications for protected area and conservation site project management are considerable. Small may not be particularly beautiful but is currently the only available option for those who need a working project management system. In the long term however the choice between ‘off the shelf’ PC-based software and the development of a networked bespoke system will be an increasingly difficult one, particularly for large land managing conservation organizations.