The impact of information and communication technology (ICT) is indirect and depends on redesign of practices and structures also outside health care. Improvements will only be realized if all parties involved can coordinate their efforts to take advantage of new technology. A 'package' of changed work practices and structures extending across organizational boundaries needs to be designed and implemented. This is very different from the common conception of introducing new ICT tools. Calls for 'evaluation of benefits' before new ICT systems are introduced need to recognize this complexity. This article investigates how analysis and economic evaluations can be used to improve decision-making when new applications are proposed. This is done by drawing parallels with experiences from other industries. We conclude that the entire 'change package' should be analysed for its consequences on the well-being of care recipients, and the requirements it presents for capital investments and changed labour inputs, in particular changed competence needs. Some concepts and structures are suggested for such evaluations. © 2005 Taylor & Francis.

Proceeding of 11th Conference on Medical Informatics, Medinfo-San Francisco, Cal. (Eds) Edward Shortliffe et.al .Amsterdam: IOS. Press, 2004

Objectives: The aim of this paper is to build a theoretical framework for analysis of when decision-makers should use end-user participation as a form of insurance for unforeseen consequences of implementing information systems in healthcare organizations. Method: Data were collected in a case study of an information system development project in a small clinical setting. During the initial phase, the future end-users of the system were allowed to actively influence the system design and test every new tool that was considered for implementation. Results: The results of the case study suggest that when time and effort are invested in allowing healthcare staff to participate in information system development processes, the benefits can well exceed the costs throughout the life cycle of the project. Risk-averse decision-makers fearing negative secondary consequences of a HIS, with regard to clinical work flow, will always adopt measures to prevent future failures, if they can find a possibility of shifting these risks. Therefore, they calculate the present discounted value of the effects accrued over time to the unit and predict the amount of resources they are willing to pay to acquire an insurance (such as design participation) that will protect the organization from future losses. Conclusions: End-user participation in the design process can be the key positive influence on the quality of the service and, thereby, organizational effectiveness. Investments in broad design participation can, consequently, be a productive activity that transforms potential current income into future benefits.

There are numerous challenges to overcome before information and communication technology (ICT) can achieve its full potential in process-oriented health-care organizations. One of these challenges is designing systems that meet users’ needs, while reflecting a continuously changing organizational environment. Another challenge is to develop ICT that supports both the internal and the external stakeholders’ demands. In this study a qualitative research strategy was used to explore the demands on ICT expressed by managers from functional and process units at a community hospital. The results reveal a multitude of partially competing goals that can make the ICT development process confusing, poor in quality, inefficient and unnecessarily costly. Therefore, from the perspective of ICT development, the main task appears to be to coordinate the different visions and in particular clarify them, as well as to establish the impact that these visions would have on the forthcoming ICT application.

Today online newspapers are putting a lot of resources into their news sites without profiting from them. They have to find ways to gain from them in order to keep them going. Lately there has been a move from print to multimedia, i.e. news is only a part among other services at the news sites and is presented as audio and video as well. We have conducted interviews at nine local newspapers in Sweden about their current situation and future plans. We have also used a cooperative scenario building technique aiming at finding new online services that could be profitable with both newspaper management and end users. The objective of this paper is to describe the current situation for these newspapers and to discuss possible new future services. Examples of services from the workshops are e.g. advertisement on demand and intermediary services.

Organizations of all types want to have individuals utilize the Information Technology (IT) they purchase. For this reason, the identification of factors that cause individuals to use IT, factors that are important when developing IT, and factors that influence organizations' performance when IT is implemented, provides helpful guidelines for decision-makers.

The empirical studies included in this thesis refer to health-care organizations and cover a span from the presentation of the economic effects of the implementation of computer based patient records, and the perceived risk that can arise during the development of IT, to the importance of stimulating direct user participation in system development processes. In the theoretical studies, basic techniques are suggested for the analysis of the economic effects of the use of methods that stimulate users' involvement, e.g. Participatory Design. Furthermore, this part also proposes an IT maturity indicator that can be used to analyze the fulfillment of integration and sophistication in the use of IT in contemporary organizations.

The results which emphasize the interaction between IT, human, and economic aspects, indicate the need to include measures of user preferences in system development and implementation processes. They also suggest that successful IT strategies almost inevitably involve simultaneous investment in organizational change, innovative business strategies, and employee human capital. The fmdings provide new insights into problems that forced organizations to re-examine criteria for investing resources when choices related to the development, introduction and use of IT are made, or when it is necessary to select approaches to system development. They also raise questions regarding resource scarcity and alternative use of invested resources.

Despite the increasing global interest in information technology among health care institutions, little has been discussed about its importance for the effectiveness of knowledge management. In this study, economic theories are used to analyze and describe a theoretical framework for the use of information technology in the exchange of knowledge. The analyses show that health care institutions would benefit from developing global problem-solving collaboration, which allows practitioners to exchange knowledge unrestricted by time and geographical barriers. The use of information technology for vertical integration of health-care institutions would reduce knowledge transaction costs, Le. decrease costs for negotiating and creating communication channels, and facilitating the determination of what, when, and how to produce knowledge. A global network would allow organizations to increase existing knowledge, and thus total productivity, while also supporting an environment where the generation of new ideas is unrestricted Using all the intellectual potential of market actors and thereby releasing economic resources can reduce today's global budget conflicts in the public sector, Le. the necessity to choose between health care services and for instance, schools and support for the elderly. In conclusion, global collaboration and coordination would reduce the transaction costs inherent in knowledge administration and allow a more effective total use of scarce health-care resources.

I den allt snabbare förändringsprocess som sker inom samtliga yrkesområden i vården blir tillgången till adekvat information allt viktigare. Det finns således behov av att både få tillgång till och att till vårdsökande och kollegor kunna förmedla relevant och korrekt information. I denna rapport beskrivs arbetsgången och de erhållna resultat från projektet ”Elektroniskt kunskapsstöd för arbetsterapeuter”, vilket genomfördes under 1996 och våren 1997. Projektets syfte var att studera vilka problem arbetsterapeuter upplever i patientarbetet samt hur dessa skulle kunna avhjälpas, helt eller delvis, med hjälp av informationsteknologi.   Projektet genomfördes i fyra delstudier. De två första delstudierna, en kvalitativ och en kvantitativ, syftade till att kartlägga de problem arbetsterapeuter upplever i sitt arbete. Den tredje delstudien syftade till att designa ett informationssystem, utifrån de identifierade problemen, för att stödja arbetsterapeuter. I den sista delstudien implementerades och utvärderades en prototyp, vilken byggde på designspesifikationen från delstudie tre.I den kvantitativa delstudien framkom problem inom områdena

möjligheten att förmedla och få information,samordna insatserna i patientarbetet,möjligheten att rådfråga kollegor eller hitta informationen i dokumenterade erfarenheter samttillgång till dokumentation så som lagtexter och nya rön.I den kvantitativa delstudien identifierades problem inom områdena;yrkesidentiteten,arbetet i vårdteamet,samverkan med andra arbetsterapeuter,möjligheten till kunskapsinhämtning ochpatientarbete.Prototypen implementerades i tre nivåer, Team/individ-nivå, Landstingsnivå och Nationell nivå. Varje nivå innehöll olika uppsättningar verktyg och informationskällor anpassade till nivåns syfte.   Utvärderingen av prototypen gjordes enligt en Heuristic Walkthrough i två grupper, den ena bestående av arbetsterapeuter och den andra av experter på informationssystem.   Arbetsterapeuterna såg möjligheten att komma i kontakt med andra arbetsterapeuter som har liknade intressen och möjlighet att få ett stöd för att bedriva projekt som främsta nyttan av systemet. Informationssystemsexperterna påpekade vikten av att lätt kunna orientera sig i systemet och att användningen måste vara effektiv.   En fullt implementerad prototyp skulle kunna stödja arbetsterapeuternas patientarbete genom att underlätta de svårigheter de själva upplever.

Background: Over the past decade, sickness absence has increased in Sweden and other Western European countries, with regard to both the number of people claiming sickness benefits and the length of the sick-leave spells. In Sweden, the activities initiated to promote RTW are performed in parallel by four different public organisations: the health services, the social services, the employment and the social insurance authorities. The present study focused on cooperation between professionals affiliated to the employment and social insurance authorities.

Aim: To gain deeper understanding on the experiences of professionals involved in cooperative projects aimed at promoting RTW among unemployed sickness benefit recipients.

Method: Qualitative analyses were performed of transcribed data from interviews of professionals participating in cooperative projects.

Result: The analyses identified four impmtant areas of the experiences of such cooperation. First, the daily collaboration on the same cases enabled development of good relationships and cooperative competence, which improved the contact with clients. Second, the cooperative projects made it possible to include only clients perceived motivated for RTW measures. Third, the closer and more frequent interaction with clients proved to be constmctive in that it facilitated recognition and mobilisation of the strengths and abilities of the clients in the RTW process. Fotnih, the differences in rules and regulations between the social insurance and the unemployment insurance standards was often mentioned, and were perceived to induce problems, for example, on how to assess the work capacity of clients.

Conclusion: The direct cooperation between the professionals from two different authorities was found to improve the application of RTW measures. The assessments of work capacity represent both important and complex tasks that professionals must perfonn without having access to either scientific knowledge or consensus agreement on which to base their decisions. Finally, it is important to gain further knowledge on how to create, develop, and maintain the 'cooperative competence' developed in the projects.