How to evaluate health informatics? A review of the debate on evaluation approaches and the shifting focus Abstract The question of evaluation is always regarded as a major contentious issue in the field of information systems, and perhaps even more so in health informatics. There is still little agreement in those questions like what should be evaluated, how to evaluate and what methods or approach should be applied. The goal of this literature review accordingly, is to present different approaches in addressing the issue of evaluation health informatics and show the conceptual shift of emphasis on evaluation, which is driven by socio-technical and tends to be process focus. In this way, this paper can help us to have a clear understanding to the interesting and complex phenomenon and important theories in this enduring topic as well as to indicate new implications for future research. Keywords: health informatics, evaluation, socio-technical, research methods Introduction Information and communication technologies(ICT) are emerging in health care such as electronic medical records, clinical decision support, and computerized physician order entry, thus leading to a new discipline “health informatics” which denoted “the use of information and ICTs to improve the quality of care and health and well-being of patients, their families and carers, and the general public.”(Bath, 2008). Despite the potential benefits of health informatics, evidence shows that use of information technology in health care lags far behind other sectors as well as indicates that health informatics can even cause unintended adverse consequences including loss of patient safety or poor cooperation between medical staff (Campbell, 2007; Ash et al., 2004), which means that health informatics might cause troubles not improvements. So, questions have arisen regarding whether or not ICTs do contribute to health care quality, if so, to what extent and how. To answer such questions requires comprehensive evaluation activities. However, in practice, evaluation remains a major contentious issue in the field of information systems, and perhaps even more so in health informatics. Complexity of features in medical health care processes mingles with the broad information systems field, making the topic of evaluation much more challenging. Moreover, the healthcare work process proves to be immensely complex because of its inherent collective and cooperative dimensions. Beuscart-Zephir et al.(2005) claims that “Each actor interacts with an organization, which is composed both of other actors and embedded shared or individual working devices, including paper or electronic records, forms, transmission sheets”. Turning back to the issue about how to evaluation health informatics, although many researchers engaged in making efforts to assess or evaluate the use of ICT applications in health care, there is still little agreement in those questions like what should be evaluated? how to evaluate? what methods or approach should be applied?
According to perspectives prevailing in the literature, most researchers turn to different methods or approaches only to evaluate the outcome or single-aspect impact of health informatics ranging from simply system performance, work efficiency, cost-effectiveness to user adoption, professionals satisfaction. Newer evaluation approaches tend to look beyond the system as merely artifact and consider relationships between system characteristics, individual characteristics, organizational characteristics, and effects among them. Such approaches encourage evaluating ICT’s impact upon an organization while evaluating organizational features’ impacts on the system (Kaplan,1997), which call for qualitative and interpretative methods to provide better understanding of what the outcomes mean and address the question of why the outcomes come. Similarly, the socio-technical view which regards the deployment of information technology in...
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