CONSEJO SECTORIAL INSTITUCION

In this project an HIS design theory was developed by bringing centuries of thought on medical ethics and the practice of medicine together with the modern phenomena of information

technology and the literature and professional guidelines for computing professionals. The result is a set of ethical guidelines that guide the HIS system design in the complex context of

contemporary healthcare.

Biomedical ethics evolved over centuries of thought about complex issues in medicine and have resulted in a progression of ethical guidelines, each capturing a specific cultural moment, a picture in time. Historically lessons of the past have been incorporated into current ethical philosophical thinking and result in a progression of guidelines that moves the medical community forward. This fairly steady progression is occasionally punctuated by significant societal and technological changes. It is during these unsettled times that we seek guidance to progress through the unknown and we turn our attention turns to ethical and moral philosophy for guidance.

Information technology has introduced significant change; global change that has significantly impacted societies, religion, education, business, cultures and the daily lives of individuals. The impact of information technology on the practice of medicine has been profound. Remarkable contributions have advanced the practice of medicine in ways that would have been

incomprehensible in the past. The use of information technology in healthcare has also had destructive consequences as well; many of which came about because of the novelty of

information systems and the fact that designers and stakeholders simply didn’t anticipate the problems that might arise from their use. The results illustrate that society in general, and our healthcare system in particular, is currently experiencing significant change. We have turned to the established ethical literature for guidance; however the issues that are faced in HIS design today have not here-to-fore been addressed. The HIS design theory offered here is an attempt to address this void. Arguably information technology and the practice of medicine can no longer be addressed separately, they have merged in practice and therefore should be merged in the literature that contains the ethical discourse from which we seek guidance. It is hoped that this theory will be the next step in the progression of ethical discourse regarding the complexities of the use of information technology in medicine today. And, that by articulating the theory in a set of guidelines for HIS designers this theory will have a positive impact on the practice of

medicine as well.

The ADDSS action research project provides a first step in validating the HIS design theory.

The action research methodology provides the opportunity to implement change in practice and at the same time advance general knowledge. It is hoped that this project is the first of many that begin to test and refine theories such as the HIS design theory offered here. The results of ADDSS project resulted in contributions for both practice and research. These contributions are discussed in the following sections.

Contributions and Implications for Research

This study began as part of a dissertation research project with the goal of testing the HIS design theory described in earlier chapters. Applying the HIS design principles in the ADDSS action research project extended the knowledge of the design of information systems for use in the healthcare context.

The use of information technology in healthcare is growing exponentially and MIS is uniquely suited for addressing the design issues that will arise. To date, information systems design at the intersection of healthcare and MIS has not been addressed in the MIS literature. The ADDSS action research project contributes to the literature seeking to understand the relationship between MIS and healthcare, and how to design ethical, effective, and efficient information systems in a healthcare context.

The hospice was a unique opportunity with regard to examining the relationship between MIS and healthcare. Given their limited use of information technology for the

admissions process, the hospice proved to be a blank slate from which to study the HIS phenomena. The organizational changes that resulted from the ADDSS could be attributed directly to the system itself.

The HIS design theory provides a conceptual framework for incorporating information technology into our understanding of the use of information systems in complex

healthcare contexts. It was originally anticipated that the action research project would result in a reduction of the design principles, however in the end each of the principles

proved valuable in the design of the ADDSS. Collaboration with the hospice, discussions with healthcare providers at the facilities visited during admissions visits, and especially meeting with patients and their families, transformed the researcher’s understanding of the implications of the ethical design theory for HIS. The diversity of education, culture, and background of each of the individuals who used the ADDSS revealed the complexity of HIS design. Illustrated was the need for a number principles that span across the entirety of the individuals and organizations that would use the system. Developing the ADDSS with the guidance of the HIS design principles resulted in a system that was able to achieve multiple goals across multiple stakeholders with varying educational and cultural backgrounds within a healthcare setting. This is a common goal in a healthcare context, and a very difficult goal to achieve. The ADDSS achieved this goal and can provide insight into future design of similar systems.

The ADDSS successfully focused the design and the resulting functionality of the system on the patient, while simultaneously achieving organizational goals. In accord with the design principles, the ADDSS enhanced patient autonomy both by providing an

education tool for the patient directly, and also by facilitating communication between the hospice nurses and the patient. The system facilitated patient decision making and allowed the patients to choose the treatment options that would best enhance their quality of life. These results illustrate the successful balance of patient autonomy, social justice (by achieving organizational goals), and patient welfare (the balance between the patient and the organization’s goals that result from the ADDSS).