“Once evaluation routines become the basis for contructing individual reality, technological claims are perceived as relevant only to those who employ the same routines while appearing as noise to those who employ different routines.”  Garud and Rappa.



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What is the proper prototype and BEST model for e-Learning we need to reveal in so that when we test it and run it in 11 emergency departments (EDs) across the country we have it right?  The recent tests of competency into the care failings at hospitals have called for sweeping changes to end the health management neglect and ailing nature of e-Services.  As a nursing professional, the article on e-management and e-services is of particular value in terms of developing a clear understanding of how e-management practice applies to nursing care organization.  E-Management is an essential part of good nursing management.  The article identifies perceptive and having sensitivity and imagination are required to engage practice.  Herein are the types of e-learning occurring and description of some of the underlying factors.


Amid today’s concerns about healthcare, the current healthcare system faces the following challenges:  A limited medical resources are unevenly distributed. About 70% of these resources are in big cities.  Furthermore, in these cities, 80% of these resources are in large hospitals.  Medical organizations lack cooperation and service linkage.  Information isolation makes cooperation and service linkage difficult, and increases healthcare costs. As the population ages, healthcare expenditures increase year after year.  Many of us working in Management have coined the phrase ‘shift left, work ahead.  Assume that the continuum of care is viewed as a horizontal ax with the patent’s home being the left most point on the axis and hospital the end-point on the right.  Here, shift-left signifies a refocusing of efforts away from acute and office-based healthcare services to consumer-focused, personalized technologies accessible to individuals and families at home.  But we find that the term ‘world-ahead’ represents the ubiquitous potential of digital communication systems and the internet to facilitate care in the home.  This is a statement that differentiates the rearview and forward-looking visions for healthcare. In other words, if a system is built from the perspective of the rearview mirror, the shift is not from the acute and office-based healthcare services to the home, it is rather a shift to the medical office or another facility.  I therefore make the case that technology-enabled care at home and the ‘medical home are new models of healthcare delivery but rather a common thread.  They are ‘disruptive innovations’ that engage the consumer and aims to rescue costs associated with unmanaged chronic conditions.

When it comes to performance management, size really doesn’t matter.  Basically, everyone needs to do it right. Employers large and small, in fact, historically have struggled with making sure they are getting the best out of their workforces.  Yet, while no one will argue that effectively managing employee performance isn’t critical to organizational success, the issue is how to do it consistently and do it well.  Employers are not given a uniform way to analyze and discuss their employees’ job performances, including goal setting and performance improvement plans.  This is a standard that will establish a threshold[i] of performance management practices that effective organizations should employ to adequately assess, improve and prepare their employees to deliver on organizational commitments.  As we learn from merited technological substitutions, fermentation process and variation technological discontinuity process there is much to be desired through process.

An adaptative technology cycle over time.

However, an ability to design and integrate systems using internal or external sources of product supply, coupled with these firms developing novel combinations of service capabilities like operations, business consultancy, and finance are required part to providing complete solutions to each customer needs from Variation Technological discontinuity through technological Substitution, even after an Era of ferment where we have already  made attempts at integrating multiple applications and enhanced collaboration.  Thus, I offer to the reader (3) ideas for e-management solutions for 2014:

Hypothesis 1:  New designs are developed as means to deal with affected changes in markets and regulations

Hypothesis 2:  New designs reflect both internal learning efforts and strategic attempts to position the firm in a future market

Hypothesis 3: Firms have three basic criteria to selecting promising designs: 1) current expected performance versus expected future market criteria, 2) fitness with specific expected regulatory schemas, and 3) fitness with designs developed by competing firms.

Service governance[ii] is the ability to place policies around services, as we define through understanding the data, logically grouping the data, defining interfaces and access approaches and defining the Analytics Services to control access to those services.  This includes who can access the services, what they can do with the services, and any usage parameters that should be set.  Take MD Anderson, a premier cancer center and university medical center and the service architecture that enables their virtual data repository.  Initiatives by MD Anderson help patients feel more a part of their treatment process by visualizing it.  Because MD Anderson could not shut down while it’s EMR was in development over the past few years, one of the important tools MD Anderson leveraged to help the clinical business analysts was software that helps visualize clinical applications.  Visualizing, as does simulating, becomes a requirement for all business analysis to use for tools when developing and at first finding this go-between point is what gives the development team and the clinicians and MD Anderson as an organization the most value.  This appeasement also allows their physicians in the community to be more actively involved in the care of these patients.   For example, the use of cloud-based platforms to store health care data is something that seems unnatural for most of those who run I.T. shops in the health care vertical.  However, the emerging data seems to pushback on this notion we find that RealPresence platforms, for example, should have at least two main purposes if they are to succeed.  The first begins with remote medical care.   Many departments[iii] are using telemedicine networks to consult with partner hospitals.  Health professionals are also able to examine patients in any other telemedicine centers, giving patients from access to experts. The second is the Electronic Library or Distance Medical Education.  This continuous programme is one of the most important components of the Integrated Telemedicine and e-Health Programmes.  It can consist of lectures, seminars, conference, workshops and other education events organized nationally and regionally which are also transmitted via the Polycom RealPresence Platform to all the centers facilitating and increasing knowledge sharing.  But, beyond these two main functions the platform is also supportive preventive and wellness, by bringing medical care to rural and remote locations.  The first phase of the project should be ‘Initiative.’ It should include the establishment of basic infrastructures, info-structure, policies and procedures.  Training and education Next, a successful e-management solution also needs the following as we see in Table 1:


S. No.


Unicode based American Multilingual Support




Comprehensive Reporting on various customizable parameters


Comprehensive Role based Assess control and Security


Data Security and Privacy


Audit logging of transactions


Powerful Search facility and tracking of patient history



Touch Screen Kiosk interface

Available on Linux and Windows platform


As we notice in Table 1, a multi-vendor’ management system or system integrator is needed which can select and combine suitable products from those of various manufacturers in accordance with the needs of each E-Hospital Management system or customer.  Technology inclusion, exclusion and hybrid combination decisions therefore, are crucial to success of latest E-Hospital management solutions.  Such efficient and precise decision in choice of technology and E-hospital solution management is possible only based on how-how and technological excellence accumulated through longstanding engagement in system design and construction in the medical area.  Are we just too busy chopping wood to sharpen our own axes?  Or have we lost sight of our objective altogether, and have redoubled our efforts. 

One successful team-based program is called socio-technical process design.[iv]  To explain this seeming jargon, all work processes, for example, patient care, surgery, sandwich factories even car making are both social and technical in nature.  People or the ‘social’ provide the movement of information or material or the technical from input to processes, and then finally to some output.  A natural benefit of this social-technical process methodology include that employees are always interest in talking about their job.  We must remember that there are disadvantages to directed change rather than guided change.  For example, when directed change is used inappropriately organizational members are forced to cope with the well-known and expected reactions of the recipients of the imposed change, for example, denial, anger, bargaining, sadness and loss.  Similarly, when planned change creates an important capacity in today’s organizations, used inappropriately it can still result in significant reductions in productivity, overwhelm organizational members with its complexity, and alienate key stakeholders as a result of limited participation and true influence in the process.  A related limitation with planned change is a lack of flexibility in the face of changing conditions.  As experience shows, planned change efforts often constrain the ability of the organization to achieve its intended goals. 

While no precise demarcation points appear between low and high-sociotechnical uncertainty, situations can be described as varying in the extent to which there are early known ways to approach the situation, an understandable sequence of steps that can be followed, and an identifiable set of established procedures and practices.  For example, in low socio-technical uncertainty contexts the solution is not known or even fully understood.  When socio-technical uncertainty is high, the problem itself is not fully described or clearly understood meaning that the search for a solution occurs simultaneously with the search for a clear definition of the problem.  So is this the case of big bad data in the law, public health and biomedical databases?  There are clear public health uses and shortcomings if HERs often only certain data entry errors so that even if HER data themselves are flawless which is why we must grapple with a variety of analytical challenges as managers.  I believe that this is therefore observational rather than experimental.  Yet, as we learn, secondary use of HER data in order to promote public health can be facilitated through a variety of other approaches. Interoperability, improvement infrastructure, and appropriate data analysis techniques are all becoming important contributing factors.   

[i] Oracle Healthcare.  Introducing eHealthcare Patient Management Without Walls.  2010.

[ii] Berkowitz, David.  EMR Connects Patients, Physicians to Real-Time Data.  2010. 

[iii] Huawei Unified Communication Healthcare Solution.  For an in-depth analysis go to:  enterprise.huawei.com/en/solutions/. 2013.

[iv] Baxter, Gordon.  Socio-technical Systems.  http://archive.cs.st-andrews.ac.uk/STSE-Handbook/SocioTechSystems.  2011.