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Bakunzibake, P., Klein, G. O. & Islam, M. S. (2019). E-government implementation and monitoring: The case of Rwanda ‘one-stop’ E-government. Electronic Journal of Information Systems in Developing Countries, 85(5), Article ID e12086.
Open this publication in new window or tab >>E-government implementation and monitoring: The case of Rwanda ‘one-stop’ E-government
2019 (English)In: Electronic Journal of Information Systems in Developing Countries, ISSN 1681-4835, E-ISSN 1681-4835, Vol. 85, no 5, article id e12086Article in journal (Refereed) Published
Abstract [en]

Taking the case of the “one‐stop” e‐government initiative in Rwanda, the present study aims to find out how the “one‐stop” e‐government initiative is monitored at different government levels and stages and the extent to which the initiative is monitored. Furthermore, the study also aims to identify potential areas for improvement in the monitoring process. An exploratory qualitative study was undertaken in Rwandana gencies. The findings show that the monitoring of the process of implementing and improving one‐stop e‐government is partly formal at central government level and informal at local government level. Furthermore, the focus of the monitoring at the stage of use and maintenance leans more towards the benefits of end users as service consumers than those of the service providers. Incorporating formal methodological approaches at local government level and in all stages of the implementation and improvement process at central government level, as well as paying increased attention to back‐end process performance aspects, could introduce additional improvements into the monitoring practice and, in turn, increase project benefits.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
E‐government implementation, evaluation, monitoring, one‐stop e‐government, Rwanda
National Category
Information Systems, Social aspects
Identifiers
urn:nbn:se:oru:diva-70145 (URN)10.1002/isd2.12086 (DOI)000486071500003 ()2-s2.0-85061800591 (Scopus ID)
Note

Funding Agency:

University of Rwanda-Sweden Capacity Building Programme 

Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2019-11-08Bibliographically approved
Bakunzibake, P., Klein, G. O. & Islam, M. S. (2019). E-Government Implementation Process in Rwanda: Exploring Changes in a Socio-technical Perspective. Business Systems Research Journal, 10(1), 53-73
Open this publication in new window or tab >>E-Government Implementation Process in Rwanda: Exploring Changes in a Socio-technical Perspective
2019 (English)In: Business Systems Research Journal, ISSN 1847-8344, E-ISSN 1847-9375, Vol. 10, no 1, p. 53-73Article in journal (Refereed) Published
Abstract [en]

Background: Failures in e-government projects to deliver expected results are frequent in the context of developing countries. These are partly attributed to the lack of balanced attention to both technical and social aspects in the implementation. However, there has been limited research on these aspects in the least Developed Countries.

Objectives: Taking a socio-technical perspective, this study aims at exploring the extent of changes and effects in the implementation of e-government service-oriented initiatives in Rwanda, one of the Least Developed Countries.

Methods/Approach: An empirical investigation was conducted, via interviews at 8 agencies during the period from January 2017 to May 2018. This involved two case projects, an Enterprise Content Management System and a One-Stop e-government system. Furthermore, government documents and online material were analyzed.

Results: A number of changes in technology, processes and people aspects were faced in both projects. However, those changes are coupled with secondary effects; there is a need for a better fit between technical systems and social systems of organizations implementing e-government; a larger gap was identified in the first case project.

Conclusions: Addressing the issues as a socio-technical system would contribute to improved work systems of agencies and better services.

Place, publisher, year, edition, pages
De Gruyter Open, 2019
Keywords
e-Government implementation, enterprise content management, ‘one-stop’ e-government, Rwanda, socio-technical theory
National Category
Information Systems
Research subject
Informatics
Identifiers
urn:nbn:se:oru:diva-73686 (URN)10.2478/bsrj-2019-0005 (DOI)000467633400005 ()2-s2.0-85065835760 (Scopus ID)
Projects
Rwanda e-government project
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-06-19Bibliographically approved
Bakunzibake, P., Grönlund, Å. & Klein, G. O. (2019). Organisational Challenges in the Implementation of ‘one-stop’ e-Government in Rwanda. Electronic Journal of e-Government, 17(1), 1-19
Open this publication in new window or tab >>Organisational Challenges in the Implementation of ‘one-stop’ e-Government in Rwanda
2019 (English)In: Electronic Journal of e-Government, ISSN 1479-439X, E-ISSN 1479-439X, Vol. 17, no 1, p. 1-19Article in journal (Refereed) Published
Abstract [en]

One-stop e-government holds potential benefits in all contexts and especially in the context of developing countries and in the Least Developed Countries (LDCs). Implementation of one-stop e-government can be challenging as it normally requires addressing a number of organisational issues including those related to the integration of the individual government information systems of different departments which traditionally function as silos; tackling organisational issues can be difficult due to the nature of the public sector. However, the contemporary literature paints a picture of scarce research on the organisational issues that impede the implementation of one-stop e-government initiatives in LDCs. This paper explores the organisational issues underlying the implementation of ‘one-stop’ e-government initiatives in Rwanda, an LDC. The study explores the status of these elements as of and up to March 2017. The qualitative case study methodology used for this study involved data collection by means of documents and interviews with key managers from central government organisations, from a private company, and from local government service clerks. Template analysis was used as a method for data analysis. Even though the number of online services for citizens, businesses, and other agencies is growing rapidly and easy payment of service fees is available, a number of organisational issues were identified. These include the lack of a clear plan of ‘to-be’ service processes and a corresponding change management strategy. Service re-design was taking place very much ad hoc. There were also unclear systematic organisational learning mechanisms and unclear operational goals in the local government. Addressing these issues would contribute towards improving the implementation of one-stop e-government and its corresponding services in such a context. The paper contributes to research by providing insights into organisational issues in a country currently in an early stage of e-government development. For Rwandan e-government professionals, the paper suggests a way forward. It also helps decision makers in Rwanda and similar countries undertaking one-stop initiatives to understand the problem context of actions taken towards IT-driven institutional reform.

Place, publisher, year, edition, pages
Academic Conferences Limited, 2019
Keywords
One-stop e-government, e-government organisational challenges, Rwanda
National Category
Other Social Sciences
Research subject
Informatics
Identifiers
urn:nbn:se:oru:diva-73592 (URN)
Projects
Rwanda e-government project
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-06-13Bibliographically approved
Karni, L., Memedi, M. & Klein, G. O. (2019). Targeting Patient Empowerment via ICT interventions: An ICT-specific Analytical Framework. In: AMCIS 2019 Proceedings: . Paper presented at 25th Americas Conference on Information Systems (AMCIS 2019), Cancun, Mexico, August 15-17, 2019. Cancun, Mexico: Association for Information Systems
Open this publication in new window or tab >>Targeting Patient Empowerment via ICT interventions: An ICT-specific Analytical Framework
2019 (English)In: AMCIS 2019 Proceedings, Cancun, Mexico: Association for Information Systems, 2019Conference paper, Published paper (Refereed)
Abstract [en]

Empowerment of patients is today often an explicit goal of various ICT interventions where the patients themselves use ICT tools, often via the internet. This study is proposing a framework model for ICT interventions aiming to empower patients. Our new model includes different aspects of the Empowerment concept, general possible strategies to achieve Empowerment using different ICT services. Finally, the ICT services and the underlying strategic model can be used to define evaluations of such interventions where the aim is to demonstrate Empowerment. Our model is based on a review of various general models of Empowerment and the Behavioral Intervention Technology Model (BIT). The implications of our model are discussed using two case studies projects, the C3-Cloud EU project about empowering patients with 4 chronic diseases and the EMPARK project about Internet-of-Things sensors based real time feedback to Parkinson patients.

Place, publisher, year, edition, pages
Cancun, Mexico: Association for Information Systems, 2019
Keywords
Empowerment, ICT-Intervention, Framework mode
National Category
Information Systems
Research subject
Informatics
Identifiers
urn:nbn:se:oru:diva-75987 (URN)
Conference
25th Americas Conference on Information Systems (AMCIS 2019), Cancun, Mexico, August 15-17, 2019
Projects
EMPARK
Funder
Knowledge Foundation
Available from: 2019-08-30 Created: 2019-08-30 Last updated: 2019-08-30Bibliographically approved
Traore, L., Assélé Kama, A., Lim Choi Keung, S., Karni, L., Klein, G. O., Lilja, M., . . . Jaulent, M.-C. (2019). User-Centered Design of the C3-Cloud Platform for Elderly with Multiple Diseases: Functional Requirements and Application Testing. In: Lucila Ohno-Machado, Brigitte Séroussi (Ed.), MEDINFO 2019: Health and Wellbeing e-Networks for All. Paper presented at 17th World Congress of Medical and Health Informatics (MEDINFO 2019), Lyon, France, (pp. 843-847). IOS Press
Open this publication in new window or tab >>User-Centered Design of the C3-Cloud Platform for Elderly with Multiple Diseases: Functional Requirements and Application Testing
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2019 (English)In: MEDINFO 2019: Health and Wellbeing e-Networks for All / [ed] Lucila Ohno-Machado, Brigitte Séroussi, IOS Press, 2019, p. 843-847Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

The number of patients with multimorbidity has been steadily increasing in the modern aging societies. The European C3-Cloud project provides a multidisciplinary and patient-centered “Collaborative Care and Cure-system” in the management of elderly with multimorbidity, enabling continous coordination of care activities between multidisciplinary care teams (MDTs), patients and informal care givers (ICG). In this paper, we report how various components of the infrastructure were tested to fulfill the functional requirements and how the entire system was subjected to an early application testing involving different groups of end-users. MDTs from participating European regions were involved in requirement elicitation and test formulation, resulting in 57 questions, distributed via an internet platform, to 48 test participants (22 MDTs, 26 patients) from three pilot sites. The results indicate an overall high level of satisfaction for all Information and Communication Technologie (ICT) components among the users. The early testing also provided user feedback important to consider for technical improvement of the entire system. 

Place, publisher, year, edition, pages
IOS Press, 2019
Series
Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365 ; 264
National Category
Health Sciences Information Systems, Social aspects
Identifiers
urn:nbn:se:oru:diva-76079 (URN)10.3233/SHTI190342 (DOI)978-1-64368-002-6 (ISBN)978-1-64368-003-3 (ISBN)
Conference
17th World Congress of Medical and Health Informatics (MEDINFO 2019), Lyon, France,
Available from: 2019-09-04 Created: 2019-09-04 Last updated: 2019-09-09Bibliographically approved
Memedi, M., Tshering, G., Fogelberg, M., Jusufi, I., Kolkowska, E. & Klein, G. O. (2018). An interface for IoT: feeding back health-related data to Parkinson's disease patients. Journal of Sensor and Actuator Networks, 7(1), Article ID 14.
Open this publication in new window or tab >>An interface for IoT: feeding back health-related data to Parkinson's disease patients
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2018 (English)In: Journal of Sensor and Actuator Networks, E-ISSN 2224-2708, Vol. 7, no 1, article id 14Article in journal (Refereed) Published
Abstract [en]

This paper presents a user-centered design (UCD) process of an interface for Parkinson’s disease (PD) patients for helping them to better manage their symptoms. The interface is designed to visualize symptom and medication information, collected by an Internet of Things (IoT)-based system, which will consist of a smartphone, electronic dosing device, wrist sensor and a bed sensor. In our work, the focus is on measuring data related to some of the main health-related quality of life aspects such as motor function, sleep, medication compliance, meal intake timing in relation to medication intake, and physical exercise. A mock-up demonstrator for the interface was developed using UCD methodology in collaboration with PD patients. The research work was performed as an iterative design and evaluation process based on interviews and observations with 11 PD patients. Additional usability evaluations were conducted with three information visualization experts. Contributions include a list of requirements for the interface, results evaluating the performance of the patients when using the demonstrator during task-based evaluation sessions as well as opinions of the experts. The list of requirements included ability of the patients to track an ideal day, so they could repeat certain activities in the future as well as determine how the scores are related to each other. The patients found the visualizations as clear and easy to understand and could successfully perform the tasks. The evaluation with experts showed that the visualizations are in line with the current standards and guidelines for the intended group of users. In conclusion, the results from this work indicate that the proposed system can be considered as a tool for assisting patients in better management of the disease by giving them insights on their own aggregated symptom and medication information. However, the actual effects of providing such feedback to patients on their health-related quality of life should be investigated in a clinical trial.

Place, publisher, year, edition, pages
Multidisciplinary Digital Publishing Institute (MDPI), 2018
Keywords
Information visualization; user-centered design; internet of things; sensor technology; Parkinson’s disease; patient empowerment; quality of life
National Category
Human Computer Interaction
Research subject
Informatics
Identifiers
urn:nbn:se:oru:diva-65675 (URN)10.3390/jsan7010014 (DOI)000428559500013 ()2-s2.0-85044327671 (Scopus ID)
Projects
EMPARK
Funder
Knowledge Foundation, 20160176
Note

Funding Agencies:

Sensidose AB  

Cenvigo AB  

Nethouse Sverige AB  

Swedish Institute 

Available from: 2018-03-12 Created: 2018-03-12 Last updated: 2018-12-19Bibliographically approved
Karni, L., Memedi, M., Kolkowska, E. & Klein, G. O. (2018). EMPARK: Internet of Things for Empowerment and Improved Treatment of Patients with Parkinson's Disease. In: : . Paper presented at International Congress of Parkinson´s Disease and Movement Disorders, Hong Kong, People's Republic of China, 5-9 October, 2018. John Wiley & Sons
Open this publication in new window or tab >>EMPARK: Internet of Things for Empowerment and Improved Treatment of Patients with Parkinson's Disease
2018 (English)Conference paper, Poster (with or without abstract) (Other (popular science, discussion, etc.))
Abstract [en]

Objective: This study aims to assess the effects of patient-directed feedback from remote symptom, medication, and disease activity monitoring on patient empowerment and treatment in Parkinson’s disease (PD).

Background: There is a need to empower patients with PD to be able to understand better and control their disease using prescribed medication and following recommendations on lifestyle. The research project EMPARK will develop an Internet of Things system of sensors, mobile devices to deliver real-time, 24/7 patient symptom information with the primary goal to support PD patients empowerment and better understanding of their disease. The system will be deployed in patient homes to continuously measure movements, time-in-bed and drug delivery from a micro-dose levodopa system. Subjective symptom scoring, time of meals and physical activities will be reported by the patients via a smartphone application. Interfaces for patients and clinicians are being developed based on the user center design methodology to ensure maximal user acceptance. 

Methods: This is a randomized controlled trial where 30 PD patients from 2 university clinics in Sweden will be randomized to receive (intervention group) or not (control group) continuous feedback from the results of the EMPARK home monitoring for 2 weeks. Disease-specific (UPDRS, PDQ-39), Quality of Life (QoL) (modified EuroQoL EQ-5D) and empowerment questionnaires will be collected prior and after the intervention. The correlation of technology-based objective and patient-reported subjective parameters will be assessed in both groups. Interviews will be conducted with the clinicians and observations will be made about the patient-clinician interaction to assess the potential treatment benefits of the intervention.

Results: Preliminary results from workshops with patients and clinicians show potential to improve patient empowerment and disease control among patients. Completion of the trial will show the degree of patient empowerment, individualized treatment, and patientclinician interactions.

Conclusions: Raising patients’ awareness about disease activity and home medication is possible among PD patients by providing them with feedback from the results of a home monitoring system. This randomized, controlled trial aims to provide evidence that this approach leads to improved patient empowerment and treatment results.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Computer and Information Sciences
Research subject
Informatics
Identifiers
urn:nbn:se:oru:diva-69955 (URN)
Conference
International Congress of Parkinson´s Disease and Movement Disorders, Hong Kong, People's Republic of China, 5-9 October, 2018
Funder
Knowledge Foundation
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2018-11-14Bibliographically approved
Laleci Erturkmen, G. B., Yuksel, M., Sarigul, B., Lindman, P., Chen, R., Zhao, L., . . . Arvanitis, T. N. (2018). Management of personalised guideline-driven care plans addressing the needs of multi-morbidity via clinical decision support services. Paper presented at 18th International Conference on Integrated Care, Utrecht, Netherlands, May 23-25, 2018. International Journal of Integrated Care, 18(132), A132-A132
Open this publication in new window or tab >>Management of personalised guideline-driven care plans addressing the needs of multi-morbidity via clinical decision support services
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2018 (English)In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 18, no 132, p. A132-A132Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Introduction: The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. C3-Cloud project aims to build an integrated care platform for addressing the growing demand for improved health outcomes of multimorbid and long-term care patients. 

Theory/Methods: C3-Cloud has established an ICT infrastructure enabling continuous coordination of patient-centred care activities by a multidisciplinary care team MDT and patients/informal care givers. The Coordinated Care and Cure Delivery Platform C3DP allows, collaborative creation and execution of personalised care plans for multi-morbid patients through systematic and semi-automatic reconciliation of clinical guidelines. Clinical decision support CDS systems implementing flowcharts from evidence based clinical guidelines are integrated to present suggestions for treatment goal and activities e.g. medications, follow-up appointments, diet, exercise, lab tests. Pilot site local care systems are integrated with the C3DP via the technical and semantic interoperability platform to facilitate informed decision making. Active patient involvement is realized through a Patient Empowerment Platform presenting personalized care plan to the patient and establishing a continuous bi-way communication with the patient to collect patient observations, questionnaire responses, symptoms and feedback about care plan goals and activities.

Results: The following research results have been achieved to enable guideline enabled personalised care plan management for addressing the needs of multi-morbidity:

43 logical flowcharts were designed out of 4 disease guidelines Type 2 Diabetes, Heart Failure, Renal Failure and Depression.

181 CDS rules assessing 166 patient criteria and recommending 154 goal/activity suggestions were implemented as CDS services in GDL covering T2D and RF.

52 reconciliation rules were designed for eliminating contradicting guideline recommendations due to multi-morbidity.

23 HL7 FHIR profiles were defined for representing care plan and patient data.

C3DP has been integrated with these CDS services via CDS-Hooks specification to recommend personalised care plan goals and activities.

Discussions: In this research, we have successfully implemented an ICT infrastructure enabling guideline-driven integrated care for multi-morbid patients. Although our ICT solution covers all the technical requirements identified by clinical partners, effective implementation of integrated care in real-life care setting requires major changes in organisational responsibilities and care pathways.

Conclusions: User-centred design and usability testing have successfully been completed. C3-Cloud pilot application will now be operated in 3 European pilot sites with the participation of 62 MDT members and 1200 multi-morbid patients for 15 months.  

Lessons learned: There are two main research lines for reconciliation of contradicting guideline recommendations: 1 fully-automated reconciliation via ontology reasoning, 2 manually-crafted reconciliation rules by clinical expert groups. Although first approach is more dynamic, research results are still for very primitive cases and not clinically validated. As we are targeting an industry-ready solution after piloting in real-life settings, we have opted for the second option.

Limitations: When a new chronic disease is to be addressed within our platform, reconciliation rules covering all disease combinations have to be re-assessed by the clinical expert group.

Suggestions for future research: Fully-automated reconciliation approaches need to be further studied and validated in real-life settings. 

Place, publisher, year, edition, pages
University of Utrecht, 2018
Keywords
personalised care plan, clinical guidelines, multi-morbidity, clinical decision support, patient empowerment
National Category
Information Systems
Identifiers
urn:nbn:se:oru:diva-73995 (URN)10.5334/ijic.s2132 (DOI)
Conference
18th International Conference on Integrated Care, Utrecht, Netherlands, May 23-25, 2018
Available from: 2019-05-02 Created: 2019-05-02 Last updated: 2019-06-18Bibliographically approved
Lagsten, J., Scandurra, I. & Klein, G. O. (2017). Analys av enkäten ”Användarsynpunkter” i Landstinget Sörmland, Rapport till Landstinget Sörmland.
Open this publication in new window or tab >>Analys av enkäten ”Användarsynpunkter” i Landstinget Sörmland, Rapport till Landstinget Sörmland
2017 (Swedish)Report (Other academic)
Publisher
p. 89
National Category
Information Systems, Social aspects
Research subject
Informatics
Identifiers
urn:nbn:se:oru:diva-71985 (URN)
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2019-01-31Bibliographically approved
Nhavoto, J. A., Grönlund, Å. & Klein, G. O. (2017). Mobile health treatment support intervention for HIV and tuberculosis in Mozambique: Perspectives of patients and healthcare workers. PLoS ONE, 12(4), Article ID e0176051.
Open this publication in new window or tab >>Mobile health treatment support intervention for HIV and tuberculosis in Mozambique: Perspectives of patients and healthcare workers
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0176051Article in journal (Refereed) Published
Abstract [en]

Background: Studies have been conducted in developing countries using SMS to communicate with patients to reduce the number of missed appointments and improve retention in treatment, however; very few have been scaled up. One possible reason for this could be that patients or staff are dissatisfied with the method in some way. This paper reports a study of patients' and healthcare workers' (HCW) views on an mHealth intervention aiming to support retention in antiretroviral therapy (ART) and tuberculosis (TB) treatment in Mozambique.

Methods: The study was conducted at five healthcare centres in Mozambique. Automated SMS health promotions and reminders were sent to patients in a RCT. A total of 141 patients and 40 HCWs were interviewed. Respondents rated usefulness, perceived benefits, ease of use, satisfaction, and risks of the SMS system using a Likert scale questionnaire. A semi-structured interview guide was followed. Interviews were transcribed and thematic analysis was conducted.

Results: Both patients and HCW found the SMS system useful and reliable. Most highly rated positive effects were reducing the number of failures to collect medication and avoiding missing appointments. Patients' confidence in the system was high. Most perceived the system to improve communication between health-care provider and patient and assist in education and motivation. The automatic recognition of questions from patients and the provision of appropriate answers (a unique feature of this system) was especially appreciated. A majority would recommend the system to other patients or healthcare centres. Risks also were mentioned, mostly by HCW, of unintentional disclosure of health status in cases where patients use shared phones.

Conclusions: The results suggest that SMS technology for HIV and TB should be used to transmit reminders for appointments, medications, motivational texts, and health education to increase retention in care. Measures must be taken to reduce risks of privacy intrusion, but these are not a main obstacle for scaling up systems of this kind.

Place, publisher, year, edition, pages
Public Library of Science, 2017
National Category
Information Systems, Social aspects
Identifiers
urn:nbn:se:oru:diva-57686 (URN)10.1371/journal.pone.0176051 (DOI)000399875200064 ()28419149 (PubMedID)2-s2.0-85017624472 (Scopus ID)
Available from: 2017-05-17 Created: 2017-05-17 Last updated: 2017-11-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1337-2394

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