5/10/24, 3:11 PM CHIM305, Module 1 - Required Readings/Resources

Topics
What is health informatics?
Domains of health informatics
The desired outcome
Four fundamental areas of healthcare informatics
Quality and safety issues in healthcare
Barriers to implementation of technology

Learning Objectives
By the end of this module, you will be able to:

Comprehend the various definitions of informatics

Demonstrate how informatics differs from information technology and information management
Discuss how informatics interacts with and optimizes information technology and information
management
Explain basic concepts around the role of informatics in healthcare and its contribution to the
delivery of healthcare
Explain the principles, functions, domains, and applications of informatics in healthcare settings

Required Readings/Resources

Reading

El Morr, C. (2018). Introduction to health informatics: A Canadian perspective (1st ed.).

Toronto: Canadian Scholars.

Chapter 1 - Introduction to Health Informatics

Chapter 2 - Computers and Networks

What Is Health Informatics?

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There are a number of definitions and areas of specialization in the field of healthcare informatics,
including:

“The application of information technologies to optimize the information management function within an
organization using:

Information management
Information technology”

Health informatics is the “study of nature and principles of information and its applications within all
aspects of healthcare delivery and promotion” (Protti, 1982).

Digital Health Canada, formerly known as COACH, Canada’s Health Informatics Association, defines
health informatics (HI) as “the intersection of clinical, IM/IT and management practices to achieve better
health.”

According to Digital Health Canada, health informatics involves the application of information technology
to facilitate the creation and use of health-related data, information, and knowledge. Health informatics
enables and supports all aspects of safe, efficient, and effective health services for all Canadians (e.g.,
planning, research, development, organization, provision, evolution of services, etc.).

Source: COACH/Digital Health Canada

Health informatics professionals develop and deploy information and systems solutions, drawing on
expert knowledge from fields such as computer science, information management, cognitive science,
communications, epidemiology, management science, and health science.

Nursing informatics is a specialty that integrates nursing science, computer science, and information
science to manage and communicate data, information, knowledge, and wisdom in nursing practice.

Nursing informatics supports patients, nurses, and other providers in their decision making in all roles
and settings. This support is accomplished through the use of information technology and information
structures to organize data, information, and knowledge for processing by computers.

Source: Healthcare Information and Management Systems Society

Medical informatics is “the science of analysis, documentation, steering, control and synthesis of
information processes within the health care delivery system, especially in the classical environment and
medical practice.”

Source: Medical Informatics (Scribd)

An International View...
“Health informatics is concerned with the systematic processing of data, information and knowledge in
medicine and healthcare. The domain covers computational and informational aspects of processes and
structures, applicable to any clinical or managerial discipline within the health sector whether on a tele
(remote) basis or not. Health informatics is delivered by operational health practitioners, academic

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researchers and educators, scientists and technologists in operational, commercial and academic
domains.”

Source: What Is Health Informatics (Scribd)

Video

Watch the video What Is Health Informatics? [6:03]

Domains of Health Informatics

The field of health informatics is so much more than just technology. It includes the following areas or
domains:

Delivery of care, health education, and health promotion activities

Management of information and application of technology
Organizational settings of healthcare

Technology is the tool, but the value is in the information. Effective information management consists
of processes to ensure that the right information is available to the right people, within and without an
organization, at the right time and place, and for the right price. It ensures that information:

Is appropriate, reliable, and valid

Is accessible
Is timely
Is cost effective
Covers the Data-Information-Knowledge-Wisdom pyramid
Emphasizes the power and value of information
Includes data modeling and data standards
Involves coding, classification, and nomenclature
Includes data analysis and statistical information
Considers methods of systems analysis and design
Includes information sources (local, national, and international)
Considers managing information resources

Information technology consists of the technical components to process and communicate data and
includes:

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Computers, voice, data and image sensing and communications devices, graphics devices,
multimedia storage, etc.
Telephones, mobile devices, and fax machines
Hardware processing and storage technologies
Computer languages
Software: operating systems, databases, and applications
Communications technologies
Local area networks
Radio frequency devices
Cloud computing
Virtualization
Virtual private networks
Wide area networks
Physical topologies or broadcast topologies and connections
Intranets and the Internet
Telemedicine
Infusion/diffusion theories
Effectiveness metrics
Security and confidentiality
Standards
Documentation

Healthcare organizations management uses both information and technology and covers such areas as:

Organization theory and models

Communications theories
Management processes and practices
Organizational development and change management
Health economics and fiscal management
Resource allocation models
Individual and group decision support systems
Ethics and legislation
Privacy and security of both information and systems

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The Desired Outcome

The long-term desired outcome is to have a greater understanding of our stakeholders, patients, clients,
population, and system to enable us to change and improve on the way we deliver care. This
transformation begins with the automation of manual processes. And, often, we stop there. But the value
comes when we achieve greater efficiencies and can make better decisions based on evidence and best
practice, eventually having greater wisdom and knowledge and transforming the way we do business.
The illustration below shows this transformation process.

Figure 1 - Transformation via information management and technology

Long Description
This image is a diagram of the transformation that takes place through the application of
information, management of the information, and use of technology. The first step is the
automation component, where we do the same work but accomplish it in a more efficient
way. The second step is managing information, where we use technology to restructure
our work processes and do things differently. The final component is when we achieve
actual transformation because we have the capabilities to work smarter and make better
clinical decisions.

Source: Created by by Terrie Tucker

Critical success factors to achieve this transformation include the

following:
(Source: Graham Wright)

Understand the nature of different clinical practices, impacts, and consequences for the use of
technology
Understand the nature of the relationship between clinical staff and management, which might

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predispose clinical staff to oppose introduction of a clinical information system

Recognize wider imperatives and establish appropriate targets
Choose robust, transferable, extendable, and proven technologies, which do not inhibit future
developments
Take into account research and evaluation of informational developments, such as terming and
classification systems
Relate the technologies to imperatives
Recognize the clinical imperative need to treat more patients at least as well, in less time, and
using new systems
Create an affordable and practical technology financial plan from a high level strategy
Involve the future users in such a way that their input is meaningful to determine system
requirements and to gain their subsequent ownership
Prepare and develop individuals and the organization to make effective use of information
technologies
Implement in an orderly and timely way
Check whether the technologies are meeting expectations and requirements, whether the system
is highly valued and react accordingly

Stages of introducing information technology are facilitated by the

informatics components:
Assess and understand how and for what reasons things happen
Assess, understand the context, and identify consequences for clinical work and imperatives for
change
Select and prioritize opportunities, problems, imperatives, and requirements for change
Know of appropriate technological developments, relate them to information requirements; know of
opportunities and imperatives for change
Create an information and technology strategic plan
Involve, inform, persuade and prepare for these technologies and other changes; plan and
introduce new technologies and other changes
Evaluate, review, and assess the impact

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Figure 2 - Four fundamental areas of health informatics

Source: Created by Terrie Tucker

Figure 2 shows four fundamental areas of health informatics. We will revisit this from time to time to
illustrate a point. Currently, there are largely standalone products that fall in one of these areas, although
many organizations are accomplishing improvements in processes by integrating these disparate
systems:

Communication
Telemedicine
Tele-radiology
Patient email and text messaging
Presentations
Unified communications tools
Website resources

Knowledge management
Journals
Consumer health information
Evidence-based medical and health information
Research and literature

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Healthcare websites
E-Learning

Decision support
Reminder and alerts systems
Diagnostic
Expert systems
Drug interaction checks
Best practice guidelines

Information management
Electronic medical records
Billing transactions
Ordering systems
Results reporting

In large part because of the Internet, the information technology landscape in healthcare has changed in
the last several years. The biggest strides that have been made are in the communication and
knowledge management arenas and include: the application of information technology in healthcare
organizations’ administrative and financial transactions, and a virtual explosion of health-related
information available to consumers via the Web, and relatedly, gains in making syntheses of evidence,
practice guidelines, and health services research more accessible to health professionals, researchers,
and patients. Also, informatics has begun to be applied in the clinical realm through such applications as
reminder systems, telemedicine, tele-radiology, online prescribing, and e-mail.

Whatever advances have been made in integrating informatics into practice settings, IT innovations have
had a modest effect on patient care. Much clinical information is still stored in paper form (Hagland M.,
2001) (Staggers et al., 2001), particularly historical information. Relatively few patients have e-mail
access to their caregivers, most patients do not benefit from even the simplest decision aids, such as
patient reminder systems, and an unacceptable number of medical errors occur because of limitations in
information systems to process and check the vast amount of clinical data that flows through the system.

Clearly, we have a long way to go in optimizing the use of technology and realizing its full benefits in the
healthcare world, but Canada has a long-term strategy, and each province has structures in place to
advance and standardize technology use.

Quality and Safety Issues in Healthcare

The Institute of Medicine produced an important report on quality and safety issues in healthcare:
Crossing the Quality Chasm.

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Information and technology are key tools to achieve the recommendations identified in the report’s
vision:

Standardized information infrastructure

Support care teams – enhance patient-centred care
Support care coordination
Measure outcomes – improve outcomes
Enhance safety – reduce errors
Enable quality measurement/monitoring – reward quality

The authors of the Quality Chasm report believe that if a substantial improvement in quality is to be
achieved over the next decade, informatics must play a central role in the redesign of the health system
(2001).

The Quality Chasm report envisions priority conditions providing a framework for the development of a
standardized information infrastructure, which is a necessary first step. This infrastructure would support
the work of care teams and enable organizations to effectively measure outcomes and processes of
care, providing them with benchmarks for continuous improvement. Innovations in information systems
would enhance safety and the way care is organized, coordinated across settings and time, and
delivered (e.g. telemedicine, eHealth). Standardized information systems would provide the
infrastructure for payment methods that reward quality (2001).

Specific initiatives would include reducing errors:

Order entry systems

Reduce medication errors
Detect potential drug interactions
Alert users to potential allergies or dosages outside acceptable ranges
Alert users to best practice guideline suggestions for treatments

Clinical decision support systems

Improve drug dosing
Improve preventive care

Source: Crossing the Quality Chasm (PDF)

Barriers to Implementation of Technology

The references for this research seem dated and, unfortunately, healthcare has not made enormous
strides in the uptake and adoption of technology and these factors are still relevant today. In addition,
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individual healthcare organizations have made significant investments in technologies that are now
somewhat outdated. Newer solutions with greater integration capacities require large resource
investments in a field where technology is not always seen as a “patient care” tool.

Barriers
In the literature, one important area of study examines barriers or obstacles inhibiting the integration of
technology into instruction. Based on the literature and practitioner experience, Leggett and Persichitte
(1998) identify five categories of barriers to technology integration: time, expertise, access, resources,
and support. They use the TEARS acronym to make these categories more memorable.

While this acronym provides a useful mnemonic, important detail is lost in this subsumption and needs
elaboration for a full understanding of these barriers. This literature speaks to technology use in
education but is equally applicable to the healthcare environment. As you read it, substitute “healthcare
providers” for “educators.”

The lack of time is at the top of their list as the obstacle most often mentioned. This includes time
to plan, collaborate with peers, prepare lessons and materials, explore, practice and evaluate, as
well as develop, maintain, and expand skills. Other articles also identify time as an important
barrier (Adams, 2002; Kagima and Hausafus, 2001). This is particularly applicable to direct care
providers. Physicians who are paid on a fee-for-service basis lose income when they take time
away from patient care to attend educational sessions. Nurses and other direct care providers
must be replaced in their workplace if they are to attend educational sessions.
Expertise is another potential barrier to technology integration. Technology training for teachers
must be available. Effective technology training must be hands on, systematic, and ongoing.
Additionally, a variety of models and approaches should be available to accommodate different
needs, schedules, and learning styles. Adams (2002) found similar barriers related to expertise,
such as limited computer training, and Kagima and Hausafus (2001) identified lack of technology
competence as a barrier. D. L. Rogers (2000) takes an even stronger position on this barrier. “The
weak link in the knowledge infrastructure in most institutions is the skills and training in Information
Age tools and processes for learners, faculty, staff, and other participants…. It is imperative that
institutions realize that it is not only technology that is important, but also the learning
methodologies utilized to employ the technology” (p. 21). She emphasizes that training focused on
both technology use and effective use in instruction is necessary.
Access is the third category used by Leggett and Persichitte (1998). Teachers must have
uninterrupted, on-demand access to the technologies they intend to use, both while inside and
outside of the classroom. Adams (2002) also reported hardware and software availability as a
potential barrier.
Their fourth category is resources. This includes resources to purchase, maintain, and upgrade
hardware and software; to provide training and support; for auxiliary costs, such as coordinating
technology access; and for continuing costs, such as maintenance contracts. They also note a
relationship where time, expertise, and access are dependent on resources.
Support is their fifth barrier category, both administrative and technical. Administrative leadership
and support may be the most critical factor. In addition to providing the needed financial resources,
the administration can set expectations, develop a vision and plan for technology integration and

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provide incentives and encouragement. Technical support not only includes the personnel for
maintaining the technology, but it also includes personnel who are knowledgeable about
pedagogical issues, such as appropriate instructional methods or media. D. L. Rogers (2000)
identifies similar barriers based on the literature and two studies she conducted: availability and
quality of hardware and software, faculty role models, funding, institutional support, models for
using technology in instruction, staff development, student learning, teacher attitudes, technical
support, and time to learn to use technology. However, she organizes these barriers differently.
Some barriers have an internal source, such as a teacher’s attitude or perception about a
technology, as well as his or her competency with that technology.
External barriers include availability and accessibility of hardware and software, technical and
institutional support, and stakeholder development. Time and funding barriers cross internal and
external sources.
D. L. Rogers (2000) then develops a model for visualizing the relationships among these barriers.

Educational Barriers to Achieving Vision

Lack of resources
Relationship/behavioural changes – New relationships, with all the disruption (including
financial) and promise that they offer, would need to be formed between educators and students,
between health professionals and institutions, between health professionals and their patients
(Kleinke, 2000) and would require all parties to radically change behaviours (Sinclair and Gardner,
1999).
Variability – There is great variability in existing informatics skills among and within schools,
students, and health professionals and likely in the receptivity to informatics infusing into the
system (Jwayyed S, 2002).
Discipline-specific issues – There is disagreement about whether informatics need to be thought
about (and taught) in discipline-specific ways or approached more generically (Masys et al., 2000)
(Mihalas et al., 2000).
Resources – Significant resources would be required to equip schools (and healthcare
organizations) with the kind of sophisticated information technology and informatics education
envisioned above, although the Internet can provide many efficiencies. There are concerns about
the financial effects on schools, as more education programs are delivered over the Internet
(Lindeman, 2000).
Continuing education restrictions – Information technology offers a way to link continuing
education with practice more directly but, in at least continuing medical education, self-initiated
learning is not allowed for the majority of physician’s category I CME credit for state licensure
(Godin et al., 1999).

Regulatory/Policy Barriers to Achieving Vision

Lack of standards
Privacy – Consumer and policy maker concerns about privacy of health information.
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Laws – Those at the provincial level that govern practice, e.g., scope of practice acts and how they
are not set up to regulate telemedicine, e-mail, and other exchanges of information
Financial – Payment issues for e-visits, telemedicine delivery methods, and other transactions that
do not result in a visit to a clinician’s office (Maddox et al., 2001) (Borowitz and Wyatt, 1998).

Adopter Categories
Adoption of new technologies falls into several categories. Traditionally, in healthcare we are
risk-averse and rarely implement technology that hasn’t been proven.

Innovators are eager to try new ideas, to the point where their venturesomeness almost becomes an
obsession. Innovators’ interest in new ideas leads them out of a local circle of peers and into social
relationships more cosmopolite than normal. Usually, innovators have substantial financial resources
and the ability to understand and apply complex technical knowledge. While others may consider the
innovator to be rash or daring, it is the hazardous risk-taking that is of salient value to this type of
individual. The innovator is also willing to accept the occasional setback when new ideas prove
unsuccessful (Rogers, 1971).

Early adopters tend to be integrated into the local social system more than innovators. The early
adopters are considered to be localites, versus the cosmopolite innovators. People in the early adopter
category seem to have the greatest degree of opinion leadership in most social systems. They provide
advice and information sought by other adopters about an innovation. Change agents will seek out early
adopters to help speed the diffusion process. The early adopter is usually respected by his or her peers
and has a reputation for successful and discrete use of new ideas (Rogers, 1971).

Members of the early majority category will adopt new ideas just before the average member of a social
system. They interact frequently with peers but are not often found holding leadership positions. As the
link between very early adopters and people late to adopt, early majority adopters play an important part
in the diffusion process. Their innovation-decision time is relatively longer than innovators and early
adopters, since they deliberate some time before completely adopting a new idea. Seldom leading, early
majority adopters willingly follow in adopting innovations (Rogers, 1971).

The late majority are a skeptical group, adopting new ideas just after the average member of a social
system. Their adoption may be borne out of economic necessity and in response to increasing social
pressure. They are cautious about innovations and are reluctant to adopt until most others in their social
system do so first. An innovation must definitely have the weight of system norms behind it to convince
the late majority. While they may be persuaded about the utility of an innovation, there must be strong
pressure from peers to adopt (Rogers, 1971).

Laggards are traditionalists and the last to adopt an innovation. Possessing almost no opinion
leadership, laggards are localite to the point of being isolates compared to the other adopter categories.
They are fixated on the past, and all decisions must be made in terms of previous generations. Individual
laggards mainly interact with other traditionalists. An innovation finally adopted by a laggard may already
be rendered obsolete by more recent ideas already in use by innovators. Laggards are likely to be
suspicious not only of innovations but of innovators and change agents as well (Rogers, 1971).

Rogers, E. M., & Shoemaker, F. F. (1971). Communication of innovation. New York: Free Press.
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The diagram below illustrates these adoption categories.

Figure 3 - Technology adoption lifecycle

Source: Chelius, C.

Some strategies for addressing these challenges may include, but are not limited to, addressing the
following:

External Barriers in Medicine – Need for Universally Accepted Standards:

Universally agreed-upon medical terminology

Standardized format
Standardized guidelines for best practices
Standardized data exchange

Educational Strategies – Need for methods and content that are sensitive to a changing environment
and use the latest in technology and best practices to enable the continuous learning required when
adopting technologies.

Didactic vs. problem solving

Competencies
Word processing
Information retrieval
Information management
Data analysis
Presentation

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Communication skills
E-mail, file transfer, or the Web

Competencies
Many argue that informatics should not be thought of as a single course or set of didactic ideas, but
rather as a method of problem solving that facilitates going beyond an individual’s own knowledge base
and encourages consulting the “growing body of electronically accessible biomedical knowledge early
and often” (Masys et al., 2000). The kinds of informatics competencies identified in the literature include:
word processing, information search and retrieval, information management, data analysis, presentation,
and a whole range of communication skills including e-mail, file transfer, and using the Web among
others (Gilje and Mallow, 1999) (Leino-Kilpi and Saranto, 1997; Gardner and Sinclair, 1999) (Masys et
al., 2000) (Saba, 2001). The textbook refers to the technical foundation of health informatics being data
input, processing, and output (El Morr, 2018).

In this course we will expand upon these ideas and explore many more competencies that contribute to
success in the field of informatics.

Assignments and Activities

Activities

Activity

In the Discussion Board, under Introductions, please share some information about yourself with
your fellow classmates: where you work, what you do, why you’re interested in informatics, and
any experience you have in the informatics field.

Discussion Board

Discussion #1: Barriers, Enables, and Impact

Consider the following topics for discussion:

Barriers and Enablers

Discuss some of the barriers to and enablers of the advancement of health
informatics in Canada.
What do you see as the emerging opportunities for health informatics in Canada?

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Technology Impact
Give some personal examples of how you have seen technology impact the way
healthcare is administered or delivered – consider your experience as a patient,
family member, healthcare provider organization, or even something you have read
about. In your example, has technology made a significant improvement in healthcare
delivery? Have there been any negative results?

Post responses to this week’s questions on the Week 1 Discussion Board.

Assignments

Assignment #2

Group Project

This is Assignment 2, which is due in Week 11, but please start thinking about it now.

Purpose of the Project

In the world of informatics in the healthcare field, working with others, working with different areas
and departments, working at a distance, and working on teams are a constant. The intent of the
team project is to simulate a real-world situation and give you a sample of some of the
experiences you will encounter. Sometimes people have different levels of leadership experience.
Sometimes people don’t contribute as expected. Your team project may encounter some of these
experiences – this is your opportunity to find solutions.

Project Requirements

Each student must participate in a team project to complete a review of a key healthcare
information system. Suggested systems include financial/statistical general ledger, human
resources/payroll, electronic health record/order communication, admission/discharge/transfer,
lab, pharmacy, DAD/NACRS, workload measurement, chart management, and executive
reporting, although you may select another system if you have better access to the information or
have experience with a different system. The project team will research and present to the class
on at least 6 of the following deliverables:

Function, purpose, and benefits

Features
Background, implementation, conversion, challenges, and whether benefits were realized

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and expectations met

How information from the system is used and applied to business or clinical processes
Uptake and adoption strategies
Strategic importance to organization
Performance issues
Current challenges
Opinion of vendor support
Whether the system is being used to its capacity
Sample outputs

The project must be presented in a presentation format (such as PowerPoint) and posted in the
Projects Module, as assigned. Speaker notes should be used to expand upon the points made in
the slides, as if you were giving the presentation in a classroom setting. Presentations should be
succinct, as if you were going to do a live presentation for approximately 15 minutes in length.
Fellow classmates are expected to ask questions, challenge, and provide feedback through the
Discussion Board. The presenting team must respond appropriately to the discussion. It is
desirable that the system being presented is from one or more of the students' own
organizations, but other options can be explored after discussion with the instructor. Please make
every effort to have the system you present be a real-world example. This may involve
interviewing outside sources.

Due Date

Projects are due to be posted and discussed during the week of Module 11. The project should
be posted no later than Saturday, the start of the module week, giving a full week for questions
and discussion. Marks will be deducted if the project is posted any later than midnight EST
Saturday at the beginning of the week.

Evaluation Criteria

The Group Project will be marked based on the criteria below. It is mandatory that all team
members contribute significantly to the project, so your first meetings should be around setting
ground rules about how people will participate and trying to find times that are mutually workable
to all team members. Should any team member fail to contribute significantly to the project, that
student will not receive full marks. Any student who does not contribute anything to the project
will receive no credit for the project. The peer evaluation will help in this assessment. The team
members will agree upon assigned roles, responsibilities, and contributions. If a team is finding
one or more members to be non-participatory, please first try and contact that team member, then
please email the instructor as soon as possible.

The project deliverable should address the criteria and demonstrate the evidence listed below:

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Criteria Evidence

Content Explains the deliverables as listed in project requirements

Comprehension Shows understanding of theories and processes learned during the

course

Knowledge Applies information systems issues, as included in lessons

Presentation Skills Presents information in a meaningful way, communicates to the class

effectively, responds to questions

Analysis Uses effective analysis of system

System Presents system function and purpose effectively to clearly

Presentation communicate benefits

Outputs Includes sample of outputs, screens, results, etc.

Teamwork Reflects contribution from all members of the team. Team members will
Contribution be required to provide feedback/evaluation on contribution from fellow
team members.

Peer Evaluation

Below is the Peer Evaluation Component that each team member will complete on his/her fellow
students on the project team. This will reflect your level of contribution and participation as
experienced by your teammates. Please provide additional comments to support your rating. In
order to ensure it is confidential, please submit your peer evaluation to the instructor via email.

Team Contribution – Peer Evaluation Component

Please identify each member on your team and rate them on a scale of 0 to 5. Providing
additional text to support your evaluation is helpful.

0 = no contribution to the project

1 = minimal or marginal contribution to the project

2 = some contribution to the project

3 = good or satisfactory contribution

4 = very good contribution

5 = excellent contribution

Team Process

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Teams will be set up and students assigned to teams. The teams will not be created until a few
weeks after the course has started, to accommodate for late starts and early dropped courses.

You will find your workspace for team work in the Discussion Board section at the end, with each
team listed. This is where you may do your collaboration work, content development, have
discussions, and work on the final project. If you choose to do your collaborative work differently,
please feel free – just make sure all team members understand the process and are
included in the conversations and communications. It is worthwhile to try and meet a few
times using online meeting tools, such as Skype or Google Hangouts. We recommend that you
do this using the video, if possible. We work better when we can place a face with a name.

Early on you should establish roles, responsibilities, timelines, and expectations. Treat this like a
project, using project management techniques. Communication is essential.

It is essential that you reach out to your fellow team members – keep following up if you are not
getting a response. Post notices in the Q & A section of the Discussion Board, send messages in
the Message section, send emails. If you continue to receive no response, check with the
instructors to see if the student may have dropped the course.

The final product – the presentation – is to be posted within the Group/Team Projects Module in
the Discussion Board. Create a new thread there with your team name. This is where you post
your presentation. Other students are expected to look at your presentation, discuss it, and ask
questions. Have fun and learn from each other! The project team should respond to any
comments.

Please review the requirements and the evaluation criteria. It is mandatory that each team
member contribute significantly to the team project. Should any team member fail to contribute,
no marks will be given to that team member for the project. Should any team member contribute
only marginally to the project, that student will receive only partial marks.

References
Bates, D. W., Cohen, M., Leape, L. L., Overhage, J. M., Shabot, M. M. & Sheridan, T. (2001).
Reducing the frequency of errors in medicine using information technology. Journal of the
American Medical Informatics Association, 8(4): 299-308.
Leggett, W. P., & Persichitte, K. A. (1998). Blood, sweat and tears: 50 years of technology
implementation obstacles. TechTrends, 43(3), 33-36.
Protti, D. J. (1982). A new undergraduate program in health/medical informatics. AMIA
Proceedings. Masson Publishing.
Rogers, D. L. (2000). A Paradigm Shift: Technology Integration for Higher Education in the New
Millennium. Educational Technology Review, 13, 19-33.
Rogers, E. M., & Shoemaker, F. F. (1971). Communication of Innovation. New York: The Free
Press.

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