It is my plan to apply this opportunity to the research I am conducting through a grant with the Blue Shield Foundation. The project is analyzing best practices and current perceptions of the use of personal health record systems with underserved populations. As the US healthcare system becomes more impacted by factors such as the oncoming flood of baby boomers, higher occurences of chronic illnesses (diabetes, hypertension, etc.), and an insufficient pool of incoming healthcare workers, the burden of managing one's own health, therapy, and medical transactions will increasingly fall on the patient and their family. As new systems for personal health management are developed it is critical then that these systems are responsive to the unique and specific needs of underserved populations. Designing systems that meet the needs of the most disadvantaged users can help to insure wider adoption of that system. By conducting interviews with current users, care managers and administrators of personal health record systems a framework for best practices can be created to assist providers and developers as they look to adopt and develop these resources.

The research mentioned in the article of “Evaluating user satisfaction in an e-government initiative” aims to use EGOVSAT to evaluate citizen satisfaction.  The model of EGOVSAT was applied in the domain of Advanced Travel Information Systems (ATIS), a form of government-to-citizen information service.  The users from LA and Minneapolis were asked to evaluate ATIS websites.  The results suggest that “utility, efficiency, and customization” are important factors that influence emotional satisfaction, while utility refers to examining whether the website is usable or not, efficiency refers to examining the accessibility and organization of the features and information available in the website, and customization refers to examining whether the website is designed to be use-centric/citizen-centric.  I believe trust is built on emotional satisfaction, where emotional satisfaction is built on the experiences.  From this model research, it is concluded that these 3 factors are important factors to influence emotional satisfaction which involves with part of the trust issue.  Thus, I believe that in order to increase the trust level on ATIS more effectively, we can increase the satisfaction levels on these 3 areas.  After all, fulfill users’ needs in the way they want should be the top priority.  Different than Mexican government, the Canadian government recognized form the beginning that the citizens demand their government be a model in giving accurate information, protecting individual privacy on-line, and ensuring transaction are secure.  Therefore, their use of governmental on-line services largely depends on their perception of how well the government can achieve these concerns.  The study also revealed that people expressed the belief that the Canadian government can ensure the information provided on its websites is pertinent, accurate and timely in nature.  Furthermore, people even have higher level of trust to government-sponsored site than private sector’s.  However the security issue is also a critical issue to them.  In a study, the issues of “unauthorized person accessing others’ personal information” and “lack of control over information shared over the Internet” are the top two concerns on security.  In responding the issues, Canadian government has built a world-leading solution called the Secure Channel to ensure on-line transactions are secure.   Canadian government believes that building and maintaining the trust and confidence of citizens, business and other governments with whom the government does business is fundamental to effective on-line services.  Indeed, in order to establish a successful e-government model, government plays an important role in terms of initiating the trust connection with citizens.

 

As mentioned by Chris, I think the differences between cultures that Celene has identified in respect to their trust of e-government is interesting. It is especially interesting to the degree that the use of IT systems can increase overall trust for governmental transactions. It makes me wonder whether people see the IT system as a fairer mediator of the transaction for which they want to engage. At the same time, it would seem obvious that this would depend on the transaction, which could make for further interesting research.

The best recent example of this that I can think of is the Total Information Awareness program that came out of the Patriot Acts. When this first came out there was a fair amount of media and public uproar at the idea of this comprehensive information architecture. Many feared that it compromised too much of our privacy. Since then it has been repackaged as the Terrorism Information Awareness Program, which ultimately did not change program intentions, but made them more publically digestable. It would appear that we trust the need for governmental surveillance in order to counter terrorist efforts, but do not trust a government enough to allow them unwarranted access to our own information. A first inclination would be that this comes from cultural fears of a totalitarian state, but it would be interesting to see in what specific respects this is true.

I’d like to focus on Celene’s research involving trust in e-government. I think cultural implications on e-governmental services are such an interesting topic that has very little focus upon it. Celene has done e-government work in Mexico and the U.S. interviewing students and other citizens in how they utilize their countries e-government services. In her results she shows how there are some significant differences in culture. That is, if you have in place two of the exact same services but separate countries, will the trust among citizens to that service change. Accroding to Celene’s research it seems the answer is yes! I found it interesting that because citizens feel their government may have (x) amounts of corruption leads them to an immediate trust point within their electronic governmental services. I also find it interesting the kiosks seem to be gaining in acceptance and citizens in Mexico are becoming much more trustworthy with the use of these. It would almost seem certain to assume if you knock out humans in an electronic governmental framework, citizens will trust it considerably more (something worth researching maybe).

In regard to a qualitative approach to emergency response, the Horan/ Schooley paper through case study methodology seemed to be a successful research project. As I have not spent time researching much in this domain there seems to be constructs which I am oblivious to. However, I would assume as initial research begins in this field there should be two central qualitative techniques utilized for a successful breadth of base knowledge. Specifically, (1) case studies and (2) focus groups would seem to be the most logical practices for this base of knowledge. Again my apologies if this assumption is ignorant, however I would recommend (in my limited knowledge) similar case studies be conducted nationwide through random communities. I say ‘random’ because similar communities may give similar results regardless of geographic location. However if random case studies and focus groups were to be conducted in theory there should be different ideologies produced by citizens of ‘random’ backgrounds, classes, education levels etc. I believe this would constitute a base framework where one could perhaps then conduct a “Likert’ like study like Nathan mentions in his blog.  

To understand how well the EMS works or find out the gaps and problems exist in the cross-organizations, it is very critical to understand the perspectives from each stakeholder in the system.  In EMS , the stakeholders includes (1) 911 callers, (2) private sector connecting and delivering the call, (3) public sector receiving and dispatching the call, (4) private/public sector providing first response, transport and health care services, and (5) public/private or non-profit sector hospital or medical center delivering health care services.   One qualitative method could be the field visit/interviews with these various stakeholders, and the interview questions should be in more detailed level such as real-scenario questions.  I believe the question makers should have a substantial understanding on the workflow of EMS in order to come out with qualitative questions.   The researchers should experience the real-world EMS operation as sitting with emergency dispatch operators, riding along with paramedic or ambulance crews, and observing the conversations among various stakeholders in order to obtain information from assorted aspects.  In addition, case study will be another good method as it would be able to collect detailed, accurate incident date from cross organizations and information systems.  Some unique or extreme events should also be included in the case study as well. 

Both EMS and PHR researches are related to human. Especially, for both EMS and PHR, time is a very critical factor because the death of a patient often depends on few minutes or even few seconds. Also, these fields require inter-organizational collaboration, which requires socio-technical approaches. For the EMS, the process from the emergency call to hospital involves many organizations such as 911 call center, ambulance drivers, and doctors in a hospital. For the PHR, individual health records should be shared among hospitals and other health related organizations for the betterment of patients. For a researcher to do inquiry these fields requires considering simultaneously many different factors that are related in a complex manner. That is, a holistic approach is required to investigate the problem domain and suggest a better solution.

From this perspective, I think using qualitative methods or both quantitative and qualitative methods is the best approach to obtain in-depth insight about EMS and PHR.  It is said that qualitative methods, such as case study, action research, ethnography, and grounded theory, usually provide comprehensive understandings about a phenomenon or situation.  In this sense, we can obtain in-depth insight by using interviews and observation or directly participating in the research domain.

As stated in the first paragraph, I think that important factors for both EMS and PHR are human, time, inter-organizational collaboration and information sharing, security, privacy, technology, and so on. These factors should be investigated holistically to obtain a better solution.

Based on the knowledge that I have for these two studies I would use two similar qualitative methods in order to explore these research topics.

 For the EMS studies I would follow somewhat the same approach used within the study. I think in order to understand a dynamic domain such as EMS that it would be beneficial to use a case study methodology using structured interviews in order to try and tease out specific needs in terms of EMS information systems and would want to compare people's responses through out different organizations. It is also possible that I might use a mixed method approach and develop a small likert-based survey that tried to get at specific facets of EMS information systems that would be important to better understand.

Likewise in regards to the study of PHR users, I would likely follow the same approach used by Deborah Lafky. PHRs are a fairly nascent technology and therefore it would be hard to get educated enough responses out of a survey methods. Perhaps I would use a grounded research methodology using interviews to try and come to a hypothesis or theory in regards to user beliefs and values about personal health information and the potential uses and considerations of PHRs.

As IT technologies have transformed businesses, e-government systems will change the types, forms, and structures of government services. Even though they are on the rather basic stages than commercial sites, the e-government systems are rapidly evolving. For example, DMV services, court services, tax filing systems and so on are adding increasingly their services.

Moreover, considering that Web 2.0 technologies progress recently, the direct democracy may be achieved by using virtual community. Even though some researches show that users still prefer in-person communications, several virtual communities are getting bigger and affecting our daily life, and we are getting accustomed to them.  So, in the future, we can set up a virtual city hall meeting, participate in the process of legislation, and cast a vote about the bills.

On the other hand, we may have also negative impacts, such as privacy and control issues.  Some researches show that public information systems will increase the control power of government over citizen. For example, social security administration can audit almost of the personal information. They may be “big brother” in the future, as Orwell said in the novel, 1984.

E-government refers to the delivery of government in formation and service online through the Internet or other digital means.  Obviously, with those services offered citizens would receive more freedom in terms of time, place or means to communication with government agencies.  The whole communication process is more efficient and convenient; and therefore, may bring more trust or positive belief toward government along with citizen positive experiences.  In addition, with greater citizen involvement and demanding, as well as better technology, not only the transparency in government has to be increased but also the efficiency.  The knowledgeable citizen may demand more governmental services in terms of higher expectation.  “How could government cope with that increased demand while funding enough for the investment of IT infrastructure” will be an issue too.  The security and privacy issue for online service will be another impact.  How would government offer reassurances on the privacy and security issue for the public who is worried about the Internet?  There will be several ways to get empirical support, such as through surveys, questionnaires, or interviews.