Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study.

BACKGROUND: Hepatocellular carcinoma (HCC) is the fastest increasing cause of cancer death in Australia. A recent Australian consensus guidelines recommended HCC surveillance for cirrhotic patients and non-cirrhotic chronic hepatitis B (CHB) patients at gender and age specific cut-offs. A cost-effectiveness model was then developed to assess surveillance strategies in Australia. METHODS: A microsimulation model was used to evaluate three strategies: biannual ultrasound, biannual ultrasound with alpha-fetoprotein (AFP) and no formal surveillance for patients having one of the conditions: non-cirrhotic CHB, compensated cirrhosis or decompensated cirrhosis. One-way and probabilistic sensitivity analyses as well as scenario and threshold analyses were conducted to account for uncertainties: including exclusive surveillance of CHB, compensated cirrhosis or decompensated cirrhosis populations; impact of obesity on ultrasound sensitivity; real-world adherence rate; and different cohort's ranges of ages. RESULTS: Sixty HCC surveillance scenarios were considered for the baseline population. The ultrasound + AFP strategy was the most cost-effective with incremental cost-effectiveness ratios (ICER) compared to no surveillance falling below the willingness-to-pay threshold of A$50,000 per quality-adjusted life year (QALY) at all age ranges. Ultrasound alone was also cost-effective, but the strategy was dominated by ultrasound + AFP. Surveillance was cost-effective in the compensated and decompensated cirrhosis populations alone (ICERs < $30,000), but not cost-effective in the CHB population (ICERs > $100,000). Obesity could decrease the diagnostic performance of ultrasound, which in turn, reduce the cost-effectiveness of ultrasound ± AFP, but the strategies remained cost-effective. CONCLUSIONS: HCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective.

A Systematic Review and Narrative Synthesis of Health Economic Evaluations of Hepatocellular Carcinoma Screening Strategies.

OBJECTIVES: Many economic evaluations of hepatocellular carcinoma (HCC) screenings have been conducted; however, these vary substantially with regards to screening strategies, patient group, and setting. This review aims to report the current knowledge of the cost-effectiveness of screening and describe the published data. METHODS: We conducted a search of biomedical and health economic databases up to July 2020. We included full and partial health economic studies if they evaluated the costs or outcomes of HCC screening strategies. RESULTS: The review included 43 studies. Due to significant heterogeneity in key aspects across the studies, a narrative synthesis was conducted. Most studies reported using ultrasound or alpha fetoprotein as screening strategies. Screening intervals were mostly annual or biannual. Incidence, diagnostic performance, and health state utility values were the most critical parameters affecting the cost-effectiveness of screening. The majority of studies reported HCC screening to be cost-effective, with the biannual ultrasound + alpha fetoprotein standing out as the most cost-effective strategy. However, few studies considered the utilization rate, and none considered the diagnostic performance of ultrasound in the context of central adiposity. Computed tomography and magnetic resonance imaging were also evaluated, but its cost-effectiveness was still controversial. CONCLUSIONS: Although many studies suggested HCC screening was cost-effective, substantial limitations of the quality of these studies means the results should be interpreted with caution. Future modeling studies should consider the impact of central adiposity on the precision of ultrasound, real-world utilization rates and projections of increased HCC incidence.

Costs associated with hereditary haemochromatosis in Australia: a cost-of-illness study.

Objective The aim of the present study was to assess health sector, other sector and time-related (productivity) costs associated with hereditary haemochromatosis from societal, government and patient perspectives for the Australian setting. Methods A national web-based survey of people with haemochromatosis was conducted between November 2013 and February 2015. Participants completed a health survey and resource use diaries. Costs were calculated using a bottom-up approach and calculated in 2015 Australian dollars. Results Cost data were available for 157 participants. From a societal perspective, the estimated annual cost of haemochromatosis was A$274million. The mean (95% confidence interval) cost for symptomatic patients was almost threefold greater than that of asymptomatic patients (A$10030 (7705-12670) vs A$3701 (2423-5296) respectively). Health sector and productivity-related time loss were the main cost drivers. When extrapolating costs to the Australian population level, asymptomatic haemochromatosis accounted for higher costs than symptomatic haemochromatosis (A$183million vs A$91million), reflecting the low clinical penetrance estimate used. Total costs increased when higher clinical penetrance estimates were used. Conclusion The present cost-of-illness study, the first to be published for haemochromatosis, found that although costs were substantial, they could be decreased by reducing clinical penetrance. Development of cost-effective strategies to increase early diagnosis is likely to result in better health outcomes for patients and lower total costs. What is known about the topic? To date, no cost-of-illness study has been conducted for haemochromatosis. Previous economic work in this area has relied on cost estimates based on expert opinion. What does the paper add? This paper provides the first cost estimates for haemochromatosis for the Australian population. These estimates, calculated using a bottom-up approach, were extrapolated to the population level based on the most robust epidemiological estimates available for the Australian population. What are the implications for practitioners? Population screening programs have been widely suggested as an approach to reduce clinical penetrance; however, the lack of high-quality economic analyses has been cited as a barrier to implementation. The present study provides the most robust cost estimates to date, which may be used to populate economic models. In addition, the present study illustrates that reducing clinical penetrance of haemochromatosis is likely to result in substantial reductions in cost.

Quality of life utility values for hereditary haemochromatosis in Australia.

BACKGROUND: Hereditary hemochromatosis (HH) is a common autosomal recessive disorder amongst persons of northern European heritage. If untreated, iron accumulates in parenchymal tissues causing morbidity and mortality. As diagnosis often follows irreversible organ damage, screening programs have been suggested to increase early diagnosis. A lack of economic evidence has been cited as a barrier to establishing such a program. Previous analyses used poorly estimated utility values. This study sought to measure utilities directly from people with HH in Australia. METHODS: Volunteers with HH were recruited to complete a web-based survey. Utility was assessed using the Assessment of Quality of Life 4D (AQOL-4D) instrument. Severity of HH was graded into four categories. Multivariable regression analysis was performed to identify parameters associated with HSUV. RESULTS: Between November 2013 and November 2014, 221 people completed the survey. Increasing severity of HH was negatively associated with utility. Mean (standard deviation) utilities were 0.76 (0.21), 0.81 (0.18), 0.60 (0.27), and 0.50 (0.27) for categories 1-4 HH respectively. Lower mean utility was found for symptomatic participants (categories 3 and 4) compared with asymptomatic participants (0.583 v. 0.796). Self-reported HH-related symptoms were negatively associated with HSUV (r = -0.685). CONCLUSIONS: Symptomatic stages of HH and presence of multiple self-reported symptoms were associated with decreasing utility. Previous economic analyses have used higher utilities which likely resulted in underestimates of the cost effectiveness of HH interventions. The utilities reported in this paper are the most robust available, and will contribute to improving the validity of future economic models for HH.

Improving colorectal cancer screening - consumer-centred technological interventions to enhance engagement and participation amongst diverse cohorts.

The current "Gold Standard" colorectal cancer (CRC) screening approach of faecal occult blood test (FOBT) with follow-up colonoscopy has been shown to significantly improve morbidity and mortality, by enabling the early detection of disease. However, its efficacy is predicated on high levels of population participation in screening. Several international studies have shown continued low rates of screening participation, especially amongst highly vulnerable lower socio-economic cohorts, with minimal improvement using current recruitment strategies. Research suggests that a complex of dynamic factors (patient, clinician, and the broader health system) contribute to low citizen engagement. This paper argues that the challenges of screening participation can be better addressed by (1) developing dynamic multifaceted technological interventions collaboratively across stakeholders using human-centered design; (2) integrating consumer-centred artificial intelligence (AI) technologies to maximise ease of use for CRC screening; and (3) tailored strategies that maximise population screening engagement, especially amongst the most vulnerable.

The Inverse Data Law: Market Imperatives, Data, and Quality in AI Supported Care.

Over the last decade, the explosion of "Big Data" and its fusion with AI has led many to believe that the development and integration of AI systems in healthcare will usher in a transformative revolution that democratises access to high quality healthcare and collectively improve patient outcomes. However, the nature of market forces in the evolving data economy, has started to show evidence that the opposite is more likely to be true. This paper argues that there is a poorly understood "Inverse Data Law" that will exacerbate the widening health divide between affluent and marginalised communities because: (1) data used to train AI systems favour individuals that are already engaged with healthcare, who have the lowest burden of disease, but the highest purchasing power; and (2) data used to drive market decisions around investment in AI health technology favours tools that increase the commodification of healthcare through over-testing, over-diagnosis, and the acute and episodic management of disease, over tools that support the patient to prevent disease. This dangerous combination is more likely to cripple efforts towards preventative medicine, as data collection and utilisation tends to be inversely proportional to the needs of the patients served - the inverse data law. The paper concludes by introducing important methodological considerations in the design and evaluation of AI systems to promote systems improvement for marginalised users.

Blockchain Enabled Patient-Centred Care for Inflammatory Bowel Disease: 4 Principles for Socio-Techical and Clinical Alignment.

Inflammatory bowel disease (IBD) is a chronic relapsing and remitting illness. The presentation, diagnosis and management IBD are complex, and involve multi-disciplinary care with complex information requirements. The lack of an accurate and comprehensive patient record is often a stumbling block for optimal patient care. Blockchain technology therefore appears to be the perfect solution to improve IBD patient care. Blockchain technology can provide comprehensive and secure data transmission. Many current projects using blockchain for IBD care focus on information delivery. Recently, clinical research has shown that patients have different perceptions of what constitutes high-quality care, compared to healthcare professionals. Patient-centred care in IBD has increasingly taken central stage. Concurrently, blockchain in healthcare has shifted focus to argue for allowing the patient to be in the driver's seat for information access, facilitated by blockchain-enabled patient-driven interoperability and patient-driven care. This paper dissects the risks and benefits of these two approaches in using blockchain in IBD patient care. This paper then explores the socio-technical and clinical considerations in using blockchain in IBD patient care. Finally, this paper presents four key principles in using blockchain to improve IBD paper care, using collaborative participatory design involving patients, healthcare professionals, and health systems.

AI Diagnostic Technologies and the Gap in Colorectal Cancer Screening Participation.

AI augmented clinical diagnostic tools are the latest research focus in colorectal cancer (CRC) detection. While the opportunity presented by AI-enhanced CRC diagnosis is sound, this paper highlights how its effectiveness with respect to reducing CRC-related mortality and enhancing patient outcomes may be limited by the fact that patient participation remains extremely low globally. This paper builds a foundation to consider how human factors tend to contribute to low participation rates and suggests that a more nuanced socio-technical approach to the development, implementation and evaluation of AI systems that is sensitive to the psycho-social and cultural dimension of CRC may lead to tools that increase screening uptake.

Survival of primary liver cancer for people from culturally and linguistically diverse backgrounds in Australia.

BACKGROUND: Survival for Primary Liver Cancer (PLC) has been investigated in Australia, but limited work has been conducted on the burden for people with different socioeconomic status, region of residence, causes of PLC, and culturally and linguistically diverse (CALD) backgrounds. This study aimed to cover this gap in the literature by investigating PLC survival with the aforementioned factors. METHODS: This study linked four administrative datasets: Victorian Cancer Registry, Admitted Episodes Dataset, Emergency Minimum Dataset, and Death Index. The cohort was all cases with a PLC notification within the Victorian Cancer Registry between 01/01/2008 and 01/01/2016. The Kaplan-Meier method was used to estimate survival probabilities and the log-rank test was used to compare the difference in survival between subgroups. The Cox proportional hazard model was used to explore factors associated with PLC survival. RESULTS: The 1-, 3- and 5-year survival rates were 50.0%, 28.1% and 20.6%, respectively, with a median survival of 12.0 months (95% confidence interval (CI): 11.0 - 12.9 months). Higher survival was associated with younger age, hepatocellular carcinoma, and higher socio-economic status. People born in Asian, African, and American regions had higher survival than those born in Australia and New Zealand. Cases with viral hepatitis as an identified aetiology had higher survival than those whose PLC was related to alcohol consumption (hazard ratio=1.52, 95% CI: 1.19 - 1.96), diabetes and fatty liver disease (hazard ratio=1.35, 95% CI: 1.08 - 1.68). CONCLUSION: Survival outcomes for people diagnosed with PLC were still poor and affected by many factors. Asian and African cases had better survival than Australian and New Zealand patients as PLC in Asian and African cases was mostly caused by viral hepatitis. Metropolitan areas were associated with a higher survival than rural areas, not only due to accessibility to surveillance and healthcare services but also because the majority of overseas-born patients reside in metropolitan areas.

Hospitalisation costs of primary liver cancer in Australia: evidence from a data-linkage study.

Objective This study aimed to estimate the public hospital costs associated with primary liver cancer (PLC) in the first and second years following the cancer diagnosis. Methods This study linked administrative datasets of patients diagnosed with PLC in Victoria, Australia, from January 2008 to December 2015. The health system perspective was adopted to estimate the direct healthcare costs associated with PLC, based on inpatient and emergency costs. Costs were estimated for the first 12 months and 12-24 months after the PLC diagnosis and expressed in 2017 Australian dollars (A$). The cost estimated was then extrapolated nationally. The linear mixed model with a Box-Cox transformation of the costs was used to explore the relationship between costs and patients' sociodemographic and clinical characteristics. Results For the first 12 months, the total and annual per-patient cost was A$211.4 million and A$63 664, respectively. Costs for the subsequent year were A$49.7 million and A$46 751, respectively. Regarding the cost extrapolation to Australia, the total cost was A$137 million for the first 12 months after notification and A$42.6 million for the period from 12 to 24 months. Higher costs per episode of care were mostly associated with older age, hepatocellular carcinoma type of PLC, metropolitan hospitals, and Asian birth region. Conclusion This study showed the public hospital admission and emergency costs associated with PLC and the substantial economic burden this cancer has placed on the Australian health system.

Patient safety and sociotechnical considerations for electronic handover tools in an Australian ehealth landscape.

The Australian Commission for Safety and Quality in Health Care (ACSQHC) coordinates national improvements in a range of complex health system problems including clinical handover, and has funded a range of handover improvement projects in Australia. One of these, the SafeTECH project in South Australia has developed guidelines for safe use of electronic handover tools. These guidelines were developed using evidence from three hospital case studies into the use of an electronic tool to support different types of shift-to-shift handover. This paper provides an overview of the project, and highlights challenges for patient safety in the design and use of electronic tools to support clinical handover in a busy clinical environment. The paper then considers these challenges within the broader context of the Australian ehealth landscape. Australia's National eHealth Transition Authority (NEHTA) is actively developing ehealth standards and infrastructure requirements for the electronic collection and secure exchange of health information. The paper argues for flexible standardisation in the design and implementation of electronic handover tools to ensure that all key dimensions of the challenges faced in ensuring patient safety are addressed.

A standard operating protocol (SOP) and minimum data set (MDS) for nursing and medical handover: considerations for flexible standardization in developing electronic tools.

As part of Australia's participation in the World Health Organization, the Australian Commission on Safety and Quality in Health Care (ACSQHC) is the leading federal government technical agency involved in the area of clinical handover improvement. The ACSQHC has funded a range of handover improvement projects in Australia including one at the Royal Hobart Hospital (RHH), Tasmania. The RHH project aims to investigate the potential for generalizable and transferable clinical handover solutions throughout the medical and nursing disciplines. More specifically, this project produced an over-arching minimum data set (MDS) and over-arching standardized operating protocol (SOP) based on research work on nursing and medical shift-to-shift clinical handover in general medicine, general surgery and emergency medicine. The over-arching MDS consists of five headings: situational awareness, patient identification, history and information, responsibility and tasks and accountability. The over-arching SOP has five phases: preparation; design; implementation; evaluation; and maintenance. This paper provides an overview of the project and the approach taken. It considers the implications of these standardized operating protocols and minimum data sets for developing electronic clinical handover support tools. Significantly, the paper highlights a human-centred design approach that actively involves medical and nursing staff in data collection, analysis, interpretation, and systems design. This approach reveals the dangers of info-centrism when considering electronic tools, as information emerges as the only factor amongst many others that influence the efficiency and effectiveness of clinical handover.

Perfect match? Generation Y as change agents for information communication technology implementation in healthcare.

The current healthcare delivery model will not meet future healthcare demands. The only sustainable healthcare future is one that best leverages advances in technology to improve productivity and efficiency. Information communication technology (ICT) has, therefore, been touted as the panacea of future healthcare challenges. Many ICT projects in healthcare, however, fail to deliver on their promises to transform the healthcare system. From a technologist's perspective, this is often due to the lack of socio-technical consideration. From a socio-cultural perspective, however, there is often strong inertia to change. While the utilisation of user-centred design principles will generate a new wave of enthusiasm among technologists, this has to be matched with socio-cultural changes within the healthcare system. Generation Y healthcare workers might be the socio-cultural factor required, in combination with new technology, to transform the healthcare system. Generation Y has generated significant technology-driven changes in many other industries. The socio-cultural understanding of generation Y healthcare workers is essential to guide the design and implementation of ICT solutions for a sustainable healthcare future. This paper presents the initial analysis of our qualitative study which aims to generate in-depth conceptual insights of generation Y healthcare workers and their view of ICT in healthcare. Our results show that generation Y healthcare workers might assist future ICT implementation in healthcare. This paper, however, argues that significant changes to the current healthcare organisation will be required in order to unleash the full potential of generation Y workers and ICT implementation. Finally, this paper presents some strategies to empower generation Y workers as change agents for a sustainable future healthcare system.

Involving clinicians in the development of an electronic clinical handover system - thinking systems not just technology.

While the need to 'involve the user' in information technology (IT) development is almost a mantra amongst information systems specialists, numerous IT projects continue to fail because of an inability to capture user insights or respond to users needs. Although there are clearly practical difficulties in addressing and responding to the heterogeneous requirements expressed by different users, marginalizing these views ultimately is to the detriment of the systems built. This paper describes the development of an electronic clinical handover system at the Department of General Internal Medicine (DGIM), Royal Hobart Hospital (RHH). More specifically, the paper aims to highlight how to engage meaningfully with clinicians in the development of a sustainable system. It is anticipated that by drawing attention to the importance of users and by outlining the practical experience of dealing with the diversity of requirements and views expressed, the paper can contribute to a stronger recognition within the domain of eHealth for a user-centred systems approach to IT development.

Socio-Technical Considerations for the Use of Blockchain Technology in Healthcare.

Blockchain technology is often considered as the fourth industrial revolution that will change the world. The enthusiasm of the transformative nature of blockchain technology has infiltrated healthcare. Blockchain is often seen as the much needed and perfect technology for healthcare, addressing the difficult and complex issues of security and inter-operability. More importantly, the "value" and trust-based system can deliver automated action and response via its smart contract mechanism. Healthcare, however, is a complex system. Health information technology (HIT) so far, has not delivered its promise of transforming healthcare due to its complex socio-technical and context sensitive interaction. The introduction of blockchain technology will need to consider a whole range of socio-technical issues in order to improve the quality and safety of patient care. This paper presents a discussion on these socio-technical issues. More importantly, this paper argues that in order to achieve the best outcome from blockchain technology, there is a need to consider a clinical transformation from "information" to "value " and trust. This paper argues that urgent research is needed to address these socio-technical issues in order to facilitate best outcomes for blockchain in healthcare. These socio-technical issues must then be further evaluated by means of working prototypes in the medical domain in coming years.

Uptake of and Expenditure on Direct-Acting Antiviral Agents for Hepatitis C Treatment in Australia.

BACKGROUND: Direct-acting antiviral agents (DAAs) have revolutionised treatment for the hepatitis C virus (HCV). Currently, treatment costs between 20,000 and 80,000 Australian dollars ($A) per patient. The Australian Federal Government provided $A1 billion over 5 years to subsidise these drugs. OBJECTIVE: The aim of this paper was to evaluate the uptake and financial impact of DAA prescribing in Australia. METHODS: We undertook a retrospective analysis of Medicare prescription and expenditure data for March 2016 to August 2017. Prescription numbers and expenditure data were extracted from the Medicare Statistical Reports website. Numbers of prescriptions were converted to per capita rates. HCV prevalence measures were used to provide context to prescription rates. All costs were reported in $A, year 2017 values. RESULTS: Nationally, 211,184 DAA prescriptions were reimbursed. Whilst $A3.6 billion was expended through the Pharmaceutical Benefits Scheme, confidential pricing agreements precluded calculation of the precise cost. In 18 months, estimated expenditure greatly exceeded the $A1 billion in funding for 5 years. Nationally, the rate of prescriptions was 872/100,000 individuals. Prescription rates were highest in the Australian Capital Territory (1087/100,000) and lowest in Western Australia (625/100,000) despite HCV prevalence being comparable to the national rate in both regions. CONCLUSIONS: Uptake of DAAs has been enthusiastic in the first 18 months of this funding agreement. However, the lack of transparency due to the confidential special pricing agreements means actual government expenditure is unknown. Post-marketing review by the Pharmaceutical Benefits Advisory Committee may enable renegotiation of DAA prices with the sponsors.

How Can Information and Communication Technology Improve Healthcare Inequalities and Healthcare Inequity? The Concept of Context Driven Care.

Advances in medicine have improved health and healthcare for many around the world. The challenge is achieving the best outcomes of health via healthcare delivery to every individual. Healthcare inequalities exist within a country and between countries. Health information technology (HIT) has provided a mean to deliver equal access to healthcare services regardless of social context and physical location. In order to achieve better health outcomes for every individual, socio-cultural factors, such as literacy and social context need to consider. This paper argues that HIT while improves healthcare inequalities by providing access, might worsen healthcare inequity. In order to improve healthcare inequity using HIT, this paper argues that we need to consider patients and context, and hence the concept of context driven care. To improve healthcare inequity, we need to conceptually consider the patient's view and methodologically consider design methods that achieve participatory outcomes.

Bermuda Triangle or three to tango: generation Y, e-health and knowledge management.

Generation Y workers are slowly gathering critical mass in the healthcare sector. The sustainability of future healthcare is highly dependent on this group of workers. This generation of workers loves technology and thrives in stimulating environments. They have great thirst for life-experience and therefore they move from one working environment to the other. The healthcare system has a hierarchical operational, information and knowledge structure, which unfortunately might not be the ideal ground to integrate with generation Y. The challenges ahead present a fantastic opportunity for electronic health implementation and knowledge management to flourish. Generation Y workers, however, have very different expectation of technology utilisation, technology design and knowledge presentation. This paper will argue that a clear understanding of this group of workers is essential for researchers in health informatics and knowledge management in order to provide socio-technical integrated solution for this group of future workers. The sustainability of a quality healthcare system will depend upon the integration of generation Y, health informatics and knowledge management strategies in a re-invented healthcare system.

Conceptualisation of socio-technical integrated information technology solutions to improve incident reporting through Maslow's hierarchy of needs: a qualitative study of junior doctors.

Medical errors are common, especially within the acute healthcare delivery. The identification of systemic factors associated with adverse events and the construction of models to improve the safety of the healthcare system seems straightforward, this process has been proven to be much more difficult in the realism of medical practice due to the failure of the incident reporting system to capture the essential information, especially from the perspective of junior doctors. The failure of incidence reporting system has been related to the lack of socio-technical consideration for both system designs and system implementations. The main reason of non-reporting can be conceptualised through the motivation psychology model: Maslow's hierarchy of needs; in order to achieve a change in the socio-cultural domain for incident reporting. This paper presents a qualitative research methodology approach to generate contextual-rich insights into the socio-cultural and technological factors of incident reporting among junior doctors. The research illuminates the guiding principles for future socio-technical integrated information communication technology designs and implementations. Using Maslow's hierarchy of needs as the conceptual framework, the guiding principles aim to design electronic incident reporting systems which will motivate junior doctors to participate in the process. This research paper aims to make a significant contribution to the fields of socio-technical systems and medical errors management. The design and implementation of the new incident reporting system has great potential to motivate junior doctors to change the culture of incident reporting and to work towards a safer future healthcare system.

Generation Y in healthcare: the need for new socio-technical consideration for future technology design in healthcare.

While identifying reasons for the failure of information communication technology (ICT) to transform the healthcare system and constructing models of better designed technology with socio-technical integration is relatively straightforward, implementing these solutions into the rapidly changing medical world has proven considerably more difficult. From a technologist's perspective, the promise of technology remains powerful. New technologies, with high level of socio-technical integration have long been considered as one of the most important factors to transform the medical world in order to deliver better and safer care. From the socio-cultural perspective, however, there is an equally powerful force, which has largely been ignored by the greater community: the entry of generation Y into the healthcare system. Generation Y has generated significant changes in many other industries. This powerful socio-cultural change within the healthcare system needs to be more clearly investigated to guide the design and implementation of sociotechnical integrated ICT solutions. This research-in -progress paper presents a methodological approach that both generates an in-depth understanding of generation Y and illuminates criteria that can be used to meaningfully identify the guiding principles for future socio-technical integrated ICT design and implementation. It aims to make a significant contribution to the field of socio-technical approach to ICT design by alluding the audience to this new generation Y phenomenon in healthcare. It provides some preliminary data to support the need to consider generation Y in future ICT design in healthcare.