The strategic management of data quality in healthcare.

This research extends and tests principles to establish good practice and overcome practical barriers in the strategic management of data quality. The research explores the issues that define and control data quality in national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The aim is to make the strategic management of data quality, and the prevention of persistent errors, everyday, ;institutionalized' activities. Using action research methodology and a combination of interpretive and positivist data collection and analysis methods, this research provides the health informatics community with an understanding of the issues related to developing and implementing programmes to improve data quality. Healthcare is a complex system that is highly political and culturally diverse, and applied health informatics research is essential to improve outcomes and performance.

Integrated PET-CT: evidence-based review of oncology indications.

Over the past few years, positron-emission tomography (PET) has been increasingly used in oncology. More recently, the fusion of the functional imaging provided by PET with the anatomic information of, computed tomography (CT) has resulted in a powerful new imaging tool. In practice, the PET-CT image fusion can be done visually, with the help of special software, or through hardware incorporating both PET and CT. We performed a review of disease-specific studies using integrated PET-CT or PET-CT with visual or software fusion and found that PET-CT offers a significant benefit in improving the diagnosis, staging, and therapeutic monitoring of patients with cancer. Integrated PET-CT improves characterization of equivocal lesions and decreases intraobserver variability; it also has the potential to significantly affect treatment planning by guiding biopsies and surgical interventions, defining target volumes for radiation therapy fields, and monitoring response to treatment. More promising clinical applications will likely be possible with other fluorine-18-based isotopes.

Telehealth in New Zealand: current practice and future prospects.

We have surveyed the current state of telehealth in New Zealand. The survey found 22 telehealth projects active in 2003, compared with 12 identified in a previous survey in 2000. Many projects were small, localized and led by enthusiasts. Sustainability was a problem and many projects had failed to enter routine operation. Teleradiology and telepsychiatry services focused on acute hospitals were the most frequent clinical applications. The majority of projects (9 of the 22) were on the North Island, concentrated around Auckland. Telehealth appears to have special potential for rural communities and for the remote treatment (telecare) of chronic disease. However, the provision of telehealth in New Zealand is patchy and meets the same barriers to success as have been identified elsewhere, which make it difficult to move telehealth into routine operation. The obstacles constitute not so much a failure of individual projects as a lack of a driving force to take advantage of the opportunities. It is to be hoped that a suggested strategic framework can help to harness the opportunities.

A needs assessment of the potential users of a South Pacific telehealth service.

Qualitative methods such as focus groups, individual interviews, case studies and participant observation were used to complete a needs assessment for a telehealth service in the South Pacific. Participants from the Cook Islands and Fiji were able to identify extensive uses for a telehealth service, but also identified barriers to its implementation. These included the extremely limited telecommunications and electrical infrastructure found in South Pacific countries, the high cost of Internet access and staffing shortages. The effective implementation of a telehealth site will probably require the use of clinician drivers with an interest in telehealth to encourage colleagues less enthusiastic to change their work practices. Telehealth in the South Pacific would improve services across a wide geographical area, but initial and continuing costs would be high due to the lack of infrastructure.