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The questions below are based on mini-cases of real-world business information systems. The first two bullets are links to a single mini-case each. The third bullet links to multiple mini-cases, from which you are to select two mini-cases, per the instructions below. The fourth and fifth bullets are publications you will search for, per the instructions below. These last two publications also each contain a single mini-case.

Address the 3 questions below, in the context of each of 6 mini-cases altogether.

QUESTIONS

  1. Each information system above doesn't neatly fall into a single IS category such as TPS, MIS, DSS, ESS, ERP, SCM, CRM, KMS, collaboration environments, GIS, GDSS, etc. Rather, most seem to possess functionalities from more than one category. Identify and discuss the multiplicity of these categories for each mini-case.
    (As a hypothetical example, one particular mini-case may describe a system that primarily appears to be a DSS for mid-to-upper-level managers working in finance and accounting, with other functionalities that resemble an MIS designed for lower-to-mid-level managers in sales and marketing. Your answer will need more elaboration and discussion, of course.)
  2. Each system assists its respective users with decision-making in their work environments. In what stage(s) of their decision-making (Figure 12-2 in the textbook) does it provide them with assistance -- intelligence stage, design stage, choice stage, and/or implementation stage? Discuss and justify your answer.
    (Address how each completed, implemented system is proving useful, not the process by which it was conceived and acquired/built.)
  3. Each system above is probably interconnected/linked to other information systems in its organization. Although the mini-cases themselves do not address this aspect, from your understanding of organizations, business processes, and systems, describe some possible/likely examples of such interconnections for each system. Explain your reasoning, while explicitly stating any assumptions.

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    C A S E S   I N   G L O B A L   H E A L T H   D E L I V E R Y   Educational material supplied by The Case Centre Copyright encoded A76HM-JUJ9K-PJMN9I Order reference F297564 Project ECHO: Expanding the Capacity of Primary Care Providers to Address Complex Conditions “Medical  knowledge  is  exploding,  but  it’s  often  not  traveling  the  last  mile  to  ensure  that  patients  get  the  right  care  in   the  right  place  at  the  right  time.  If  we  can  leverage  technology  to  spread  best  practices  through  case-­‐‑based  learning  and   mentoring  of  providers,  we  can  move  knowledge—instead  of  patients—to  get  better  care  to  rural  and  underserved   communities  across  the  country.”   —Sanjeev  Arora,  MD,  Project  ECHO  Founder  and  ECHO  Institute  Director       In  December  2016,  Sanjeev  Arora,  MD,  spoke  to  a  group  of  primary  care  and  specialist  physicians  from   across   the   globe   interested   in   joining   Project   Extension   for   Community   Healthcare   Outcomes,   or   Project   ECHO®.   Arora   had   developed   Project   ECHO—a   web-­‐‑based   guided   practice   model—at   the   University   of   New   Mexico   in   2003   to   address   the   tremendous   need   for   hepatitis   C   care,   particularly   in   medically   underserved  areas.  At  the  time,  he  was  one  of  the  only  liver  specialists  in  New  Mexico,  and  patients  were   waiting   for   months   and   traveling   hundreds   of   miles   to   see   him.   Using   videoconferencing,   Arora   began   training  primary  care  providers  in  remote  areas  to  manage  and  treat  their  hepatitis  C  patients.   Arora  and  his  team  worked  hard  to  spread  and  grow  the  model,  using  grants  to  fund  their  work.  By   December  2016,  more  than  100  institutions  in  over  20  countries  were  using  the  Project  ECHO  model  to  train   primary  care  providers  to  treat  more  than  55  complex  medical  conditions.  Dozens  of  peer-­‐‑reviewed  studies   showed  Project  ECHO  was  improving  provider  self-­‐‑efficacy  and  job  satisfaction,  increasing  patient  access  to   specialty  care,  and,  in  some  cases,  saving  costs  by  reducing  emergency  room  and  hospital  visits.   In   December   2016,   the   United   States   Congress   passed   the   ECHO   Act,   mandating   that   the   federal   government   study   the   implementation   and   impact   of   Project   ECHO’s   collaborative   learning   model.   Arora   and   his   team   had   been   thinking   hard   about   how   to   balance   fidelity   to   the   model   with   ensuring   local   partners  could  adapt  it  as  needed.  He  was  unsure  how  the  results  of  the  government  study  might  impact  his   ability  to  scale  Project  ECHO  to  meet  the  demands  of  new  and  current  partners.   Amy  Madore,  Julie  Rosenberg,  and  Rebecca  Weintraub  prepared  this  teaching  case  with  assistance  from  Claire  Donovan  for  the  purpose  of  classroom   discussion  rather  than  to  illustrate  either  effective  or  ineffective  health  care  delivery  practice.       Cases  in  Global  Health  Delivery  are  produced  by  the  Global  Health  Delivery  Project  at  Harvard.  Financial  support  was  provided  in   part  by  GE  Foundation.  ©  2017  The  President  and  Fellows  of  Harvard  College.  This  case  is  licensed  Creative  Commons  Attribution-­‐‑ NonCommercial-­‐‑NoDerivs  4.0  International.     We  invite  you  to  learn  more  at  www.globalhealthdelivery.org  and  to  join  our  network  at  GHDonline.org case centre Distributed by The Case Centre www.thecasecentre.org All rights reserved North America t +1 781 239 5884 e info.usa@thecasecentre.org Rest of the world t +44 (0)1234 750903 e info@thecasecentre.org Purchased for use on the IT for Business Transformation, at University of Baltimore. Taught by Rajesh Mirani, from 29-May-2017 to 23-Jul-2017. Order ref F297564. Usage permitted only within these parameters otherwise contact info@thecasecentre.org GHD-­‐‑036   MARCH  2017   Project  ECHO     GHD-­‐036 The United States of America The   United   States   of   America   is   located   in   North   America,   bordered   by   Canada   to   the   north   and   Mexico  to  the  south  (see  Exhibit  1  for  map).  It  comprises  50  states  and  several  unincorporated  territories.  In   2016,  it  was  the  world’s  third-­‐‑largest  country  in  terms  of  population  and  land  area  (9,147,420  km2).   Educational material supplied by The Case Centre Copyright encoded A76HM-JUJ9K-PJMN9I Order reference F297564 During   the   16th   and   17th   centuries,   Europeans   colonized   the   eastern   territory   of   North   America,   displacing   indigenous   populations   (known   as   “American   Indians”   or   “Native   Americans”).   After   settlers   established   the   United   States   of   America   (US;   see   Appendix   for   common   abbreviations)   in   the   late   18th   century,   the   agricultural   industry   in   the   southern   part   of   the   country   grew   rapidly.   Americans   imported   more   than   100,000   African   slaves   to   work   the   land.1   In   the   19th   century,   the   federal   government   forcibly   moved  Native  Americans  to  “reservations”  to  make  way  for  expansion.  Following  a  civil  war  (1861–1865),   the   US   ended   slavery   and   gave   Native   Americans   citizenship;   however,   these   groups   continued   to   be   treated  as  second-­‐‑class  citizens.2   The   US   became   increasingly   powerful   and   wealthy   during   the   20th   century;   however,   not   all   Americans  benefitted  equally.  Discriminatory  policies  curtailed  the  rights  of  Americans  of  color,  particularly   black   Americans.   Organized   protests   against   this   treatment,   known   as   the   Civil   Rights   Movement   (1954– 1968),   culminated   in   the   Civil   Rights   Act   of   1964.3   The   Act   outlawed   discrimination   based   on   race,   color,   religion,   sex,   and   nationality.4   Nevertheless,   discrimination   continued   through   redlining—the   denial   of   services   to   certain   areas   based   on   their   racial   or   ethnic   makeup—in   the   decades   that   followed.   Inequities   persisted  between  ethnic  groups  and  geographic  regions.5   Demographics and Economy In  2014,  most  of  the  US  population  was  white  (77.4%);  the  remainder  was  black  (13.2%),  Asian  (5.4%),   Native   American   or   Alaskan   Native   (1.2%),   or   mixed-­‐‑race   (2.5%).   About   17%   were   of   Hispanic   or   Latino   origin.6  Almost  one-­‐‑fifth  of  Americans  lived  in  rural  areas,7  which  tended  to  be  poorer  than  suburban  and   urban  areas.8   In   2015,   88%   of   adults   had   a   high   school   education;   less   than   one-­‐‑third   held   a   bachelor’s   or   higher   degree.9  More  than  46  million  Americans,  including  11  million  “working  poor,”*  lived  below  the  US  poverty   line  (USD  11,670  per  year  for  an  individual;  USD  23,850  per  year  for  a  family  of  four).11,12  Median  household   income  was  USD  53,657  in  2015.13  Income  inequality  was  on  the  rise:  In  2014,  the  average  income  of  the  top   10%   of   households   was   nearly   nine   times   higher   than   the   bottom   90%.14   White   households   had   13   times   more  wealth  than  the  median  black  household  and  10  times  more  than  the  median  Hispanic  household.15  In   2015,   unemployment   was   5.3%,   down   from   9.6%   in   2010.16,17   The   US   was   the   largest   national   economy   in   terms  of  gross  domestic  product  (GDP).18   * The US identified anyone who spent more than half the year working or looking for work and whose income was below the poverty line as “working poor.”10 2   Purchased for use on the IT for Business Transformation, at University of Baltimore. Taught by Rajesh Mirani, from 29-May-2017 to 23-Jul-2017. Order ref F297564. Usage permitted only within these parameters otherwise contact info@thecasecentre.org History GHD-­‐036                   Project  ECHO INDICATOR     YEAR   UN  Human  Development  Index  ranking   8  out  of  188   2014   Population  (thousands)   318,857   2014   Urban  population  (%)   81   2014   Population  using  improved  drinking  water  sources  (%)   Households  with  children  living  under     USD  2  per  day  (millions)   98   2012   1.65   2011   Gini  index   41.1   2013   GDP  per  capita  (current  USD)   55,837   2015   Adult  literacy  (%)   86   2013   Educational material supplied by The Case Centre Copyright encoded A76HM-JUJ9K-PJMN9I Order reference F297564 New Mexico In  2015,  New  Mexico  was  the  5th  largest  US  state,  roughly  the  size  of  Vietnam,  and  the  15th  smallest  in   terms  of  population  (2,085,109).19  One-­‐‑third  of  the  population  was  rural,20  and  18%  lived  in  poverty.21  Most   New  Mexicans  were  white  (82.8%),  10.4%  were  Native  American  or  Alaskan  Native,  and  2.5%  were  black.   Nearly  half  were  Hispanic  or  Latino.22   Health in the United States In  2014,  the  top  causes  of  death  were  heart  disease  and  cancer,  followed  by  chronic  lower  respiratory   diseases;   accidents;   stroke;   Alzheimer’s   disease;   diabetes;   influenza   and   pneumonia;   kidney   disease;   and   suicide.23  Drug  overdose  deaths  were  rising;  opioid-­‐‑related  deaths  increased  200%  from  2000  to  2015.24   Health System The   US   health   care   system   was   decentralized,   fragmented,   and   complex.   A   variety   of   public   and   private  institutions  handled  payment,  insurance,  and  delivery  functions.   Governance The   Department   of   Health   and   Human   Services   was   the   federal   agency   responsible   for   health   promotion   and   service   delivery.25   It   oversaw   other   agencies   that   addressed   public   health   (the   Centers   for   Disease   Control   and   Prevention)   and   health   care   quality   and   safety   (the   Agency   for   Healthcare   Research   and   Quality),   the   two   main   public   health   insurance   programs   (Medicare   and   Medicaid),   and   the   needs   of   indigenous  populations  (Indian  Health  Service;  IHS).26–28   The  Veterans  Health  Administration  (VHA)  was  the  largest  integrated  health  system  in  the  country  in   2016,  with  152  medical  centers  serving  8.76  million  military  veterans  at  1,700  outpatient  clinics  annually.29   † Compiled by case writers using data from World Bank, the World Health Organization, UNESCO, UNDP, and the US Department of Education.   3   Purchased for use on the IT for Business Transformation, at University of Baltimore. Taught by Rajesh Mirani, from 29-May-2017 to 23-Jul-2017. Order ref F297564. Usage permitted only within these parameters otherwise contact info@thecasecentre.org Basic Socioeconomic and Demographic Indicators† Project  ECHO     GHD-­‐036 States   were   also   responsible   for   health   services,   including   epidemiological   surveillance;   public   health   emergency   response;   health   promotion   and   disease   prevention;   environmental   health;   prison   health   care;   federal  program  administration;  and  some  lab  services.30   Service Delivery Federally  qualified  health  centers  (FQHCs),  rural  health  clinics,  and  other  qualifying  facilities  received   federal  funding  to  deliver  preventive  and  primary  health  care  services  to  underserved  populations.31  In  2013,   there   were   more   than   1,200   FQHCs   serving   more   than   21   million   patients.32   Half   of   FQHC   patients   were   members  of  ethnic  or  minority  groups,  and  28%  had  no  health  insurance.33   In   2016,   over   80%   of   physician   offices   used   electronic   health   records.34   Clinicians   also   had   access   to   computerized  reminders,  clinical  guidelines,  patient  data  reports,  and  diagnostic  support.   Educational material supplied by The Case Centre Copyright encoded A76HM-JUJ9K-PJMN9I Order reference F297564 Financing In   2014,   just   over   half   of   US   health   spending   was   private;   the   rest   was   public.35   Although   Americans   could   purchase   private   health   insurance,   most   participated   in   voluntary   employer-­‐‑sponsored   health   insurance  plans,  sharing  premium  costs  with  their  employers.27  In  2015,  over  two-­‐‑thirds  of  people  under  age   65   had   private   health   insurance.36   About   36.5%   of   the   population   relied   on   government-­‐‑sponsored   health   insurance—primarily  Medicare  and  Medicaid.37  People  age  65  or  older  or  those  with  certain  disabilities  or   end-­‐‑stage  renal  disease  qualified  for  Medicare.38   Medicaid,   one   of   the   largest   payers   for   health   care,   provided   coverage   to   qualifying   low-­‐‑income   families,   the   elderly,   people   with   disabilities,   and   residents   of   institutional   programs.39   Each   state   ran   its   own  Medicaid  program  and  determined  its  payment  model.  States  were  moving  away  from  fee-­‐‑for-­‐‑service   models  toward  private  managed  care  organizations  (health  management  organizations;  HMOs)  and  paying   HMOs  a  capitation  rate  (per  patient,  per  period  of  time).  HMOs  then  negotiated  compensation  plans  with   providers.   Specialist   providers   often   received   more   than   general   practitioners.   Medicaid   payments   to   providers  often  were  lower  than  private  insurance  payments.     Certain  Medicaid  recipients  (e.g.,  children,  the  terminally  ill)  were  exempt  from  out-­‐‑of-­‐‑pocket  costs;  the   rest   paid   a   small   copayment.40   Medicaid   “super-­‐‑utilizers”   (about   5%   of   enrollees)   with   complex   needs   accounted  for  half  of  total  Medicaid  spending  in  2011.41   In   2015,   the   number   of   uninsured   Americans   was   the   lowest   it   had   been   in   decades   (34.5   million,   or   10.7%  of  the  population).  This  was  due  in  part  to  the  2010  Affordable  Care  Act  (ACA),42  which  increased  the   income  cap  for  Medicaid  eligibility.  Between  2013  and  2016,  Medicaid  enrollment  grew  by  over  15  million   (27%).  In  2016,  more  than  72  million  Americans  were  insured  through  Medicaid.43   Many  newly  insured  Americans  suffered  from  chronic  conditions,  had  had  little  to  no  previous  contact   with   health   care   providers,   and   lived   in   underserved   rural   areas.44   Many   private   providers   did   not   accept   Medicaid.  Congress  expanded  the  FQHC  system  to  support  the  Medicaid-­‐‑eligible  population.44   In  2014,  the  US  had  the  highest  per  capita  and  total  health  expenditures  globally  (USD  9,403  and  USD  3   trillion,   respectively).45,46   Health   spending   represented   17.5%   of   GDP   and   was   climbing,47   but   the   US   had   poorer  access,  equity,  and  health  outcome  measures  than  other  high-­‐‑income  countries.   4   Purchased for use on the IT for Business Transformation, at University of Baltimore. Taught by Rajesh Mirani, from 29-May-2017 to 23-Jul-2017. Order ref F297564. Usage permitted only within these parameters otherwise contact info@thecasecentre.org Private   providers   delivered   a   majority   of   health   care   in   the   US,   even   when   publicly   financed.   Americans  typically  received  primary  health  care  from  private  outpatient  clinics  or  community-­‐‑based  health   centers.   Specialist   clinics   or   hospitals   provided   secondary   care   and   typically   required   patients   to   obtain   a   referral  from  their  primary  care  provider.  Large  hospitals  delivered  tertiary  care.   GHD-­‐036                   Project  ECHO Most  primary  care  payment  in  the  US  was  fee  for  service,  typically  ranging  from  USD  90  to  USD  230   per  visit  at  FQHCs,  with  additional  fees  for  tests.27  FQHCs  offered  a  sliding  fee  scale  to  patients.48   INDICATOR     YEAR   Average  life  expectancy  at  birth  (total/female/  male)   Maternal  mortality  ratio  (per  100,000  live  births)   79/  81/77   14   2015   2015   Under–five  mortality  rate  (per  1,000  live  births)   Infant  mortality  rate  (per  1,000  live  births)   Vaccination  rates  (%  of  DTP3  coverage)   7   6   94   2015   2015   2014   Undernourished  (%)  
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