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lasted until the last patient was seen, usually around 1600 1800 hours The site layouts were different at each location, and the clinical treatment areas, pharmacy, and lens-making areas were positioned based on available space and power considerations Users involved in the employment phase of the data collection included two experts from physical therapy, one expert from general medicine, two veterinarians, one licensed practical nurse, one optometrist, one dentist, one pharmacy technician, two computer specialists, one observer, and one respondent of undetermined status All of the patient demographic information and chief complaints were collected in the triage area on the patient collection form Thai Military or Thai Public Health, along with US Navy personnel, staffed the initial entry point From that point, at each site, patients were initially screened and sent to one of several functional areas, including general medicine, physical therapy, dental, optometry, and the pharmacy Palm PDAs with the MCHM installed were located at each of these functional areas, with three to ve PDAs located in the general medicine area, one PDA located in ophthalmology, one PDA in dental, and one PDA in physical therapy The veterinary treatment area was provided with two PDAs, with one of the PDAs used by the veterinary team that would travel to outlying areas Following treatment in each area, data was entered into the PDAs, including narrative comments Several times each day, this data was downloaded to a laptop computer, utilizing small PDA disks This provided the HCA Commander, Commanding Of cer Fleet Naval Hospital, and local Thai public health of cials with near real-time information regarding the total patients processed at that point Before departing the site, the IT team was able to deliver all of the customized reports of the day s activities available on the web-based server to the personnel mentioned previously This was of valuable interest to the mentioned parties, because the HCA Commander could provide his superiors with a recap of activities at the site, and the medical personnel could see the results of their work At the conclusion of each session, these data were downloaded and transmitted, via dial up or broadband connection, to the US server In this manner, the data could be accessed via the Internet, for those who had established user accounts The data were presented in several reporting formats and provided near real-time patient information data for US and Thai military personnel and Thai public health of cials The average le size was 54989 kb, with the largest le being 907 kb and the smallest being 396 kb The average transmission time for dial-up access was 19 minutes 41 seconds, with the longest time being 26 minutes at a connection speed of 366 bps for a 907 kb le, and the shortest time being 5 minutes at a connection speed of 566 bps for a721 kb le The average transmission time for broadband connection was 3 minutes for le sizes of 579 kb and 470 kb Following the exercise, each of the known users participated in structured interviews and completed surveys The users opinions and insights regarding the operation of the MCHM were recorded and will be used for future development of the system At the conclusion of the nal data collection, the Healthcare Administrator (HCA) and the Of cer in Charge (OIC) of the Fleet Naval Hospital, along with
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pertinent Thai of cials, were provided a detailed roll-up of the total patient encounters captured throughout the nine supported data collection sites This data would be used to inform their superiors and proper personnel of the outcome and success of the data collection These data are still available on the website Presently, users are querying this data for reporting purposes The team s task was to test and evaluate the MCHM and to measure its capability to collect smart data The team functioned as active participants in the project According to Creswell [6], a qualitative approach is necessary when research must be undertaken in a natural setting where the researcher is an instrument of smart data collection, data is analyzed inductively, the focus is on the meaning of participants, and a process needs to be described Qualitative researchers want to interpret phenomena in terms of the meanings people bring to them [7] Selection of a qualitative approach should ow from research questions that attempt to answer why or how [8], so that initial forays into the topic describe what is going on [6] The intention of the research was to test and evaluate an MCHM that streamlines and automates the discovery disclosure process of smart data The team was also responsible for the education and training of end-users to assist them in using the system to develop their own processes based on their own needs From a problem solution perspective, the team wanted to better understand how new technology is implemented in support of a complex process or discovery disclosure in an environment unaccustomed to change With this knowledge, we could then derive better solutions for improving information ow related to discovery disclosure in a medical environment The MCHM system not only required dramatic changes to the existing technology infrastructure, it also required a paradigm shift in the way end-users interact with technology The MCHM system allows end-users direct control over the design of their processes without the need for computer programming As a result of the collection of this smart data, both the end-users and management had to rethink the way they operated Change is dif cult in any setting, but radical change is even more dif cult to manage In pursuing the answers to the research question we wanted to record the people, political, technical, and managerial dynamics of the smart data involved in the case We entered into the project with an understanding that the MCHM testing and evaluation needed to be completed on schedule and that what was learned from the smart data collection and our participation would be used to facilitate process change A survey was designed to investigate the smart data collection utility of the MCHM This exploratory instrument was offered to MC decision makers The survey was speci cally designed to initially assess the importance, effectiveness, and suitability of the MC as used in the data collection and the HM Implementation was successful, if success was measured as a function of use, and the MCHM project overall was considered to be a success A review of the smart data supplied by the surveys suggests that decision makers consistently found the MCHM important for completion of the commanders missions For example, 10 SMEs had favorable comments on the importance of MC tasks that were performed Nine respondents had favorable comments on the importance of the task
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