臺灣博碩士論文加值系統

This study attempts to investigate the issues of aging population in the context of Singapore through metaphorical approach and the potential of tapping on the collaborative characteristics of a health service cloud computing system to meet the needs in elderly care, hence allowing active aging. The use of electronic health records (EHR) in various countries, particularly the meaningful use of EHR in USA is examined to understand its current features and usage. By employing conceptual mapping and blending of metaphorical study, the concepts in cloud computing are probed to gain better understanding on the characteristics of the technology. Similarly, with concepts drawn from an eco-system blended with concepts in a health service system, the characteristics of EHR and finally the characteristics of a health service cloud computing system are illustrated. With understanding in aging population, present usage of EHR and potential of cloud computing in Singapore, multi-methods research consisting of intensive interviews and archival document collations are employed. Triangulation amongst the datasets collated using open coding via ATLAS.ti resulted in 6 issues of concern in aging population pertaining to the Singapore context to arise, namely (i) primary care, (ii) familial support, (iii) awareness in health maintenance and transparency in information, (iv) improved efficiency and accuracy in healthcare with seamless transfer of care and (v) intermediate care and (vi) collaboration between stakeholders. Further analysis of the results draws up the possibilities for enhancing meaningful use of health service cloud computing system for active aging, which criteria are: (i) empowerment and ownership, (ii) sustainable homecare and (iii) seamless transfer of care. Finally, a conceptual mapping of health service cloud computing system and the criteria for effective aging give rise to a model framework that is set for active aging.

This study attempts to investigate the issues of aging population in the context of Singapore through metaphorical approach and the potential of tapping on the collaborative characteristics of a health service cloud computing system to meet the needs in elderly care, hence allowing active aging. The use of electronic health records (EHR) in various countries, particularly the meaningful use of EHR in USA is examined to understand its current features and usage. By employing conceptual mapping and blending of metaphorical study, the concepts in cloud computing are probed to gain better understanding on the characteristics of the technology. Similarly, with concepts drawn from an eco-system blended with concepts in a health service system, the characteristics of EHR and finally the characteristics of a health service cloud computing system are illustrated. With understanding in aging population, present usage of EHR and potential of cloud computing in Singapore, multi-methods research consisting of intensive interviews and archival document collations are employed. Triangulation amongst the datasets collated using open coding via ATLAS.ti resulted in 6 issues of concern in aging population pertaining to the Singapore context to arise, namely (i) primary care, (ii) familial support, (iii) awareness in health maintenance and transparency in information, (iv) improved efficiency and accuracy in healthcare with seamless transfer of care and (v) intermediate care and (vi) collaboration between stakeholders. Further analysis of the results draws up the possibilities for enhancing meaningful use of health service cloud computing system for active aging, which criteria are: (i) empowerment and ownership, (ii) sustainable homecare and (iii) seamless transfer of care. Finally, a conceptual mapping of health service cloud computing system and the criteria for effective aging give rise to a model framework that is set for active aging.

1. Introduction Pg 1–3
2. Literature Review
2.1 Electronic Health Records (EHR) Pg 4-16
2.1.1 The development of EHR
2.1.2 Shifting the Paradigm - USA’s initiative towards a patient-centered healthcare system
2.1.3 A patient-centered approach to tackling issues of aging population
2.1.4 Cloud computing in EHR
2.1.5 Delivery modes of cloud computing
2.2 Concepts of metaphor Pg 17-23
2.2.1 Using metaphors for new inventions
2.2.2 Conceptual metaphor
2.2.3 Conceptual blending in metaphors
2.2.4 Applying conceptual metaphor of ‘cloud’ on ‘computing
2.3 The Dossia Health Service SystemPg 24-28
2.4 Characteristics of ecosystem Pg 29-40
2.4.1 Determining if a health service system satisfy the characteristics of an ecosystem
2.4.2 Sustaining the effectiveness of an ecosystem
2.4.3 Concept of keystone metaphor in ecosystem
2.4.4 Conceptual blending of cloud computing technology and electronic health records system
2.4.5 The component that links – Water as a metaphor for data and information
2.4.6 Opening possibilities – Entailments of water
2.5 Aging population in Singapore Pg 41-47
2.5.1 Problems of aging population in Singapore
2.5.2 Importance of familial support in Singapore
2.5.3 Present EHR system in Singapore
2.5.4 Tapping on cloud computing for healthcare in Singapore
3. Research Methodology:Multi-methods research Pg 48-52
3.1 Data Collection
3.2 Triangulation
4. Results Pg 53-64
4.1 Primary Care
4.2 Familial Support
4.3 Awareness in health maintenance and transparency in information
4.4 Improved efficiency and accuracy in healthcare with seamless transfer of care
4.5 Intermediate care sectors
4.6 Collaboration between stakeholders
5. Discussion Pg 65-77
5.1 Empowerment and ownership
5.2 Homecare as key pillar of support for effective aging
5.3 Primary and intermediate care support for seamless transfer of care
5.4 Collaboration through health service cloud computing system for effective aging
6. Conclusion Pg 78-80
7. References Pg 81-86
8. Appendix 1: Intensive interview questionsPg 87-88
9. Appendix 2: Results of research data Pg 89-97

List of Figures and Tables

Figure 1: Standards of cloud computing taxonomy (Cloud Computing case use white paper, 2010) Pg 15
Figure 2: The architecture of cloud computing (Boroujerdi & Nazem, 2009) Pg 16
Figure 3: Conceptual blending between cloud and computing technology Pg 22
Table 1: Players and their responsibilities in Dossia Health Service System Pg 24
Figure 4: Pictorial representation of system in Dossia Health Service System Pg 26
Figure 5: Conceptual Blending between health service system and ecosystem Pg 32
Figure 6: Conceptual blending between cloud computing technology and Electronic Health Records (EHR) Pg 37
Figure 7: Population age pyramid (Statistics Singapore, 2010) Pg 42
Figure 8: Old age support ratio (Statistics Singapore, 2010) Pg 42
Table 2: List of intensive interview stakeholders and archival documents Pg 49 – 51
Figure 9: Inter-relationships between concepts derived from coding and analysis of data Pg 66
Table 3: Possible stakeholders in health service cloud computing system for elderly care in Singapore Pg 67
Figure 10: Conceptual mapping between health service cloud computing system and criteria for active aging Pg 77

Armbrust, M., Fox, A., Griffith, R., Joseph, A.D., Katz, R., Konwinski, A., Lee, G., Patterson, D., Rabkin, A., Stoica, I. & Zaharia, M.(2010). A view on cloud computing. Communications of the ACM, 53(4), 50-58.

Amrhein, D., Andrew de Andrade, P.A., Armstrong, J. E., James, A.B., Bruklis, R., Cameron, K. (2010). Cloud computing use cases white paper version 3.0 ed., Cloud computing use case discussion group.

Bates, D.W., & Bitton, A. (2010). The future of health information technology in the patient-centered medical home. Health Affairs, 4(2010), 614-621.

Bateson, P. G. (1983). Optimal outbreeding: In Mate choice. Cambridge: Cambridge University Press.

Bergman,H., Beland, F., Lebel, P., Contandriopoulos, A., Tousignant, P., Brunelle, Y., Kaufman, T., Leibovich, E., Rodriguez, R. & Clarfield, M. (1997). Care for Canada’s frail elderly population: Fragmentation of integration? Canadian Medical Association, 157(8), 1116-1121.

Bernard, H.R. & Ryan, G.W.(2010). Analyzing qualitative data: Systematic approaches. Thousand Oaks, California: SAGE Publications.

Boroujerdi, M.M. & Nazem, S.(2009). Cloud computing: Changing cogitation about computing. World Academy of Science, Engineering and Technology, 1112-1116.

Bryne, J. & Humble, A.M. (2007). An introduction to mixed method research. Atlantic Research Centre for Family-Work Issues, 1-4.

Chan, A. (2001). Singapore’s changing structure and the policy implications for financial security, employment, living arrangements and health care. Asian MetaCentre Research Paper Series, 3, 1-21.

Clark, V.L.P. (2010). The adoption and practice of mixed methods: U.S. trends in federally funded health-related research. Qualitative Inquiry, 16(6), 428-440.

Corallo,A., Passiante, G. & Prencipe, A.(2007). The digital business ecosystem. Northampton, Mass: Edward Elgar Publication.

Cornelissen, J. P. (2006). Making sense of theory construction: metaphor and disciplined imagination. Organization Studies, 27(1), 1579–1597.

Cornelissen, J. P. & Kafouros, M. (2008). The Emergent Organization: Primary and Complex Metaphors in Theorizing about Organizations. Organization Studies, 29(7), 957 - 978.

Creswell, J.W. (2009). Research design: Qualitative, quantitative and mixed methods approaches. Thousand Oaks, California: SAGE Publications.

Creswell, J.W. & Clark, V.L.P. (2007). Designing and conducting mixed methods research. Thousand Oaks, California: SAGE Publications.

Detmer, D.E. (2009) Electronic health records: Their time has come. Issues in Science and Technology, 57-60.

Dong, X. & Simon, M.A. (2010) Health and aging in a Chinese population: urban and rural disparities. Geriatrics Gerontology International, 10, 85-93.

Du,W. (2009). Towards a community-based personal cloud computing. Proceedings of World Academy of Science, Engineering and Technology, 41, 901-907.

Fauconnier, G. & Turner, Mark. (1998). Conceptual integration networks. Cognitive Science, 22(2), 133-187.

Fauconnier, G. & Turner, M. (2002). The way we think: Conceptual blending and the mind’s hidden complexities. New York: Basic Books

Hardy, Z. & Paulo, A. C. (2009). Merging, masquerading and morphing: Metaphors and the World Wide Web. Organization Studies, 30(08), 821–843.

Hastings, R. (2009). Cloud computing. Collaboration 2.0, 10-12.

Iansiti, M. & Levien, R. (2004). The keystone advantage: What the new dynamics of business ecosystems mean for strategy, innovation and sustainability. Boston, Mass: Harvard Business School Press.

Jaeger, P. T., Lin, J., & Grimes, J. M.(2008). Cloud computing and information policy: Computing in a policy cloud? , Journal of Information Technology & Politics, 5(3), 269-283.

Kovecses, Z.(2006) Language, mind and culture: A practical introduction. USA. Oxford University Press.

Kushniruk, A., Borycki, E.& Kuo, M.H.(2010) Advances in electronic health records in Denmark: From national strategy to effective healthcare system implementation. EFMI Special Topic Conference in Reykjavok, 18(2), 96-99.

Lakoff, G.& Johnson.M. (1980).Metaphors we live by. Chicago. University of Chicago.

Lam, P.M. (2010, Mar 3). Updates on the national electronic health records system [Qn 302]. Retrieved from http://www.moh.gov.sg/mohcorp/parliamentaryqa.aspx?id=23922

Lee, R. & Mason, A.(2010). Some macroeconomic aspects of global population aging. Demography, 47, 151-172.

Leonard, J.L.(2008). Is Canada ready for patient accessible electronic health records? A national scan. BMC Medical Informatics and Decision Making, 8(33).

Lev S. Kuchment.(2004), The hydrological cycle and human impact on it, Encyclopedia of Life Support Systems, Eolss Publishers; Oxford ,UK.

Lombard, C. G.(2005). Conceptual metaphors in computer networking terminology. Southern African Linguistics and Applied Language Studies, 23(2), 177–185.

Marquez, D.X., Bustamante, E.E., Blissmer, J. & Prohaska, T.R.(2009). Health promotion for successful aging. American Journal of Lifestyle Medicine, 3(12), 12-19.

McCormac, R.M.(1971). A cognitive theory of metaphor. Cambridge, Mass: MIT Press.

Moore, J. F.(1993, May/June). Harvard Business Review: Predators and prey: a new ecology of competition. Retrieved from http://hbr.org/1993/05/predators-and-prey/ar/1

Moore, J. F. (1997). The death of competition: Leadership and strategy in the age of business ecosystems. New York: Harperbusiness.

Murphy, J.(2010). The journey to meaningful use of electronic health records. Nursing Informatics, 28(4), 283-286.

Murray, A., & Mohamed, M.(2010). Are you ready for the coming knowledge cloud? [Article]. KM World, 19(4), 22-22.

National Institute of Health.(2006). Electronic health records overview. McLean, Virginia: National Center for Research Resources.

N’Guessen.K.G.(2009) The metaphor of water in Praisesong of the widow, The women of Brewster place and the beloved. Université de Cocody-Abidjan.

Nikova, M.K.(2010). Older people: new opportunities of just another limitation? Russian Social Science Review, 51(4), 16-33.

Ofstedal, M.B., Chayovan, A. Chan, Y.L. Chuang, A., Perez & A.I. Hermalin.(2001). ‘Policies and programs pertaining to the welfare of the elderly’, in A.I. Hermalin (Ed.), The Well-Being of the Elderly in Asia: A Four-Country Comparative Study, Ann Arbor, Michigan: University of Michigan Press.

Ortony, A.(1993). Metaphor, language, and thought, in Metaphor and thought. A. Ortony (Ed.),1–16. NewYork: Press Syndicate,Cambridge University Press.

Paneth-Pollak,R., Schillinger, J.A., Borrelli, J.M., Handel, S., Pathela, P. & Blank,.S.(2010). Using STD electronic medical record data to drive public health program decisions in New York City. American Journal of Public Health, 100(4), 586-590.

Petrie, H.(1979). Metaphor and Learning, in Ortony, A. (ed.) Metaphor and Thought Cambridge: Cambridge University Press.

Poh, A. (2009). Integrating clinical and genomics data. Bio-IT World, 8(2), 28-33.

Pool, I.(2000). Age-structural transitions and policy: frameworks. Paper presented at the IUSSP Conference on Age Structural Transitions and Policy Implications, November 8-10, Phuket, Thailand.

Radman,Z. (1997). Metaphors: Figures of the mind. Boston, Mass: Kluwer Academic.

Ralston, J.D., Revere, D., Robins, L.S. & Goldberg, H.I. (2004). Patients’ experience with a diabetes support programme based on an interactive electronic record: qualitative study. British Medical Journal, 328, 1-4.

Rodrigues, S.B. (2006). The role of metaphor in an evolving corporate context. Paper presented at the 22nd European Group on Organization Studies Colloquium, Bergen, Norway.

Ross, S. E., Moore, L. E., Earnest, M. E., Wittevrongel, L. & Chen-Tan, L. (2004). Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial. Journal of Medical Internet Research, 6(12).

Rudestam, K.E. & Newton, R.R. (2007). Surviving your dissertation: A comprehensive guide to content and process. Thousand Oaks, California: SAGE Publications.

Shield, R.R., Goldman, R.E., Anthony, D.A., Wang, N., Doyle, R.J. & Borkan, J. (2010). Gradual electronic health record implementation: New insights on physician and patient adaptation. Annals of Family Medicine, 8(4), 316-326.

Statistics Singapore. (2010). Key annual indicators. Retrieved from http://www.singstat.gov.sg/stats/keyind.html.

Stead, W.W. & Lin, H.S.(2009). Computational technology for effective health care: Immediate steps and strategic directions. Committee on Engaging the Computer Science Research Community in Health Care Informatics. Computer Science and Telecommunications Board, National Research Council. Washington, D.C.: National Academies Press.

Strauss, A. & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, California: SAGE Publications.

Teddlie, C. & Tashakkori, A. (2009). Foundations of mixed methods research. Thousand Oaks, California: SAGE Publications.

The metropolitan field guide. (2010). The hydrologic cycle [Diagram of the hydrologic cycle]. Retrieved from http://www.metrofieldguide.com/?p=91.

Urowitz, S., Wiljer, D., Apatu, E., Eysenbach, G., DeLenardo, C., Harth, T., Pao, H., & Stead, W.W. (2009). Electronic health records. Information Knowledge Systems Management, 119-143.

United Nations population division. (2002). World population aging: 1950 -2050. Retrieved from http://www.un.org/esa/population/publications/worldageing19502050/

Winslow, C.E. (1920). The untilled fields of public health. Science, 51(1306), 23-33.

World Health Organization. (2010). Health expenditure in the world [Data file]. Retrieved from http://www.who.int/nha/en/index.html