Issues in the Implementation of Electronic Commerce in the Human Services: Reflections on the Victorian Initiatives Tanya Castleman, Paul A. Swatman and Craig M. Parker School of Management Information Systems, Deakin University 221 Burwood Highway, Burwood, Victoria, Australia, 3125. Tel: +613 9244 6924 Fax: +613 9244 6928 Email:
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Abstract Electronic commerce technologies have many potential applications in the health and human services sector. Implementation of these techniques is growing and assisting the administration and delivery of these services. There are a number of aspects of e-commerce in human services delivery which distinguish it from commercial transactions. This paper discusses factors affecting the development of e-commerce in the Victorian (Australian) human services sector. Some of these factors are related to the organisational context in which these services are delivered, some are related to the characteristics of the users and their carers and some derive from the symbolic meanings attached to the technologies themselves. To reap the benefits of e-commerce for health and human services, it is important that we understand the often complicated social and organisational context in which it is to be implemented.
Introduction The potential of electronic commerce (e-commerce) to improve business effectiveness in the private commercial sector, selling goods and services, has been widely noted and explored [13]. E-commerce and the use of information and communication technologies (ICT) can help organisations reach customers, integrate their business processes, simplify their data management systems, communicate with business partners and coordinate their intra-organisational functions. These benefits are not limited to commercial operations and the definitions of e-commerce are becoming broader to encompass non-commercial applications. Such applications include government uses of these techniques to manage and integrate service provision, to management health care provision and to distribute benefits to recipients of social welfare. There has been a mixed reception for such developments [21, 24, 26, 28]. Governments and the non-government agencies with which they work have developed various electronic business connections, and recipients of benefits are increasingly engaged directly in their use. It is this aspect of e-commerce in the human services that is the of particular relevance to this paper which discusses factors which impinge on the development of e-commerce in the human services sector, particularly for service delivery and the management of benefits. The points made here refer specifically to systems and technologies currently being developed by the Australian State of Victoria to assist in reforms to the human services sector. This case illustrates the range of social and contextual issues that need to inform e-commerce developments in the health and human services and the implementation strategies for achieving system-wide integration. It is important to recognise that governments play a complex role in the human services system which is itself typically complex. The implication of this is that while e-commerce may have business and social benefits, there are aspects of human services delivery which are significantly different from the commercial sector and from those government operations which closely parallel commercial transactions [2]. This paper reports observations from a study of the complex system underlying the provision of human services in Victoria. Our study has highlighted a richness in the underlying system which suggests that investigations into the beneficial applications of e-commerce which address only instrumental criteria are inadequate.
Background to the human service context The human services sector comprises health and welfare service delivery in a variety of forms. It includes acute health care in clinics and hospitals, nursing care in the home, day care in special centres, respite care, personal and domestic assistance and specialised transportation. In Australia some of these services are offered on a completely private fee-for-service basis but more commonly, such services rely substantially on government funding while being delivered through a multitude of non-government agencies.
Benefits of e-commerce for human services There are many examples of electronic commerce in the health and human services sector and they are likely to become much more common in the future. Both private providers and insurers and governments have established such systems with apparent success. Many of the same benefits that apply to standard commercial transactions have also been claimed in the human services sector. These potential benefits include efficiency improvements, cost reduction and more responsive service delivery. They may also include life-saving records retrieval, fraud prevention and improved privacy for patients and clients [9, 22, 30].
International e-commerce applications in health and human services The various ways in which e-commerce and, in particular, smartcard technology has been used worldwide in human services delivery [1, 15, 18, 22, 29]. These applications can be categorised as follows:
Identifying clients and/or health care workers Many insurance agencies and hospitals worldwide are now encouraging or requiring clients and health care works to use data cards (including magnetic stripe and smart cards) for identification and authentication purposes. The client data cards typically provide indexes to central databases containing client records and/or insurance information. Similarly, healthcare professional data cards are typically used to identify carers and to limit their access to client records to those which they are authorised to view. Examples of these types of projects include: • Charlotte Medical Center (Florida, USA), which issues the Med-Key Card for in- and out-patient registration and for indexing centralised databases • health insurance data cards in Germany, which store identification information about the insured person, including name, data of birth, policy status and expiration, and their identification number [4]. More sophisticated healthcare professional access to centralised records is now being achieved with hand-held computers used by workers. For example, the Royal District Nursing Service (RDNS) in Victoria, Australia provides its nurses with hand-held computers to store/retrieve data from the RDNS central computer, to connect to the Internet and to communicate with other nurses involved a patient’s care.
Client record storage Smart cards, which are capable of holding large volumes of data when compared to magnetic stripe cards, are currently being given to clients to store information which the clients can carry on their person. This information includes medical histories, allergies and administrative data such as drug prescriptions. Some smart cards are quite sophisticated and include security mechanisms which provide levels of data read/write access specific to certain categories of care worker; and which can authenticate a PIN entered by the client which will then permit the worker to access this data. Examples of these types of projects include: • the CARDLINK 2 project, which is a multi-country European Union pilot project which will demonstrate the feasibility of a patient-held smart card containing the patient’s entire medical history for emergency purposes [10]; • Health Passport Project (USA), where pregnant women and mothers in Bismarck (North Dakota), Cheyenne (Wyoming) and Reno (Nevada) will be given smart cards storing demographic and routinely shared health information (e.g., medical test results, immunisations) [27] • the Rimouski (Canada) project, where citizens of the city of Rimouski were given smart cards storing identification information, emergency information, vaccination details, medications being used, medical history, consultations, follow-ups, etc [16, 17].
Electronic Benefits Transfer Electronic Benefits Transfer (EBT) is an increasingly popular method of managing client use of food stamps and access to welfare payments, especially given the fraud and security problems associated with the former paper-based methods of distributing benefits to clients. The EBT approach typically involves giving clients data cards which can be used in retail outlets to purchase goods and services. Examples of these types of projects include: • the Lone Star Card Initiative (Texas), where recipients are given cards and a welfare allowance. Retailers swipe the cards, the welfare recipients enter their PIN and the funds are transferred directly to the retailer from a central EBT system. This approach is similar to credit card transactions and therefore has the advantage of removing the stigma attached to paper-based coupons [11, 25]. • the Anti-Poverty Programme (Mexico), where eligible families are given a smart card which has been “charged” with the amount of their welfare allowance. This stored-value approach works in a similar manner to the Lone Star Card Initiative, except the payment is transferred from the card to the retailer [7]. The advantages claimed for these schemes are substantial in terms of efficiency, effectiveness and economy. However, there appear to be no systematic and inclusive evaluations of the overall impact of these schemes in the public domain.
Victorian human services context - clients, providers and consumers E-commerce development to support the delivery of the health and human services in Australia is in its infancy but there are active policy developments on the part of several state governments and the Commonwealth government to utilise this capability to improve service delivery and streamline payment and record keeping. The state of Victoria has been particularly active in pursuing such developments. These developments are clearly informed by international. The main initiatives are detailed in a State Government policy framework (Victoria 21) which sets out initiative to promote economic development by encouraging multimedia and related activities. Part of this initiative is the Electronic Service Delivery Project. It is expected that this ‘will improve customer service, make Government services more accessible, lower the cost of doing business, open opportunities for new services and products, coordinate the delivery of services and information by different agencies and spheres of government and stimulate the development of the local communication and information technology industries and the Victorian economy at large’ [19]. Targeting its own areas of responsibility, the Department of Human Services which is responsible for the delivery of health and human services has developed a policy framework (known as Transforming Business 21 or TB21) [3] which sets out a number of areas in which the can alter its business practices to improve the way it allocates its resources, interacts with organisations providing direct services and services the recipients of benefits using a information and communication technologies and e-commerce techniques. The TB21 initiative aims to make the business relationships between the Department and the provider agencies more sophisticated, allowing service providers to do business with the Department electronically. The development of this IT initiative will also include service planning and purchasing, performance monitoring and accountability. It will also include direct consumer involvement to give them electronic access to information, electronic service delivery and coordination of care. During 1998 a further policy initiative was developed which will integrate the management of health care and community support services, including general practitioners, pharmacists, community health centres and public hospitals to provide a ‘seamless service system’ to local communities. The Department is sponsoring Demonstration Projects with groups of providers working together to develop these policy directions into implementation plans. As part of this initiative, the Department will examine ICT directions to support the system it plans to institute [5]. This is an ambitious agenda which will require a great deal of work to accomplish. Even leaving aside the health care by doctors and hospitals, the system for managing Victoria’s community-based human services is itself fragmented and complex. The provision of human services is structured more like a ménage a trois than a simple buyer-seller duo. The Government allocates funding to individual recipients (‘consumers’) and then
usually pays the provider agencies which deliver these services to the consumer. The Department works with many provider agencies and provides few services to benefits recipients itself. These agencies range widely in size and resources. It may also be the case that the provider population has become increasingly unstable with the application of commercial principles into Government purchasing and the introduction of Compulsory Competitive Tendering1 [20] for shorter supply contracts The Department itself is very large and diverse comprising 10 divisions. It runs many different programs for delivering services to consumers. Victoria’s population of approximately 3.6 million is concentrated in its capital city, Melbourne, but the remainder is widely dispersed over an area nearly the size of the UK. This geography means that • • •
there are consumers in remote rural areas, often with poor ICT access the Department itself is divided into 9 regional areas and these Regions have a degree of operating autonomy that sometimes makes organisational integration problematic a significant number of provider agencies are located near the borders of neighbouring states and provide services under entirely different government funding arrangements.
Further, all the States rely substantially for funding for human services on the Commonwealth (national) government and must address its standards and requirements. Consensus among the state governments has historically been very difficult to achieve on any issue, but the development of national data standards is currently underway. This structure may not be more complex than many other settings in which e-commerce has been implemented but it does provide some distinct challenges to e-commerce implementation. A number of these issues are discussed below.
Issues The issues which have been identified fall broadly in into three categories. One set of issues has to do with the way that the human services delivery is placed in an organisational system. This involves interorganisational relationships and the broad policy and political context in which this system operates. The second issue involves the characteristics of the consumer groups. The third issue involves the symbolic dimensions of ecommerce technologies and popular attitudes to government information usage.
The human services delivery system One significant issue is the organisation of the Victorian human services sector. Many of challenges facing the implementation of the initiatives described above stem from the complexity and diversity, not to say fragmentation, of the existing structure of organisational relationships. A characteristic of the Victorian human services delivery system is the centrality of the large government organisation which works with a multitude of other autonomous organisations to deliver services to consumers.
Complexity of stakeholders One important factor in shaping the Department’s operations is the complex range of stakeholders in the health and human services delivery areas. The three major stakeholder groups include • the recipients of government benefits (the ‘consumers’) • the agencies which provide services directly to the consumers • the Government sector which establishes policies for allocating benefits to consumers and funds the provision of services. However, within each of these categories is further diversity of interests and perspectives. This often makes it difficult to develop a consensus, even within major stakeholder groups. The role of an electronic commerce innovation will need to support the management of the overall system of benefits provision by the Department, assist providers in their own business activities and in their transactions with the Department and benefit consumers by facilitating their access to and receipt of services.
1 All agencies are required to bid in an ‘open market’ for a contract with the Government to provide specified services.
Diversity of providers The delivery of services is carried out by a large number of providers, some of which are charitable or nonprofit organisations, others are commercially established. They vary widely in size, governance structures and orientation. Of perhaps greater importance for e-commerce development is the wide variation in technological development, sophistication and infrastructure among the agencies. At one pole, some agencies are well resourced with good management information systems, Internet and email access and highly skilled staff. But agencies at the other pole use outdated equipment and, as with many organisations in the community sector, have small budgets and little scope for IT investment. Internet access is clearly important in the Government’s information strategy which is problematic for many agencies. Agencies in remote rural areas of the state do not necessarily have less access to the Internet or use IT at a lower level than their metropolitan counterparts. But unlike metropolitan-based agencies, rural agencies’ access to reliable servers is not assured. Improvement in telecommunications infrastructure depends on decisions taken at Commonwealth government policy level and by the commercial telecommunications companies. Infrastructure requirements and costs The Department and providers alike confront issues surrounding the development of infrastructure for any system that might be implemented. The dispersed nature of service delivery and the large number of service staff requires a substantial investment in whatever devices are used to support the system of delivery. While it is possible to use the telephone for data input, this is relatively cumbersome and inflexible, difficult for many to use and limited in its ability to record complex information. It is likely that if provider agencies are required to implement e-commerce systems to support their delivery human services it will undermine the viability of a number of agencies, forcing them to withdraw from the sector because they cannot meet the costs of the infrastructure required. This raises issues about policy and engages the question of consumers’ empowerment. In fact, the nature of the clientele for human services gives rise to some quite interesting contradictions. On the one hand, many individual consumers are relatively powerless because of their dependence on public funding, their lack of alternatives and the circumstances of their lives. On the other hand, the high profile of consumer advocacy and its input into the government policy process means that moves which reduce the number of service providers could well be strongly and publicly resisted. Multiple relationships among providers The Department purchases services on behalf of consumers from many provider organisations but the agency from which services are purchased is not necessarily the agency which provides the services. This process of ‘brokering’ may occur in two ways. An agency may sub-contract some or all of the services the Department has purchased to other agencies. In fact some agencies act solely as brokers rather than providers. Alternatively the agency may place a consumer in a range of programs offered by other agencies and reciprocal or ‘cross brokering’ arrangements are not uncommon. The Department’s dealings are only with the lead agency but the practices of the various other agencies delivering services will have a significant impact on the introduction of new business processes involving e-commerce. Service delivery is, in fact, even more complex than at first appears. Governmental and political complexity The provider field is not the only one characterised by only diverse stakeholders and complex arrangements. The Government sector itself is divided along many lines. State governments receive funding from the national (Commonwealth) government. Both levels have policy frameworks which are not always completely coordinated. The area of Commonwealth-State relations is a complex one in all areas of government activity. There are also complexities within the State government and the organisation of the public service. The Victorian health, human services and youth affairs areas have fairly recently been amalgamated into a single large Ministry. Previously, the Department of Health and the Department of Community Services were separate. Therefore, even organisationally, there is no long history of integration. The integration of these diverse areas at a policy level is perhaps less challenging than the integration and coordination of the organisational practices built over a long period. A number of initiatives have been undertaken to standardise some of these procedures and establish common definitions and procedures across organisational units. However, the Department is frequently characterised as having a ‘silo’ structure which makes integration difficult to achieve and change difficult to manage.
Another source of organisational complexity derives from activities in the political arena. Because governments seek to gain electoral advantage from expenditure on health and social welfare, there is an inducement to develop new, targeted benefits schemes which will lend kudos to the government of the day. While this increases the responsiveness to the needs of particular consumer groups, it results in a plethora of benefits categories which are difficult to integrate into a transparent system. The Department has taken steps to reduce the number of funding programs to streamline the benefits system.
Complexity of benefits Partly as a result of the organisational complexity described above, the consumer is often confronted by a maze funding categories and a variety of program types. Each program has its own eligibility criteria but they are not mutually exclusive. Consumers commonly receive benefits from several different programs but this is not registered on a single database. Consumers’ benefit level depends on their individual access to information about programs for which they are eligible. As a result, there is reason to believe that benefits are not always equitably distributed with some consumers gaining access to a wide range of benefits while others with similar needs have lower benefits because they are not aware of what is available to them. This is a matter of concern for the Government and for the consumer advocacy groups. Figure 1 represents the structure of the service provision and relationships between the Department, the provider agencies and a hypothetical consumer.
[Insert Figure 1 here] In this example, the consumer receives funding from three separate funding programs to meet her range of support needs. Most of this allocation comes through Region VIII but one program is accessed through Region V. The consumer engages two agencies (Agency 1 and Agency 3) to deliver services. Agency 1 subcontracts part of the consumer’s care to Agency 2. Agency 3 operates solely as a brokerage agency and contracts the client’s care to Agencies 4 and 5. This is a hypothetical but not a fanciful example. Many such complicated service arrangements exist. Even more complicated ones are possible. Such a structure poses difficulties for Departmental and agency administration and is commonly daunting and impenetrable for consumers. Implementing an e-commerce system in this context will require considerable organisational and administrative changes.
Dispersed location of service provision In line with Government efforts to reduce reliance on institutionalised care, the human services sector in Victoria is increasingly moving to provide services to people in their own homes. These services include home cleaning and home maintenance, nursing services and personal care. For provider agencies, this means organising a highly dispersed workforce over what is often a large geographical area. It also means that service delivery will often occur outside normal working hours when conventional home-office support is not available. This aspect of human services delivery suggests a major opportunity for the use of ICTs and e-commerce techniques. The ability of such technologies to facilitate remote communication and asynchronous reporting of service delivery. However, with the exception of a few pilot projects, there has been little development of ecommerce initiatives in this area. What initiatives have been taken are largely localised and not integrated into the system in the way suggested by the most recent policy initiatives. Among the many reasons for this apparent delay is (1) the characteristics of the care delivery staff and the consumers themselves and (2) the costs of infrastructure to support such initiatives.
Management of the service delivery workforce The frontline of service delivery is the staff who may work in day care centres or visit consumers’ homes. Thus, the service delivery context is widely dispersed and staff are not directly supervised at all times. Even staff working in day care centres often travel from one venue to with consumers. It is also work very frequently undertaken on a part-time basis with a large number of staff working a small number of hours. The service delivery personnel are a diverse group, ranging from qualified nursing staff to attendant care and cleaning staff with no formal job qualifications. As such, there is a wide variation in the technical sophistication of the service delivery staff which limits the kinds of technology that could be introduced without substantial induction and training programs for agency personnel. Simple log-on / log-off electronic technologies have been used to track staff delivery time in some instances, but this is at a rather low level of e-commerce usage. A
sophisticated integrated system of purchasing, delivery validation, case management and payment would require considerably greater technical knowledge than is common among current service delivery personnel. Although many service personnel have few formally recognised skills and qualifications and their level of remuneration is low, they are usually carefully chosen by the agencies because of their personal qualities and their ability to work with consumers. Many choose this type of work on the basis of its intrinsic rewards. This makes it all the more important to tread carefully in implementing e-commerce technologies to track service delivery. There is a fine balance to be struck between ensuring that consumers receive the services to which they are entitled and preserving a work setting free of intrusive, Tayloristic electronic monitoring. An insensitively implemented electronic system could cost the service system more than it delivers if it undermines the goodwill of staff
Consumer characteristics The consumers of human services are more than likely to have difficulties meeting the demands of everyday life. They include those who are aged and frail, people with physical or intellectual disabilities or those with chronic illness. These factors directly affect the ability of many (though not all) consumers of human services to use e-commerce technologies. Introduction of e-commerce which involves direct consumer involvement should therefore be treated with great caution because whatever the elegance of a transaction system, there may be unforeseen negative effects on users or difficulties with users’ participation. At the very least, the pace of introduction of systems and technologies is best linked to the existing capabilities of consumers. Induction and training programs may address many potential difficulties but may not overcome all obstacles. In discussing the scope for implementing e-commerce technologies at the level of direct consumer service, it is important to take account of the philosophies of consumer empowerment, a key points made in the current policy documents [5] and the protection of consumers’ personal autonomy and their rights to choose. Central to this is the ability of consumers to give informed consent to any transactions over care. This means that a consumer must understand what a transaction entails including how they might use any electronic technologies involved in that transaction. For consumers who are unable to understand conventional transactions, a carer (for example, a family member) acts on their behalf. In such cases, the requirement for informed consent applies to the carer. An extension of the principle of informed consent suggests that whatever technologies might be adopted for keeping track of human service delivery, the consumers must not be inadvertently disempowered because of their inability to understand or effectively use those technologies. Useability is not such an issue in the mainstream of commercial transactions but human services recipients include people with a wide range of abilities.
Social attitudes and symbolic connotations Response to the implementation of e-commerce technologies for human services consumers by Victorian Department of Human Services is likely to be somewhat hostile. This is not simply because of ignorance and conservatism but reflects three major issues of some import.
Non-stigmatising technologies A system involving human services consumers must protect their privacy and dignity in a number of ways, not simply by keeping explicit data about them in a secure fashion. The devices they are required to use should be similar to mainstream technologies; should lack of insignia or identifiers which would reveal information about the person’s health or welfare state; and should not expose the consumer to undue embarrassment because he/she finds the device difficult to use. A positive aspect of the use of cards for EBT instead of food stamps is that it reduces the stigma attached to welfare recipients. Because they use a standard device in standard settings, it is less likely that their welfare status will be revealed. Similarly, health care cards which are properly secure are nearly universal and thus do not single out categories of users. However, for some consumers who have serious physical disabilities, devices such as smart cards or data storage cards may be difficult or impossible to use independently. Others may have difficulties with these devices because of intellectual or sensory problems. There are many alternatives to the universal datacard for consumer-based human services transactions. Chips embedded in medallions can transfer data on contact with a
reader, for example or contactless cards could be scanned remotely, reducing the physical or intellectual demands on the user. However, these technologies (the devices and their uses) are commonly associated with animal management techniques and are likely to be considered highly offensive by many people. Although most older people in Australia comfortably use datacards for banking, health membership and the like, many aged people are uncomfortable with this device and have a strong preference for cash which can be seen. We do not know how widespread this attitude is nor for how long this will be characteristic of the upper age cohorts. But it does suggest that introduction of these devices should be carried out sensitively and that no such change will deter aged recipients from participating in human services programs. Consumers are not the only group for whom the symbolic dimension of electronic technologies is an issue. Electronic charting of service delivery is strongly associated with ‘clocking in and out’ and suggests an instrumental, even punitive view of human service work, even if this is not the intention. Such an association is seen as particularly alien in human service delivery. The benefits of ICT and e-commerce methods are more likely to be realised if their design preserves staffs’ sense of professionalism and a degree of flexibility in how they meet consumers’ needs. A system of rigid accounting does not sit comfortably with the nature of the care relationship which is expected to be professional but not impersonal.
Privacy protection vs data needs The capacity for integrated electronic data systems to make personal information available to unauthorised others, either intentionally or not, has long been recognised. In response to these concerns, a great deal of effort has gone into developing standards and privacy codes to govern future system developments [8, 22, 6]. The issue of information privacy is paramount in any system dealing with health or social welfare data because this is an area of particular sensitivity where anxieties about possible breaches are very high [32]. The more integrated a human services delivery system becomes, the more problematic privacy issues loom. Further policy development and refinement has been necessary to keep pace with technological changes. The issue is even further complicated because of the tension between the needs for a high security database for patients and consumers on the one hand and the potential uses of aggregated consumer data for monitoring, planning and program development. It could be argued that the maximum system benefit of e-commerce in the human services can only be gained if there is good access to accurate data for profiling and service projections as well as for checks on the integrity of the system as a whole. It would be understandable if there were strong resistance from consumer advocates and provider representatives.
Apprehension about IT and ‘Big Brother’ There is a good deal of public trepidation in Australia as elsewhere about the long-term results of universal data collection and storage of the type made possible by IT. The common fear of entering commercial transactions via the Internet are out of proportion to the actual risk to buyers has been widely noted. However, the inprinciple distrust of governments seems even more entrenched. In the early 1980s the public outcry against a national identity card system (proposed by the Hawke Labor Government to combat tax fraud) was so strong that the ‘Australia Card’ idea was quickly abandoned. Even with more recent legislation designed to address these fears and provide privacy safeguards, the concerns about how governments will use service delivery and other personal information will need attention.
Summary There are many benefits that e-commerce can offer in the delivery of human services and the distribution of government social funding. Insofar as government activities are judged by the standards of business performance, these technologies can be used to improve the efficiency and effectiveness of those operations. In that sense, all the well-known advantages (as well as the known caveats) will apply. In cases where human services delivery fits most closely the commercial model, e-commerce innovation should be relatively unproblematic. The paradigm case of such applications appears to be in the use of datacards as an alternative to paper-based benefits recording such as food stamps or taxi vouchers. In these cases, the infrastructure for using the devices is already in place, keeping the costs for the providers of good and services very low. There is no obvious distinction in the transactions between benefits recipients and ordinary commercial users of datacards. Indeed, the transaction relationships can be understood in almost entirely commercial terms.
However, there are significant differences between the commercial context and the non-commercial context in which human services are delivered. These transactions are embedded in a complex environment of personalised professional relationships. An appropriate electronic system for this environment would support the major stakeholders in their activities: the Department to streamline its business processes and facilitate its planning; providers to manage their businesses and workforces more effectively; and consumers to access needed information and manage their benefits with more confidence. The example of the Victorian human services sector which has been discussed in this paper illustrates the need for e-commerce initiatives to be carefully evaluated and tailored to the particular organisational systems in which they are applied. The diversity among the group of provider agencies and the particular spread of consumer characteristics make the introduction of e-commerce difficult and highly sensitive. In contrast to the general population, many human services consumers are highly vulnerable and may be prevented from participating appropriately in mainstream systems. Therefore, the development and introduction of these systems should err on the side of caution and proceed at a pace which will allow the many necessary adjustments to be made. It is important that governments as peak funding and policy bodies take the initiative in developing an information framework to facilitate the use of electronic technologies to manage human services delivery. But this must be done working thoroughly with local groups of providers and consumers to develop systems which are appropriate. If e-commerce in human services can improve efficiency, helping to make more money available for direct care, improve service delivery and coordination and assure appropriate levels of privacy and dignity for consumers, it will make a major contribution.
Conclusions Our investigation involving, as it did, a multi-disciplinary team has identified a range of complexities characteristic of the human services area. This has demonstrated the difficulties and dangers inherent in simple – or simplistic – approaches to the use of otherwise promising e-commerce techniques in health and human services. While we believe that the promise may be fulfilled, there is a need to monitor the introduction of such systems on a variety of dimensions, not simply their ability to manage transaction data effectively or even to cut costs. Future research should evaluate such systems, comparing findings across schemes and government contexts. This research should entail practical fieldwork in the formal study of e-commerce in human services from a multidisciplinary point of view and might, thus, assist in the evolution of appropriate e-commerce applications for the human services sector.
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28
Sullivan, M. and Munford, R. ‘The Articulation of Theory and Practice: critique and resistance in Aotearoa New Zealand’ Disability and Society, (1998) Vol. 13, No. 2:183-198.
29
University of Texas. 'Electronic Benefits http://www.utexas.edu/lbj/rhodesprp/EBTPS.html
30
USDA. ‘Nutrition Program Facts: Electronic Benefits Transfer’, 1998, http://www.usda.gov/fes/ogapi/ebtunf~1.htm. Access 30/01/99.
Transfer
in
the
Public
Sector',
1996.
(1998)
31
WGA (Western Governors’ Association). Health Passport Project: General Functional Description, 1999. http://www.westgov.org/hpp. Accessed 30/01/99.
32
Willison, D. J. ‘Health Services Research and Personal Health Information: Privacy concerns, new legislation and beyond’, Canadian Medical Association Journal, (1998) Vol. 159, Issue 11: 1378-1381.
State Government Department of Human Services Head Office
Funding Programs
Department Regions
I II III IV
A
B
C
V VI
VII
D
VIII IX
Funding Allocations
Consumer Agency 1 (subcontract) Agency 2
Agency 3 (Broker)
Agency 4
Agency 5
Figure 1. Government benefits and service provision to the consumer
