This paper presents early findings of a study on how users appropriate a computerised mobile system designed to administer service orders. The theoretical lens used was Adaptive Structuration Theory (AST) and focused on Structural Features, Spirit and Appropriation of Structure. In order to accomplish the purpose, two aspects were to be considered: the system's structure and the user's appropriation, because the structure of a system affects the appropriation of the system. The study was conducted at a large international company's Swedish subsidiary operating in heavy industry, machines and transportation. The methods used were a blend of several instruments, such as analysing documents, observations and interviews. These qualitative empirical data were analysed from the perspective of AST. The initial results demonstrate that some of the tested constructs within AST are not applicable to computerised mobile information and therefore some adjustments must be made in AST to fit the mobile computing domain. In order to test these results further, at least two possible strategies lie ahead: either a closer study of the underlying assumptions of Structural Features and Spirit or a broader test of more of the propositions in the AST framework.

Handheld computing and mobile information systems are continuously breaking new ground, with an increased importance for business. However, there is evidence that we still have lessons to learn concerning the design of handheld information systems. Handheld information system poses challenges to the designer in the unique properties of handheld technologies and the conditions of use of handheld technologies. Hence, this paper is based on the assumption that handheld information systems has unique properties, and dependencies between properties, that should to be considered in the design of such a system in order to design appropriate information systems for the mobile workforce. The purpose in this paper is to further enhance the usefulness of the Accentuated Factor Framework by describing dependencies between factors in the framework and by this enhance the efficacy in the design process. The theoretical foundation for the paper is the Accentuated Factor Framework, illustrating the unique properties of handheld information systems whereas the expected use settings are the mobile workforce. The empirical data collection was performed via interviews with experienced practitioners, case studies, workshops and studies of software. The Accentuated Factor Framework enhanced with explanatory dependencies between factors provides the opportunity to enhance the design process by reducing the risk of reengineering in design.

This review has examined research on handheld computing from a design science perspective. The review was underpinned by the assumption that handheld computing has specific features compared to stationary computing that ought to be managed in order to harness the possibilities of handheld computing. The purpose of this study was to identify areas of investigation in handheld computing from a design-orientated perspective. Publications were analysed by four dimensions: handheld computing, design oriented approach, accentuated factors of handheld computing and organisational settings -- whether or not the users were a member of the mobile workforce. The findings revealed that research on handheld computing is unevenly distributed and that research on the mobile workforce is under-represented. A reflection made is that more research on factors such as field use conditions, support issues, supporting technologies and time critical is needed in order to harness the possibilities of handheld computing.

The rapid development of handheld technologies such as smartphones and personal digital assistants in recent years has created opportunities for the mobile workforce to take advantage of computerised information systems. To apprehend and harness the opportunities of computerised information systems implemented on handheld devices it is crucial to fully understand the user group and the handheld technology.

However, there is a lack of comprehensive frameworks and toolkits supporting designers of computerised handheld information systems for the mobile workforce. The aim of this dissertation is to address this issue by developing both a framework and a toolkit for use early in the design process.

To develop and evaluate the framework and the toolkit, various qualitative methods such as interviews, artefact studies, and experiments were applied for assessing both users’ and designers’ views on handheld computing. The analysis is made from a designers’ perspective and based on the entities, user, application, context and technologies.

The proposed accentuated factors framework is a comprehensive framework of fifteen factors, evaluated and approved by experienced practitioners.

The HISD Toolkit presented is based on the accentuated factors framework and supported by the design propositions Least Common Denominator, Flexible Forms, Tune-In and Defensive Design, which are also presented in this dissertation.

The main implication for research is the use of the accentuated factors framework in analysis of handheld computing. The main implications in practice are the use of the HISD Toolkit in the design of handheld information systems, in the teaching of handheld computing, and in the evaluation of existing systems as in the procurement of computerised handheld information systems.

The study has been supported by the Swedish Research School of Management and Information Technology (MIT)

The recent years of development in mobile computing as powerful handheld computers and high-speed wireless networks creates opportunities for new user-groups in the mobile workforce to take advantage of mobile technologies. User-groups may be more or less geographical distributed and as a consequence more or less marooned when it comes to obtaining IT/IS support and this increases the complexity of delivering IT/IS support to these geographically distributed end-users. In this design paper the aim is to develop a design theory to manage problems in IT/IS support to the outbound user. Semistructured interviews were performed with developers and documents studies of an information system comprising handheld mobile computing devices for drivers. From the interviews, a design theory based on the implemented strategy of defensive design is presented. The six components of IS design theory by Gregor and Jones is applied as a theoretical framework for evaluation of the design theory. 

This review has examined research in mobile computing from a developer’s perspective. The review was underpinned by the assumption that mobile computing has accentuated factors compared to stationary computing that ought to be managed to harness the possibilities of mobile computing. Applying a developer’s perspective rendered a certain interest in design-oriented research, i.e. prescriptive research. Articles were categorised in three dimensions; the first dimension was developmental factors accentuated by mobile computing. The second dimension regarded the approach, if it was descriptive or prescriptive. The third dimension regarded the organisational settings, if the user were a member of the mobile workforce or not. The purpose of this study was to identify areas of inquiry in mobile computing from a design-oriented perspective. The findings revealed that research among accentuated factors of mobility is unevenly distributed and that research on the mobile workforce is under-represented. However, design-oriented research has a reasonable representation in the set of publications. The under-representation of research concerning the mobile workforce ought to have relevance for business informatics research. In conjunction with these findings some thoughts on future research areas are presented.

In recent years the Swedish Police Force (SPF) have encountered greater demands on availability and 24/7 services when dealing with errands that are regarded as low priority compared to regular police work, e.g. collecting tips from the public. One attempt to meet these increasing demands was the development of a mobile communications platform that allowed the public to communicate easily with the SPF using their own mobile phones by sending SMS and MMS. The focus of this paper is on the early phases of development of this m-service, in particular, on the specific technical issues such as interoperability and standards used by the actors on the scene affecting the development of mobile information systems. The learning experiences are as follows: First, mobile communication platforms have a large potential for contributing to the field of emergency management information systems since they can be based on open and nationally accepted standards. Second, global and national standards for sending multimedia messages are not always truly standardized. Operators and mobile phone manufacturers make minor alterations and interpretations of the standard and thereby some of the benefits found in standards disappear. Third, when developing mobile information systems we suggest and recommend that the analysis phase should be enhanced compared to traditional system development, and it should address the interoperability between mobile phones on one hand and operators on the other hand.

This paper presents the learning experiences from the development of a mobile-based communication platform, called OrdningsVaktsCentralen (OVC). OVC can be translated to Security Guard Central. OVC is designed to enable the Swedish Police Force (SPF) to comply with new legal requirements and enhance their collaboration with Appointed Security Guards (ASG). The focus of this paper is on the early phases of development; in particular on the specific technical issues such as interoperability and standards used in the development of mobile based systems. The learning experiences are as follows: firstly, when developing mobile based systems we suggest and recommend that the analysis phase should be enhanced and it should address the interoperability between mobile phones on one hand and operators on the other hand. Secondly, global and national standards, such as the MMS7 for sending multi-media messages, are not always standardized. It seems that operators and mobile phone manufacturers make minor alterations and interpretations of the standard and thereby some of the benefits found in standards disappear. Thirdly, mobile based communication platforms have a large potential for contributing to the field of emergency management information systems since they can be based on open and nationally accepted standards.

From a diffusion and innovation perspective, the use of advanced mobileservices is limited, immature, and unsophisticated in several Swedish businessorganizations. In this paper, we report the result from a survey of the 20 out of the 50largest business corporations in Sweden. A number of factors explain the currentsituation, e.g. the mobile phone operators current business models, the lack ofservice providers working between the user organisations and the operators,difficulties in integrating mobile phones with other systems, and a generation issuewhere managers perceive advanced mobile service as a teenage thing.

The recent years of rapid development of mobile technologies create opportunities for new user groups in the mobile workforce to take advantage of information systems (IS). However, to apprehend and harness these opportunities for mobile IS, it is crucial to fully understand the user group and the mobile technology. In this chapter, we deductively, from previous research on aspects on mobility, synthesize a tentative analytical framework capturing factors accentuated in mobile IS design. We evaluate the framework based on criteria of completeness, distinctiveness and simplicity. Eventually, these two steps develop the framework towards a theoretical contribution as theory for describing handheld computing from a designer’s perspective. Thirteen semi-structured interviews were made and the tentative framework was elaborated and confirmed.

Despite the numerous stories in academic journals and the business press of systems that fail to deliver anticipated benefits, mobile information systems (IS) are still gaining ground. The nature of mobile IS introduces additional aspects that require attention during the development process, compared to more traditional information systems built for stationary computers. The underlying assumption in this paper is that successful management of these aspects is crucial in order to harness the possibilities of mobility. This paper presents the AUDE- (Application, User, Device, Environment) framework; an analytical framework that addresses the additional aspect of mobile IS. The framework integrates previous research on mobile IS and is tested retrospectively on a case with mobile service technicians. Of the 19 attributes covered by the AUDE framework 2 attributes were not applicable in the investigated case. Of the remaining 17 attributes only 6 were actively handled (3 of them only partly), 8 were not taken into account, and for 3 we were not able to retrieve data. With the ignorance of specific attributes for mobile IS development it was possible to explain why the developed IS did not meet expectations and was considered a failure by its users.

A large corporate group in northern Europe within the heavy industry and haulage sector implemented a mobile service order system for their 280 service technicians in Sweden. Savings due to shorter lead-time from ordered service to sent invoice was one of the main reasons for developing and implementing the system. The desired benefits were achieved when the time from order to invoice was cut from 3 weeks to 3 days. The service technicians, however, deemed the system a failure owing to increased administration on their part from 20 to 90 min per day and lack of support for the service technician’s vital information needs. Post-implementation evaluation showed that the production loss caused by the technicians spending more than an hour less per day actually performing service could have been avoided if the system had been adapted to how the technician performed service order administration in the field (Andersson 2008).

Technological advancements in mobile computing and wireless networks open up to new applications and new user-groups in the mobile workforce. However, a considerable part of the mobile workforce, such as e.g. drivers or healthcare staff, is chiefly performing other tasks than interacting with their computers. As a result, they are not able to pay attention to computer interaction, making them mainly off computer tasks. The aim of the paper is to develop a design theory to manage off-task situations in mobile computing. Interviews were performed with developers of an information system comprising mobile devices for drivers. From the interviews, a design of an artifact and a design theory based on a strategy to automate routine administration task using place awareness is presented. The eight components of IS design theory by Gregor and Jones is applied as a theoretical framework.

File-sharing has become synonym with the “digital economy” where large music conglomerates as well as certain artist voice strong concern over the impact on their bottom line. This research analyzes the music industry, which has been heavily impacted by a major technological shift i.e. the invention, and rollout, of the Internet. We look to the technological shift that has enabled the downloading phenomenon, as well as analyze the uniqueness of the music industries situation. By comparing the book publishing industry as well as the software industry, which are arguably also influenced by intellectual property rights and plagiarism, we try to find similarities as well as dissimilarities with the music industry. We find that the music industry has used alliances as well as Mergers and Acquisitions in order to consolidate their positions in an attempt to slow down change. There is no consensus on the exact extent of ill effects of file sharing. We point to an unwillingness to achieve convergence of purpose between the IT-community and the much of the music industry. Finally we point to the historical fact that consumers always get what they want in the end, which should indicate a need to find a viable e-commerce solution.

Public health surveillance and response to disease outbreaks is still a hurdle in many developing countries across sub-Saharan Africa. Pivotal in disease surveillance and response is the reliance on valid information, hence, the need for information which has high Information Quality (IQ) characteristics. A key issue with disease surveillance systems, stem from the diverse range of data sources with various levels of information quality that may affect the trustworthiness of the information. However, with the increasing diffusion of mobile phone technologies, there are opportunities to improve IQ. The aim of this study was to assess the information quality in data collected through a smartphone application. Based on qualitative data from interviews, workshop and system specifications, it was found that information quality improves with the use of smartphone applications but aspects such as user competence and trustworthiness, must be addressed to maximize the benefits of using mobile technologies for disease surveillance.

Background: Improved availability of mobile phones in low- and middle-income countries (LMICs) offer an opportunity to improve delivery of Community Case Management (CCM). Despite enthusiasm for introducing mHealth into healthcare across LMICs, end-user attitudes towards mHealth solutions for CCM are limited. We aimed to explore Health Surveillance Assistants' (HSAs) perceptions of the Supporting LIFE electronic CCM Application (SL eCCM App) and their experiences incorporating it as part of their clinical practice.

Methods: This exploratory qualitative study was part of a mixed methods feasibility study investigating whether children under-5 presenting to village clinics could be followed-up to collect patient outcome data. The convenience sample of 12 HSAs enrolled into the feasibility study participated in semi-structured interviews, which were conducted at village clinics after HSAs had field-tested the SL eCCM App over a 10-day period. Interviews explored HSAs perceptions of the SL eCCM App and their experiences in using the App in addition to paper CCM to assess and treat acutely unwell children. Open coding was used to label emerging concepts, which were iteratively defined and developed into six key themes.

Results: HSAs' perceived enhanced clinical decision-making, quality of CCM delivery, and work efficiency as opportunities associated with using the SL eCCM App. HSAs believed the inability to retrieve patient records,, cumbersome duplicate assessments/data entry study procedures, and inconsistencies between the SL eCCM App and paper-based CCM guidelines as challenges to implementation. Adding features to the App, such as, permitting communication between colleagues/supervisors, drug stock-out reporting, and community assessments, were identified as potentially supporting HSAs' many roles in the community.

Conclusion: This study identified opportunities and challenges associated with using the SL eCCM App in Malawi. This information can be used to inform future development and evaluation of the SL eCCM App, and similar mHealth solutions for CCM in Malawi and other developing countries.

BACKGROUND: The introduction of a paper-based Community Case Management (CCM) in Malawi has contributed to a reduction of child morbidity and mortality rates. In addition, the introduction of electronic Community Case Management (eCCM) (smartphones with built in CCM apps) may help to reduce the under-five mortality rates even further.

PURPOSE: It is not uncommon for Apps with a similar area of interest to develop different features to assist the end users. Such differences between Apps may have a significant role to play in its overall adoption and integration. The purpose of this research was to explore end users perspectives of two eCCM decision support tools developed and implemented by the Supporting LIFE project (SL eCCM App) and D-Tree International's (Mangologic eCCM App)in Northern Malawi.

METHODS: A mixed methods approach was applied, involving a survey of 109 users (106 Health Surveillance Assistants (HSAs), and 3 Integrated Management of Childhood Il6lnesses (IMCI) coordinators). This was followed up with semi-structured interviews with 34 respondents (31 HSAs, and 3 IMCI coordinators). Quantitative data was analyzed using SPSS version 20 where descriptive statistics and Chi-Squared tests were generated. Qualitative data were analyzed based on thematic analysis.

RESULTS: Participants reported that both Apps could assist the HSAs in the management of childhood illnesses. However, usability differed between the two apps where the Supporting LIFE eCCM App was found to be easier to use (61%) compared to the Mangologic eCCM App (4%). Both Apps were perceived to provide credible and accurate information.

CONCLUSION: It is essential that the quality of the data within Mobile Health (mHealth) Apps is high, however even Apps with excellent levels of data quality may not succeed if the overall usability of the App is low. Therefore it is essential that the Apps has high levels of data quality, usability and credibility. The results of this study will help inform mobile Health (mHealth) App designers in developing future eCCM Apps as well as researchers and policy makers when considering the adoption of mHealth solutions in the future in Malawi and other LMICs.

BACKGROUND: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi.

OBJECTIVE: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi.

METHODS: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ≥2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis.

RESULTS: A total of 6965 children were recruited-49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission).

CONCLUSIONS: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345.

Background: The global health community and funding agencies are currently engaged in ensuring that worthwhile research-based programmes are sustainable. Despite its importance, few studies have analysed the sustainability of global health interventions. In this paper, we aim to explore barriers and facilitators for the wider implementation and sustainability of a mobile health (mHealth) intervention (Supporting LIFE Community Case Management programme) in Malawi, Africa.

Methods: Between January and March 2017, a qualitative approach was used to carry out and analyse 13 in-depth semi-structured interviews with key stakeholders across all levels of healthcare provision in Malawi to explore their perceptions with regards to the implementation and sustainability of the mHealth programme. Data were analysed thematically by two reviewers.

Results: Overall, our analysis found that the programme was successful in achieving its goals. However, there are many challenges to the wider implementation and sustainability of this programme, including the absence of monetary resources, limited visibility outside the healthcare sector, the lack of integration with community-based and nationwide programmes, services and information and communication technologies, and the limited local capacity in relation to the maintenance, further development, and management.

Conclusions: Future developments should be aligned with the strategic goals and interests of the Ministry of Health and engage with national and international stakeholders to develop shared goals and strategies for nationwide scale-up. These developments should also focus on building local capacity by educating trainers and ensuring that training methods and guidelines are appropriately accredited based on national policies. Our findings provide a framework for a variety of stakeholders who are engaged in sustaining mHealth programmes in resource-poor settings and can be used to develop an evidence-based policy for the utilization of technology for healthcare delivery across developing countries.

BACKGROUND: There is evidence to suggest that frontline community health workers in Malawi are under-referring children to higher-level facilities. Integrating a digitized version of paper-based methods of Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospitalization rates, in two districts in Northern Malawi.

METHODS/DESIGN: This is a pragmatic, stepped-wedge cluster-randomized trial assessing the added value of the SL eCCM App on urgent referral, re-consultation and hospitalization rates of children aged 2 months and older to up to 5 years, within 7 days of the index visit. One hundred and two health surveillance assistants (HSAs) were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple, computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations and a cost evaluation determined the financial and time-related costs to caregivers of subsequent health care utilization. The trial was conducted between July 2016 and February 2017.

DISCUSSION: This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of children aged under 5 years. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other low- and middle-income countries.

TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02763345 . Registered on 3 May 2016.

Historically, organizations developed their information systems in-house. Today, a large portion of information systems development is based on the acquisition of pre-made information systems, so-called commercially off-the-shelf (COTS) systems. This approach for developing information systems requires new skills and methods supporting the process of evaluating and selecting information systems. This paper presents a method for selecting COTS systems. The method includes the following phases: problem framing, requirements and appraisal, and selection of systems. The idea and distinguishing feature behind the method is that improved understanding of organizational ‘ends’ or goals should govern the selection of a COTS system. This can also be expressed as a match or fit between ‘ends’ (e.g. improved organizational effectiveness) and ‘means’ (e.g. implementing COTS systems). This way of approaching the selection of COTS systems as viewing them as a ‘means’ to reach organizational ‘ends’ is different from the mainstream views of information systems development, namely the view that sees information systems development as a problem-solving process, and the underlying ontological view in other COTS selection methods, which focus on selection of functionality not reaching organizational ends.

Payments are central for society. Historically, it involved two parties exchanging goods and services for money. Today, payments, with increasing frequency, consist of digital representations of money that are transferred through globally intertwined network. Payments involve many parties such as payers, payment services providers, banks, central banks, telecom operators, mobile handset manufactures, and payees. The digitization of payments that occurs around the world, leads to the emergence of Digital Infrastructure (DI) that is characterized by the number and heterogeneity of included socio-technical components, relations, and their dynamic and unexpected interactions. DIs are IT solutions that frequently are the shared responsibility of an ecosystem, including private and governmental agencies. In consequence, development of DIs requires approaches that are different from the traditional systems development approaches. It is about modifying (changing and extending) a distributed installed base, shaping the evolution of DIs in desired directions. In this paper we inquiry into the possibilities for actors, such as governments, interested in the DI to influence its evolution towards specific ends. Specifically, through a case study of the payment infrastructure we identify and describe the role of legal and technical architectural control points. These control points are parts of an DI that have particular strategic importance, for example a monopolized gateway or a de jure mandatory standard for behavior or data interchange. 

INTRODUCTION: Community Case Management (CCM) aims to improve health outcomes among children under five with malaria, diarrhea, and pneumonia, but its effectiveness in Malawi is limited by inconsistent standards of delivery characteristic of paper-based interventions. This may lead to negative impacts on child health outcomes and inefficient use of health system resources. This study evaluated the acceptability and impact of the Supporting LIFE Community Case Management App (SL eCCM App) by Health Surveillance Assistants (HSAs) and caregivers in two districts of Northern Malawi.

METHODS: Data were collected through semi-structured interviews with HSAs and caregivers as part of a nested study within a larger trial. We used deductive and inductive approaches during data analysis. Relevant constructs were identified from the Consolidated Framework for Implementation Research and combined with emerging concepts from the data. The Framework Method was used to chart and explore data, leading to the development of themes.

RESULTS: Seventeen HSAs and 28 caregivers were interviewed. Participants were generally enthusiastic about the SL eCCM App. Nearly all HSAs expressed a preference for the App over routine paper-based CCM. Most HSAs claimed the App was more reliable and less error prone, facilitated more accurate diagnoses and treatment recommendations, and enhanced professional confidence and respect in the community. Some HSAs believed additional features would improve usability of the App, others identified mobile network or electricity shortages as barriers. Not all caregivers understood the purpose of the App, but most welcomed it as a health and technological advancement.

CONCLUSION: The SL eCCM App is acceptable to both HSAs and caregivers, and in most cases, preferred, as it was believed to foster improvements in CCM delivery. Our findings suggest that mobile health interventions for CCM, such as the SL eCCM App, may have potential to improve the effectiveness and efficiency of care to children under five.

There is a growing interest on Open Source Enterprise Resource Planning (OS-ERP) systems among organizations today. When developing ERP systems a major problem is requirements management. Proponents of open source development often claim it has a high level of involvement from users in adopting organizations. However, comparing with proprietary ERP development it is not that clear if users are more or less involved in OS-ERP development. User involvement in ERP requirement management is problematic and it makes development a complex endeavour. One problematic area is about identifying and selecting requirements for future development. In this paper we explore how requirements engineering is done in the OS-ERP area. To do this, we use a theoretical base on requirements management in the ERP field from which we investigate how requirement engineering in development of four different OS-ERP systems is done. The basic question asked is: How are requirements engineering done in Open Source ERP development. From the investigation we present a general picture of the requirements management process in the OS-ERP area. The main conclusion is that the requirement engineering in OS-ERP development does not differ a lot from proprietary ERP development, for example regarding end-users involvement it is found that they are not involved to the extent first expected and when comparing with proprietary ERP development a similarity regarding requirements engineering in both types of ERP development was discovered. 

Measuring adherence to clinical guidelines using mobile health (mHealth) technologies when form field validation is enforced or turned on could potentially be viewed as skewing the dataset, leading to 100% adherence to the clinical rule base. In theory, healthcare providers should fully abide by clinical guidelines, whether in paper or digital format, to ensure that the patient receives appropriate care. However, what happens when mHealth form field validation is turned off? As part of a feasibility study in Malawi, Africa, we explored this phenomenon. Switching off validation on the mHealth artefact served its purpose within the context of a feasibility study where a parallel paper-based clinical assessment process remained in place. The design of this technical artefact with the turnkey validation feature afforded us the opportunity to turn validation on and off seamlessly. Ultimately, from an ethical, clinical and technical perspective the optimum approach is to ensure that form field validation is switched on. With form field validation on adherence to the clinical guidelines is enforced which minimises incomplete assessment and the potential for suboptimal clinical decisions that could adversely affect patient care.