This paper reports the findings from a 4-year study on the UK National Health Service on the introduction of a national programme for information technology. 1 This is the largest civil IT programme worldwide at an estimated technical cost of d6.2 billion over a 10-year period. An institutional analysis of our historical and empirical data from six NHS organisations identifies growing fragmentation in the organisational field of healthcare, as past and present institutional logics both fuel and inhibit changes in the governance systems and working practices of healthcare practitioners. This is further complicated by new institutional logics that place the citizen at centre stage of the NPfIT, in a move to promote patient choice and public value.

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This article analyzes how new public financial management system should address the efficiency and effectiveness of the public sector and the emerging accrual basis accounting with e-governance for greater e-transparency on public-sector accounting in Sri Lanka. Despite the setting up of e-framework in 1983, the Sri Lankan public-sector accountancy environment during the last two decades raises concerns about efficiency, effectiveness, and accountability of the e-framework. The findings provide evidence of the importance of the economy and efficiency in the usage of public funds to provide more convenient access to government accounting information for citizens in Sri Lanka.

The technological development by the beginning of the 21st century is making it humanly impossible for unaided healthcare professionals to possess all the knowledge needed to deliver medical care with the efficacy and safety made possible by current scientific knowledge. Several healthcare organizations are adopting rigorous methods and technologies for KM as a potential solution to the knowledge predicament. However, awareness and understanding of such methods are not widespread with critics claiming that these technologies are not designed to be compatible with others neither are they interoperable. This paper describes an effort by the NHS for individuals, organizations and partners (commercial companies supplying services to the NHS) to demonstrate their belief in the importance of improving KM in medicine and show that this can be best achieved through collaboration and consensus. It looks at National Knowledge Service, set up to provide a range of services, through one or more open-access web sites. There is an asymmetry in most of the discussion of the field. KM, in this paper, is primarily discussed from the point of view of the user of medical knowledge. The motivation is seen to be the enhancement capabilities, and the utilization of knowledge to increase healthcare effectiveness.