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Nguyen KH, Comans T, Nguyen TT, Simpson D, Woods L, Wright C, Green D, McNeil K, Sullivan C. Cashing in: cost-benefit analysis framework for digital hospitals. BMC Health Serv Res 2024; 24:694. [PMID: 38822341 PMCID: PMC11143650 DOI: 10.1186/s12913-024-11132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND For many countries, especially those outside the USA without incentive payments, implementing and maintaining electronic medical records (EMR) is expensive and can be controversial given the large amounts of investment. Evaluating the value of EMR implementation is necessary to understand whether or not, such investment, especially when it comes from the public source, is an efficient allocation of healthcare resources. Nonetheless, most countries have struggled to measure the return on EMR investment due to the lack of appropriate evaluation frameworks. METHODS This paper outlines the development of an evidence-based digital health cost-benefit analysis (eHealth-CBA) framework to calculate the total economic value of the EMR implementation over time. A net positive benefit indicates such investment represents improved efficiency, and a net negative is considered a wasteful use of public resources. RESULTS We developed a three-stage process that takes into account the complexity of the healthcare system and its stakeholders, the investment appraisal and evaluation practice, and the existing knowledge of EMR implementation. The three stages include (1) literature review, (2) stakeholder consultation, and (3) CBA framework development. The framework maps the impacts of the EMR to the quadruple aim of healthcare and clearly creates a method for value assessment. CONCLUSIONS The proposed framework is the first step toward developing a comprehensive evaluation framework for EMRs to inform health decision-makers about the economic value of digital investments rather than just the financial value.
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Affiliation(s)
- Kim-Huong Nguyen
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tracy Comans
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Thi Thao Nguyen
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- School of the Environment, The University of Queensland, Brisbane, Australia.
| | - Digby Simpson
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Leanna Woods
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Chad Wright
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Keith McNeil
- Queensland Department of Health, Brisbane, Australia
| | - Clair Sullivan
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Service, Herston, Australia
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Zheng F, Wang K, Wang Q, Yu T, Wang L, Zhang X, Wu X, Zhou Q, Tan L. Factors Influencing Clinicians' Use of Hospital Information Systems for Infection Prevention and Control: Cross-Sectional Study Based on the Extended DeLone and McLean Model. J Med Internet Res 2023; 25:e44900. [PMID: 37347523 PMCID: PMC10337337 DOI: 10.2196/44900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Healthcare-associated infections have become a serious public health problem. Various types of information systems have begun to be applied in hospital infection prevention and control (IPC) practice. Clinicians are the key users of these systems, but few studies have assessed the use of infection prevention and control information systems (IPCISs) from their perspective. OBJECTIVE This study aimed to (1) apply the extended DeLone and McLean Information Systems Success model (D&M model) that incorporates IPC culture to examine how technical factors like information quality, system quality, and service quality, as well as organizational culture factors affect clinicians' use intention, satisfaction, and perceived net benefits, and (2) identify which factors are the most important for clinicians' use intention. METHODS A total of 12,317 clinicians from secondary and tertiary hospitals were surveyed online. Data were analyzed using partial least squares-structural equation modeling and the importance-performance matrix analysis. RESULTS Among the technical factors, system quality (β=.089-.252; P<.001), information quality (β=.294-.102; P<.001), and service quality (β=.126-.411; P<.001) were significantly related to user satisfaction (R2=0.833), use intention (R2=0.821), and perceived net benefits (communication benefits [R2=0.676], decision-making benefits [R2=0.624], and organizational benefits [R2=0.656]). IPC culture had an effect on use intention (β=.059; P<.001), and it also indirectly affected perceived net benefits (β=.461-.474; P<.001). In the importance-performance matrix analysis, the attributes of service quality (providing user training) and information quality (readability) were present in the fourth quadrant, indicating their high importance and low performance. CONCLUSIONS This study provides valuable insights into IPCIS usage among clinicians from the perspectives of technology and organization culture factors. It found that technical factors (system quality, information quality, and service quality) and hospital IPC culture have an impact on the successful use of IPCISs after evaluating the application of IPCISs based on the extended D&M model. Furthermore, service quality and information quality showed higher importance and lower performance for use intention. These findings provide empirical evidence and specific practical directions for further improving the construction of IPCISs.
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Affiliation(s)
- Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Kang Wang
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Qianning Wang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Tiantian Yu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Lu Wang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Qian Zhou
- Department of Hospital Infection Management, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Tan
- Tongji Hospital, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
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Akwaowo CD, Sabi HM, Ekpenyong N, Isiguzo CM, Andem NF, Maduka O, Dan E, Umoh E, Ekpin V, Uzoka FM. Adoption of electronic medical records in developing countries-A multi-state study of the Nigerian healthcare system. Front Digit Health 2022; 4:1017231. [PMID: 36479191 PMCID: PMC9720323 DOI: 10.3389/fdgth.2022.1017231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/28/2022] [Indexed: 08/29/2023] Open
Abstract
Electronic medical records (EMR) are extensively used in developed countries to manage patient records and facilitate consultations and follow-up of treatment. This has resulted in centralised databases where different services and clinicians can quickly access patient data to support healthcare delivery. However, adoption and usage of EMR in developing countries is not common and, in most cases, non-existent. Clinicians are dependent on patients keeping their own records manually with no centralised database to manage and control the patient medical history. The key objective of this study was to investigate the propensity of clinicians and senior management personnel in healthcare facilities to adopt EMR and evaluate the contextual factors that impact or impede adoption. Using Davis's technology adoption model extended with other factors, this study determined if contextual or situational factors are associated with barriers that impede adoption of EMRs in developing countries. Using a cross-sectional quantitative research approach, a questionnaire was designed to collect data across four states in the Niger Delta region of Nigeria. Stratified random sampling was used to select healthcare facilities that participated in the survey and selection of respondents from each healthcare facility. Data was collected by trained research assistants and a total of 1,177 valid responses were received and analysed using factor analysis and multiple regression analysis. The results from the analysis show that usefulness, critical success factors, awareness and relative advantage significantly influence clinicians' intention to adopt EMRs. Surprisingly, infrastructure availability was not statistically significant. Meanwhile, risk and data security both negatively influence adoption, indicating that user perception of risk and safety of their data decreases their propensity to adopt EMRs. The results from this study suggests that usefulness and anticipated success factors in facilitating operations within healthcare facilities have a great influence on user adoption of EMRs. Awareness, training and education of users on the effectiveness of EMRs and their usefulness will increase adoption. The results will be beneficial in helping government and healthcare leaders formulate policies that will guide and support adoption of EMR. Other policy recommendations and suggestions for future research were also proffered.
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Affiliation(s)
- Christie Divine Akwaowo
- Community Medicine Department, University of Uyo, Uyo, Nigeria
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
| | | | - Nnette Ekpenyong
- Community Health Department, University of Calabar, Calabar, Nigeria
| | | | - Nene Francis Andem
- Hopsital’s Management Board, Akwa Ibom State Ministry of Health, Uyo, Nigeria
| | - Omosivie Maduka
- Department of Preventive and Social Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Emem Dan
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Edidiong Umoh
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
- Fisheries and Aquaculture, University of Uyo, Uyo, Nigeria
| | - Victory Ekpin
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Faith-Michael Uzoka
- Department of Mathematics and Computing, Mount Royal University, Calgary, Alberta, Canada
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Alsyouf A, Ishak AK, Lutfi A, Alhazmi FN, Al-Okaily M. The Role of Personality and Top Management Support in Continuance Intention to Use Electronic Health Record Systems among Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191711125. [PMID: 36078837 PMCID: PMC9518177 DOI: 10.3390/ijerph191711125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 05/24/2023]
Abstract
This study examines nurses' Continuance Intention (CI) to use electronic health records (EHRs) through a combination of three conceptual frameworks: the Unified Theory of Acceptance and Use of Technology (UTAUT), the theory of expectation-confirmation (ECT), and the Five-Factor Model (FFM). A model is developed to examine and predict the determinants of nurses' CI to use EHRs, including top management support (TMS) and the FFM's five personality domains. Data were collected from a survey of 497 nurses, which were analyzed using partial least squares. No significant relationship was found between TMS and CI. The study revealed that performance expectancy significantly mediated the influences of two different hypotheses of two predictors: agreeableness and openness to testing CI. A significant moderating impact of conscientiousness was found on the relationship between performance expectancy and CI and the relationship between social influence and CI. The findings of this study indicated that rigorous attention to the personality of individual nurses and substantial TMS could improve nurses' CI to use EHRs. A literature gap was filled concerning the mediating effects of performance expectancy on the FFM-CI relationship, and the moderation effects of Conscientiousness on UTAUT constructs and CI are another addition to the literature. The results are expected to assist government agencies, health policymakers, and health institutions all over the globe in their attempts to understand the post-adoption use of EHRs.
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Affiliation(s)
- Adi Alsyouf
- Department of Managing Health Services and Hospitals, Faculty of Business Rabigh, College of Business (COB), King Abdulaziz University, Jeddah 21991, Saudi Arabia
| | - Awanis Ku Ishak
- School of Business Management, College of Business, University Utara Malaysia (UUM), Sintok 06010, Kedah Darul Aman, Malaysia
| | - Abdalwali Lutfi
- Department of Accounting, College of Business Administration, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Fahad Nasser Alhazmi
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Yang MH, Liu CY, Wang TJ, Lee YH, Ko SH, Chao SC, Lin HR. A Comparison of Two Cross-Sectional Studies on Successful Model of Introducing Nursing Information System in a Regional Teaching Hospital in Taiwan. Comput Inform Nurs 2022; 40:571-579. [PMID: 34740222 DOI: 10.1097/cin.0000000000000818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nursing information system introduction is an important measure for hospital nursing departments to promote the clinical practice of nursing with both efficiency and quality. A comparison of two cross-sectional study designs was adopted, and the information systems success model, as proposed by DeLone and McLean (2003), was used to explore the effectiveness of the six dimensions of system quality, information quality, service quality, use, user satisfaction, and net benefits at 6 and 12 months after the introduction launch of the nursing information system in hospitals. Multiple regression analysis was used across the two cross-sectional studies. The research results found that the nursing information system conformed to the information systems success model, and half a year to 1 year after the introduction of the nursing information system, use affected the nursing information system net benefits via the mediator variable of user satisfaction; however, the effect of full mediation changed to partial mediation effect with time. The research results can be used as a reference for hospitals and nursing administrators for the newly developed nursing information system.
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Affiliation(s)
- Meei-Horng Yang
- Author Affiliations: PhD Program, School of Nursing, National Taipei University of Nursing and Health Sciences (Mrs Yang), Taipei; Department of External Affairs, Wei Gong Memorial Hospital (Mrs Yang), Miaoli; Biostatistical Consultant Lab and Department of Speech Language Pathology and Audiology (Dr Liu) and School of Nursing (Dr Lin and Dr Wang), National Taipei University of Nursing and Health Sciences, Taipei; Department of Nursing, China Medical University Hsinchu Hospital (Mrs Lee), HsinChu; Department of Nursing, Wei Gong Memorial Hospital (Ms Chao), Miaoli; and Department of Nursing, Chong Ren Hospital (Mrs Ko), Miaoli, Taiwan
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Krick T. Evaluation frameworks for digital nursing technologies: analysis, assessment, and guidance. An overview of the literature. BMC Nurs 2021; 20:146. [PMID: 34404406 PMCID: PMC8369663 DOI: 10.1186/s12912-021-00654-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The evaluation of digital nursing technologies (DNT) plays a major role in gaining knowledge about certain aspects of a technology such as acceptance, effectiveness, or efficiency. Evaluation frameworks can help to classify the success or failure of a DNT or to further develop the technology. In general, there are many different evaluation frameworks in the literature that provide overviews of a wide variety of aspects, which makes this a highly diverse field and raises the question how to select a suitable framework. The aim of this article is to provide orientation in the field of comprehensive evaluation frameworks that can be applied to the field of DNT and to conduct a detailed analysis and assessment of these frameworks to guide field researchers. Methods This overview was conducted using a three-component search process to identify relevant frameworks. These components were (1) a systematized literature search in PubMed; (2) a narrative review and (3) expert consultations. Data relating to the frameworks’ evaluation areas, purpose, perspectives, and success definitions were extracted. Quality criteria were developed in an expert workshop and a strength and weakness assessment was carried out. Results Eighteen relevant comprehensive evaluation frameworks for DNT were identified. Nine overarching evaluation areas, seven categories of purposes, five evaluation perspectives and three categories of success definitions could be identified. Eleven quality criteria for the strengths and weaknesses of DNT-related evaluation frameworks were developed and the included frameworks were assessed against them. Conclusion Evaluators can use the concise information and quality criteria of this article as a starting point to select and apply appropriate DNT evaluation frameworks for their research projects or to assess the quality of an evaluation framework for DNT, as well as a basis for exploring the questions raised in this article. Future research could address gaps and weaknesses in existing evaluation frameworks, which could improve the quality of future DNT evaluations. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00654-8.
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Affiliation(s)
- Tobias Krick
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 3, 28359, Bremen, Germany. .,University of Bremen, High-profile Area of Health Sciences, Bremen, Germany.
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Measures of success of computerized clinical decision support systems: An overview of systematic reviews. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Implementing an Integrated Large-Scale Clinical Information System for ISSSTE's Hospital Network in Mexico. ACTA ACUST UNITED AC 2021; 3:444-453. [PMID: 33521563 PMCID: PMC7826294 DOI: 10.1007/s42399-020-00713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/26/2022]
Abstract
The Institute for Security and Social Services for State Workers (ISSSTE) is a large public provider of health care services that serve around 13.2 million Mexican government workers and their families. To attain process efficiencies, cost reductions, and improvement of the quality of diagnostic and imaging services, ISSSTE was set out in 2019 to create a digital filmless medical image and report management system. A large-scale clinical information system (CIS), including radiology information system (RIS), picture archiving and communication system (PACS), and clinical data warehouse (CDW) components, was implemented at ISSSTE's network of forty secondary- and tertiary-level public hospitals, applying global HL-7 and Digital Imaging and Communications in Medicine (DICOM) standards. In just 5 months, 40 hospitals had their endoscopy, radiology, and pathology services functionally interconnected within a national CIS and RIS/PACS on secure private local area networks (LANs) and a secure national wide area network (WAN). More than 2 million yearly studies and reports are now in digital form in a CDW, securely stored and always available. Benefits include increased productivity, reduced turnaround times, reduced need for duplicate exams, and reduced costs. Functional IT solutions allow ISSSTE hospitals to leave behind the use of radiographic film and printed medical reports with important cost reductions, as well as social and environmental impacts, leading to direct improvement in the quality of health care services rendered. Supplementary Information The online version of this article (10.1007/s42399-020-00713-2) contains supplementary material, which is available to authorized users.
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Ngugi P, Babic A, Kariuki J, Santas X, Naanyu V, Were MC. Development of standard indicators to assess use of electronic health record systems implemented in low-and medium-income countries. PLoS One 2021; 16:e0244917. [PMID: 33428656 PMCID: PMC7799790 DOI: 10.1371/journal.pone.0244917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/20/2020] [Indexed: 12/04/2022] Open
Abstract
Background Electronic Health Record Systems (EHRs) are being rolled out nationally in many low- and middle-income countries (LMICs) yet assessing actual system usage remains a challenge. We employed a nominal group technique (NGT) process to systematically develop high-quality indicators for evaluating actual usage of EHRs in LMICs. Methods An initial set of 14 candidate indicators were developed by the study team adapting the Human Immunodeficiency Virus (HIV) Monitoring, Evaluation, and Reporting indicators format. A multidisciplinary team of 10 experts was convened in a two-day NGT workshop in Kenya to systematically evaluate, rate (using Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) criteria), prioritize, refine, and identify new indicators. NGT steps included introduction to candidate indicators, silent indicator ranking, round-robin indicator rating, and silent generation of new indicators. 5-point Likert scale was used in rating the candidate indicators against the SMART components. Results Candidate indicators were rated highly on SMART criteria (4.05/5). NGT participants settled on 15 final indicators, categorized as system use (4); data quality (3), system interoperability (3), and reporting (5). Data entry statistics, systems uptime, and EHRs variable concordance indicators were rated highest. Conclusion This study describes a systematic approach to develop and validate quality indicators for determining EHRs use and provides LMICs with a multidimensional tool for assessing success of EHRs implementations.
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Affiliation(s)
- Philomena Ngugi
- Department of Information Science and Media studies, University of Bergen, Bergen, Norway
- Institute of Biomedical Informatics, Moi University, Eldoret, Kenya
- * E-mail:
| | - Ankica Babic
- Department of Information Science and Media studies, University of Bergen, Bergen, Norway
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - James Kariuki
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Xenophon Santas
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Martin C. Were
- Institute of Biomedical Informatics, Moi University, Eldoret, Kenya
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Pfeuffer N, Penndorf P, Hoffmann W, van den Berg N. Current Developments in Electronic Health Records. SYSTEMS MEDICINE 2021. [DOI: 10.1016/b978-0-12-801238-3.11662-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Scott IA, Sullivan C, Staib A. Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation. AUST HEALTH REV 2020; 43:302-313. [PMID: 29792259 DOI: 10.1071/ah17153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/29/2018] [Indexed: 11/23/2022]
Abstract
Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.
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Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Clair Sullivan
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Andrew Staib
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
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Morquin D. [Legitimate resistance without technophobia: Analysis of electronic medical records impacts on the medical profession]. Rev Med Interne 2020; 41:617-621. [PMID: 32467002 DOI: 10.1016/j.revmed.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/09/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
The objective of this short narrative literature review is to highlight the different difficulties encountered by medical doctor in the daily use of EMR. We show that these are not simple transitional phenomena related to a "resistance to change", but rather the fact of a deeper and unfinished transformation. Beyond the "perception of misfit with work processes" or the threat of a loss of autonomy, we propose to analyze this so-called "resistance" in relation to the formalization of medical work induced by EMR. Our question concerns the compatibility of the multiple objectives of EMR, the potential influence of computerization on the steps of entering and consulting medical information, the impact on the clinical reasoning, the reality of assistance to medical "performance". The question is not so much what EMRs do less well than the paper record, but to provide insights into how tomorrow's EMRs will do better than today's.
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Affiliation(s)
- D Morquin
- Département des Maladies Infectieuses et Tropicales - CHU de Montpellier, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier, France; Délégation à l'Usage clinique du Numérique, CHU de Montpellier - Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier, France.
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Abdulhamid NG, Ayoung DA, Kashefi A, Sigweni B. A survey of social media use in emergency situations: A literature review. INFORMATION DEVELOPMENT 2020. [DOI: 10.1177/0266666920913894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study reviews literature on the use of Social Media (SM) in emergency response operations while identifying gaps in this research stream that need attention from Information Systems (IS) researchers. The research is grounded in past works and attempts to build on research on the application of SM in emergencies. It focuses on understanding the role of SM in the prevention, management and response to emergencies. The review contains a detailed literature exposition of IS and disasters journals. The appraisal of such research stream led the review to focus on the concept of digital volunteerism as an offshoot of crowdsourcing initiatives. Findings from the review reveal that previous studies overlooked the interfacing challenges between formal and traditional aid agencies on one hand and digital humanitarians on the other. Consequently, we identify gaps in the extant literature and propose areas of interest for future research.
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Affiliation(s)
| | | | | | - Boyce Sigweni
- Botswana International University of Science and Technology (BIUST)
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Lindberg MH, Venkateswaran M, Abu Khader K, Awwad T, Ghanem B, Hijaz T, Mørkrid K, Frøen JF. eRegTime, Efficiency of Health Information Management Using an Electronic Registry for Maternal and Child Health: Protocol for a Time-Motion Study in a Cluster Randomized Trial. JMIR Res Protoc 2019; 8:e13653. [PMID: 31392962 PMCID: PMC6702800 DOI: 10.2196/13653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Paper-based routine health information systems often require repetitive data entry. In the West Bank, the primary health care system for maternal and child health was entirely paper-based, with care providers spending considerable amounts of time maintaining multiple files and client registers. As part of the phased national implementation of an electronic health information system, some of the primary health care clinics are now using an electronic registry (eRegistry) for maternal and child health. The eRegistry consists of client-level data entered by care providers at the point-of-care and supports several digital health interventions that are triggered by the documented clinical data, including guideline-based clinical decision support and automated public health reports. OBJECTIVE The aim of the eRegTime study is to investigate whether the use of the eRegistry leads to changes in time-efficiency in health information management by the care providers, compared with the paper-based systems. METHODS This is a substudy in a cluster randomized controlled trial (the eRegQual study) and uses the time-motion observational study design. The primary outcome is the time spent on health information management for antenatal care, informed and defined by workflow mapping in the clinics. We performed sample size estimations to enable the detection of a 25% change in time-efficiency with a 90% power using an intracluster correlation coefficient of 0.1 and an alpha of .05. We observed care providers for full workdays in 24 randomly selected primary health care clinics-12 using the eRegistry and 12 still using paper. Linear mixed effects models will be used to compare the time spent on health information management per client per care provider. RESULTS Although the objective of the eRegQual study is to assess the effectiveness of the eRegistry in improving quality of antenatal care, the results of the eRegTime study will contribute to process evaluation, supplementing the findings of the larger trial. CONCLUSIONS Electronic health tools are expected to reduce workload for the care providers and thus improve efficiency of clinical work. To achieve these benefits, the implementation of such systems requires both integration with existing workflows and the creation of new workflows. Studies assessing the time-efficiency of electronic health information systems can inform policy decisions for implementations in resource-limited low- and middle-income settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13653.
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Affiliation(s)
- Marie Hella Lindberg
- Faculty of Health Sciences, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Khadija Abu Khader
- Palestinian National Institute of Public Health, World Health Organization, Al-Bireh, Occupied Palestinian Territory
| | - Tamara Awwad
- Palestinian National Institute of Public Health, World Health Organization, Al-Bireh, Occupied Palestinian Territory
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, World Health Organization, Al-Bireh, Occupied Palestinian Territory
| | - Taghreed Hijaz
- Ministry of Health, Ramallah, Occupied Palestinian Territory
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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Yu X, Han W, Jiang J, Wang Y, Xin S, Wu S, Sun H, Wang Z, Zhao Y. Key Issues in the Development of an Evidence-Based Stratified Surgical Patient Safety Improvement Information System: Experience From a Multicenter Surgical Safety Program. J Med Internet Res 2019; 21:e13576. [PMID: 31237241 PMCID: PMC6613327 DOI: 10.2196/13576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/18/2019] [Accepted: 05/18/2019] [Indexed: 01/04/2023] Open
Abstract
Surgery is still far from being completely safe and reliable. Surgical safety has, therefore, been the focus of considerable attention over the last few decades, and there are a growing number of national drives to improve it. There are also a number of large surgical complication reporting systems and system-based interventions, both of which have made remarkable progress in the past two decades. These systems, however, have either mainly focused on reporting complications and played a limited role in guiding practice or have provided nonselective interventions to all patients, perhaps imposing unnecessary burdens on frontline medical staff. We have, therefore, developed an evidence-based stratified surgical safety information system based on a multicenter surgical safety improvement program. This study discusses some critical issues in the process of developing this information system, including (1) decisions about data gathering, (2) establishing and sharing knowledge, (3) developing functions for the system, (4) system implementation, and (5) evaluation and continuous improvement. Using examples drawn from the surgical safety improvement program, we have shown how this type of system can be fitted into day-to-day clinical practice and how it can guide medical practice by incorporating inherent patient-related risk and providing tailored interventions for patients with different levels of risk. We concluded that multidisciplinary collaboration, involving experts in health care (including senior staff in surgery, nursing, and anesthesia), data science, health care management, and health information technology, can help build an evidence-based stratified surgical patient safety improvement system. This can provide an information-intensified surgical safety learning platform and, therefore, benefit surgical patients by delivering tailored interventions and an integrated workflow.
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Affiliation(s)
- Xiaochu Yu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Science, Beijing, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Science, Beijing, China
| | - Yipeng Wang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shijie Xin
- The First Hospital of China Medical University, Shenyang, China
| | - Shizheng Wu
- Qinghai Provincial People's Hospital, Xining, China
| | - Hong Sun
- Xiangya Hospital, Central South University, Changsha, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Science, Beijing, China
| | - Yupei Zhao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Nadar M, Jouvet P, Tucci M, Toledano B, Cyr M, Sicotte C. The implementation of a synchronous telemedicine platform linking off-site pediatric intensivists and on-site fellows in a pediatric intensive care unit: A feasibility study. Int J Med Inform 2019; 129:219-225. [PMID: 31445259 DOI: 10.1016/j.ijmedinf.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/02/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility of implementing a synchronous telemedicine platform in a pediatric intensive care unit (STEP-PICU). METHOD A prospective mixed study was conducted. Two sources of data were mobilised: a survey with structured questionnaires and direct non-intrusive observation. The study site was the PICU of a university hospital. Users' perceptions of six aspects of the STEP-PICU were studied: telemedicine system quality, data quality, quality of technical support, use of the new system, overall satisfaction and system benefits. RESULTS During the 6-month experimentation period, use of the telemedicine platform was rather limited and fell short of the promoter's expectations.The mean scores for the six user perception dimensions were low, with no differences between the two groups of users. A Mann-Whitney test showed that being an off-site pediatric intensivist or on-site fellow did not make a statistically significant difference in responses on system quality (p = .518), data quality (p = 1.00), quality of technical support (p = 1.00), system use (p = .556), overall satisfaction (p = .482), or benefits (p = .365). The low use of the STEP-PICU was attributed to three root causes: human factors, the platform's functionalities, and technical problems. DISCUSSION The synchronous telemedicine service for PICU was feasible but would need good pre-implementation preparation to be truly helpful. Its usefulness during the night shift and holiday on-call periods was scored as low by the off-site pediatric intensivists and the on-site fellows. It would appear that such a service could be more beneficial for communications with other remote healthcare facilities, where there is a greater need for the expertise of a pediatric critical care intensivist.
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Affiliation(s)
- Mahmoud Nadar
- Department of Nursing and Health Sciences, Université du Québec en Outaouais, C.P. 1250, Succursale Hull, Gatineau, Quebec, J8X 3X7, Canada; Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, 7101 Park Ave, Montreal, Québec, H3N1X9, Canada; Public Health Research Institute of the University of Montreal, 7101 Park Ave, Montreal, Québec, H3N1X9, Canada.
| | - Philippe Jouvet
- Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine University Hospital, 3175 Chemin de la côte-Sainte-Catherine, Montreal, Québec, H3T1C5, Canada.
| | - Marisa Tucci
- Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine University Hospital, 3175 Chemin de la côte-Sainte-Catherine, Montreal, Québec, H3T1C5, Canada.
| | - Baruch Toledano
- Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine University Hospital, 3175 Chemin de la côte-Sainte-Catherine, Montreal, Québec, H3T1C5, Canada.
| | - Martin Cyr
- Department of Biomedical Engineering, Sainte-Justine University Hospital, 3175 Chemin de la côte-Sainte-Catherine, Montreal, Québec, H3T1C5, Canada.
| | - Claude Sicotte
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, 7101 Park Ave, Montreal, Québec, H3N1X9, Canada; Public Health Research Institute of the University of Montreal, 7101 Park Ave, Montreal, Québec, H3N1X9, Canada.
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Shahzad K, Jianqiu Z, Sardar T, Hafeez M, Shaheen A, Wang L. Hospital information-system (HIS) acceptance: A physician’s stance. HUMAN SYSTEMS MANAGEMENT 2019. [DOI: 10.3233/hsm-180415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Khuram Shahzad
- School of Economics and Management, Beijing University of Posts and Telecommunications, People’s Republic of China
| | - Zeng Jianqiu
- School of Economics and Management, Beijing University of Posts and Telecommunications, People’s Republic of China
| | - Taiba Sardar
- School of Economics and Management, Beijing University of Posts and Telecommunications, People’s Republic of China
| | - Muhammad Hafeez
- School of Economics and Management, Beijing University of Posts and Telecommunications, People’s Republic of China
| | - Aliya Shaheen
- School of Economics and Management, Beijing University of Posts and Telecommunications, People’s Republic of China
| | - Lei Wang
- School of Economics and Management, Beijing University of Posts and Telecommunications, People’s Republic of China
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Almutairi BA, Potts HWW, Al-Azmi SF. Physicians' Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres. Sultan Qaboos Univ Med J 2019; 18:e476-e482. [PMID: 30988966 DOI: 10.18295/squmj.2018.18.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/19/2018] [Accepted: 10/11/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to evaluate physicians' perceptions of electronic prescribing in Kuwaiti primary healthcare centres. Methods This cross-sectional study was conducted between June and August 2017 among 368 physicians from 25 primary healthcare centres in Kuwait. Data were collected from the participants using a self-reported questionnaire, including sociodemographic characteristics, previous experience with computers and awareness, knowledge and use of e-prescribing systems and their functional features. In addition, perceptions of the benefits and levels of satisfaction associated with e-prescribing were explored. Results A total of 306 physicians completed the survey (response rate: 83%). The majority had positive perceptions regarding the use of e-prescribing, particularly in terms of time-savings (86%), healthcare quality (84%), productivity (80%) and clinical workflow and efficiency (83%). However, many respondents indicated that e-prescribing systems required additional improvements in terms of functionality. Conclusion Most physicians in primary healthcare centres in Kuwait recognised the importance of e-prescribing to improve the quality of patient care, streamline workflow, increase productivity and reduce medical errors. However, there is a need to improve the design and infrastructure of e-prescribing systems, which may aid in the adoption of such systems in Kuwait.
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Affiliation(s)
- Bashair A Almutairi
- Department of Medical Records, College of Health Sciences, Public Authority of Applied Education & Training, Kuwait City, Kuwait
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - Saadoun F Al-Azmi
- Department of Medical Records, College of Health Sciences, Public Authority of Applied Education & Training, Kuwait City, Kuwait
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19
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Zozus MN, Penning M, Hammond WE. Factors impacting physician use of information charted by others. JAMIA Open 2019; 2:107-114. [PMID: 30976757 PMCID: PMC6447025 DOI: 10.1093/jamiaopen/ooy041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/30/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022] Open
Abstract
Objectives To identify factors impacting physician use of information charted by others. Materials and methods A 4-round Delphi process was conducted with physicians and non-physicians publishing in the healthcare data quality literature to identify and characterize factors impacting physician use of information charted by others (other people or devices), either within or external to their organization. Factors with high average importance and reliability were categorized according to similarity of topic. Results Thirty-nine factors were ultimately identified as impacting physician use of information charted by others. Five categories of factors included aspects of: the information source, the information itself, the information user, the information system, and aspects of healthcare as an institution. In addition, 4 themes were identified: (1) value of narrative text in providing context, (2) importance of mental models and personal heuristics in deciding whether, and how to use information, (3) loss of confidence in, and decreased use of information due to errors encountered, and (4) existence of a trust hierarchy potentially influencing information use. Discussion Five similarly focused studies have recently probed clinician willingness to use information in decision-making. Our results mostly confirmed factors identified by prior studies, and uniquely identified aspects of the information user as important. Conclusion According to the participants in this study, information quality is prominent among factors impacting physician use of information charted by others. Based on this and similar studies, it appears that despite concerns about information quality, physicians use information charted by others.
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Affiliation(s)
- Meredith N Zozus
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melody Penning
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - William E Hammond
- Duke University Center for Health Informatics, Durham, North Carolina, USA
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20
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Danovaro-Holliday MC, Contreras MP, Pinto D, Molina-Aguilera IB, Miranda D, García O, Velandia-Gonzalez M. Assessing electronic immunization registries: the Pan American Health Organization experience. Rev Panam Salud Publica 2019; 43:e28. [PMID: 31093252 PMCID: PMC6519664 DOI: 10.26633/rpsp.2019.28] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/13/2018] [Indexed: 11/24/2022] Open
Abstract
Objective. To develop a methodology to assess electronic immunization registries (EIRs) in low- and middle-income countries (LMICs) in Latin America and the Caribbean. Methods. A team from the Immunization Unit at the Pan American Health Organization (PAHO) reviewed existing methodologies to evaluate health information systems, particularly the Performance of Routine Information System Management (PRISM) framework and methodologies used to assess information systems. In 2014, the PAHO team convened a small working group to develop an evaluation approach to be added to the existing World Health Organization immunization data quality self-assessment (DQS) tool. The resulting DQS with an added EIR component was named “DQS Plus.” The DQS Plus methodology was used in Panama in May 2014 and in Honduras in November 2015. Results. The DQS Plus tool proved feasible and easy to implement in Panama and Honduras, including by not adding much time or resources to those needed for a usual DQS. The information obtained from the DQS Plus assessment was practical and helped provide health authorities with recommendations to update and improve their EIR, strengthen the use of the registry, and enhance the data the assessment produced, at all levels of the health system. These recommendations are currently being implemented in the two countries. Conclusions. The DQS Plus proved to be a practical and useful approach for assessing an EIR in an LMIC and generating actionable recommendations. Further work on defining operational and related EIR functional standards in LMICs will help develop an improved EIR assessment tool for Latin America and the Caribbean, and potentially elsewhere.
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Affiliation(s)
- M Carolina Danovaro-Holliday
- World Health Organization Department of Immunization, Vaccines and Biologicals Expanded Programme on Immunization Strategic information Group Geneva Switzerland Strategic information Group, Expanded Programme on Immunization, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marcela P Contreras
- Comprehensive Family Immunization Unit Comprehensive Family Immunization Unit Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Comprehensive Family Immunization Unit, Washington, D.C., United States of America
| | - Dalys Pinto
- Programa Ampliado de Inmunización Programa Ampliado de Inmunización Ministerio de Salud de la República de Panamá Panamá Panamá Ministerio de Salud de la República de Panamá, Programa Ampliado de Inmunización, Panamá, Panamá
| | - Ida Berenice Molina-Aguilera
- Centro Nacional de Biológicos Centro Nacional de Biológicos Secretaría de Salud de Honduras TegucigalpaFrancisco Morazán Honduras Secretaría de Salud de Honduras, Centro Nacional de Biológicos, Tegucigalpa, Francisco Morazán, Honduras
| | - Diana Miranda
- Región de San Miguelito - San Miguelito Salud Región de San Miguelito - San Miguelito Salud Panamá Panamá Región de San Miguelito - San Miguelito Salud, Panamá, Panamá
| | - Odalys García
- Pan American Health Organization Pan American Health Organization Tegucigalpa Honduras Pan American Health Organization, Tegucigalpa, Honduras
| | - Martha Velandia-Gonzalez
- Comprehensive Family Immunization Unit Comprehensive Family Immunization Unit Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Comprehensive Family Immunization Unit, Washington, D.C., United States of America
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Bahadori M, Teymourzadeh E, Ravangard R, Saadati M. Accreditation effects on health service quality: nurse viewpoints. Int J Health Care Qual Assur 2019; 31:697-703. [PMID: 30354888 DOI: 10.1108/ijhcqa-07-2017-0126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to determine accreditation effects on Iranian military hospital health service quality through nurses' viewpoints. DESIGN/METHODOLOGY/APPROACH The paper is a cross-sectional questionnaire-based study. Sampling drew from a hospital nurse census ( n=160). Descriptive statistics were used to analyze participant demographics and nurses' views. Linear regression analysis determined the independent variables' overall effect on the accreditation quality results dimension (dependent variable). FINDINGS From the nurses' viewpoints, accreditation effects on services quality mean score was 3.60±0.61. Linear regression analysis showed that leadership and quality management were identified as the most important accreditation quality predictors. The R2 value (0.698) showed that nearly 70 percent of the dependent variable changes were affected by the independent variables. PRACTICAL IMPLICATIONS This study gives hospital managers a deeper insight into accreditation and its effects on military hospital service quality. Military hospitals benefit from military organization such as hierarchy and command chain, so managers should employ these characteristics to adopt appropriate policies to promote human resource management as a competitive advantage. Furthermore, results will guide public and private hospital managers on how to manage organizational variables that benefit from accreditation. ORIGINALITY/VALUE Accreditation was introduced as a hospital quality improvement program. However, implementing accreditation programs should be cost-effective. Hospital managers and employees should feel that accreditation can improve service quality. Nurses had positive viewpoints about accreditation and its effects on military hospital service quality.
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Affiliation(s)
- Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences , Tehran, Iran
| | - Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences , Tehran, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Mohammad Saadati
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences , Tabriz, Iran
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Markazi-Moghaddam N, Kazemi A, Alimoradnori M. Using the importance-performance analysis to improve hospital information system attributes based on nurses’ perceptions. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Robbins T, Lim Choi Keung SN, Sankar S, Randeva H, Arvanitis TN. Diabetes and the direct secondary use of electronic health records: Using routinely collected and stored data to drive research and understanding. Digit Health 2018; 4:2055207618804650. [PMID: 30305917 PMCID: PMC6176528 DOI: 10.1177/2055207618804650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Electronic health records provide an unparalleled opportunity for the use of
patient data that is routinely collected and stored, in order to drive
research and develop an epidemiological understanding of disease. Diabetes,
in particular, stands to benefit, being a data-rich, chronic-disease state.
This article aims to provide an understanding of the extent to which the
healthcare sector is using routinely collected and stored data to inform
research and epidemiological understanding of diabetes mellitus. Methods Narrative literature review of articles, published in both the medical- and
engineering-based informatics literature. Results There has been a significant increase in the number of papers published,
which utilise electronic health records as a direct data source for diabetes
research. These articles consider a diverse range of research questions.
Internationally, the secondary use of electronic health records, as a
research tool, is most prominent in the USA. The barriers most commonly
described in research studies include missing values and misclassification,
alongside challenges of establishing the generalisability of results. Discussion Electronic health record research is an important and expanding area of
healthcare research. Much of the research output remains in the form of
conference abstracts and proceedings, rather than journal articles. There is
enormous opportunity within the United Kingdom to develop these research
methodologies, due to national patient identifiers. Such a healthcare
context may enable UK researchers to overcome many of the barriers
encountered elsewhere and thus to truly unlock the potential of electronic
health records.
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Affiliation(s)
- Tim Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Sailesh Sankar
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Lepore L, Metallo C, Schiavone F, Landriani L. Cultural orientations and information systems success in public and private hostitals: preliminary evidences from Italy. BMC Health Serv Res 2018; 18:554. [PMID: 30012127 PMCID: PMC6048904 DOI: 10.1186/s12913-018-3349-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background The effective adoption and use of digital and computerized systems and records in hospitals are crucial for increasing the overall quality, safety and outcomes of any national health community. Prior research found that hospitals’ dominant cultural orientation affects the adoption of new technology. However, the organizational culture of hospitals can greatly vary between public and private hospitals. Thus, the ownership type of the hospital is likely to affect, to some extent, the aforementioned relationship between culture and information system success. The present article focuses in detail on this issue and attempts to answer the following research question: which cultural orientations are promoting information system success in public and private hospitals? Methods The authors develop and test two hypotheses about this relationship via two regression approaches (single-level and multi-level). The authors collected data from 172 respondents—clinicians and non-clinicians—working in two (one public and one private) hospitals in Campania, one of the largest regions in Italy. Results The findings of this study show clear differences between private and public hospitals. First, a dominant cultural orientation that emphasizes flexibility values (clan and adhocracy cultures) positively influences information systems success in terms of individual impact. Second, the influence of a clan orientation on individual impact is stronger in the public hospital. Third, the influence of an adhocracy orientation is stronger in the private hospital. Overall, the type of ownership—either public or private—of these healthcare organizations affects the link between cultural orientations and IS success. Conclusion Managers of private hospitals should offer to their employees the opportunity to adopt and implement new information systems processes driven by openness towards the external environment in order to benchmark and learn from what was done previously in other organizations. Managers of public hospitals should set up human resource management practices, knowledge creation mechanisms, and internal communication capable of generating a friendly learning environment for their employees when adopting new technology.
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Affiliation(s)
- Luigi Lepore
- Department of Law, University of Naples Parthenope, Naples, Italy
| | - Concetta Metallo
- Department of Science and Technology, University of Naples Parthenope, Centro Direzionale -Isola C4, 80143, Naples, Italy.
| | - Francesco Schiavone
- Department of Management Studies & Quantitative Methods, University of Naples Parthenope, Naples, Italy.,Department of Strategy and Management, Paris School of Business, Paris, France
| | - Loris Landriani
- Department of Management, Accounting and Economics, University of Naples Parthenope, Naples, Italy
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End-user support for primary care electronic medical records: a qualitative case study of users' needs, expectations and realities. Health Syst (Basingstoke) 2017. [PMID: 26225209 DOI: 10.1057/hs.2013.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Support is considered an important factor for realizing the benefits of health information technology (HIT) but there is a dearth of research on the topic of support, especially in primary care. We conducted a qualitative multiple case study of 4 family health teams (FHTs) and one family health organization (FHO) in Ontario, Canada in an attempt to gain insight into users' expectations and needs, and the realities of end-user support for primary care electronic medical records (EMRs). Data were collected by semi-structured interviews, documents review, and observation of training sessions. The analysis highlights the important role of on-site information technology (IT) staff and super-users in liaising with various stakeholders to solve technical problems and providing hardware and functional ('how to') support; the local development of data support practices to ensure consistent documentation; and the gaps that exist in users' and support personnel's understanding of each other's work processes.
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Nguyen L, Wickramasinghe N, Redley B, Haddad P, Muhammad I, Botti M. Exploring nurses’ reactions to electronic nursing documentation at the point of care. INFORMATION TECHNOLOGY & PEOPLE 2017. [DOI: 10.1108/itp-10-2015-0269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to investigate nurses’ attitudes, perceptions, and reactions to a new point-of-care information system for documenting nursing care.
Design/methodology/approach
A design science research methodology (DSRM) was used to examine the feasibility and usability of a novel nursing informatics solution in the context of acute hospital care. Data were collected using focus groups and non-participant observations. Analyses were guided by the theoretical lens of actor-network theory (ANT).
Findings
The findings unpack an understanding of the potential value of a new technology, rather than a binary understanding of positive or negative value. Using the ANT lens, the study reveals the dynamics of the nurse-technology relationships and consequent disruptions throughout the translation process. The findings highlight the central role of negotiation in the socio-technical construction of the hybrid actor-network during the implementation of new technology in acute hospital contexts.
Research limitations/implications
Further studies are needed to investigate the dynamics and complexity of the translation process that occurs during technology adoption, reactions of the involved actors to the emerging network and impacts on their role and work process.
Practical implications
Engaging nurses early during development and testing; aligning the new system’s functionality and interface with nurses’ interests and work practices; and supporting changes to clinical work process to enable an effective heterogeneous actor-network to emerge and become stable.
Originality/value
This study presents a novel use of ANT in a DSRM to understand an enterprise-wide system involving nurses and real clinical settings. The emerged actor-network provides insights into the translation process when nurses adapt to using new technology in their work.
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Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A'Court C, Hinder S, Fahy N, Procter R, Shaw S. Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res 2017; 19:e367. [PMID: 29092808 PMCID: PMC5688245 DOI: 10.2196/jmir.8775] [Citation(s) in RCA: 883] [Impact Index Per Article: 126.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/08/2017] [Accepted: 09/23/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. OBJECTIVE Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. METHODS The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs-video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing-using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. RESULTS The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. CONCLUSIONS Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.
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Affiliation(s)
- Trisha Greenhalgh
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jennifer Lynch
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Gemma Hughes
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Christine A'Court
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan Hinder
- RAFT Research and Consulting Ltd, Clitheroe, Lancs, United Kingdom
| | - Nick Fahy
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rob Procter
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Sara Shaw
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Hoerbst A, Schweitzer M. A Systematic Investigation on Barriers and Critical Success Factors for Clinical Information Systems in Integrated Care Settings. Yearb Med Inform 2017; 10:79-89. [PMID: 26293853 DOI: 10.15265/iy-2015-018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Clinical Information Systems (CIS) have ever since the introduction of information technology in healthcare played an important role to support healthcare professionals and the process of treatment. With the rise of the concept of integrated care organizational borders, the sole focus on data aggregation or healthcare professionals as users disappear more and more. The manuscript discusses the concept of CISs and investigates critical success factors for CISs in the context of integrated care and in the course of time. METHODS In order to identify critical success factors and barriers for CISs a systematic literature review was conducted based on the results from PubMed and Cochrane, using MaxQDA. Search results were thereby limited to reviews or meta-analysis. RESULTS We have found 1919 references of which 40 met the inclusion criteria. The analysis of the manuscripts resulted in a comprehensive list of success factors and barriers related to CISs in integrated care settings. Most barriers were user-related whereas for the success factors an even distribution of organizational, technical and user-related factors was observed. The vast majority of publications was focused on healthcare professionals. CONCLUSION It is important to incorporate experiences made/ collected over time, as the problems encountered seem to remain almost unvaried. In order to support further systematic investigations on the topic it is necessary to rethink existing concepts and definitions to realign them with the ideas of integrated care.
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Affiliation(s)
- A Hoerbst
- Alexander Hörbst, Research Division eHealth and Telemedicine, University for Health Sciences, Medical Informatics, and, Technology (UMIT), Eduard-Wallnoefer-Zentrum 1, 6060 Hall in Tirol, Austria, Tel.: +43 50 8648 3814, Fax: +43 50 8648 67 3814, E-mail: , Web: http://ehealth.umit.at
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Abstract
Purpose
The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England.
Design/methodology/approach
Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process.
Findings
Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals.
Research limitations/implications
The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed.
Originality/value
There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries.
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Liljamo P, Kinnunen UM, Ohtonen P, Saranto K. Quality of nursing intensity data: inter-rater reliability of the patient classification after two decades in clinical use. J Adv Nurs 2017; 73:2248-2259. [PMID: 28252207 DOI: 10.1111/jan.13288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to measure the inter-rater reliability of the Oulu Patient Classification and to discuss existing methods of reliability testing. BACKGROUND The Oulu Patient Classification, part of the RAFAELA® System, has been developed to assist nursing managers with the proper allocation of nursing resources. Due to the increased intensity of inpatient care during recent years, there is a need for the reliability testing of the classification, which has been in clinical use for 20 years. DESIGN Retrospective statistical study. METHODS To test inter-rater reliability, a pair of nurses classified the same patients, without knowledge of each other's ratings, as a part of annually conducted standardization. Data on the parallel classifications (n = 19,997) was obtained from inpatient units (n = 32) with different specialties at a university hospital in Finland during 2010-2015. Parallel classification practices were also analysed. The reliability of the overall classification and its subareas were calculated using suitable statistical coefficients. RESULTS Inter-rater reliability coefficients were a reliable or almost perfect means of considering the nursing intensity category and various practices, but there were detectable differences between subareas. The lowest agreement levels occurred in the subareas 'Planning and Coordination of Nursing Care' and 'Guiding of Care/Continued Care and Emotional Support'. CONCLUSIONS There is a need to develop the descriptions of subareas and to clarify the related concepts. Precise nursing documentation can promote a high level of agreement and reliable results. The traditional overall proportion of agreement does not provide an adequate picture of reliability - weighted kappa coefficients should be used instead.
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Affiliation(s)
- Pia Liljamo
- Division of Operative Care, Oulu University Hospital, Finland
| | - Ulla-Mari Kinnunen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Kaija Saranto
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Kang'a SG, Muthee VM, Liku N, Too D, Puttkammer N. People, Process and Technology: Strategies for Assuring Sustainable Implementation of EMRs at Public-Sector Health Facilities in Kenya. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2017; 2016:677-685. [PMID: 28269864 PMCID: PMC5333339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Ministry of Health (MoH) rollout of electronic medical record systems (EMRs) has continuously been embraced across health facilities in Kenya since 2012. This has been driven by a government led process supported by PEPFAR that recommended standardized systems for facilities. Various strategies were deployed to assure meaningful and sustainable EMRs implementation: sensitization of leadership; user training, formation of health facility-level multi-disciplinary teams; formation of county-level Technical Working Groups; data migration; routine data quality assessments; point of care adoption; successive release of software upgrades; and power provision. Successes recorded include goodwill and leadership from the county management (22 counties), growth in the number of EMR trained users (2561 health care workers), collaboration in among other things, data migration(90 health facilities completed) and establishment of county TWGs (13 TWGs). Sustenance of EMRs demand across facilities is possible through; county TWGs oversight, timely resolution of users' issues and provision of reliable power.
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Affiliation(s)
- Samuel G Kang'a
- International Training and Education Center for Health, University of Washington, Nairobi, Kenya
| | - Veronica M Muthee
- International Training and Education Center for Health, University of Washington, Nairobi, Kenya
| | - Nzisa Liku
- International Training and Education Center for Health, University of Washington, Nairobi, Kenya
| | - Diana Too
- International Training and Education Center for Health, University of Washington, Nairobi, Kenya
| | - Nancy Puttkammer
- International Training and Education Center for Health, University of Washington, Seattle, WA
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Ramoni RB, Walji MF, Kim S, Tokede O, McClellan L, Simmons K, Skourtes E, Yansane A, White JM, Kalenderian E. Attitudes toward and beliefs about the use of a dental diagnostic terminology: A survey of dental care providers in a dental practice. J Am Dent Assoc 2017; 146:390-7. [PMID: 26025826 DOI: 10.1016/j.adaj.2015.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/02/2015] [Accepted: 02/09/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Attitudes and views are critical to the adoption of innovation. Although there have been broadening calls for a standardized dental diagnostic terminology, little is known about the views of private practice dental team members regarding the adoption of such a terminology. METHODS The authors developed a survey by using validated questions identified through literature review. Domain experts' input allowed for further modifications. The authors administered the final survey electronically to 814 team members at a multioffice practice based in the US Pacific Northwest. RESULTS Response proportion was 92%. The survey had excellent reliability (Cronbach α coefficient = 0.87). Results suggested that participants showed, in general, positive attitudes and beliefs about using a standardized diagnostic terminology in their practices. Additional written comments by participants highlighted the potential for improved communication with use of the terminology. CONCLUSIONS Dental care providers and staff in 1 multioffice practice showed positive attitudes about the use of a diagnostic terminology; specifically, they believed it would improve communication between the dentist and patient, as well as among providers, while expressing some concerns about whether using standardized dental diagnostic terms helps clinicians to deliver better dental care. PRACTICAL IMPLICATIONS As the dental profession is advancing toward the use of standardized diagnostic terminology, successful implementation will require that dental team leaders prepare their teams by gauging their attitude about the use of such a terminology.
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Shen N, Yufe S, Saadatfard O, Sockalingam S, Wiljer D. Rebooting Kirkpatrick: Integrating Information System Theory Into the Evaluation of Web-based Continuing Professional Development Interventions for Interprofessional Education. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2017; 37:137-146. [PMID: 28562503 DOI: 10.1097/ceh.0000000000000154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Information system research has stressed the importance of theory in understanding how user perceptions can motivate the use and adoption of technology such as web-based continuing professional development programs for interprofessional education (WCPD-IPE). A systematic review was conducted to provide an information system perspective on the current state of WCPD-IPE program evaluation and how current evaluations capture essential theoretical constructs in promoting technology adoption. METHODS Six databases were searched to identify studies evaluating WCPD-IPE. Three investigators determined eligibility of the articles. Evaluation items extracted from the studies were assessed using the Kirkpatrick-Barr framework and mapped to the Benefits Evaluation Framework. RESULTS Thirty-seven eligible studies yielded 362 evaluation items for analysis. Most items (n = 252) were assessed as Kirkpatrick-Barr level 1 (reaction) and were mainly focused on the quality (information, service, and quality) and satisfaction dimensions of the Benefits Evaluation. System quality was the least evaluated quality dimension, accounting for 26 items across 13 studies. WCPD-IPE use was reported in 17 studies and its antecedent factors were evaluated in varying degrees of comprehensiveness. DISCUSSION Although user reactions were commonly evaluated, greater focus on user perceptions of system quality (ie, functionality and performance), usefulness, and usability of the web-based platform is required. Surprisingly, WCPD-IPE use was reported in less than half of the studies. This is problematic as use is a prerequisite to realizing any individual, organizational, or societal benefit of WCPD-IPE. This review proposes an integrated framework which accounts for these factors and provides a theoretically grounded guide for future evaluations.
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Affiliation(s)
- Nelson Shen
- Mr. Shen: PhD Candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Ms. Yufe: MA Candidate, Department of Psychology, York University, Toronto, Ontario, Canada. Mr. Saadatfard: Researcher, Norwegian Centre for E-health, Tromsø, Norway. Dr. Sockalingam: Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Deputy Psychiatrist-in-Chief, Centre for Mental Health, University Health Network, Toronto, Ontario, Canada. Dr. Wiljer: Associate Professor, Institute of Health Policy, Management and Evaluation, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Executive Director, Education, Technology & Innovation, University Health Network, Toronto, Ontario, Canada
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Can Social Cognitive Theories Help Us Understand Nurses' Use of Electronic Health Records? Comput Inform Nurs 2016; 34:169-74. [PMID: 26844529 DOI: 10.1097/cin.0000000000000226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Electronic health record implementations have accelerated in clinical settings around the world in an effort to improve patient safety and enhance efficiencies related to care delivery. As the largest group of healthcare professionals globally, nurses play an important role in the use of these records and ensuring their benefits are realized. Social cognitive theories such as the Theory of Reasoned Action, Theory of Planned Behaviour, and the Technology Acceptance Model have been developed to explain behavior. Given that variation in nurses' electronic health record utilization may influence the degree to which benefits are realized, the aim of this article is to explore how the use of these social cognitive theories may assist organizations implementing electronic health records to facilitate deeper-level adoption of this type of clinical technology.
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Sicotte C, Clavel S, Fortin MA. A cancer care electronic medical record highly integrated into clinicians' workflow: users' attitudes pre-post implementation. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27454341 DOI: 10.1111/ecc.12548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 11/28/2022]
Abstract
The purpose was to study users' attitudes towards an electronic medical record (EMR) closely integrated into the clinicians' cancer care workflow. The EMR, implemented in an ambulatory cancer care centre, was designed as a care pathway information system providing real-time support to the coordination of shared care processes involving all the care personnel. Mixed method pre-post study design was used. The study population consisted of all care personnel. A survey measured the quality attributes of the EMR, the clinical information it produces, the perceived usefulness of the system for supporting clinical data management tasks and the perceived impacts in terms of access and quality of care. The survey shows that users' attitudes towards the EMR (response rate of 71%) measured after the go-live were positive ranging from 3.42 to 3.95 on a 5-point scale. Besides, the content analysis of 33 pre-post interviews revealed five main themes: magnitude of the changes caused by the EMR; its innovative potential; its positive benefits; an ongoing growth in users' expectancies; and the burden associated with the time required to operate the EMR. In sum, the study shows that users can largely apply innovative uses of information technologies that automate their clinical processes.
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Affiliation(s)
- C Sicotte
- Department of Health Administration, University of Montreal, Montreal, QC, Canada.,EHESP (French School of Public Health), MOS (EA 7348), France
| | - S Clavel
- Department of Radiation Oncology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Centre intégré de cancérologie de Laval, CISSSL, Laval, QC, Canada
| | - M A Fortin
- Department of Radiation Oncology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Centre intégré de cancérologie de Laval, CISSSL, Laval, QC, Canada
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Torrent-Sellens J, Díaz-Chao Á, Soler-Ramos I, Saigí-Rubió F. Modelling and Predicting eHealth Usage in Europe: A Multidimensional Approach From an Online Survey of 13,000 European Union Internet Users. J Med Internet Res 2016; 18:e188. [PMID: 27450189 PMCID: PMC4975796 DOI: 10.2196/jmir.5605] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/11/2016] [Accepted: 05/30/2016] [Indexed: 12/13/2022] Open
Abstract
Background More advanced methods and models are needed to evaluate the participation of patients and citizens in the shared health care model that eHealth proposes. Objective The goal of our study was to design and evaluate a predictive multidimensional model of eHealth usage. Methods We used 2011 survey data from a sample of 13,000 European citizens aged 16–74 years who had used the Internet in the previous 3 months. We proposed and tested an eHealth usage composite indicator through 2-stage structural equation modelling with latent variables and measurement errors. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage was calculated using health status and sociodemographic independent variables. Results The dimensions with more explanatory power of eHealth usage were health Internet attitudes, information health Internet usage, empowerment of health Internet users, and the usefulness of health Internet usage. Some 52.39% (6811/13,000) of European Internet users’ eHealth usage was more intensive (greater than the mean). Users with long-term health problems or illnesses (OR 1.20, 95% CI 1.12–1.29) or receiving long-term treatment (OR 1.11, 95% CI 1.03–1.20), having family members with long-term health problems or illnesses (OR 1.44, 95% CI 1.34–1.55), or undertaking care activities for other people (OR 1.58, 95% CI 1.40–1.77) had a high propensity toward intensive eHealth usage. Sociodemographic predictors showed that Internet users who were female (OR 1.23, 95% CI 1.14–1.31), aged 25–54 years (OR 1.12, 95% CI 1.05–1.21), living in larger households (3 members: OR 1.25, 95% CI 1.15–1.36; 5 members: OR 1.13, 95% CI 0.97–1.28; ≥6 members: OR 1.31, 95% CI 1.10–1.57), had more children <16 years of age (1 child: OR 1.29, 95% CI 1.18–1.14; 2 children: OR 1.05, 95% CI 0.94–1.17; 4 children: OR 1.35, 95% CI 0.88–2.08), and had more family members >65 years of age (1 member: OR 1.33, 95% CI 1.18–1.50; ≥4 members: OR 1.82, 95% CI 0.54–6.03) had a greater propensity toward intensive eHealth usage. Likewise, users residing in densely populated areas, such as cities and large towns (OR 1.17, 95% CI 1.09–1.25), also had a greater propensity toward intensive eHealth usage. Educational levels presented an inverted U shape in relation to intensive eHealth usage, with greater propensities among those with a secondary education (OR 1.08, 95% CI 1.01–1.16). Finally, occupational categories and net monthly income data suggest a higher propensity among the employed or self-employed (OR 1.07, 95% CI 0.99–1.15) and among the minimum wage stratum, earning ≤€1000 per month (OR 1.66, 95% CI 1.48–1.87). Conclusions We provide new evidence of inequalities that explain intensive eHealth usage. The results highlight the need to develop more specific eHealth practices to address different realities.
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Affiliation(s)
- Joan Torrent-Sellens
- Department of Economics and Business, Universitat Oberta de Catalunya, Barcelona, Spain
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Schaller S, Marinova-Schmidt V, Setzer M, Kondylakis H, Griebel L, Sedlmayr M, Graessel E, Maler JM, Kirn S, Kolominsky-Rabas PL. Usefulness of a Tailored eHealth Service for Informal Caregivers and Professionals in the Dementia Treatment and Care Setting: The eHealthMonitor Dementia Portal. JMIR Res Protoc 2016; 5:e47. [PMID: 27050401 PMCID: PMC4822652 DOI: 10.2196/resprot.4354] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 09/11/2015] [Accepted: 01/04/2016] [Indexed: 12/02/2022] Open
Abstract
Background The European eHealthMonitor project (eHM) developed a user-sensitive and interactive Web portal for the dementia care setting called the eHM Dementia Portal (eHM-DP). It aims to provide targeted support for informal caregivers of persons with dementia and professionals. Objective The objective of this study was to assess the usefulness and impact of the eHM-DP service in the dementia care setting from two user perspectives: informal caregivers and professionals. Methods The evaluation study was conducted from June to September 2014 and followed a before-after, user-participatory, mixed-method design with questionnaires and interviews. The used intervention was the eHM-DP: an interactive Web portal for informal caregivers and professionals that was tested for a 12-week period. Primary outcomes for caregivers included empowerment, quality of life, caregiver burden, decision aid, as well as perceived usefulness and benefits of the eHM-DP. Primary outcomes for professionals involved decision aid, perceived usefulness, and benefits of the eHM-DP. Results A total of 25 informal caregivers and 6 professionals used the eHM-DP over the 12-week study period. Both professionals and informal caregivers indicated perceived benefits and support by the eHM-DP. In total, 65% (16/25) of informal caregivers would use the eHM-DP if they had access to it. Major perceived benefits were individualized information acquisition, improved interaction between informal caregivers and professionals, access to support from home, and empowerment in health-related decisions (PrepDM Score: 67.9). Professionals highlighted the improved treatment and care over the disease course (83%, 5/6) and improved health care access for people living in rural areas (67%, 4/6). However, there was no improvement in caregiver burden (Burden Scale for Family Caregivers) and quality of life (EuroQol-5D-5L) over the study period. Conclusions Our study provides insight into the different user perspectives on an eHealth support service in the dementia treatment and care setting. These results are of importance for future developments and the uptake of eHealth solutions in the dementia domain and reinforce the importance of early user involvement. Turning to the primary target of the eHM-DP service, our findings suggest that the eHM-DP service proved to be a valuable post-diagnostic support service, in particular for the home-based care setting. Further research on a larger scale is needed to enhance the implementation in existing health care infrastructures.
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Affiliation(s)
- Sandra Schaller
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany.
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Di Capua P, Wu B, Sednew R, Ryan G, Wu S. Complexity in Redesigning Depression Care: Comparing Intention Versus Implementation of an Automated Depression Screening and Monitoring Program. Popul Health Manag 2016; 19:349-56. [PMID: 27028043 DOI: 10.1089/pop.2015.0084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Health care technology promises to improve quality and decrease costs while improving the patient experience. A recent trial tested a novel health technology that sought to reduce barriers to guideline-recommended depression care by coupling automated telephonic patient assessment with provider notification and decision support. This study compares the intended effects and the end users' experience with using this technology. Responses to semi-structured interviews with the leadership and design team (the intention group) were compared with responses from health professionals in clinics using the technology (the implementation group). Qualitative methods were applied to compare perspectives on the role of technology in care delivery and on the technology's impact on barriers to providing guideline-recommended care. Four members of the intention group and 17 members of the implementation group were interviewed. The 2 groups had similar notions of technology's role in care delivery. The technology increased provider awareness, empowered midlevel providers, and facilitated collaboration among care team members. However, the implementation group identified gaps in care processes and in the informatics system that the technology did not address, and for which providers remained responsible. The 2 groups had comparable perspectives on the value and limits of technology in improving adherence to guideline-recommended care. However, the intention group did not discuss many of the shortcomings identified by the implementation group. Also, the interviews suggest that although some barriers persisted and a few new ones arose, the technology succeeded in reducing barriers to guideline-recommended care.
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Affiliation(s)
- Paul Di Capua
- 1 Baptist Health Medical Group , Coral Gables, Florida.,2 Department of Family Medicine, Herbert Wertheim College of Medicine at Florida International University , Miami, Florida.,3 Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Brian Wu
- 4 Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Renee Sednew
- 5 UCLA Fielding School of Public Health , Los Angeles, California
| | - Gery Ryan
- 6 Pardee RAND Graduate School, RAND Corporation , Santa Monica, California
| | - Shinyi Wu
- 7 School of Social Work and Epstein Department of Industrial and Systems Engineering, University of Southern California , RAND Corporation, Los Angeles, California
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Hadji B, Degoulet P. Information system end-user satisfaction and continuance intention: A unified modeling approach. J Biomed Inform 2016; 61:185-93. [PMID: 27033175 DOI: 10.1016/j.jbi.2016.03.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/18/2016] [Accepted: 03/27/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Permanent evaluation of end-user satisfaction and continuance intention is a critical issue at each phase of a clinical information system (CIS) project, but most validation studies are concerned with the pre- or early post-adoption phases. OBJECTIVE The purpose of this study was twofold: to validate at the Pompidou University Hospital (HEGP) an information technology late post-adoption model built from four validated models and to propose a unified metamodel of evaluation that could be adapted to each context or deployment phase of a CIS project. METHODS Five dimensions, i.e., CIS quality (CISQ), perceived usefulness (PU), confirmation of expectations (CE), user satisfaction (SAT), and continuance intention (CI) were selected to constitute the CI evaluation model. The validity of the model was tested using the combined answers to four surveys performed between 2011 and 2015, i.e., more than ten years after the opening of HEGP in July 2000. Structural equation modeling was used to test the eight model-associated hypotheses. RESULTS The multi-professional study group of 571 responders consisted of 158 doctors, 282 nurses, and 131 secretaries. The evaluation model accounted for 84% of variance of satisfaction and 53% of CI variance for the period 2011-2015 and for 92% and 69% for the period 2014-2015. In very late post adoption, CISQ appears to be the major determinant of satisfaction and CI. Combining the results obtained at various phases of CIS deployment, a Unified Model of Information System Continuance (UMISC) is proposed. CONCLUSION In a meaningful CIS use situation at HEGP, this study confirms the importance of CISQ in explaining satisfaction and CI. The proposed UMISC model that can be adapted to each phase of CIS deployment could facilitate the necessary efforts of permanent CIS acceptance and continuance evaluation.
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Affiliation(s)
- Brahim Hadji
- INSERM - UMRS 1138, CRC, Team 22, Paris, France; Georges Pompidou European University Hospital (HEGP), Paris, France; Pierre and Marie Curie University, Paris, France.
| | - Patrice Degoulet
- INSERM - UMRS 1138, CRC, Team 22, Paris, France; Georges Pompidou European University Hospital (HEGP), Paris, France; Paris Descartes University, Paris, France.
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Wye L, Lasseter G, Simmonds B, Duncan L, Percival J, Purdy S. Electronic palliative care coordinating systems (EPaCCS) may not facilitate home deaths: A mixed methods evaluation of end of life care in two English counties. J Res Nurs 2016. [DOI: 10.1177/1744987116628922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Electronic palliative care coordination systems (EPaCCS) detail preferred place of death across health and voluntary sector boundaries. Quantitative studies suggest that individuals recorded on EPaCCS are more likely to die at home. This study aimed to explore this relationship between EPaCCS and home deaths. Patient records from EPaCCS were collected from 1 September 2011 to 29 February 2012, linked to death data and analysed using descriptive statistics. We interviewed 101 professionals, including community nurses, and employed framework analysis. Few eligible patients were entered on EPaCCS (9% North Somerset, 13% Somerset). Of those, the majority died in community settings (87%, 81/93 North Somerset; 93% 307/331 Somerset). However, interviews and EPaCCS record analysis suggested that EPaCCS was almost exclusively used by community nurses and GPs, so, unsurprisingly, the relationship between EPaCCS and home deaths was strong. Difficulties included professional reluctance to discuss death, and the burden of data entry falling on daytime staff for out-of-hours colleagues. These results challenge assumptions that EPaCCS facilitates increased home deaths, as qualitative investigation identified selection bias. To avoid misinterpretations, future studies should employ mixed methods. The implementation of an electronic tool is not enough on its own to ensure that advanced care wishes are available, as long-standing organisational and cultural issues, such as professionals working in silos and professional reluctance to have ‘end of life’ discussions, also need to be addressed.
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Affiliation(s)
- Lesley Wye
- Senior Research Fellow, Centre for Academic Primary Care, University of Bristol, UK
| | - Gemma Lasseter
- Research Associate, Centre for Academic Primary Care, University of Bristol, UK
| | - Bethany Simmonds
- Research Associate, Centre for Academic Primary Care, University of Bristol, UK
| | - Lorna Duncan
- Research Assistant, Centre for Academic Primary Care, University of Bristol, UK
| | - John Percival
- Research Associate, Centre for Academic Primary Care, University of Bristol, UK
| | - Sarah Purdy
- Associate Dean, Faculty of Health Sciences, University of Bristol, UK
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Sebetci Ö, Çetin M. Developing, applying and measuring an e-Prescription Information Systems Success Model from the persperctives of physicians and pharmacists. HEALTH POLICY AND TECHNOLOGY 2016. [DOI: 10.1016/j.hlpt.2015.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hadji B, Martin G, Dupuis I, Campoy E, Degoulet P. 14 Years longitudinal evaluation of clinical information systems acceptance: The HEGP case. Int J Med Inform 2015; 86:20-9. [PMID: 26725691 DOI: 10.1016/j.ijmedinf.2015.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/18/2022]
Abstract
CONTEXT Meaningful use and end-user satisfaction are two major components of the success of a clinical information system (CIS). The purpose of this study was to longitudinally measure and analyze the CIS use and satisfaction determinants in a multi-professional group at the Georges Pompidou university hospital (HEGP) in Paris. METHODS From the different evaluation surveys performed at HEGP, three periods were considered corresponding to 4, 8 and over 10 years after the first CIS deployment in 2000, respectively. Six acceptance dimensions were considered: CIS quality (CISQ), facilitating conditions (FC), perceived usefulness (PU), confirmation of expectations (CE), use, and global satisfaction (GS). Relationships between these constructs were tested through multiple regressions analysis and structural equation modeling (SEM). RESULTS Responses were obtained from 298, 332, and 448 users for the three periods considered. CIS acceptance dimensions progressively and significantly increased over time. Significant differences between professions were observed with an initial low PU among medical staff. In the early deployment phase, GS appeared to be determined by CIS use, CISQ and PU (R(2)=.53 in SEM). In the very late post-adoption phase, GS was strongly determined by CISQ, CE, and PU (R(2)=.86 in SEM) and was no longer associated with CIS use. CONCLUSION Acceptance models should be adapted to the phase of deployment of a CIS and integrate end-users' individual characteristics. Progressive reduction over time of the positive relationships between CIS use and satisfaction could possibly be considered as a maturity indicator of CIS deployment. These observations validate the introduction in post-adoption models of a continuance intention dimension.
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Affiliation(s)
- Brahim Hadji
- INSERM-UMRS 1138, CRC, Team 22, Paris, France; Georges Pompidou European University Hospital (HEGP), Paris, France; Pierre and Marie Currie University, Paris, France.
| | - Guillaume Martin
- INSERM-UMRS 1138, CRC, Team 22, Paris, France; Paris Descartes University, Paris, France; CeTIMA, St. Mandé, France
| | - Isabelle Dupuis
- Georges Pompidou European University Hospital (HEGP), Paris, France
| | - Eric Campoy
- DRM (UMR CNRS 7088), PSL-Paris Dauphine University, Paris, France
| | - Patrice Degoulet
- INSERM-UMRS 1138, CRC, Team 22, Paris, France; Georges Pompidou European University Hospital (HEGP), Paris, France; Paris Descartes University, Paris, France.
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Cohen JF, Coleman E, Kangethe MJ. An importance-performance analysis of hospital information system attributes: A nurses' perspective. Int J Med Inform 2015; 86:82-90. [PMID: 26564330 DOI: 10.1016/j.ijmedinf.2015.10.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/25/2015] [Accepted: 10/31/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Health workers have numerous concerns about hospital IS (HIS) usage. Addressing these concerns requires understanding the system attributes most important to their satisfaction and productivity. Following a recent HIS implementation, our objective was to identify priorities for managerial intervention based on user evaluations of the performance of the HIS attributes as well as the relative importance of these attributes to user satisfaction and productivity outcomes. PROCEDURES We collected data along a set of attributes representing system quality, data quality, information quality, and service quality from 154 nurse users. Their quantitative responses were analysed using the partial least squares approach followed by an importance-performance analysis. Qualitative responses were analysed using thematic analysis to triangulate and supplement the quantitative findings. MAIN FINDINGS Two system quality attributes (responsiveness and ease of learning), one information quality attribute (detail), one service quality attribute (sufficient support), and three data quality attributes (records complete, accurate and never missing) were identified as high priorities for intervention. CONCLUSIONS Our application of importance-performance analysis is unique in HIS evaluation and we have illustrated its utility for identifying those system attributes for which underperformance is not acceptable to users and therefore should be high priorities for intervention.
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Affiliation(s)
- Jason F Cohen
- University of the Witwatersrand, Johannesburg, South Africa.
| | - Emma Coleman
- University of the Witwatersrand, Johannesburg, South Africa
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Anticipating mismatches of HIT investments: Developing a viability-fit model for e-health services. Int J Med Inform 2015; 85:104-15. [PMID: 26526279 DOI: 10.1016/j.ijmedinf.2015.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Albeit massive investments in the recent years, the impact of health information technology (HIT) has been controversial and strongly disputed by both research and practice. While many studies are concerned with the development of new or the refinement of existing measurement models for assessing the impact of HIT adoption (ex post), this study presents an initial attempt to better understand the factors affecting viability and fit of HIT and thereby underscores the importance of also having instruments for managing expectations (ex ante). METHODS We extend prior research by undertaking a more granular investigation into the theoretical assumptions of viability and fit constructs. In doing so, we use a mixed-methods approach, conducting qualitative focus group discussions and a quantitative field study to improve and validate a viability-fit measurement instrument. RESULTS Our findings suggest two issues for research and practice. First, the results indicate that different stakeholders perceive HIT viability and fit of the same e-health services very unequally. Second, the analysis also demonstrates that there can be a great discrepancy between the organizational viability and individual fit of a particular e-health service. CONCLUSION The findings of this study have a number of important implications such as for health policy making, HIT portfolios, and stakeholder communication.
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Tilahun B, Fritz F. Modeling antecedents of electronic medical record system implementation success in low-resource setting hospitals. BMC Med Inform Decis Mak 2015; 15:61. [PMID: 26231051 PMCID: PMC4522063 DOI: 10.1186/s12911-015-0192-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the increasing implementation of Electronic Medical Record Systems (EMR) in developing countries, there is a growing need to identify antecedents of EMR success to measure and predict the level of adoption before costly implementation. However, less evidence is available about EMR success in the context of low-resource setting implementations. Therefore, this study aims to fill this gap by examining the constructs and relationships of the widely used DeLone and MacLean (D&M) information system success model to determine whether it can be applied to measure EMR success in those settings. METHODS A quantitative cross sectional study design using self-administered questionnaires was used to collect data from 384 health professionals working in five governmental hospitals in Ethiopia. The hospitals use a comprehensive EMR system since three years. Descriptive and structural equation modeling methods were applied to describe and validate the extent of relationship of constructs and mediating effects. RESULTS The findings of the structural equation modeling shows that system quality has significant influence on EMR use (β = 0.32, P < 0.05) and user satisfaction (β = 0.53, P < 0.01); information quality has significant influence on EMR use (β = 0.44, P < 0.05) and user satisfaction (β = 0.48, P < 0.01) and service quality has strong significant influence on EMR use (β = 0.36, P < 0.05) and user satisfaction (β = 0.56, P < 0.01). User satisfaction has significant influence on EMR use (β = 0.41, P < 0.05) but the effect of EMR use on user satisfaction was not significant. Both EMR use and user satisfaction have significant influence on perceived net-benefit (β = 0.31, P < 0.01; β = 0.60, P < 0.01), respectively. Additionally, computer literacy was found to be a mediating factor in the relationship between service quality and EMR use (P < 0.05) as well as user satisfaction (P < 0.01). Among all the constructs, user satisfaction showed the strongest effect on perceived net-benefit of health professionals. CONCLUSION EMR implementers and managers in developing countries are in urgent need of implementation models to design proper implementation strategies. In this study, the constructs and relationships depicted in the updated D&M model were found to be applicable to assess the success of EMR in low resource settings. Additionally, computer literacy was found to be a mediating factor in EMR use and user satisfaction of health professionals. Hence, EMR implementers and managers in those settings should give priority in improving service quality of the hospitals like technical support and infrastructure; providing continuous basic computer trainings to health professionals; and give attention to the system and information quality of the systems they want to implement.
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Affiliation(s)
- Binyam Tilahun
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, Münster, D-48149, Germany.
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, Münster, D-48149, Germany
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Prioritizing factors influencing nurses' satisfaction with hospital information systems: a fuzzy analytic hierarchy process approach. Comput Inform Nurs 2015; 32:174-81. [PMID: 24469556 DOI: 10.1097/cin.0000000000000031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our aim was to use the fuzzy analytic hierarchy process approach to prioritize the factors that influence nurses' satisfaction with a hospital information system. First, we reviewed the related literature to identify and select possible factors. Second, we developed an analytic hierarchy process framework with three main factors (quality of services, of systems, and of information) and 22 subfactors. Third, we developed a questionnaire based on pairwise comparisons and invited 10 experienced nurses who were identified through snowball sampling to rate these factors. Finally, we used Chang's fuzzy extent analysis method to compute the weights of these factors and prioritize them. We found that information quality was the most important factor (58%), followed by service quality (22%) and then system quality (19%). In conclusion, although their weights were not similar, all factors were important and should be considered in evaluating nurses' satisfaction.
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Kent B, Redley B, Wickramasinghe N, Nguyen L, Taylor NJ, Moghimi H, Botti M. Exploring nurses’ reactions to a novel technology to support acute health care delivery. J Clin Nurs 2015; 24:2340-51. [DOI: 10.1111/jocn.12881] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Bernice Redley
- Epworth Healthcare and Deakin University; Richmond Vic. Australia
| | - Nilmini Wickramasinghe
- Epworth Chair in Health Information Management; Epworth HealthCare and Deakin University; Vic. Australia
| | - Lemai Nguyen
- Deakin Business School; Department of Information Systems and Business Analytics; Deakin University; VIC. Australia
| | | | - Hoda Moghimi
- Epworth Research Institute; RMIT University; Richmond Vic. Australia
| | - Mari Botti
- Epworth/Deakin Centre for Clinical Nursing Research Epworth Health Care; Richmond Vic. Australia
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Tilahun B, Fritz F. Comprehensive evaluation of electronic medical record system use and user satisfaction at five low-resource setting hospitals in ethiopia. JMIR Med Inform 2015; 3:e22. [PMID: 26007237 PMCID: PMC4460264 DOI: 10.2196/medinform.4106] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/12/2015] [Accepted: 02/17/2015] [Indexed: 11/18/2022] Open
Abstract
Background Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01). Conclusions Health professionals’ use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock.
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Affiliation(s)
- Binyam Tilahun
- Institute of Medical Informatics, University of Münster, Münster, Germany.
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Seidman G, Unnikrishnan S, Kenny E, Myslinski S, Cairns-Smith S, Mulligan B, Engmann C. Barriers and enablers of kangaroo mother care practice: a systematic review. PLoS One 2015; 10:e0125643. [PMID: 25993306 PMCID: PMC4439040 DOI: 10.1371/journal.pone.0125643] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 03/24/2015] [Indexed: 11/19/2022] Open
Abstract
Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in preterm infants. Although KMC is a key intervention package in newborn health initiatives, there is limited systematic information available on the barriers to KMC practice that mothers and other stakeholders face while practicing KMC. This systematic review sought to identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. We searched nine electronic databases and relevant reference lists for publications reporting barriers or enablers to KMC practice. We identified 1,264 unique publications, of which 103 were included based on pre-specified criteria. Publications were scanned for all barriers / enablers. Each publication was also categorized based on its approach to identification of barriers / enablers, and more weight was assigned to publications which had systematically sought to understand factors influencing KMC practice. Four of the top five ranked barriers to KMC practice for mothers were resource-related: "Issues with the facility environment / resources," "negative impressions of staff attitudes or interactions with staff," "lack of help with KMC practice or other obligations," and "low awareness of KMC / infant health." Considering only publications from low- and middle-income countries, "pain / fatigue" was ranked higher than when considering all publications. Top enablers to practice were included "mother-infant attachment" and "support from family, friends, and other mentors." Our findings suggest that mother can understand and enjoy KMC, and it has benefits for mothers, infants, and families. However, continuous KMC may be physically and emotionally difficult, and often requires support from family members, health practitioners, or other mothers. These findings can serve as a starting point for researchers and program implementers looking to improve KMC programs.
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Affiliation(s)
- Gabriel Seidman
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Emma Kenny
- Boston Consulting Group, New York City, New York, United States of America
| | - Scott Myslinski
- Boston Consulting Group, Boston, Massachusetts, United States of America
| | - Sarah Cairns-Smith
- Boston Consulting Group, Boston, Massachusetts, United States of America
| | - Brian Mulligan
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Cyril Engmann
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
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Raymond L, Paré G, Ortiz de Guinea A, Poba-Nzaou P, Trudel MC, Marsan J, Micheneau T. Improving performance in medical practices through the extended use of electronic medical record systems: a survey of Canadian family physicians. BMC Med Inform Decis Mak 2015; 15:27. [PMID: 25888991 PMCID: PMC4397686 DOI: 10.1186/s12911-015-0152-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous calls have been made for greater assimilation of information technology in healthcare organizations in general, and in primary care settings in particular. Considering the levels of IT investment and adoption in primary care medical practices, a deeper understanding is needed of the factors leading to greater performance outcomes from EMR systems in primary care. To address this issue, we developed and tested a research model centered on the concept of Extended EMR Use. METHODS An online survey was conducted of 331 family physicians in Canadian private medical practices to empirically test seven research hypotheses using a component-based structural equation modeling approach. RESULTS Five hypotheses were partially or fully supported by our data. Family physicians in our sample used 67% of the clinical and 41% of the communicational functionalities available in their EMR systems, compared to 90% of the administrative features. As expected, extended use was associated with significant improvements in perceived performance benefits. Interestingly, the benefits derived from system use were mainly tied to the clinical support provided by an EMR system. The extent to which physicians were using their EMR systems was influenced by two system design characteristics: functional coverage and ease of use. The more functionalities that are available in an EMR system and the easier they are to use, the greater the potential for exploration, assimilation and appropriation by family physicians. CONCLUSIONS Our study has contributed to the extant literature by proposing a new concept: Extended EMR Use. In terms of its practical implications, our study reveals that family physicians must use as many of the capabilities supported by their EMR system as possible, especially those which support clinical tasks, if they are to maximize its performance benefits. To ensure extended use of their software, vendors must develop EMR systems that satisfy two important design characteristics: functional coverage and system ease of use.
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Affiliation(s)
- Louis Raymond
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Guy Paré
- Chair in Information Technology in Health Care, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada.
| | - Ana Ortiz de Guinea
- Chair in Information Technology in Health Care, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
| | | | - Marie-Claude Trudel
- Chair in Information Technology in Health Care, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
| | | | - Thomas Micheneau
- Chair in Information Technology in Health Care, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
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