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Senteio C, Murdock PJ. The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review. J Med Internet Res 2022; 24:e22124. [PMID: 35377331 PMCID: PMC9016513 DOI: 10.2196/22124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 01/23/2022] [Indexed: 12/26/2022] Open
Abstract
Background Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital. Conclusions This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations.
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Affiliation(s)
- Charles Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, United States
| | - Paul Joseph Murdock
- Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Kalil-Filho FA, Pinto JSDP, Borsato EP, Kuretzki CH, Ariede BL, Mathias JEF, Campos ACL, Malafaia O. MULTIPROFESSIONAL ELECTRONIC PROTOCOL FOR DIGESTIVE SURGERY VALIDATION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1583. [PMID: 34669879 PMCID: PMC8521891 DOI: 10.1590/0102-672020210002e1583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022]
Abstract
Background: The creation of a computerized clinical database with the ability to collect prospective information from patients and with the possibility of rescue and crossing data enables scientific studies of higher quality and credibility in less time. Aim: To validate, in a single master protocol, the clinical data referring to Surgery of Digestive System in a multidisciplinary way, incorporating in the SINPE© platform, and to verify the incidence of digestive diseases based on the prospectively performed collections. Method: Organize in one software, in a standardized structure, all the pre-existing items in the SINPE© database; the theoretical basis was computerized through the MIGRASINPE© module creating a single multiprofessional master protocol for use as a whole. Results: The existing specific protocols were created and/or adapted - they correspond to the most prevalent digestive diseases - unifying them. The possibility of multiprofessional use was created by integrating all data collected from medicine, nursing, physiotherapy, nutrition and health management in a prospective way. The total was 4,281 collections, distributed as follows: extrahepatic biliary tract, n=1,786; esophagus, n=1015; anorectal, n=736; colon, n=550; small intestine, n=86; pancreas, n=71; stomach, n=23; liver, n=14. Conclusions: The validation of the unification and structuring in a single master protocol of the clinical data referring to the Surgery of the Digestive System in a multiprofessional and prospective way was possible and the epidemiological study carried out allowed to identify the most prevalent digestive diseases.
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Affiliation(s)
- Faruk Abrão Kalil-Filho
- Postgraduate Program in Surgical Clinic, Health Sciences Sector, Federal University of Paraná, Curitiba, PR, Brazil
| | - José Simão de Paula Pinto
- Postgraduate Program in Informatics, Exact Sciences Sector, Federal University of Paraná, Curitiba PR, Brazil
| | - Emerson P Borsato
- Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Carlos Henrique Kuretzki
- Postgraduate Program in Surgical Clinic, Health Sciences Sector, Federal University of Paraná, Curitiba, PR, Brazil.,Positivo University, Curitiba, PR, Brazil
| | | | - Jorge Eduardo Fouto Mathias
- Postgraduate Program in Surgical Clinic, Health Sciences Sector, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Osvaldo Malafaia
- Postgraduate Program in Surgical Clinic, Health Sciences Sector, Federal University of Paraná, Curitiba, PR, Brazil.,Mackenzie Evangelical College of Paraná, Curitiba, PR, Brazil
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Samal L, Fu HN, Camara DS, Wang J, Bierman AS, Dorr DA. Health information technology to improve care for people with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:1006-1036. [PMID: 34363220 PMCID: PMC8515226 DOI: 10.1111/1475-6773.13860] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps. DATA SOURCES We searched MEDLINE, CINAHL, PsycINFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010 and 2020. STUDY DESIGN We identified studies of health IT interventions for PLWMCC across three domains as follows: self-management support, care coordination, and algorithms to support clinical decision making. DATA COLLECTION/EXTRACTION METHODS Structured search queries were created and validated. Abstracts were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data were extracted independently by two reviewers. PRINCIPAL FINDINGS The search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi-experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models were included. Five RCTs had positive results, and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient-centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality. CONCLUSIONS Despite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.
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Affiliation(s)
- Lipika Samal
- Brigham and Women's HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Helen N. Fu
- Indiana University Richard M. Fairbanks School of Public HealthIndianapolisINUSA
- Regenstrief InstituteCenter for Biomedical InformaticsIndianapolisINUSA
| | - Djibril S. Camara
- Center for Disease Control and Prevention, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS) Division of Scientific Education and Professional Development, Public Health Informatics Fellowship ProgramAtlantaGeorgiaUSA
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
| | - Jing Wang
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
- Florida State University College of NursingTallahasseeFloridaUSA
- Health and Aging Policy Fellows Program at Columbia UniversityNew YorkNYUSA
| | - Arlene S. Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
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Park J, Liang M, Alpert JM, Brown RF, Zhong X. The Causal Relationship Between Portal Usage and Self-Efficacious Health Information-Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data. J Med Internet Res 2021; 23:e17782. [PMID: 33502334 PMCID: PMC7875689 DOI: 10.2196/17782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/25/2020] [Accepted: 12/21/2020] [Indexed: 01/26/2023] Open
Abstract
Background Patient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients’ health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals. Objective The aim of this study was to examine the causal relationship between the usage of patient portals and patients’ self-efficacy toward obtaining health information and performing self-care. Methods This study was a secondary data analysis that used data from a US national survey, the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients’ confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method. Results We showed that frequently using patient portals improves patients’ confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95% CI 0.06-0.23; P<.001). This means that when increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times per year, the expected average increase in confidence level measured on a Likert-type scale would be 0.14. However, we could not conclusively determine the causal effect between patient portal usage and patients’ confidence in exercising self-care. Conclusions The results support the use of patient portals and encourage better support and education to patients. The proposed statistical method can be used to exploit the potential of national survey data for causal inference studies.
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Affiliation(s)
- Jaeyoung Park
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, United States
| | - Muxuan Liang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, FL, United States
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Xiang Zhong
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, United States
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The Ability of Practices to Report Clinical Quality Measures: More Evidence of the Size Paradox? J Am Board Fam Med 2020; 33:620-625. [PMID: 32675274 PMCID: PMC7453756 DOI: 10.3122/jabfm.2020.04.190369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess whether primary care practices with and without support from a larger organization differ in their ability to produce timely reports on cardiovascular disease quality measures. BACKGROUND Although many primary care practices are now part of larger organizations, it is not clear whether such a shift will improve the ability of those who work in these primary care settings to easily access and use their own data for improvement. METHODS Smaller primary care practices were enrolled in a trial of external practice support to build quality improvement (QI) capacity. A request for clinical quality measure (eCQM) data were sent to each practice and study outcomes were defined based on the date on which practices first submitted valid data for at least 1 of the 3 measures. A practice survey completed by a clinic manager captured practice characteristics, including the presence of QI support from a larger organization. RESULTS Of the 209 enrolled practices, 205 had complete data for analysis. Practices without central QI support had higher rates of eCQM submission at 30 days (38% vs 20%) and 60 days, (63% vs 48%) than practices with central QI support. Practices with central QI support took longer to submit data (median, 57 days) compared with practices without centralized support (median, 40 days) although this difference was not significant. CONCLUSION The ability of smaller practices without centralized QI support to report their eCQMs more quickly may have implications for their subsequent ability to improve these measures.
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Improving Provider Compliance With Adult Inflammatory Bowel Disease Patient Care Guidelines in the Ambulatory Setting Through the Use of Electronic Health Records. Gastroenterol Nurs 2020; 42:470-477. [PMID: 31770348 DOI: 10.1097/sga.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Electronic health record (EHR) systems have the ability to improve the quality of patient care, patient safety, and provide benefits to providers and clinic practices. These systems can transform quality measurement and quality improvement methods, facilitate workflow, and track patients over time to ensure that they receive guideline-recommended, evidence-based care. Simply having an EHR system, however, may not be enough to improve the quality and safety of healthcare, especially if the system is not designed to include features specific to the treatment population. A comprehensive literature review of the evidence on EHRs and the implementation of clinical guidelines was conducted. The positive outcomes in this review supports the notion that using well-designed, evidence-based clinical decision tools or checklists within the workflow of the EHR system can improve provider compliance with inflammatory bowel disease (IBD) clinical practice guidelines. Critical content to include in the IBD checklist for the adult patient in the ambulatory setting is also recommended.
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Heselmans A, Delvaux N, Laenen A, Van de Velde S, Ramaekers D, Kunnamo I, Aertgeerts B. Computerized clinical decision support system for diabetes in primary care does not improve quality of care: a cluster-randomized controlled trial. Implement Sci 2020; 15:5. [PMID: 31910877 PMCID: PMC6947861 DOI: 10.1186/s13012-019-0955-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
Background The EBMeDS system is the computerized clinical decision support (CCDS) system of EBPNet, a national computerized point-of-care information service in Belgium. There is no clear evidence of more complex CCDS systems to manage chronic diseases in primary care practices (PCPs). The objective of this study was to assess the effectiveness of EBMeDS use in improving diabetes care. Methods A cluster-randomized trial with before-and-after measurements was performed in Belgian PCPs over 1 year, from May 2017 to May 2018. We randomly assigned 51 practices to either the intervention group (IG), to receive the EBMeDS system, or to the control group (CG), to receive usual care. Primary and secondary outcomes were the 1-year pre- to post-implementation change in HbA1c, LDL cholesterol, and systolic and diastolic blood pressure. Composite patient and process scores were calculated. A process evaluation was added to the analysis. Results were analyzed at 6 and 12 months. Linear mixed models and logistic regression models based on generalized estimating equations were used where appropriate. Results Of the 51 PCPs that were enrolled and randomly assigned (26 PCPs in the CG and 25 in the IG), 29 practices (3815 patients) were analyzed in the study: 2464 patients in the CG and 1351 patients in the IG. No change differences existed between groups in primary or secondary outcomes. Change difference between CG and IG after 1-year follow-up was − 0.09 (95% CI − 0.18; 0.01, p-value = 0.06) for HbA1c; 1.76 (95% CI − 0.46; 3.98, p-value = 0.12) for LDL cholesterol; and 0.13 (95% CI − 0.91; 1.16, p-value = 0.81) and 0.12 (95% CI − 1.25;1.49, p-value = 0.86) for systolic and diastolic blood pressure respectively. The odds ratio of the IG versus the CG for the probability of no worsening and improvement was 1.09 (95% CI 0.73; 1.63, p-value = 0.67) for the process composite score and 0.74 (95% CI 0.49; 1.12, p-value = 0.16) for the composite patient score. All but one physician was satisfied with the EBMeDS system. Conclusions The CCDS system EBMeDS did not improve diabetes care in Belgian primary care. The lack of improvement was mainly caused by imperfections in the organizational context of Belgian primary care for chronic disease management and shortcomings in the system requirements for the correct use of the EBMeDS system (e.g., complete structured records). These shortcomings probably caused low-use rates of the system. Trial registration ClinicalTrials.gov, NCT01830569, Registered 12 April 2013.
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Affiliation(s)
- Annemie Heselmans
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok j, 3000, Leuven, Belgium.
| | - Nicolas Delvaux
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok j, 3000, Leuven, Belgium
| | - Annouschka Laenen
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok j, 3000, Leuven, Belgium
| | - Stijn Van de Velde
- Centre for Informed Health Choices, Division for Health Services, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
| | - Dirk Ramaekers
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35 blok d, 3000, Leuven, Belgium
| | - Ilkka Kunnamo
- Duodecim, Scientific Society of Finnish Physicians, PO Box 874, Kaivokatu 10, 00101, Helsinki, Finland
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok j, 3000, Leuven, Belgium
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Andrikopoulou E, Scott P, Herrera H, Good A. What are the important design features of personal health records to improve medication adherence for patients with long-term conditions? A systematic literature review. BMJ Open 2019; 9:e028628. [PMID: 31558449 PMCID: PMC6773318 DOI: 10.1136/bmjopen-2018-028628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This systematic literature review aims to identify important design features of the electronic personal health record (PHR) that may improve medication adherence in the adult population with long-term conditions. DATA SOURCES PubMed (including MEDLINE), CINAHL, Science Direct (including EMBASE), BioMed Central, ACM digital, Emerald Insight, Google Scholar and Research Gate. METHODS Studies that were published between 1 January 2002 and 31 May 2018 in English were included if the participants were adults, with at least one long-term condition, were able to self-administer their medication and were treated in primary care settings. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the risk of bias was appraised using the Cochrane risk of bias tool. RESULTS From a total of 27 studies that matched the inclusion criteria, 12 were excluded due to low quality of evidence, 10 were rated moderate and 5 were rated high quality. All the included studies had low sample size and limited follow-up duration. Thirteen of the included studies found that the use of a PHR has increased medication adherence. The identified design features are reminders, education, personalisation and tailoring, feedback and alerts, gamification, medication management, medical appointment management, diary and self-monitoring, health condition management, set goals, patient's blog and tethered. It was impossible to draw conclusions as to which feature is important to what group of patients and why. The most frequently identified conditions were HIV and diabetes. This review did not identify any papers with negative results. It was not possible to numerically aggregate the PHR effect due to high heterogeneity of the medication adherence measurement, study type, participants and PHRs used. CONCLUSION Although we found recurrent evidence that PHRs can improve medication adherence, there is little evidence to date to indicate which design features facilitate this process. PROSPERO REGISTRATION NUMBER CRD42017060542.
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Affiliation(s)
- Elisavet Andrikopoulou
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
- School of Computing, Buckingham Building, Lion Terrace, Portsmouth, UK
| | - Philip Scott
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, Faculty of Science, University of Portsmouth, Portsmouth, UK
| | - Alice Good
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
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Huang L, Shea AL, Qian H, Masurkar A, Deng H, Liu D. Patient clustering improves efficiency of federated machine learning to predict mortality and hospital stay time using distributed electronic medical records. J Biomed Inform 2019; 99:103291. [PMID: 31560949 DOI: 10.1016/j.jbi.2019.103291] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022]
Abstract
Electronic medical records (EMRs) support the development of machine learning algorithms for predicting disease incidence, patient response to treatment, and other healthcare events. But so far most algorithms have been centralized, taking little account of the decentralized, non-identically independently distributed (non-IID), and privacy-sensitive characteristics of EMRs that can complicate data collection, sharing and learning. To address this challenge, we introduced a community-based federated machine learning (CBFL) algorithm and evaluated it on non-IID ICU EMRs. Our algorithm clustered the distributed data into clinically meaningful communities that captured similar diagnoses and geographical locations, and learnt one model for each community. Throughout the learning process, the data was kept local at hospitals, while locally-computed results were aggregated on a server. Evaluation results show that CBFL outperformed the baseline federated machine learning (FL) algorithm in terms of Area Under the Receiver Operating Characteristic Curve (ROC AUC), Area Under the Precision-Recall Curve (PR AUC), and communication cost between hospitals and the server. Furthermore, communities' performance difference could be explained by how dissimilar one community was to others.
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Affiliation(s)
- Li Huang
- Academy of Arts and Design, Tsinghua University, Beijing 10084, China; The Future Laboratory, Tsinghua University, Beijing 10084, China
| | - Andrew L Shea
- Computer Science & Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Huining Qian
- College of Applied Mathematical and Physical Science, Beijing University of Technology, Beijing 100124, China
| | - Aditya Masurkar
- School of Engineering, Northeastern University, Boston, MA 02115, United States
| | - Hao Deng
- Department Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston 02115, United States; School of Public Health, Johns Hopkins University, United States; Boston Children's Hospital, Boston, MA 02115, United States
| | - Dianbo Liu
- Computer Science & Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States; Boston Children's Hospital, Boston, MA 02115, United States; Medical School, Harvard University, Boston, MA 02115, United States.
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Riddle MC, Blonde L, Gerstein HC, Gregg EW, Holman RR, Lachin JM, Nichols GA, Turchin A, Cefalu WT. Diabetes Care Editors' Expert Forum 2018: Managing Big Data for Diabetes Research and Care. Diabetes Care 2019; 42:1136-1146. [PMID: 31666233 DOI: 10.2337/dci19-0020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 02/03/2023]
Abstract
Technological progress in the past half century has greatly increased our ability to collect, store, and transmit vast quantities of information, giving rise to the term "big data." This term refers to very large data sets that can be analyzed to identify patterns, trends, and associations. In medicine-including diabetes care and research-big data come from three main sources: electronic medical records (EMRs), surveys and registries, and randomized controlled trials (RCTs). These systems have evolved in different ways, each with strengths and limitations. EMRs continuously accumulate information about patients and make it readily accessible but are limited by missing data or data that are not quality assured. Because EMRs vary in structure and management, comparisons of data between health systems may be difficult. Registries and surveys provide data that are consistently collected and representative of broad populations but are limited in scope and may be updated only intermittently. RCT databases excel in the specificity, completeness, and accuracy of their data, but rarely include a fully representative sample of the general population. Also, they are costly to build and seldom maintained after a trial's end. To consider these issues, and the challenges and opportunities they present, the editors of Diabetes Care convened a group of experts in management of diabetes-related data on 21 June 2018, in conjunction with the American Diabetes Association's 78th Scientific Sessions in Orlando, FL. This article summarizes the discussion and conclusions of that forum, offering a vision of benefits that might be realized from prospectively designed and unified data-management systems to support the collective needs of clinical, surveillance, and research activities related to diabetes.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | - Hertzel C Gerstein
- McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Rury R Holman
- Diabetes Trial Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
| | - John M Lachin
- The George Washington University Biostatistics Center, Rockville, MD
| | - Gregory A Nichols
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Gagnon MP, Ndiaye MA, Larouche A, Chabot G, Chabot C, Buyl R, Fortin JP, Giguère A, Leblanc A, Légaré F, Motulsky A, Sicotte C, Witteman HO, Kavanagh E, Lépinay F, Roberge J, Délétroz C, Abbasgholizadeh-Rahimi S. Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial. BMJ Open 2019; 9:e028554. [PMID: 30944143 PMCID: PMC6500232 DOI: 10.1136/bmjopen-2018-028554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Multimorbidity increases care needs and primary care use among people with chronic diseases. The Concerto Health Program (CHP) has been developed to optimise chronic disease management in primary care services. However, in its current version, the CHP primarily targets clinicians and does not aim to answer directly patients' and their informal caregivers' needs for chronic disease management. Various studies have shown that interventions that increase patient activation level are associated with better health outcomes. Furthermore, educational tools must be adapted to patients and caregivers in terms of health literacy and usability. This project aims to develop, implement and evaluate a user-centred, multifunctional and personalised eHealth platform (CONCERTO+) to promote a more active patient role in chronic disease management and decision-making. METHODS AND ANALYSIS This project uses a collaborative research approach, aiming at the personalisation of CHP through three phases: (1) the development of one module of an eHealth platform based on scientific evidence and user-centred design; (2) a feasibility study of CONCERTO+ through a pilot cluster randomised controlled trial where patients with chronic diseases from a primary healthcare practice will receive CONCERTO+ during 6 months and be compared to patients from a control practice receiving usual care and (3) an analysis of CONCERTO+ potential for scaling up. To do so, we will conduct two focus groups with patients and informal caregivers and individual interviews with health professionals at the two study sites, as well as health care managers, information officers and representatives of the Ministry of Health. ETHICS AND DISSEMINATION This study received ethical approval from Ethics Committee of Université Laval. The findings will be used to inform the effectiveness of CONCERTO+ to improve management care in chronic diseases. We will disseminate findings through presentations in scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03628963; Pre-results.
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Affiliation(s)
- Marie-Pierre Gagnon
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Faculty of Nursing Sciences, Université Laval, Quebec City, QC, Canada
| | - Mame Awa Ndiaye
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
| | | | | | | | - Ronald Buyl
- Faculty of Medicine and Pharmacy, VrjeUniversiteit, Brussel, Belgium
| | - Jean-Paul Fortin
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Anik Giguère
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Annie Leblanc
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - France Légaré
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Aude Motulsky
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Claude Sicotte
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Eric Kavanagh
- École de design, Université Laval, Quebec City, QC, Canada
| | | | | | - Carole Délétroz
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Lausanne, Switzerland
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12
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Croff R, Hoffman K, Alanis-Hirsch K, Ford J, McCarty D, Schmidt L. Overcoming Barriers to Adopting and Implementing Pharmacotherapy: the Medication Research Partnership. J Behav Health Serv Res 2019; 46:330-339. [PMID: 29845513 PMCID: PMC6265123 DOI: 10.1007/s11414-018-9616-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pharmacotherapy includes a growing number of clinically effective medications for substance use disorder, yet there are significant barriers to its adoption and implementation in routine clinical practice. The Medication Research Partnership (MRP) was a successful effort to promote adoption of pharmacotherapy for opioid and alcohol use disorders in nine substance abuse treatment centers and a commercial health plan. This qualitative analysis of interviews (n = 39) conducted with change leaders at baseline and at the end/beginning of 6-month change cycles explains how treatment centers overcame obstacles to the adoption, implementation, and sustainability of pharmacotherapy. Results show that barriers to adopting, implementing, and sustaining pharmacotherapy can be overcome through incremental testing of organizational change strategies, accompanied by expert coaching and a learning community of like-minded professionals. The greatest challenges lie in overcoming abstinence-only philosophies, establishing a business case for pharmacotherapy, and working with payers and pharmaceutical representatives.
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Affiliation(s)
- Raina Croff
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA
| | - Kim Hoffman
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA.
| | | | - Jay Ford
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 610 Walnut St, Madison, WI, 53726, USA
| | - Dennis McCarty
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA
| | - Laura Schmidt
- School of Medicine, University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
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13
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Sandefer RH, Westra BL, Khairat SS, Pieczkiewicz DS, Speedie SM. Assessment of Personal Health Care Management and Chronic Disease Prevalence: Comparative Analysis of Demographic, Socioeconomic, and Health-Related Variables. J Med Internet Res 2018; 20:e276. [PMID: 30341046 PMCID: PMC6231843 DOI: 10.2196/jmir.8784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 05/01/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022] Open
Abstract
Background The use of personal health care management (PHM) is increasing rapidly within the United States because of implementation of health technology across the health care continuum and increased regulatory requirements for health care providers and organizations promoting the use of PHM, particularly the use of text messaging (short message service), Web-based scheduling, and Web-based requests for prescription renewals. Limited research has been conducted comparing PHM use across groups based on chronic conditions. Objective This study aimed to describe the overall utilization of PHM and compare individual characteristics associated with PHM in groups with no reported chronic conditions, with 1 chronic condition, and with 2 or more such conditions. Methods Datasets drawn from the National Health Interview Survey were analyzed using multiple logistic regression to determine the level of PHM use in relation to demographic, socioeconomic, or health-related factors. Data from 47,814 individuals were analyzed using logistic regression. Results Approximately 12.19% (5737/47,814) of respondents reported using PHM, but higher rates of use were reported by individuals with higher levels of education and income. The overall rate of PHM remained stable between 2009 and 2014, despite increased focus on the promotion of patient engagement initiatives. Demographic factors predictive of PHM use included people who were younger, non-Hispanic, and who lived in the western region of the United States. There were also differences in PHM use based on socioeconomic factors. Respondents with college-level education were over 2.5 times more likely to use PHM than respondents without college-level education. Health-related factors were also predictive of PHM use. Individuals with health insurance and a usual place for health care were more likely to use PHM than individuals with no health insurance and no usual place for health care. Individuals reporting a single chronic condition or multiple chronic conditions reported slightly higher levels of PHM use than individuals reporting no chronic conditions. Individuals with no chronic conditions who did not experience barriers to accessing health care were more likely to use PHM than individuals with 1 or more chronic conditions. Conclusions The findings of this study illustrated the disparities in PHM use based on the number of chronic conditions and that multiple factors influence the use of PHM, including economics and education. These findings provide evidence of the challenge associated with engaging patients using electronic health information as the health care industry continues to evolve.
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Affiliation(s)
- Ryan H Sandefer
- Department of Health Informatics and Information Management, College of St. Scholastica, Duluth, MN, United States
| | - Bonnie L Westra
- Center for Nursing Informatics, School of Nursing & Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
| | - Saif S Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David S Pieczkiewicz
- Institute for Health Informatics, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Stuart M Speedie
- Institute for Health Informatics, University of Minnesota Twin Cities, Minneapolis, MN, United States
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14
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Mikles SP, Suh H, Kientz JA, Turner AM. The use of model constructs to design collaborative health information technologies: A case study to support child development. J Biomed Inform 2018; 86:167-174. [PMID: 30195086 PMCID: PMC6251717 DOI: 10.1016/j.jbi.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/15/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Health information technology could provide valuable support for inter-professional collaboration to address complex health issues, but current HIT systems do not adequately support such collaboration. Existing theoretical research on supporting collaborative work can help inform the design of collaborative HIT systems. Using the example of supporting collaboration between child development service providers, we describe a deductive approach that leverages concepts from the literature and analyzes qualitative user-needs data to aid in collaborative system design. MATERIALS AND METHODS We use the Collaboration Space Model to guide the deductive qualitative analysis of interviews focused on the use of information technology to support child development. We deductively analyzed 44 interviews from two separate research initiatives and included data from a wide range of stakeholder groups including parents and various service providers. We summarized the deductively coded interview excerpts using quantitative and qualitative methods. RESULTS The deductive analysis method provided a rich set of design data, highlighting heterogeneity in work processes, barriers to adequate communication, and gaps in stakeholder knowledge in supporting child development work. DISCUSSION Deductive qualitative analysis considering constructs from a literature-based model provided useful, actionable data to aid in design. Design implications underscore functions needed to adequately share data across many stakeholders. More work is needed to validate our design implications and to better understand the situations where specific system features would be most useful. CONCLUSIONS Deductive analysis considering model constructs provides a useful approach to designing collaborative HIT systems, allowing designers to consider both empirical user data and existing knowledge from the literature. This method has the potential to improve designs for collaborative HIT systems.
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Affiliation(s)
- Sean P Mikles
- Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Hyewon Suh
- Human Centered Design & Engineering, University of Washington, 428 Sieg Hall, Box 352315, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Julie A Kientz
- Human Centered Design & Engineering, University of Washington, 428 Sieg Hall, Box 352315, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Anne M Turner
- Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, Seattle, WA 98195, USA; Department of Health Services, University of Washington, Magnuson Health Sciences Center, Room H-680, Box 357660, 1959 NE Pacific Street, Seattle, WA 98195, USA
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15
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Lockett H, Waghorn G, Kydd R. A framework for improving the effectiveness of evidence-based practices in vocational rehabilitation. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Helen Lockett
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
- The Wise Group, Hamilton, New Zealand
| | - Geoffrey Waghorn
- The ORS Group, Brisbane, Queensland, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Rob Kydd
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
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16
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Cox JL, Parkash R, Abidi SS, Thabane L, Xie F, MacKillop J, Abidi SR, Ciaccia A, Choudhri SH, Abusharekh A, Nemis-White J. Optimizing primary care management of atrial fibrillation: The rationale and methods of the Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) study. Am Heart J 2018; 201:149-157. [PMID: 29807323 DOI: 10.1016/j.ahj.2018.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
The Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) is an investigator designed, prospective, randomized, un-blinded, cluster design clinical trial, conducted in the primary care setting of Nova Scotia, Canada. Its aim is to evaluate whether an electronic Clinical Decision Support System (CDSS) designed to assist both practitioners and patients with evidence-based management strategies for Atrial Fibrillation (AF) can improve process of care and outcomes in a cost-efficient manner as compared to usual AF care. At least 200 primary care providers are being recruited and randomized at the level of the practice to control (usual care) or intervention (eligible to access to CDSS) cohorts. Over 1,000 patients of participating providers with confirmed AF will be managed per their provider's respective assignment. The targeted primary clinical outcome is a reduction in the composite of unplanned cardiovascular (CV) or major bleeding hospitalizations and AF-related emergency department visits. Secondary clinical outcomes, process of care, patient and provider satisfaction as well as economic costs at the system and patient levels are being examined. The trial is anticipated to report in 2018.
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Affiliation(s)
- Jafna L Cox
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Heart and Stroke Foundation of Nova Scotia Endowed Chair in Cardiovascular Outcomes Research.
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Syed Sr Abidi
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Departments of Anesthesia/Pediatrics, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, Centre for Evaluation of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute (PHRI), Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; System-Linked Research Unit (SLRU), McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Departments of Anesthesia/Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - James MacKillop
- Sydney Primary Care Medical Clinic, Sydney, Nova Scotia, Canada; Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samina R Abidi
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Antonio Ciaccia
- Medical Affairs - Cardiovascular Medicine, Bayer Inc, Mississauga, Ontario, Canada
| | - Shurjeel H Choudhri
- Medical & Scientific Affairs, Bayer Inc, Mississauga, Ontario, Canada; Canadian Clinical Trial Coordinating Centre (CCTCC); Medical Advisory Team (MAT), Innovative Medicines, Canada; Canadian Arrhythmia Network (CANet)
| | - A Abusharekh
- NICHE Research Group, Faculty of Computer Science, Dalhousie University, Halifax, Canada
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17
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Veinot TC, Senteio CR, Hanauer D, Lowery JC. Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis. J Am Med Inform Assoc 2018; 25:746-758. [PMID: 29025114 PMCID: PMC7646963 DOI: 10.1093/jamia/ocx085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/18/2017] [Accepted: 08/01/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. Materials and Methods We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. Results The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. Discussion The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. Conclusion The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.
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Affiliation(s)
- Tiffany C Veinot
- School of Information and School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Charles R Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - David Hanauer
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Julie C Lowery
- Center for Clinical Management, Research, VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, USA
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18
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Litchfield I, Gill P, Avery T, Campbell S, Perryman K, Marsden K, Greenfield S. Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives. BMC FAMILY PRACTICE 2018; 19:72. [PMID: 29788906 PMCID: PMC5964721 DOI: 10.1186/s12875-018-0761-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/02/2018] [Indexed: 11/29/2022]
Abstract
Background Primary care is changing rapidly to meet the needs of an ageing and chronically ill population. New ways of working are called for yet the introduction of innovative service interventions is complicated by organisational challenges arising from its scale and diversity and the growing complexity of patients and their care. One such intervention is the multi-strand, single platform, Patient Safety Toolkit developed to help practices provide safer care in this dynamic and pressured environment where the likelihood of adverse incidents is increasing. Here we describe the attitudes of staff toward these tools and how their implementation was shaped by a number of contextual factors specific to each practice. Methods The Patient Safety Toolkit comprised six tools; a system of rapid note review, an online staff survey, a patient safety questionnaire, prescribing safety indicators, a medicines reconciliation tool, and a safe systems checklist. We implemented these tools at practices across the Midlands, the North West, and the South Coast of England and conducted semi-structured interviews to determine staff perspectives on their effectiveness and applicability. Results The Toolkit was used in 46 practices and a total of 39 follow-up interviews were conducted. Three key influences emerged on the implementation of the Toolkit these related to their ease of use and the novelty of the information they provide; whether their implementation required additional staff training or practice resource; and finally factors specific to the practice’s local environment such as overlapping initiatives orchestrated by their CCG. Conclusions The concept of a balanced toolkit to address a range of safety issues proved popular. A number of barriers and facilitators emerged in particular those tools that provided relevant information with a minimum impact on practice resource were favoured. Individual practice circumstances also played a role. Practices with IT aware staff were at an advantage and those previously utilising patient safety initiatives were less likely to adopt additional tools with overlapping outputs. By acknowledging these influences we can better interpret reaction to and adoption of individual elements of the toolkit and optimise future implementation.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Paramjit Gill
- Warwick Medical School - Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Tony Avery
- School of Medicine, Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Katherine Perryman
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Kate Marsden
- School of Medicine, Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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19
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Tao D, Wang T, Wang T, Liu S, Qu X. Effects of consumer-oriented health information technologies in diabetes management over time: a systematic review and meta-analysis of randomized controlled trials. J Am Med Inform Assoc 2018; 24:1014-1023. [PMID: 28340030 DOI: 10.1093/jamia/ocx014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/09/2017] [Indexed: 12/23/2022] Open
Abstract
Objective To reveal the effects of consumer-oriented health information technologies (CHITs) on patient outcomes in diabetes management over time through systematic review and meta-analysis. Methods We searched 5 electronic databases (from database inception to July 2016) for studies that reported on randomized controlled trials examining the effects of CHITs on glycemic control and other patient outcomes in diabetes management. Data were analyzed using either meta-analysis or a narrative synthesis approach. Results Eighty randomized controlled trial studies, representing 87 individual trials, were identified and included for analysis. Overall, the meta-analysis showed that the use of CHITs resulted in significant improvement in glycemic control compared to usual care (standardized mean difference = -0.31%, 95% confidence interval -0.38 to -0.23, P < .001) in patients with diabetes. Specifically, improvement in glycemic control was significant at intervention durations of 3, 6, 8, 9, 12, 15, 30, and 60 months, while no significant differences were found at other time points reported. The narrative synthesis provided mixed effects of CHITs on other clinical, psychosocial, behavioral, and knowledge outcomes. Conclusions The use of CHITs appears to be more effective than usual care in improving glycemic control for patients with diabetes. However, their effectiveness did not remain consistent over time and in other patient outcomes. Further efforts are required to examine long-term effects of CHITs and to explore factors that can moderate the effects over time.
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Affiliation(s)
- Da Tao
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, China
| | - Tieyan Wang
- School of Management, Xi'an Polytechnic University, Xi'an, China
| | - Tieshan Wang
- School of Management, Xi'an Polytechnic University, Xi'an, China
| | - Shuang Liu
- Marine Human Factors Engineering Lab, China Institute of Marine Technology and Economy, Beijing, China
| | - Xingda Qu
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, China
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20
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Ranade-Kharkar P, Weir C, Norlin C, Collins SA, Scarton LA, Baker GB, Borbolla D, Taliercio V, Del Fiol G. Information needs of physicians, care coordinators, and families to support care coordination of children and youth with special health care needs (CYSHCN). J Am Med Inform Assoc 2018; 24:933-941. [PMID: 28371887 DOI: 10.1093/jamia/ocx023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/24/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). Materials and Methods We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes. Results The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes. Discussion and Conclusion Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions.
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Affiliation(s)
- Pallavi Ranade-Kharkar
- Intermountain Healthcare, Murray, UT, USA.,Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.,VA Medical Center, Salt Lake City, UT, USA
| | - Chuck Norlin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Sarah A Collins
- Partners HealthCare, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lou Ann Scarton
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Vanina Taliercio
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
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21
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Plastiras P, O'Sullivan DM. Combining Ontologies and Open Standards to Derive a Middle Layer Information Model for Interoperability of Personal and Electronic Health Records. J Med Syst 2017; 41:195. [PMID: 29081012 DOI: 10.1007/s10916-017-0838-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
The aim of our study was to enable better interoperability between Personal Health Record (PHR) and Electronic Health Record (EHR) systems and vice versa. A multi-layer architectural model that resides between a PHR and EHR system has been developed. The model consists of an ontology-driven information model and a set of transformation rules that work in conjunction to process data exported from a PHR or EHR system and prepare it accordingly for the receiving system. The model was evaluated by executing a set of case study scenarios containing data from both a PHR and an EHR system. This allowed various challenges to emerge and revealed gaps in current standards in use. The proposed information model offers a number of advantages. Altering only the information model can incorporate modifications to either a PHR or EHR system. The model uses classes and attributes to define how data is captured which allows greater flexibility in how data can be manipulated by receiving systems.
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Affiliation(s)
- Panagiotis Plastiras
- Health Informatics Research Group, Department of Computer Science, City University of London, EC1V 0HB, London, UK.
| | - Dympna M O'Sullivan
- Health Informatics Research Group, Department of Computer Science, City University of London, EC1V 0HB, London, UK
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22
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Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2017; 22:443-446. [PMID: 27799445 DOI: 10.1177/1357633x16670479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/27/2016] [Indexed: 11/16/2022]
Abstract
This paper reports a subset of data from a mixed methods project interviewing community nurses and nurse leaders/managers to explore the views, expectations, practice and attitudes of registered nurses working in the community concerning electronic health records and the use of mobile devices. Nurses displayed excellent understanding of privacy and consent concerning electronic patient records and health information technology (e-health). With targeted, individualised education, nurses use e-health and telehealth effectively. However, significant barriers were found regarding duplication of paper and electronic patient notes and multiple logins for different platforms and systems, resulting in forgotten and shared passwords. There was also evidence of some avoidance of essential systems; lack of infrastructure in some settings; inadequate systems for the use of digital cameras (e.g. tracking wound healing); and inability to access patient notes across settings to ensure integrated care. In conclusion, nurses are the largest group of health practitioners in New Zealand and are at the front line of patient care. Nurses need systems designed around their work methods and a good understanding of e-health in order to be able to use it effectively. Greater consultation with nurses is required to ensure the potential of e-health and its use is maximised.
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Affiliation(s)
- Léonie Walker
- Graduate School of Nursing and Midwifery, Victoria University, New Zealand
| | - Jill Clendon
- Graduate School of Nursing and Midwifery, Victoria University, New Zealand
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Ramirez M, Wu S, Ryan G, Towfighi A, Vickrey BG. Using Beta-Version mHealth Technology for Team-Based Care Management to Support Stroke Prevention: An Assessment of Utility and Challenges. JMIR Res Protoc 2017; 6:e94. [PMID: 28536094 PMCID: PMC5461415 DOI: 10.2196/resprot.7106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/05/2017] [Accepted: 04/22/2017] [Indexed: 11/13/2022] Open
Abstract
Background Beta versions of health information technology tools are needed in service delivery models with health care and community partnerships to confirm the key components and to assess the performance of the tools and their impact on users. We developed a care management technology (CMT) for use by community health workers (CHWs) and care managers (CMs) working collaboratively to improve risk factor control among recent stroke survivors. The CMT was expected to enhance the efficiency and effectiveness of the CHW-CM team. Objective The primary objective was to describe the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) CMT and investigate CM and CHW perceptions of the CMT’s usefulness and challenges for team-based care management. Methods We conducted qualitative interviews with all users of the beta-version SUCCEED CMT, namely two CMs and three CHWs. They were asked to demonstrate and describe their perceptions of the CMT’s ease of use and usefulness for completing predefined key care management activities. They were also probed about their general perceptions of the CMT’s information quality, ease of use, usefulness, and impact on CM and CHW roles. Interview transcripts were coded using a priori codes. Coded excerpts were grouped into broader themes and then related in a conceptual model of how the CMT facilitated care management. We also conducted a survey with 14 patients to obtain their perspective on CHW tablet use during CHW-patient interactions. Results Care managers and community health workers expressed that the CMT helped them keep track of patient interactions and plan their work. It guided CMs in developing and sharing care plans with CHWs. For CHWs, the CMT enabled electronic collection of clinical assessment data, provided decision support, and provided remote access to patients’ risk factor values. Long loading times and downtimes due to outages were the most significant challenges encountered. Additional issues included extensive use of free-text responses and manual data transfer from the electronic medical record. Despite these challenges, patients overall did not perceive the tablet as interfering with CHW-patient interactions. Conclusions Our findings suggest useful functionalities of CMTs supporting health care and community partners in collaborative chronic care management. However, usability issues need to be addressed during the development process. The SUCCEED CMT is an initial step toward the development of effective health information technology tools to support collaborative, team-based models of care and will need to be modified as the evidence base grows. Future research should assess the CMT’s effects on team performance.
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Affiliation(s)
- Magaly Ramirez
- Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Edward R Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.,Daniel J Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, United States
| | - Gery Ryan
- RAND Corporation, Santa Monica, CA, United States
| | - Amytis Towfighi
- Keck School of Medicine, Department of Neurology, University of Southern California, Los Angeles, CA, United States.,Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, United States
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Brandão ABDF, Timi JRR, Malafaia O. Electronic protocol for clinical data collection in chronic visceral ischemia. J Vasc Bras 2017; 16:35-42. [PMID: 29930621 PMCID: PMC5829690 DOI: 10.1590/1677-5449.006916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with vascular diseases present with a long medical history which makes for complex and confusing medical records. Electronic record systems have a large storage capacity and high information processing capabilities, and may therefore improve the quality and reliability of prospective clinical studies. In the present study, a theoretical framework for clinical data collection in chronic visceral ischemia was created containing 5706 items, organized into six major categories: medical history, physical examination, laboratory testing, diagnosis, treatment and outcome. The database was used to construct an electronic data collection protocol, which was uploaded into the Integrated Electronic Protocol System (Sistema Integrado de Protocolos Eletrônicos, SINPE©) and then used to perform retrospective collection and analysis of clinical data from 10 patients using the SINPE© analysis module.
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Affiliation(s)
| | - Jorge Rufino Ribas Timi
- Instituto da Circulação, Curitiba, PR, Brazil.,Universidade Federal do Paraná́ - UFPR, Department of Surgery, Curitiba, PR, Brazil
| | - Osvaldo Malafaia
- Universidade Federal do Paraná́ - UFPR, Department of Surgery, Curitiba, PR, Brazil.,Faculdade Evangélica do Paraná́ - FEPAR, Department of Surgery, Curitiba, PR, Brazil
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25
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Portz JD. A review of web-based chronic disease self-management for older adults. GERONTECHNOLOGY : INTERNATIONAL JOURNAL ON THE FUNDAMENTAL ASPECTS OF TECHNOLOGY TO SERVE THE AGEING SOCIETY 2017; 16:12-20. [PMID: 30705614 DOI: 10.4017/gt.2017.16.1.002.00] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective To examine the current evidence related to the efficacy of web-based chronic disease self-management interventions (web-based SM) for older populations. Methods A search of experimental and quasi-experimental publications related to older adults and web-based SM was conducted. The search identified 12 articles representing 10 distinct studies that were used for review and critique. Results Articles most frequently investigated web-based SM targeting diabetes and heart disease. Interventions incorporated a variety of technologies including visual-charting, instant messenger, among others. Overall the web-based SM for older adults resulted in positive effects for most outcomes, including: healthcare utilization, depression, loneliness, social support, quality of life, self-efficacy, anxiety, disease specific outcomes, functioning levels, diet, exercise, and health status. Discussion While these studies suggest that web-based SM may be effective in producing positive health outcomes for older adults, more research is needed to focus on the efficacy and appropriateness of such interventions for older adults.
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Affiliation(s)
- Jennifer Dickman Portz
- University of Colorado, School of Medicine, Aurora, Colorado, USA.,Colorado State University, School of Social Work, Fort Collins, Colorado, USA
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26
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Sorondo B, Allen A, Fathima S, Bayleran J, Sabbagh I. Patient Portal as a Tool for Enhancing Patient Experience and Improving Quality of Care in Primary Care Practices. EGEMS (WASHINGTON, DC) 2017; 4:1262. [PMID: 28203611 PMCID: PMC5302860 DOI: 10.13063/2327-9214.1262] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study assessed whether patient portals influence patients' ability for self-management, improve their perception of health state, improve their experience with primary care practices, and reduce healthcare utilization. METHODS Patients participating in a nurse-led care coordination program received personalized training to use the portal to communicate with the care team. Data analysis included pre-post comparison of self-efficacy (CDSES), health state (EQVAS), functional status (PROMIS®), experience with the provider/practice (CG-CAHPS), and healthcare utilization (admissions and ED visits). RESULTS A total of 94 patients were enrolled, and 92 (Intent to Treat) were followed up for 7 months to assess their experience, and for 12 months to assess healthcare utilization. Seventy four (mean age 60+13 years) used the portal (Users). Comparison between baseline and 7-month follow-up showed no statistically significant improvements in self-efficacy, perception of health state or experience with the primary care practice. Only functional status improved significantly. ED visits/1000 patients were reduced by 26% and 21% in the Intent to Treat and Users groups, respectively. Hospital admissions/1000 patients were reduced by 46% in the Intent to Treat group and by 38% in the Users group. DISCUSSION For patients in care coordination, having access to patient portals may improve access to providers and health data that lead to improvements in patients' functional status and reduce high-cost healthcare utilization, but it does not seem to improve self-efficacy, perception of health state, or experience with primary care practices. CONCLUSION In this study, the use of patient portals improved functional status and reduced high-cost healthcare utilization in patients with chronic conditions.
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Coffey S, Vanderlip E, Sarvet B. The Use of Health Information Technology Within Collaborative and Integrated Models of Child Psychiatry Practice. Child Adolesc Psychiatr Clin N Am 2017; 26:105-115. [PMID: 27837936 DOI: 10.1016/j.chc.2016.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a consistent need for more child and adolescent psychiatrists. Despite increased recruitment of child and adolescent psychiatry trainees, traditional models of care will likely not be able to meet the need of youth with mental illness. Integrated care models focusing on population-based, team-based, measurement-based, and evidenced-based care have been effective in addressing accessibility and quality of care. These integrated models have specific needs regarding health information technology (HIT). HIT has been used in a variety of different ways in several integrated care models. HIT can aid in implementation of these models but is not without its challenges.
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Affiliation(s)
- Sara Coffey
- Department of Psychiatry, Oklahoma State University School of Community Medicine, 4502 East 41st, Tulsa, OK 74135, USA.
| | - Erik Vanderlip
- Department of Psychiatry, Oklahoma State University School of Community Medicine, 4502 East 41st, Tulsa, OK 74135, USA
| | - Barry Sarvet
- Division of Child and Adolescent Psychiatry, Baystate Medical Center, 3300 Main Street 4th Floor, Springfield, MA 01199, USA
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Campmans-Kuijpers MJE, Lemmens LC, Baan CA, Rutten GEHM. Patient-centeredness and quality management in Dutch diabetes care organizations after a 1-year intervention. Patient Prefer Adherence 2016; 10:1957-1966. [PMID: 27784994 PMCID: PMC5063289 DOI: 10.2147/ppa.s117388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND More focus on patient-centeredness in care for patients with type 2 diabetes requests increasing attention to diabetes quality management processes on patient-centeredness by managers in primary care groups and outpatient clinics. Although patient-centered care is ultimately determined by the quality of interactions between patients and clinicians at the practice level, it should be facilitated at organizational level too. This nationwide study aimed to assess the state of diabetes quality management on patient-centeredness at organizational level and its possibilities to improve after a tailored intervention. METHODS This before-after study compares the quality management on patient-centeredness within Dutch diabetes care groups and outpatient clinics before and after a 1-year stepwise intervention. At baseline, managers of 51 diabetes primary care groups and 28 outpatient diabetes clinics completed a questionnaire about the organization's quality management program. Patient-centeredness (0%-100%) was operationalized in six subdomains: facilitating self-management support, individualized care plan support, patients' access to medical files, patient education policy, safeguarding patients' interests, and formal patient involvement. The intervention consisted of feedback and benchmark and if requested a telephone call and/or a consultancy visit. After 1 year, the managers completed the questionnaire again. The 1-year changes were examined by dependent (non) parametric tests. RESULTS Care groups improved significantly on patient-centeredness (from 47.1% to 53.3%; P=0.002), and on its subdomains "access to medical files" (from 42.0% to 49.4%), and "safeguarding patients' interests" (from 58.1% to 66.2%). Outpatient clinics, which scored higher at baseline (66.7%) than care groups, did not improve on patient-centeredness (65.6%: P=0.54) or its subdomains. "Formal patient involvement" remained low in both care groups (23.2%) and outpatient clinics (33.9%). CONCLUSION After a simple intervention, care groups significantly improved their quality management on patient-centeredness, but outpatient clinics did not. Interventions to improve quality management on patient-centeredness in diabetes care organizations should differ between primary and secondary care.
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Affiliation(s)
| | - Lidwien C Lemmens
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, Utrecht, the Netherlands
| | - Caroline A Baan
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, Utrecht, the Netherlands
| | - Guy EHM Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht
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Lee J, Choi JY. Texas hospitals with higher health information technology expenditures have higher revenue: A longitudinal data analysis using a generalized estimating equation model. BMC Health Serv Res 2016; 16:117. [PMID: 27048305 PMCID: PMC4820871 DOI: 10.1186/s12913-016-1367-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/29/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The benefits of health information technology (IT) adoption have been reported in the literature, but whether health IT investment increases revenue generation remains an important research question. METHODS Texas hospital data obtained from the American Hospital Association (AHA) for 2007-2010 were used to investigate the association of health IT expenses and hospital revenue. The generalized estimation equation (GEE) with an independent error component was used to model the data controlling for cluster error within hospitals. RESULTS We found that health IT expenses were significantly and positively associated with hospital revenue. Our model predicted that a 100% increase in health IT expenditure would result in an 8% increase in total revenue. The effect of health IT was more associated with gross outpatient revenue than gross inpatient revenue. CONCLUSION Increased health IT expenses were associated with greater hospital revenue. Future research needs to confirm our findings with a national sample of hospitals.
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Affiliation(s)
- Jinhyung Lee
- />Department of Economics, Sungkyunkwan University College of Economics, Seoul, Republic of Korea
| | - Jae-Young Choi
- />Program in Healthcare Management, Hallym University College of Business, Kangwon-do, Chuncheon, 200-702 Republic of Korea
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Sauers-Ford HS, Moore JL, Guiot AB, Simpson BE, Clohessy CR, Yost D, Mayhaus DC, Simmons JM, Gosdin CH. Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital. Pediatrics 2016; 137:peds.2015-0039. [PMID: 26983469 DOI: 10.1542/peds.2015-0039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In our previous work, providing medications in-hand at discharge was a key strategy to reduce asthma reutilization (readmissions and emergency revisits) among children in a large, urban county. We sought to spread this work to our satellite hospital in an adjacent county. A key initial barrier was the lack of an outpatient pharmacy on site, so we sought to determine if a partnership with community pharmacies could improve the percentage of patients with medications in-hand at discharge, thus decreasing reutilization. METHODS A multidisciplinary team partnered with community pharmacies. Using rapid-cycle improvement methods, the team aimed to reduce asthma reutilization by providing medications in-hand at discharge. Run charts were used to display the proportion of patients with asthma discharged with medications in-hand and to track 90-day reutilization rates. RESULTS During the intervention period, the median percentage of patients with asthma who received medications in-hand increased from 0% to 82%. A key intervention was the expansion of the medication in-hand program to all patients. Additional changes included expanding team to evening stakeholders, narrowing the number of community partners, and building electronic tools to support key processes. The mean percentage of patients with asthma discharged from the satellite who had a readmission or emergency department revisit within 90 days of their index admission decreased from 18% to 11%. CONCLUSIONS Impacting population-level asthma outcomes requires partnerships between community resources and health providers. When hospital resources are limited, community pharmacies are a potential partner, and providing access to medications in-hand at hospital discharge can reduce asthma reutilization.
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Affiliation(s)
| | - Jennifer L Moore
- Department of Patient Services, Cincinnati Children's Hospital Medicine Center, Cincinnati, Ohio; and
| | - Amy B Guiot
- Division of Hospital Medicine, Department of Pediatrics, and
| | - Blair E Simpson
- Division of Hospital Medicine, Department of Pediatrics, and
| | | | | | - David C Mayhaus
- Department of Patient Services, Cincinnati Children's Hospital Medicine Center, Cincinnati, Ohio; and
| | | | - Craig H Gosdin
- Division of Hospital Medicine, Department of Pediatrics, and
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Kuo A, Dang S. Secure Messaging in Electronic Health Records and Its Impact on Diabetes Clinical Outcomes: A Systematic Review. Telemed J E Health 2016; 22:769-77. [PMID: 27027337 DOI: 10.1089/tmj.2015.0207] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
UNLABELLED In 2009, President Barack Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act, which aims for the universal adoption of electronic health records (EHRs) in primary care settings and "meaningful use" of this technology. The objectives of "meaningful use" are well defined and executed in stages; one of the objectives of stage 2, beginning in 2014, was implementation of a secure messaging system between patients and providers. Secure messaging has been shown to positively affect patients who struggle with managing chronic diseases on a day to day basis. This review aims to assess the clinical evidence supporting the use of secure messaging in EHRs in self-management of diabetes. METHODS A systematic search of PubMed was conducted, and 320 results were returned. Of these, 11 were selected based on outlined criteria. CONCLUSIONS Evidence from 7 of the 11 included studies suggests significant improvement in patients' hemoglobin A1c (HbA1c) with the use of secure messaging. However, improvements in patients' secondary outcomes, such as blood pressure and cholesterol, were inconsistent. Further work must be done to determine how to best maximize the potential of available tools such as secure messaging and EHRs to improve patient outcomes.
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Affiliation(s)
- Alyce Kuo
- 1 University of Miami , Coral Gables, Florida
| | - Stuti Dang
- 2 Miami VA Healthcare System Geriatric, Research Education and Clinical Center and Extended Care and Research Services , Miami, Florida.,3 Division of Geriatrics and Palliative Care, Department of Medicine, University of Miami Miller School of Miami , Miami, Florida
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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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Ramirez M, Wu S, Jin H, Ell K, Gross-Schulman S, Myerchin Sklaroff L, Guterman J. Automated Remote Monitoring of Depression: Acceptance Among Low-Income Patients in Diabetes Disease Management. JMIR Ment Health 2016; 3:e6. [PMID: 26810139 PMCID: PMC4736285 DOI: 10.2196/mental.4823] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/11/2015] [Accepted: 09/22/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Remote patient monitoring is increasingly integrated into health care delivery to expand access and increase effectiveness. Automation can add efficiency to remote monitoring, but patient acceptance of automated tools is critical for success. From 2010 to 2013, the Diabetes-Depression Care-management Adoption Trial (DCAT)-a quasi-experimental comparative effectiveness research trial aimed at accelerating the adoption of collaborative depression care in a safety-net health care system-tested a fully automated telephonic assessment (ATA) depression monitoring system serving low-income patients with diabetes. OBJECTIVE The aim of this study was to determine patient acceptance of ATA calls over time, and to identify factors predicting long-term patient acceptance of ATA calls. METHODS We conducted two analyses using data from the DCAT technology-facilitated care arm, in which for 12 months the ATA system periodically assessed depression symptoms, monitored treatment adherence, prompted self-care behaviors, and inquired about patients' needs for provider contact. Patients received assessments at 6, 12, and 18 months using Likert-scale measures of willingness to use ATA calls, preferred mode of reach, perceived ease of use, usefulness, nonintrusiveness, privacy/security, and long-term usefulness. For the first analysis (patient acceptance over time), we computed descriptive statistics of these measures. In the second analysis (predictive factors), we collapsed patients into two groups: those reporting "high" versus "low" willingness to use ATA calls. To compare them, we used independent t tests for continuous variables and Pearson chi-square tests for categorical variables. Next, we jointly entered independent factors found to be significantly associated with 18-month willingness to use ATA calls at the univariate level into a logistic regression model with backward selection to identify predictive factors. We performed a final logistic regression model with the identified significant predictive factors and reported the odds ratio estimates and 95% confidence intervals. RESULTS At 6 and 12 months, respectively, 89.6% (69/77) and 63.7% (49/77) of patients "agreed" or "strongly agreed" that they would be willing to use ATA calls in the future. At 18 months, 51.0% (64/125) of patients perceived ATA calls as useful and 59.7% (46/77) were willing to use the technology. Moreover, in the first 6 months, most patients reported that ATA calls felt private/secure (75.9%, 82/108) and were easy to use (86.2%, 94/109), useful (65.1%, 71/109), and nonintrusive (87.2%, 95/109). Perceived usefulness, however, decreased to 54.1% (59/109) in the second 6 months of the trial. Factors predicting willingness to use ATA calls at the 18-month follow-up were perceived privacy/security and long-term perceived usefulness of ATA calls. No patient characteristics were significant predictors of long-term acceptance. CONCLUSIONS In the short term, patients are generally accepting of ATA calls for depression monitoring, with ATA call design and the care management intervention being primary factors influencing patient acceptance. Acceptance over the long term requires that the system be perceived as private/secure, and that it be constantly useful for patients' needs of awareness of feelings, self-care reminders, and connectivity with health care providers. TRIAL REGISTRATION ClinicalTrials.gov NCT01781013; https://clinicaltrials.gov/ct2/show/NCT01781013 (Archived by WebCite at http://www.webcitation.org/6e7NGku56).
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Affiliation(s)
- Magaly Ramirez
- Daniel J Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, United States
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Sandefer RH, Westra BL, Khairat SS, Pieczkiewicz DS, Speedie SM. Determinants of Consumer eHealth Information Seeking Behavior. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:1121-1129. [PMID: 26958251 PMCID: PMC4765703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patients are increasingly using the Internet and other technologies to engage in their own healthcare, but little research has focused on the determinants of consumer eHealth behaviors related to Internet use. This study uses data from 115,089 respondents to four years of the National Health Interview Series to identify the associations between one consumer eHealth behavior (information seeking) and demographics, health measures, and Personal Health Information Management (PHIM) (messaging, scheduling, refills, and chat). Individuals who use PHIM are 7.5 times more likely to search the internet for health related information. Just as health has social determinants, the results of this study indicate there are potential social determinants of consumer eHealth behaviors including personal demographics, health status, and healthcare access.
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North JC, Jordan KC, Metos J, Hurdle JF. Nutrition Informatics Applications in Clinical Practice: a Systematic Review. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:963-972. [PMID: 26958233 PMCID: PMC4765562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nutrition care and metabolic control contribute to clinical patient outcomes. Biomedical informatics applications represent a way to potentially improve quality and efficiency of nutrition management. We performed a systematic literature review to identify clinical decision support and computerized provider order entry systems used to manage nutrition care. Online research databases were searched using a specific set of keywords. Additionally, bibliographies were referenced for supplemental citations. Four independent reviewers selected sixteen studies out of 364 for review. These papers described adult and neonatal nutrition support applications, blood glucose management applications, and other nutrition applications. Overall, results indicated that computerized interventions could contribute to improved patient outcomes and provider performance. Specifically, computer systems in the clinical setting improved nutrient delivery, rates of malnutrition, weight loss, blood glucose values, clinician efficiency, and error rates. In conclusion, further investigation of informatics applications on nutritional and performance outcomes utilizing rigorous study designs is recommended.
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Affiliation(s)
- Jennifer C North
- Division of Nutrition, University of Utah, Salt Lake City, Utah, United States
| | - Kristine C Jordan
- Division of Nutrition, University of Utah, Salt Lake City, Utah, United States
| | - Julie Metos
- Division of Nutrition, University of Utah, Salt Lake City, Utah, United States
| | - John F Hurdle
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
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Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care. J Am Board Fam Med 2015; 28 Suppl 1:S63-72. [PMID: 26359473 PMCID: PMC7304941 DOI: 10.3122/jabfm.2015.s1.150133] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. METHODS This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. RESULTS Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. CONCLUSION Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators.
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Corser W, Yuan S. Mixed Influence of Electronic Health Record Implementation on Diabetes Order Patterns for Michigan Medicaid Adults. J Diabetes Sci Technol 2015; 10:429-34. [PMID: 26292961 PMCID: PMC4773952 DOI: 10.1177/1932296815601689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND These 2011-2013 analyses examined the authors' hypothesis that relative diabetes care order changes would be measured after electronic health record (EHR) implementation for 291 Medicaid adults who received all of their office-based care at one midwestern federally qualified health center (FQHC) over a 24-month period (n = 2727 encounters, 2489 claims). METHOD Beneficiary sociodemographic, clinical, and claims data were validated with clinic EHR and state Medicaid claims linked to providers' national identifier numbers. Overall pre-post order rate comparisons, and a series of controlled within group binary logistic models were conducted under penalized maximum likelihood estimation terms. RESULTS After EHR implementation, both the overall order rates and odds ratios of per beneficiary hemoglobin A1C (HbA1C) orders increased significantly (ie, from mean of 0.65 [SD = 1.19] annual tests to 0.96 tests [SD = 1.24] [P < .001]). Although the overall post-EHR order rates of dilated eye exams and microalbumin urine tests appeared fairly stable, the odds of eye exam orders being placed at the claims level decreased significantly (OR = 0.774, P = .0030). CONCLUSIONS These mixed results provide evidence of the varied diabetes care ordering patterns likely seen from increased office use of EHR technologies. The authors attempt to explain these post-EHR differences (or lack of) that generally resemble some of the authors' results from another funded project. Ideally, these findings provide Medicaid and health care officials with a more realistic indication of how EHRs may, or may not, influence diabetes care ordering patterns for vulnerable lower-income primary health care consumers.
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Affiliation(s)
- William Corser
- Statewide Campus System, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Sha Yuan
- Institute for Health Policy, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Supporting chronic pain management across provincial and territorial health systems in Canada: Findings from two stakeholder dialogues. Pain Res Manag 2015; 20:269-79. [PMID: 26291124 PMCID: PMC4596635 DOI: 10.1155/2015/918976] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic pain is a serious health problem affecting one in five Canadians. To provide better care for patients affected by chronic pain, there is a need to identify how provinces and territories across the country can strengthen its management. In this report, the authors summarize key findings from two stakeholder dialogues that addressed the support of chronic pain management by health system decisionmakers and across health systems. An overview of examples of the progress that has been made since the dialogues is also provided. BACKGROUND: Chronic pain is a serious health problem given its prevalence, associated disability, impact on quality of life and the costs associated with the extensive use of health care services by individuals living with it. OBJECTIVE: To summarize the research evidence and elicit health system policymakers’, stakeholders’ and researchers’ tacit knowledge and views about improving chronic pain management in Canada and engaging provincial and territorial health system decision makers in supporting comprehensive chronic pain management in Canada. METHODS: For these two topics, the global and local research evidence regarding each of the two problems were synthesized in evidence briefs. Three options were generated for addressing each problem, and implementation considerations were assessed. A stakeholder dialogue regarding each topic was convened (with 29 participants in total) and the deliberations were synthesized. RESULTS: To inform the first stakeholder dialogue, the authors found that systematic reviews supported the use of evidence-based tools for strengthening chronic pain management, including patient education, self-management supports, interventions to implement guidelines and multidisciplinary approaches to pain management. While research evidence about patient registries/treatment-monitoring systems is limited, many dialogue participants argued that a registry/system is needed. Many saw a registry as a precondition for moving forward with other options, including creating a national network of chronic pain centres with a coordinating ‘hub’ to provide chronic pain-related decision support and a cross-payer, cross-discipline model of patient-centred primary health care-based chronic pain management. For the second dialogue, systematic reviews indicated that traditional media can be used to positively influence individual health-related behaviours, and that multistakeholder partnerships can contribute to increasing attention devoted to issues on policy agendas. Dialogue participants emphasized the need to mobilize behind an effort to build a national network that would bring together existing organizations and committed individuals. CONCLUSIONS: Developing a national network and, thereafter, a national pain strategy are important initiatives that garnered broad-based support during the dialogues. Efforts toward achieving this goal have been made since convening the dialogues.
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Kuziemsky CE. Review of Social and Organizational Issues in Health Information Technology. Healthc Inform Res 2015; 21:152-60. [PMID: 26279951 PMCID: PMC4532839 DOI: 10.4258/hir.2015.21.3.152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 01/10/2023] Open
Abstract
Objectives This paper reviews organizational and social issues (OSIs) in health information technology (HIT). Methods A review and synthesis of the literature on OSIs in HIT was conducted. Results Five overarching themes with respect to OSIs in HIT were identified and discussed: scope and frameworks for defining OSIs in HIT, context matters, process immaturity and complexity, trade-offs will happen and need to be discussed openly, and means of studying OSIs in HIT. Conclusions There is a wide body of literature that provides insight into OSIs in HIT, even if many of the studies are not explicitly labelled as such. The two biggest research needs are more explicit and theoretical studies of OSI in HITs and more research on integrating micro and macro perspectives of HIT use in organizations.
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Carey M, Noble N, Mansfield E, Waller A, Henskens F, Sanson-Fisher R. The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting. J Med Internet Res 2015; 17:e126. [PMID: 26001983 PMCID: PMC4468568 DOI: 10.2196/jmir.3817] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 01/12/2023] Open
Abstract
Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world’s morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward.
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Affiliation(s)
- Mariko Carey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.
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Markossian TW, O'Neal CM, Senkowski C. Geographic disparities in pancreatic cancer survival in a southeastern safety-net academic medical center. Aust J Rural Health 2015; 24:73-8. [PMID: 25989096 DOI: 10.1111/ajr.12200] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2015] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To quantify the effects of race, measures of socioeconomic status and geographic residency status on pancreatic cancer survival time. DESIGN Retrospective review. SETTING A southeastern safety-net academic medical centre in the United States. PARTICIPANTS The study population consisted of all patients who were diagnosed, referred to or treated at the medical centre between 2009 and 2012 (n = 245). To ensure completeness and accuracy of the data, follow-up treatment and survival information about the cases were collected from the Georgia Comprehensive Cancer Registry in 2013. MAIN OUTCOME MEASURES The odds of receiving first-course treatment (surgery, radiation or chemotherapy) and overall survival following a pancreatic cancer diagnosis. RESULTS There were no observed differences in receipt of initial treatment; however, patients from low socioeconomic and rural areas had significant increase in risk of death compared to patients from affluent and urban areas. CONCLUSIONS Results from this single site study suggests the significance of factors other than treatment differences that contribute to geographic disparities in mortality.
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Affiliation(s)
- Talar W Markossian
- Department of Public Health Sciences, Loyola University Chicago, Chicago, Illinois, USA
| | - Cindy-Marie O'Neal
- Department of Surgery, Memorial University Medical Center, Savannah, Georgia, USA
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The perils of meta-regression to identify clinical decision support system success factors. J Biomed Inform 2015; 56:65-8. [PMID: 25998518 DOI: 10.1016/j.jbi.2015.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/12/2015] [Accepted: 05/11/2015] [Indexed: 11/22/2022]
Abstract
Clinical decision support interventions are typically heterogeneous in nature, making it difficult to identify why some interventions succeed while others do not. One approach to identify factors important to the success of health information systems is the use of meta-regression techniques, in which potential explanatory factors are correlated with the outcome of interest. This approach, however, can result in misleading conclusions due to several issues. In this manuscript, we present a cautionary case study in the context of clinical decision support systems to illustrate the limitations of this type of analysis. We then discuss implications and recommendations for future work aimed at identifying success factors of medical informatics interventions. In particular, we identify the need for head-to-head trials in which the importance of system features is directly evaluated in a prospective manner.
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Bhuyan SS, Chandak A, Powell MP, Kim J, Shiyanbola O, Zhu H, Shiyanbola O. Use of Information Technology for Medication Management in Residential Care Facilities: Correlates of Facility Characteristics. J Med Syst 2015; 39:70. [DOI: 10.1007/s10916-015-0252-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/30/2015] [Indexed: 11/30/2022]
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Vydra TP, Cuaresma E, Kretovics M, Bose-Brill S. Diffusion and Use of Tethered Personal Health Records in Primary Care. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2015; 12:1c. [PMID: 26755897 PMCID: PMC4696089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Personal health records (PHRs) enable patients to access their healthcare information in a secure environment, increasing patient engagement in medical care. PHRs can be tethered to a patient's electronic health record (EHR). Tethered PHRs, also known as patient portals, allow patients to access relevant medical information from their provider. Despite recent policy efforts to promote the use of health information technology and increased availability of PHRs in the clinical setting, PHR adoption rates remain relatively low overall. This article examines physician characteristics of high vs. low PHR adopters. OBJECTIVE The objectives of this study were to (1) examine PHR use patterns in the primary care setting, (2) identify physician characteristics affecting PHR adoption, and (3) explore physician perspectives encouraging and deterring use. METHODS Information technology records provided data on primary care patient portal use at a large Midwestern academic medical center. Electronic surveys were administered to affiliated primary care physicians to measure their perceived use of patient portals. A focus group consisting of physician providers who completed the survey was used to further elucidate the trends and perceived utilization of the patient portal in the clinical setting. RESULTS While they expended significant time communicating with patients using the portal, physicians generally overestimated the time spent per week on the system. Physicians who had been in practice longer estimated a higher average time spent on the system when compared to newer physicians. Patient portal activation rates and use decreased with increased years in practice. During the focus groups, physicians voiced motivation to use patient portals because they perceived improved patient communication and satisfaction with use. However, continued lack of reimbursement for time spent in portal communication was reported as a major barrier to providers' engagement with this technology. DISCUSSION Physician endorsement and engagement is critical to achieve widespread adoption of PHRs. Such endorsement can be obtained through (1) providing rewards from health system employers for high use of PHRs, (2) providing financial reimbursement for time spent electronically communicating with patients via the PHR from federal initiatives incentivizing meaningful use of health information technology, (3) building robust support staff assistance for PHR communication into primary care workflows, and (4) integrating more PHR-specific education into providers' EHR training.
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Affiliation(s)
| | | | - Matthew Kretovics
- Division of General Internal Medicine at the Ohio State University Wexner Medical Center in Columbus, OH
| | - Seuli Bose-Brill
- Division of General Internal Medicine at the Ohio State University Wexner Medical Center in Columbus, OH
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Trick WE, Deamant C, Smith J, Garcia D, Angulo F. Implementation of an audio computer-assisted self-interview (ACASI) system in a general medicine clinic: patient response burden. Appl Clin Inform 2015; 6:148-62. [PMID: 25848420 DOI: 10.4338/aci-2014-09-ra-0073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/26/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Routine implementation of instruments to capture patient-reported outcomes could guide clinical practice and facilitate health services research. Audio interviews facilitate self-interviews across literacy levels. OBJECTIVES To evaluate time burden for patients, and factors associated with response times for an audio computer-assisted self interview (ACASI) system integrated into the clinical workflow. METHODS We developed an ACASI system, integrated with a research data warehouse. Instruments for symptom burden, self-reported health, depression screening, tobacco use, and patient satisfaction were administered through touch-screen monitors in the general medicine clinic at the Cook County Health & Hospitals System during April 8, 2011-July 27, 2012. We performed a cross-sectional study to evaluate the mean time burden per item and for each module of instruments; we evaluated factors associated with longer response latency. RESULTS Among 1,670 interviews, the mean per-question response time was 18.4 [SD, 6.1] seconds. By multivariable analysis, age was most strongly associated with prolonged response time and increased per decade compared to < 50 years as follows (additional seconds per question; 95% CI): 50-59 years (1.4; 0.7 to 2.1 seconds); 60-69 (3.4; 2.6 to 4.1); 70-79 (5.1; 4.0 to 6.1); and 80-89 (5.5; 4.1 to 7.0). Response times also were longer for Spanish language (3.9; 2.9 to 4.9); no home computer use (3.3; 2.8 to 3.9); and, low mental self-reported health (0.6; 0.0 to 1.1). However, most interviews were completed within 10 minutes. CONCLUSIONS An ACASI software system can be included in a patient visit and adds minimal time burden. The burden was greatest for older patients, interviews in Spanish, and for those with less computer exposure. A patient's self-reported health had minimal impact on response times.
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Affiliation(s)
- W E Trick
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - C Deamant
- Division of General Medicine, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - J Smith
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - D Garcia
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - F Angulo
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
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Dehling T, Gao F, Schneider S, Sunyaev A. Exploring the Far Side of Mobile Health: Information Security and Privacy of Mobile Health Apps on iOS and Android. JMIR Mhealth Uhealth 2015; 3:e8. [PMID: 25599627 PMCID: PMC4319144 DOI: 10.2196/mhealth.3672] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 10/21/2014] [Accepted: 11/03/2014] [Indexed: 12/18/2022] Open
Abstract
Background Mobile health (mHealth) apps aim at providing seamless access to tailored health information technology and have the potential to alleviate global health burdens. Yet, they bear risks to information security and privacy because users need to reveal private, sensitive medical information to redeem certain benefits. Due to the plethora and diversity of available mHealth apps, implications for information security and privacy are unclear and complex. Objective The objective of this study was to establish an overview of mHealth apps offered on iOS and Android with a special focus on potential damage to users through information security and privacy infringements. Methods We assessed apps available in English and offered in the categories “Medical” and “Health & Fitness” in the iOS and Android App Stores. Based on the information retrievable from the app stores, we established an overview of available mHealth apps, tagged apps to make offered information machine-readable, and clustered the discovered apps to identify and group similar apps. Subsequently, information security and privacy implications were assessed based on health specificity of information available to apps, potential damage through information leaks, potential damage through information manipulation, potential damage through information loss, and potential value of information to third parties. Results We discovered 24,405 health-related apps (iOS; 21,953; Android; 2452). Absence or scarceness of ratings for 81.36% (17,860/21,953) of iOS and 76.14% (1867/2452) of Android apps indicates that less than a quarter of mHealth apps are in more or less widespread use. Clustering resulted in 245 distinct clusters, which were consolidated into 12 app archetypes grouping clusters with similar assessments of potential damage through information security and privacy infringements. There were 6426 apps that were excluded during clustering. The majority of apps (95.63%, 17,193/17,979; of apps) pose at least some potential damage through information security and privacy infringements. There were 11.67% (2098/17,979) of apps that scored the highest assessments of potential damages. Conclusions Various kinds of mHealth apps collect and offer critical, sensitive, private medical information, calling for a special focus on information security and privacy of mHealth apps. In order to foster user acceptance and trust, appropriate security measures and processes need to be devised and employed so that users can benefit from seamlessly accessible, tailored mHealth apps without exposing themselves to the serious repercussions of information security and privacy infringements.
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Affiliation(s)
- Tobias Dehling
- Department of Information Systems, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
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The development and deployment of integrated electronic care records in a regional adult and paediatric cystic fibrosis unit. J Cyst Fibros 2014; 13:681-6. [DOI: 10.1016/j.jcf.2014.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 03/02/2014] [Accepted: 03/02/2014] [Indexed: 01/09/2023]
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Gartrell K, Storr CL, Trinkoff AM, Wilson ML, Gurses AP. Electronic personal health record use among registered nurses. Nurs Outlook 2014; 63:278-87. [PMID: 25982768 DOI: 10.1016/j.outlook.2014.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Nurses promote self-care and active participation of individuals in managing their health care, yet little is known about their own use of electronic personal health records (ePHRs). The purpose of this study was to examine factors associated with ePHR use by nurses for their own health management. METHODS A total of 664 registered nurses working in 12 hospitals in the Maryland and Washington DC area participated in an online survey from December 2013 to January 2014. Multiple logistic regression models identified factors associated with ePHR use. RESULTS More than a third (41%; 95% confidence interval [CI], 0.37-0.44) of the respondents were ePHR users. There was no variation between ePHR users and nonusers by demographic or job-related information. However, ePHR users were more likely to be active health care consumers (i.e., have a chronic medical condition and take prescribed medications; odds ratio [OR] = 1.64; 95% CI, 1.06-2.53) and have health care providers who used electronic health records for care (OR = 3.62; 95% CI, 2.45-5.36). CONCLUSIONS Nurses were proactive in managing their chronic medical conditions and prescribed medication use with ePHRs. ePHR use by nurses can be facilitated by increasing use of electronic health records.
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Affiliation(s)
- Kyungsook Gartrell
- National Institutes of Health/National Library of Medicine/ Lister Hill National Center for Biomedical Communications, Bethesda, MD.
| | - Carla L Storr
- University of Maryland School of Nursing, Baltimore, MD
| | | | | | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology, Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD
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Maria Piras E, Zanutto A. “One day it will be you who tells us doctors what to do!”. Exploring the “Personal” of PHR in paediatric diabetes management. INFORMATION TECHNOLOGY & PEOPLE 2014. [DOI: 10.1108/itp-02-2013-0030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Personal Health Record (PHR) systems make possible to integrate data from different sources and circulate them within the illness care and management network. The new arrangements prefigure a redefinition of the relations among healthcare practitioners, patients, and caregivers. The purpose of this paper is to consider the role and the meanings attributed to information when a technical artifact enables new forms of communication within the healthcare management network.
Design/methodology/approach
– The authors adopted a qualitative research design, conducting a pre-post analysis on a theoretical sample of patients and of a paediatrics department. The authors selected 12 patients (six females and six males) aged between four and 20 years old.
Findings
– The patients were willing to act as “stewards of their own information” (Halamka et al., 2008), but they interpreted this role in terms of restricting access to their information, rather than facilitating its dissemination. In fact, the PHR was symbolized as an instrument to support personal diabetes management but the patients want to preserve their own competence and independent management on the information regarding their “Personal” diseases.
Originality/value
– This work highlights two connotation of “Personal” information. The first is the dimension of the right to the privacy of information when it is believed that it may be used to pass judgement on the patient. The second connotation of “Personal” is the assertion by patients of their competence and autonomy in interpreting the information on the basis of personal knowledge about their diabetes.
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Price M, Lau F. The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems. BMC Med Inform Decis Mak 2014; 14:43. [PMID: 24884588 PMCID: PMC4050391 DOI: 10.1186/1472-6947-14-43] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 05/21/2014] [Indexed: 11/10/2022] Open
Abstract
Health information systems (HISs) hold the promise to transform health care; however, their adoption is challenged. We have developed the Clinical Adoption Meta-Model (CAMM) to help describe processes and possible challenges with clinical adoption. The CAMM, developed through an action research study to evaluate a provincial HIS, is a temporal model with four dimensions: availability, use, behaviour changes, and outcome changes. Seven CAMM archetypes are described, illustrating classic trajectories of adoption of HISs over time. Each archetype includes an example from the literature. The CAMM and its archetypes can support HIS implementers, evaluators, learners, and researchers.
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Affiliation(s)
- Morgan Price
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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