A literature review for large-scale health information system project planning, implementation and evaluation

Health professionals' expectations of a national patient portal for self-management

OBJECTIVE

Patient portals have the potential to support patient empowerment, self-care, and management, but their adoption and use have reported to be limited. Patients' more active role creates tension, as health professionals need to change their traditional expert role and share control with patients. Professionals may also have other expectations and concerns that influence the acceptance of patient portals supporting patient empowerment. This study explores the health professionals' expectations influencing their support for a new patient portal for self-management prior to implementation.

DESIGN

The study empirically evaluates the impact of several variables on health professionals' support for a new patient portal for self-management. The study variables include 1) expected influences on professionals' work, 2) expected influences on patients, 3) usability, 4) professional autonomy, 5) informing, 6) implementation practices, and 7) user participation.

METHODS

Data was collected through an online survey of 2943 health professionals working in 14 health organizations in Finland. The participating organizations run a joint Self-Care and Digital Value Services (ODA) project, developing a national patient portal for self-management. Three main services of the patient portal are well-being coaching, diagnostic tool, and a health care plan.

RESULTS AND CONCLUSIONS

The results show that health professionals' positive expectations about the new patient portal, adequate informing of professionals ahead of time, and the organization's good implementation practices had a positive impact on their support for the patient portal. Perceived threat to professional autonomy had a negative impact on professionals' support for the portal. Age, gender, and user participation did not influence support. Professionals' concerns were related especially to patients' willingness and capability to use the patient portal. The findings can guide health care providers to facilitate professionals' support and remove obstacles to introduce patient portals already in the pre-implementation phase.

Towards a Clinical Trial Protocol to Evaluate Health Information Systems: Evaluation of a Computerized System for Monitoring Tuberculosis from a Patient Perspective in Brazil

Assessment of health information systems consider different aspects of the system itself. They focus or on the professional who will use the software or on its usability or on the software engineering metrics or on financial and managerial issues. The existent approaches are very resources consuming, disconnected, and not standardized. As the software becomes more critical in the health organizations and in patients, becoming used as a medical device or a medicine, there is an urgency to identify tools and methods that can be applied in the development process. The present work is one of the steps of a broader study to identify standardized protocols to evaluate the health information systems as medicines and medical devices are evaluated by clinical trials. The goal of the present work was to evaluate the effect of the introduction of an information system for monitoring tuberculosis treatment (SISTB) in a Brazilian municipality from the patients' perspective. The Patient Satisfaction Questionnaire and the Hospital Consumer Assessment of Healthcare Providers and Systems were answered by the patients before and after the SISTB introduction, for comparison. Patients from an outpatient clinic, formed the control group, that is, at this site was not implanted the SISTB. Descriptive statistics and mixed effects model were used for data analysis. Eighty-eight interviews were conducted in the study. The questionnaire's results presented better averages after the system introduction but were not considered statistically significant. Therefore, it was not possible to associate system implantation with improved patient satisfaction. The HIS evaluation need be complete, the technical and managerial evaluation, the safety, the impact on the professionals and direct and/or indirect impact on patients are important. Developing the right tools and methods that can evaluate the software in its entirety, from the beginning of the development cycle with a normalized scale, are needed.

Resolving embarrassing medical conditions with online health information

PURPOSE

Reliance on online health information is proliferating and the Internet has the potential to revolutionize the provision of public health information. The anonymity of online health information may be particularly appealing to people seeking advice on 'embarrassing' health problems. The purpose of this study was to investigate (1) whether data generated by the embarrassingproblems.com health information site showed any temporal patterns in problem resolution, and (2) whether successful resolution of a medical problem using online information varied with the type of medical problem.

METHODS

We analyzed the responses of visitors to the embarrassingproblems.com website on the resolution of their problems. The dataset comprised 100,561 responses to information provided on 77 different embarrassing problems grouped into 9 classes of medical problem over an 82-month period. Data were analyzed with a Bernoulli Generalized Linear Model using Bayesian inference.

RESULTS

We detected a statistically important interaction between embarrassing problem type and the time period in which data were collected, with an improvement in problem resolution over time for all of the classes of medical problem on the website but with a lower rate of increase in resolution for urinary health problems and medical problems associated with the mouth and face. As far as we are aware, this is the first analysis of data of this nature.

CONCLUSIONS

Findings support the growing recognition that online health information can contribute to the resolution of embarrassing medical problems, but demonstrate that outcomes may vary with medical problem type. The results indicate that building data collection into online information provision can help to refine and focus health information for online users.

Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements

BACKGROUND

Information technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients' knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user' adoption is optimal.

OBJECTIVE

The purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM.

METHODS

This qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis.

RESULTS

Appropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients' ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align the platform to users' workflow.

CONCLUSIONS

By employing a UCD, this study provides insight into the desired functionalities and usability of patients and HCPs regarding a shared patient-centered, Web-based medication platform, thus increasing the likelihood to achieve a functional and useful system. Substantial and ongoing engagement by all intended user groups is necessary to reconcile differences in requirements of patients and HCPs, especially regarding medication safety alerts and access control. Moreover, effective training of patients and HCPs on medication self-management (support) and optimal use of the tool will be a prerequisite to unfold the platform's full potential.

The intention to use an electronic health record and its antecedents among three different categories of clinical staff

Background

Like other sectors, the healthcare sector has to deal with the issue of users’ acceptance of IT. In healthcare, different factors affecting healthcare professionals’ acceptance of software applications have been investigated. Unfortunately, inconsistent results have been found, maybe because the different studies focused on different IT and occupational groups. Consequently, more studies are needed to investigate these implications for recent technology, such as Electronic Health Records (EHR).

Methods

Given these findings in the existing literature, we pose the following research question: “To what extent do the different categories of clinical staff (physicians, paraprofessionals and administrative personnel) influence the intention to use an EHR and its antecedents?” To answer this research question we develop a research model that we empirically tested via a survey, including the following variables: intention to use, ease of use, usefulness, anxiety, self-efficacy, trust, misfit and data security. Our purpose is to clarify the possible differences existing between different staff categories.

Results

For the entire personnel, all the hypotheses are confirmed: anxiety, self-efficacy, trust influence ease of use; ease of use, misfit, self-efficacy, data security impact usefulness; usefulness and ease of use contribute to intention to use the EHR. They are also all confirmed for physicians, residents, carers and nurses but not for secretaries and assistants. Secretaries’ and assistants’ perception of the ease of use of EHR does not influence their intention to use it and they could not be influenced by self-efficacy in the development of their perception of the ease of use of EHR.

Conclusions

These results may be explained by the fact that secretaries, unlike physicians and nurses, have to follow rules and procedures for their work, including working with EHR. They have less professional autonomy than healthcare professionals and no medical responsibility. This result is also in line with previous literature highlighting that administrators are more motivated by the use of IT in healthcare.

Development of an Evaluation Framework for Health Information Systems (DIPSA)

Introduction:

Use of Integrated Health Information Systems (IHIS) for the provision of healthcare services benefits both healthcare professionals and patients, while requiring continuous evaluation and upgrading to fully support its role.

Aim:

The main purpose of the study was to develop an evaluation framework for hospitals utilizing IHIS, within the three main areas identified as Human factor, Technology and Organization.

Material and methods:

The questionnaire consisted of 43 questions, with 17 questions (related to categories procedures, system quality and satisfaction), 25 questions (related to categories, safety and collaboration) and 1 question related to accessibility to the system (within the category system quality). Three open questions were added to evaluate users’ perception on what was needed for the improvement of health services in their respective hospitals for all 3 variables being evaluated. The open questions were included to allow participants to express their opinion in a more detailed setting. A database was developed, and the data were processed and analyzed.

Results:

Factor analysis formed 5 categories for the evaluation framework. Cronbach’s alpha coefficient was found in all categories to be above > 0.85.

Conclusion:

Evaluation frameworks can be designed, developed and implemented by using different methodologies. For an evaluation framework to be effective it should be designed and implemented based on the aims and purpose of the research and the specific needs of the particular healthcare setting or hospital. Considering the categories satisfaction, collaboration, safety, system quality, procedures, and by using Likert scale and open questions in the current study, DIPSA can provide a holistic image of IHIS by evaluating any hospital system.

Bridging clinical researcher perceptions and health IT realities: A case study of stakeholder creep

PURPOSE

We present a case report detailing a challenge in health information technology (HIT) project implementations we term "stakeholder creep": not thoroughly identifying which stakeholders need to be involved and why before starting a project, consequently not understanding the true effort, skill sets, social capital, and time required to complete the project.

METHODS

A root cause analysis was performed post-implementation to understand what led to stakeholder creep. HIT project stakeholders were given a questionnaire to comment on these misconceptions and a proposed implementation tool to help mitigate stakeholder creep.

FINDINGS

Stakeholder creep contributed to an unexpected increase in time (3-month delayed go-live) and effort (68% over expected HIT work hours). Four main clinician/researcher misconceptions were identified that contributed to the development of stakeholder creep: 1) that EHR IT is a single group; 2) that all EHR IT members know the entire EHR functionality; 3) that changes to an EHR need the input of just a single EHR IT member; and 4) that the technological complexity of a project mirrors the clinical complexity. HIT project stakeholders similarly perceived clinicians/researchers to hold these misconceptions. The proposed stakeholder planning tool was perceived to be feasible and helpful.

CONCLUSIONS

Stakeholder creep can negatively affect HIT project implementations. Projects may be susceptible to stakeholder creep when clinicians/researchers hold misconceptions related to HIT organization and processes. Implementation tools, such as the proposed stakeholder checklist, could be helpful in preempting and mitigating the effect of stakeholder creep.

Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies

BACKGROUND

Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level.

OBJECTIVE

Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program.

METHODS

The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs-video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing-using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback.

RESULTS

The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs.

CONCLUSIONS

Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.

Optimal feature selection using a modified differential evolution algorithm and its effectiveness for prediction of heart disease

Enormous data growth in multiple domains has posed a great challenge for data processing and analysis techniques. In particular, the traditional record maintenance strategy has been replaced in the healthcare system. It is vital to develop a model that is able to handle the huge amount of e-healthcare data efficiently. In this paper, the challenging tasks of selecting critical features from the enormous set of available features and diagnosing heart disease are carried out. Feature selection is one of the most widely used pre-processing steps in classification problems. A modified differential evolution (DE) algorithm is used to perform feature selection for cardiovascular disease and optimization of selected features. Of the 10 available strategies for the traditional DE algorithm, the seventh strategy, which is represented by DE/rand/2/exp, is considered for comparative study. The performance analysis of the developed modified DE strategy is given in this paper. With the selected critical features, prediction of heart disease is carried out using fuzzy AHP and a feed-forward neural network. Various performance measures of integrating the modified differential evolution algorithm with fuzzy AHP and a feed-forward neural network in the prediction of heart disease are evaluated in this paper. The accuracy of the proposed hybrid model is 83%, which is higher than that of some other existing models. In addition, the prediction time of the proposed hybrid model is also evaluated and has shown promising results.

Barcode Technology Acceptance and Utilization in Health Information Management Department at Academic Hospitals According to Technology Acceptance Model

Nowdays, due to the increasing importance of quality care, organizations focuse on the improving provision, management and distribution of health. On one hand, incremental costs of the new technologies and on the other hand, increased knowledge of health care recipients and their expectations for high quality services have doubled the need to make changes in order to respond to resource constraints (financial, human, material). For this purpose, several technologies, such as barcode, have been used in hospitals to improve services and staff productivity; but various factors effect on the adoption of new technologies and despite good implementation of a technology and its benefits, sometimes personnel don't accept and don't use it.

METHODS

This is an applied descriptive cross-sectional study in which all the barcode users in health information management department of the three academic hospitals (Feiz, Al-Zahra, Ayatollah Kashani) affiliated to Isfahan University of Medical Sciences were surveyed by the barcode technology acceptance questionnaire, in six areas as following: barcode ease of learning, capabilities, perception of its usefulness and its ease of use, users attitudes towards its using, and users intention.

RESULTS

The finding showed that barcode technology total acceptance was relatively desirable (%76.9); the most compliance with TAM model was related to the user perceptions about the ease of use of barcode technology and the least compliance was related to the ease of learning barcode technology (respectively %83.7 and %71.5).

CONCLUSION

Ease of learning and barcode capability effect of usefulness and perceived ease of barcode technology. Users perceptions effect their attitudes toward greater use of technology and their attitudes have an effect on their intention to use the technology and finally, their intention makes actual use of the technology (acceptance). Therefore, considering the six elements related to technology implementation can be important in the barcode acceptance; because their chained relationship is clearly visible.