Information access at the point of care: what can we learn for designing a mobile CPR system?

Health professionals' acceptance of mobile-based clinical guideline application in a resource-limited setting: using a modified UTAUT model

INTRODUCTION

Clinical guidelines are crucial for assisting health professionals to make correct clinical decisions. However, manual clinical guidelines are not accessible, and this increases the workload. So, a mobile-based clinical guideline application is needed to provide real-time information access. Hence, this study aimed to assess health professionals' intention to accept mobile-based clinical guideline applications and verify the unified theory of acceptance and technology utilization model.

METHODS

Institutional-based cross-sectional study design was used among 803 study participants. The sample size was determined based on structural equation model parameter estimation criteria with stratified random sampling. Amos version 23 software was used for analysis. Internal consistency of latent variable items, and convergent and divergent validity, were evaluated using composite reliability, AVE, and a cross-loading matrix. Model fitness of the data was assessed based on a set of criteria, and it was achieved. P-value < 0.05 was considered for assessing the formulated hypothesis.

RESULTS

Effort expectancy and social influence had a significant effect on health professionals' attitudes, with path coefficients of (β = 0.61, P-value < 0.01), and (β = 0.510, P-value < 0.01) respectively. Performance expectancy, facilitating condition, and attitude had significant effects on health professionals' acceptance of mobile-based clinical guideline applications with path coefficients of (β = 0.37, P-value < 0.001), (β = 0.44, P-value < 0.001) and (β = 0.57, P-value < 0.05) respectively. Effort expectancy and social influence were mediated by attitude and had a significant partial relationship with health professionals' acceptance of mobile-based clinical guideline application with standardized estimation coefficients of (β = 0.22, P-value = 0.027), and (β = 0.19, P-value = 0.031) respectively. All the latent variables accounted for 57% of health professionals' attitudes, and latent variables with attitudes accounted for 63% of individuals' acceptance of mobile-based clinical guideline applications.

CONCLUSIONS

The unified theory of acceptance and use of the technology model was a good model for assessing individuals' acceptance of mobile-based clinical guidelines applications. So, enhancing health professionals' attitudes, and computer literacy through training are needed. Mobile application development based on user requirements is critical for technology adoption, and people's support is also important for health professionals to accept and use the application.

Information Needs Assessment for a Medicine Ward-Focused Rounding Dashboard

To identify the routine information needs of inpatient clinicians on the general wards for the development of an electronic dashboard. Survey of internal medicine and subspecialty clinicians from March 2014-July 2014 at Saint Marys Hospital in Rochester, Minnesota. An information needs assessment was generated from all unique data elements extracted from all handoff and rounding tools used by clinicians in our ICUs and general wards. An electronic survey was distributed to 104 inpatient medical providers. 89 unique data elements were identified from currently utilized handoff and rounding instruments. All data elements were present in our multipurpose ICU-based dashboard. 42 of 104 (40 %) surveys were returned. Data elements important (50/89, 56 %) and unimportant (24/89, 27 %) for routine use were identified. No significant differences in data element ranking were observed between supervisory and nonsupervisory roles. The routine information needs of general ward clinicians are a subset of data elements used routinely by ICU clinicians. Our findings suggest an electronic dashboard could be adapted from the critical care setting to the general wards with minimal modification.

Improving the informational continuity of care in diabetes mellitus treatment with a nationwide Shared EHR system: Estimates from Austrian claims data

PURPOSE

Shared Electronic Health Record (EHR) systems, which provide a health information exchange (HIE) within a community of care, were found to be a key enabler of informational continuity of diabetes mellitus (DM) care. Quantitative analyses of the actual contribution of Shared EHR systems to informational continuity of care are rare. The goal of this study was to quantitatively analyze (i) the degree of fragmentation of DM care in Austria as an indicator for the need for HIE, and (ii) the quantity of information (i.e. number of documents) from Austrian DM patients that would be made available by a nationwide Shared EHR system for HIE.

METHODS

Our analyses are based on social security claims data of 7.9 million Austrians from 2006 and 2007. DM patients were identified through medication data and inpatient diagnoses. The degree of fragmentation was determined by the number of different healthcare providers per patient. The amount of information that would be made available by a nationwide Shared EHR system was estimated by the number of documents that would have been available to a healthcare provider if he had access to information on the patient's visits to any of the other healthcare providers. As a reference value we determined the number of locally available documents that would have originated from the patient's visits to the healthcare provider himself. We performed our analysis for two types of systems: (i) a "comprehensive" Shared EHR system (SEHRS), where each visit of a patient results in a single document (progress note), and (ii) the Austrian ELGA system, which allows four specific document types to be shared.

RESULTS

391,630 DM patients were identified, corresponding to 4.7% of the Austrian population. More than 90% of the patients received health services from more than one healthcare provider in one year. Both, the SEHRS as well as ELGA would have multiplied the available information during a patient visit in comparison to an isolated local EHR system; the median ratio of external to local medical documents was between 1:1 for a typical visit at a primary care provider (SEHRS as well as ELGA) and 39:1 (SEHRS) respectively 28:1 (ELGA) for a typical visit at a hospital.

CONCLUSIONS

Due to the high degree of care fragmentation, there is an obvious need for HIE for Austrian DM patients. Both, the SEHRS as well as ELGA could provide a substantial contribution to informational continuity of care in Austrian DM treatment. Hospitals and specialists would have gained the most amount of external information, primary care providers and pharmacies would have at least doubled their available information. Despite being the most important potential feeders of a national Shared EHR system according to our analysis, primary care providers will not tap their full corresponding potential under the current implementation scenario of ELGA.

The EHR-ARCHE project: satisfying clinical information needs in a Shared Electronic Health Record system based on IHE XDS and Archetypes

PURPOSE

While contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers' information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment.

METHODS

Using methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study.

RESULTS

We identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8-14min versus 20min or more).

CONCLUSIONS

Our results show that for an efficient satisfaction of health care providers' information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is superior to a conventional metadata-based XDS search.

Comparison of response times of a mobile-web EHRs system using PHP and JSP languages

Performance evaluation is highly important in the Electronic Health Records (EHRs) system implementation. Response time's measurement can be considered as one manner to make that evaluation. In the e-health field, after the creation of EHRs available through different platforms such as Web and/or mobile, a performance evaluation is necessary. The operation of the system in the right way is essential. In this paper, a comparison of the response times for the MEHRmobile system is presented. The first version uses PHP language with a MySQL database and the second one employs JSP with an eXist database. Both versions have got the same functionalities. In addition to the technological aspects, a significant difference is the way the information is stored. The main goal of this paper is choosing the version which offers better response times. We have created a new benchmark to calculate the response times. Better results have been obtained for the PHP version. Nowadays, this version is being used for specialists from Fundación Intras, Spain.

Design and development of a mobile computer application to reengineer workflows in the hospital and the methodology to evaluate its effectiveness

This paper describes a new method of collecting additional data for the purpose of skin cancer research from the patients in the hospital using the system Mobile Computing in Medicine Graz (MoCoMed-Graz). This system departs from the traditional paper-based questionnaire data collection methods and implements a new composition of evaluation methods to demonstrate its effectiveness. The patients fill out a questionnaire on a Tablet-PC (or iPad Device) and the resulting medical data is integrated into the electronic patient record for display when the patient enters the doctor's examination room. Since the data is now part of the electronic patient record, the doctor can discuss the data together with the patient making corrections or completions where necessary, thus enhancing data quality and patient empowerment. A further advantage is that all questionnaires are in the system at the end of the day - and manual entry is no longer necessary - consequently raising data completeness. The front end was developed using a User Centered Design Process for touch tablet computers and transfers the data in XML to the SAP based enterprise hospital information system. The system was evaluated at the Graz University Hospital - where about 30 outpatients consult the pigmented lesion clinic each day - following Bronfenbrenner's three level perspective: The microlevel, the mesolevel and the macrolevel: On the microlevel, the questions answered by 194 outpatients, evaluated with the System Usability Scale (SUS) resulted in a median of 97.5 (min: 50, max: 100) which showed that it is easy to use. On the mesolevel, the time spent by medical doctors was measured before and after the implementation of the system; the medical task performance time of 20 doctors (age median 43 (min: 29; max: 50)) showed a reduction of 90%. On the macrolevel, a cost model was developed to show how much money can be saved by the hospital management. This showed that, for an average of 30 patients per day, on a 250 day basis per year in this single clinic, the hospital management can save up to 40,000 EUR per annum, proving that mobile computers can successfully contribute to workflow optimization.

General practitioners' reasoning about using mobile distance-spanning technology in home care and in nursing home care

The trend for health care and nursing care turns from hospital to health care and nursing care at home. Studies have shown that health care professionals have no access to patient records in home and nursing home settings. Technological development creates opportunities for a host of mobile technology solutions. The aim of this study was to describe the reasoning among general practitioners (GPs) about the use of mobile distance-spanning technology (MDST) in care at home and in nursing homes. Seventeen GPs were divided in five groups for a group interview. The interviews were tape-recorded and transcribed verbatim. The qualitative content analysis resulted in four areas about the MDST, MDST has an impact on GPs' work, the nurses' profession, and the patient and the family, with nine adherent categories. The findings were interpreted and formulated in the theme: MDST should be used with caution. The results show quite a few expressions about the MDST as useful and valuable in health care at home and in nursing home settings; however, in every category, there were text that we interpreted as caution when using the MDST. The MDST cannot be used in all situations and cannot replace human meetings in health care and nursing care at home and in nursing homes. The MDST should primarily be a tool for the profession, and understanding the professions' reasoning about technology use in health care at home and in nursing home settings must be the base for implementing MDST.

Mobile and fixed computer use by doctors and nurses on hospital wards: multi-method study on the relationships between clinician role, clinical task, and device choice

Background

Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions.

Objective

We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards.

Methods

Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions. Assessment of the physical attributes of three devices—stationary PCs, computers on wheels (COWs) and tablet PCs—was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out.

Results

The majority (93.1%) of observed nursing tasks were conducted using generic COWs. Most nursing tasks were performed in patients’ rooms (57%) or in the corridors (36%), with a small percentage at a patient’s bedside (5%). Most nursing tasks related to the preparation and administration of drugs. Doctors on ward rounds conducted 57.3% of observed clinical tasks on generic COWs and 35.9% on tablet PCs. On rounds, 56% of doctors’ tasks were performed in the corridors, 29% in patients’ rooms, and 3% at the bedside. Doctors not on a ward round conducted 93.6% of tasks using stationary PCs, most often within the doctors’ office. Nurses and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper.

Conclusions

The choice of device was related to clinical role, nature of the clinical task, degree of mobility required, including where task completion occurs, and device design. Nurses’ work, and clinical tasks performed by doctors during ward rounds, require highly mobile computer devices. Nurses and doctors on ward rounds showed a strong preference for generic COWs over all other devices. Tablet PCs were selected by doctors for only a small proportion of clinical tasks. Even when using mobile devices clinicians completed a very low proportion of observed tasks at the bedside. The design of the devices and ward space configurations place limitations on how and where devices are used and on the mobility of clinical work. In such circumstances, clinicians will initiate workarounds to compensate. In selecting hardware devices, consideration should be given to who will be using the devices, the nature of their work, and the physical layout of the ward.

Organizational effects of information and communication technology (ICT) in elderly homecare: a case study

The use of information and communication technology (ICT) to support integrated healthcare services in elderly homecare is becoming more established. In particular, ICT can enable information exchange, knowledge sharing and documentation at the point-of-care (POC). The aim of this study was to explore these effects using the Old@Home prototype. Old@Home was perceived to contribute in developing horizontal links for communication between individuals who work together, independent of geographical distance or organizational affiliation, and to contribute to increased work efficiency. The prototype was further seen to reduce professional isolation by providing a holistic overview of the care process. User centred design and implementation of Old@Home was considered key to facilitating acceptance of organizational changes. Participation of care professionals not only led to a better understanding of the needs of involved organizations, but also increased end-users' involvement and commitment, stimulating them to test and improve the prototype until the final version.

Bridging the gap: a virtual health record for integrated home care

INTRODUCTION

The coexistence of different information systems that are unable to communicate is a persistent problem in healthcare and in integrated home care in particular.

THEORY AND METHODS

Physically federated integration is used for design of the underlying technical architecture to implement a mobile virtual health record for integrated home care. A user centered system development approach is followed during design and development of the system.

RESULTS

A technical platform based on a service-oriented approach where database functionality and services are separated has been developed. This guarantees flexibility with regard to changed functional demands and allows third party systems to interact with the platform in a standardized way. A physically federated integration enables point-of-care documentation, integrated presentation of information from different feeder systems, and offline access to data on handheld devices. Feeder systems deliver information in XML-files that are mapped against an ideal XML schema, published as an interface for integration with the information broker, and inserted into the mediator database.

CONCLUSIONS

A seamless flow of information between both different care professionals involved in integrated home care and patients and relatives is provided through mobile information access and interaction with different feeder systems using the virtual health record.

Systematic planning of patient records for cooperative care and multicenter research

PURPOSE

The purpose of this paper is to introduce a method for systematically planning patient records for structured data entry that can be used in cooperative environments (e.g. cooperative care, multicenter trials) in a way that enables multipurpose use and shared data entry.

METHODS

Design research, formal logic.

RESULTS

The method suggests five steps: analyze the prevailing documentation infrastructure, provide terminology management system (TMS), provide documentation management system (DMS), plan the logical architecture, provide all necessary tools.

CONCLUSIONS

The era of eHealth enables cooperative care and collaborative documentation. This can only be efficient if a multiple use and shared entry of data is realized. The task of the medical informatics community is to plan these environments systematically especially in complex environments which are enabled by emerging technologies.

Mobile computing acceptance factors in the healthcare industry: a structural equation model

OBJECTIVE

This paper presents a revised technology acceptance model to examine what determines mobile healthcare systems (MHS) acceptance by healthcare professionals.

METHOD

Conformation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique was used to evaluate the causal model.

RESULTS

The results indicated that compatibility, perceived usefulness and perceived ease of use significantly affected healthcare professional behavioral intent. MHS self-efficacy had strong indirect impact on healthcare professional behavioral intent through the mediators of perceived usefulness and perceived ease of use. Yet, the hypotheses for technical support and training effects on the perceived usefulness and perceived ease of use were not supported.

CONCLUSION

This paper provides initial insights into factors that are likely to be significant antecedents of planning and implementing mobile healthcare to enhance professionals' MHS acceptance. The proposed model variables explained 70% of the variance in behavioral intention to use MHS; further study is needed to explore extra significant antecedents of new IT/IS acceptance for mobile healthcare. Such as privacy and security issue, system and information quality, limitations of mobile devices; the above may be other interesting factors for implementing mobile healthcare and could be conducted by qualitative research.

A systematic review of the literature on multidisciplinary rounds to design information technology

Multidisciplinary rounds (MDR) have become important mechanisms for communication and coordination of care. To guide design of tools supporting MDR, we reviewed the literature published from 1990 to 2005 about MDR on information tools used, information needs, impact of information tools, and evaluation measures. Fifty-one papers met inclusion criteria and were included. In addition to patient-centric information tools (e.g., medical chart) and decision-support tools (e.g., clinical pathway), process-oriented tools (e.g., rounding list) were reported to help with information organization and communication. Information tools were shown to improve situation awareness of multidisciplinary care providers, efficiency of MDR, and length of stay. Communication through MDR may be improved by process-oriented information tools that help information organization, communication, and work management, which could be achieved through automatic extraction from clinical information systems, displays and printouts in condensed forms, at-a-glance representations of the care unit, and storing work-process information temporarily.