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Lin A, Ford N, Willett P. Scholarly communication between health informatics and information systems: A bibliometric study. Health Informatics J 2024; 30:14604582241259331. [PMID: 38856153 DOI: 10.1177/14604582241259331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
The challenges of IT adoption in the healthcare sector have generated much interest across a range of research communities, including Information Systems (IS) and Health Informatics (HI). Given their long-standing interest in IT design, development, implementation, and adoption to improve productivity and support organisational transformation, the IS and HI fields are highly correlated in their research interests. Nevertheless, the two fields serve different academic audiences, have different research foci, and theorise IT artifacts differently. We investigate the dyadic relationship between health information systems (HIS) research in IS and HI through the communication patterns between the two fields. We present the citation analysis results of HIS research published in IS and HI journals between 2000 and 2020. The results revealed that despite the two fields sharing a common interest, communication between them is limited and only about specific topics. Potentially relevant ideas and theories generated in IS have not yet been sufficiently recognised by HI scholars and incorporated into the HI literature. However, the upward trend of HIS publications in IS indicates that IS has the potential to contribute more to HI.
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Affiliation(s)
- Angela Lin
- Information School, University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Nigel Ford
- Information School, University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Peter Willett
- Information School, University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
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Alhur A, Aldosari B. Strengths and Obstacles of Health Informatics and Health Information Management Education and Professions in Hail City, Kingdom of Saudi Arabia: A Qualitative Study. Cureus 2024; 16:e52619. [PMID: 38374838 PMCID: PMC10875908 DOI: 10.7759/cureus.52619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Health and higher education ministries in Saudi Arabia recognize the need for a highly qualified workforce specializing in health informatics and information management (HIIM). Therefore, KSA colleges and universities offer HIIM programs, health information systems, and health information technology. It is critical to investigate the HIIM professions and education in Hail City due to differences in these educational programs. This study examined HIIM professions and education in Hail City, Saudi Arabia, and provided strategies and recommendations. Based on a qualitative research approach, we interviewed 39 academicians, health informaticians, and other stakeholders in Hail City. The strengths, weaknesses, opportunities, threats (SWOT) framework was used to explore HIIM status and make recommendations. According to participants, HIIM Saudi professionals in Hail City have been growing and motivated, as have the university's undergraduate and postgraduate programs. Informants indicated several weaknesses, but many opportunities were found, including Saudi Vision 2030 and a new HIIM faculty at the University of Hail. According to our findings, relevant specialties control HIIM leadership while unspecialized academicians provide instruction. The extraordinary transmission of digital health in Saudi Arabia promises to enhance HIIM professions and education strengths and opportunities and reduce their weaknesses and threats.
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Affiliation(s)
- Anas Alhur
- Health Informatics, College of Public Health and Health Informatics, University of Hail, Hail, SAU
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van de Wetering R, Versendaal J. Information Technology Ambidexterity, Digital Dynamic Capability, and Knowledge Processes as Enablers of Patient Agility: Empirical Study. JMIRX MED 2021; 2:e32336. [PMID: 37725556 PMCID: PMC10414313 DOI: 10.2196/32336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 09/21/2023]
Abstract
BACKGROUND There is a limited understanding of information technology's (IT) role as an enabler of patient agility and the department's ability to respond to patients' needs and wishes adequately. OBJECTIVE This study aims to contribute to the insights of the validity of the hypothesized relationship among IT resources, practices and capabilities, and hospital departments' knowledge processes, and the department's ability to adequately sense and respond to patient needs and wishes (ie, patient agility). METHODS This study conveniently sampled data from 107 clinical hospital departments in the Netherlands and used structural equation modeling for model assessment. RESULTS IT ambidexterity positively enhanced the development of a digital dynamic capability (β=.69; t4999=13.43; P<.001). Likewise, IT ambidexterity also positively impacted the hospital department's knowledge processes (β=.32; t4999=2.85; P=.005). Both digital dynamic capability (β=.36; t4999=3.95; P<.001) and knowledge processes positively influenced patient agility (β=.33; t4999=3.23; P=.001). CONCLUSIONS IT ambidexterity promotes taking advantage of IT resources and experiments to reshape patient services and enhance patient agility.
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Affiliation(s)
- Rogier van de Wetering
- Department of Information Sciences, Open University of the Netherlands, Heerlen, Netherlands
| | - Johan Versendaal
- Department of Information Sciences, Open University of the Netherlands, Heerlen, Netherlands
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Lafferty M, Harrod M, Krein S, Manojlovich M. It's like sending a message in a bottle: A qualitative study of the consequences of one-way communication technologies in hospitals. J Am Med Inform Assoc 2021; 28:2601-2607. [PMID: 34569593 PMCID: PMC8763228 DOI: 10.1093/jamia/ocab191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We examine how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds. MATERIALS AND METHODS We conducted a qualitative study at 4 U.S. hospitals during 2017. Researchers spent 2 weeks at each hospital conducting unit-based observation, shadowing, interviews, and focus groups with nurses and physicians. Using an iterative process, we inductively coded and thematically analyzed data to derive preliminary themes. The theory of workarounds provides an organizational lens on workarounds, consisting of 5 components: antecedents, types, effects, managerial stance, and organizational challenges of workarounds. The first 3 components of the theory helped us to organize and explain our findings. RESULTS Communication technologies consisted of pagers and telephones. Antecedents to workarounds included one-way information flow, differential access related to differences in technology types, and technology mismatch. Types of workarounds included bypassing a variety of obstacles and substituting for unavailable resources. Direct effects of workarounds included pager fatigue, interruptions in patient care, and potential errors. DISCUSSION One-way communication technologies created an environment where workarounds could flourish. By placing results within the context of the theory of workarounds, we extend what we know about why and how workarounds develop, and offer strategies to minimize workarounds' adverse effects. CONCLUSIONS Through the theory of workarounds, we see that there is a trajectory to workarounds with potential consequences for clinicians and patients. Two-way communication technologies could minimize workarounds and gaps in information exchange, and reduce unnecessary interruptions and the potential for adverse events.
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Affiliation(s)
- Megan Lafferty
- United States Department of Veterans Affairs, Center to Improve Veteran Involvement in Care, VA Medical Center, Portland, Oregon, USA
| | - Molly Harrod
- United States Department of Veterans Affairs, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Sarah Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Milisa Manojlovich
- School of Nursing, Department of Systems, Populations, and Leadership, University of Michigan, Ann Arbor, Michigan, USA
- Corresponding Author: Milisa Manojlovich, PhD, RN, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48103, USA;
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Health-care information technologies for dispersed knowledge management. JOURNAL OF KNOWLEDGE MANAGEMENT 2021. [DOI: 10.1108/jkm-10-2020-0786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose
The health-care industry has multiple stakeholders, with knowledge dispersed among clinicians, experts and patients and their families. As the adoption of health-care information technologies (HITs) depends on multiple factors, this study aims to uncover the motivators for adopting them.
Design/methodology/approach
The study considers 391 respondents, representing the health-care sector, to evaluate the motivators for adopting HITs for better-dispersed knowledge management. The authors analyze the responses using exploratory factor analysis (EFA) to identify the actual structure of the factors, followed by confirmatory factor analysis (CFA).
Findings
EFA categorized the factors into four classes: quality management; information sharing; strategic governance; and available technological infrastructure. CFA revealed that the strategic governance factor is most predictive of successfully adopting HITs that model the normative pressure of Institutional theory in health-care organizations. These results indicate that, along with considerations of finances, care quality and infrastructure, effective government involvement and policy-making are important for successful HIT adoption.
Practical implications
Results reveal that stakeholders’ motivating factors for HIT adoption in a developed economy like the United Arab Emirates are based on considering HITs as a knowledge management mechanism. These factors may help other nations in HIT implementation and drive valuable innovations in the health-care sector. This research presents the implications for health-care professionals and stakeholders in relation to adopting HITs and their role in knowledge flow for efficient care.
Originality/value
HITs offer an affordable and convenient platform for collaboration among diverse teams in the health-care sector. Apart from this, it helps in facilitating an interactive platform for knowledge creation and transfer for the benefit of users and providers.
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JointCalc: A web-based personalised patient decision support tool for joint replacement. Int J Med Inform 2020; 142:104217. [PMID: 32853974 PMCID: PMC7607377 DOI: 10.1016/j.ijmedinf.2020.104217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/23/2022]
Abstract
JointCalc is the first complete web decision support tool for joint replacement. User-centred design helps avoid common health information system design. Modern software production methods synergise with and enable user-centred design. JointCalc implementation supports claims of high efficiency of eHealth.
Background and purpose Health information systems (HIS) are expected to be effective and efficient in improving healthcare services, but empirical observation of HIS reveals that most perform poorly in terms of these metrics. Theoretical factors of HIS performance are widely studied, and solutions to mitigate poor performance have been proposed. In this paper we implement effective methods to eliminate some common drawbacks of HIS design and demonstrate the synergy between the methods. JointCalc, the first comprehensive patient-facing web-based decision support tool for joint replacement, is used as a case study for this purpose. Methods and results User-centred design and thorough end-user involvement are employed throughout the design and development of JointCalc. This is supported by modern software production paradigms, including continuous integration/continuous development, agile and service-oriented architecture. The adopted methods result in a user-approved application delivered well within the scope of project. Conclusion This work supports the claims of high potential efficiency of HIS. The methods identified are shown to be applicable in the production of an effective HIS whilst aiding development efficiency.
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Bonten TN, Rauwerdink A, Wyatt JC, Kasteleyn MJ, Witkamp L, Riper H, van Gemert-Pijnen LJ, Cresswell K, Sheikh A, Schijven MP, Chavannes NH. Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study. J Med Internet Res 2020. [PMID: 32784173 DOI: 10.2196/1777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Despite the increase in use and high expectations of digital health solutions, scientific evidence about the effectiveness of electronic health (eHealth) and other aspects such as usability and accuracy is lagging behind. eHealth solutions are complex interventions, which require a wide array of evaluation approaches that are capable of answering the many different questions that arise during the consecutive study phases of eHealth development and implementation. However, evaluators seem to struggle in choosing suitable evaluation approaches in relation to a specific study phase. OBJECTIVE The objective of this project was to provide a structured overview of the existing eHealth evaluation approaches, with the aim of assisting eHealth evaluators in selecting a suitable approach for evaluating their eHealth solution at a specific evaluation study phase. METHODS Three consecutive steps were followed. Step 1 was a systematic scoping review, summarizing existing eHealth evaluation approaches. Step 2 was a concept mapping study asking eHealth researchers about approaches for evaluating eHealth. In step 3, the results of step 1 and 2 were used to develop an "eHealth evaluation cycle" and subsequently compose the online "eHealth methodology guide." RESULTS The scoping review yielded 57 articles describing 50 unique evaluation approaches. The concept mapping study questioned 43 eHealth researchers, resulting in 48 unique approaches. After removing duplicates, 75 unique evaluation approaches remained. Thereafter, an "eHealth evaluation cycle" was developed, consisting of six evaluation study phases: conceptual and planning, design, development and usability, pilot (feasibility), effectiveness (impact), uptake (implementation), and all phases. Finally, the "eHealth methodology guide" was composed by assigning the 75 evaluation approaches to the specific study phases of the "eHealth evaluation cycle." CONCLUSIONS Seventy-five unique evaluation approaches were found in the literature and suggested by eHealth researchers, which served as content for the online "eHealth methodology guide." By assisting evaluators in selecting a suitable evaluation approach in relation to a specific study phase of the "eHealth evaluation cycle," the guide aims to enhance the quality, safety, and successful long-term implementation of novel eHealth solutions.
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Affiliation(s)
- Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Anneloek Rauwerdink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
| | - Jeremy C Wyatt
- Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Leonard Witkamp
- Department of Medical Informatics, Amsterdam UMC, Amsterdam, Netherlands
- Ksyos Health Management Research, Amstelveen, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Lisette Jewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
| | - Kathrin Cresswell
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
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Bonten TN, Rauwerdink A, Wyatt JC, Kasteleyn MJ, Witkamp L, Riper H, van Gemert-Pijnen LJ, Cresswell K, Sheikh A, Schijven MP, Chavannes NH. Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study. J Med Internet Res 2020; 22:e17774. [PMID: 32784173 PMCID: PMC7450369 DOI: 10.2196/17774] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/09/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Despite the increase in use and high expectations of digital health solutions, scientific evidence about the effectiveness of electronic health (eHealth) and other aspects such as usability and accuracy is lagging behind. eHealth solutions are complex interventions, which require a wide array of evaluation approaches that are capable of answering the many different questions that arise during the consecutive study phases of eHealth development and implementation. However, evaluators seem to struggle in choosing suitable evaluation approaches in relation to a specific study phase. OBJECTIVE The objective of this project was to provide a structured overview of the existing eHealth evaluation approaches, with the aim of assisting eHealth evaluators in selecting a suitable approach for evaluating their eHealth solution at a specific evaluation study phase. METHODS Three consecutive steps were followed. Step 1 was a systematic scoping review, summarizing existing eHealth evaluation approaches. Step 2 was a concept mapping study asking eHealth researchers about approaches for evaluating eHealth. In step 3, the results of step 1 and 2 were used to develop an "eHealth evaluation cycle" and subsequently compose the online "eHealth methodology guide." RESULTS The scoping review yielded 57 articles describing 50 unique evaluation approaches. The concept mapping study questioned 43 eHealth researchers, resulting in 48 unique approaches. After removing duplicates, 75 unique evaluation approaches remained. Thereafter, an "eHealth evaluation cycle" was developed, consisting of six evaluation study phases: conceptual and planning, design, development and usability, pilot (feasibility), effectiveness (impact), uptake (implementation), and all phases. Finally, the "eHealth methodology guide" was composed by assigning the 75 evaluation approaches to the specific study phases of the "eHealth evaluation cycle." CONCLUSIONS Seventy-five unique evaluation approaches were found in the literature and suggested by eHealth researchers, which served as content for the online "eHealth methodology guide." By assisting evaluators in selecting a suitable evaluation approach in relation to a specific study phase of the "eHealth evaluation cycle," the guide aims to enhance the quality, safety, and successful long-term implementation of novel eHealth solutions.
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Affiliation(s)
- Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Anneloek Rauwerdink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
| | - Jeremy C Wyatt
- Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Leonard Witkamp
- Department of Medical Informatics, Amsterdam UMC, Amsterdam, Netherlands
- Ksyos Health Management Research, Amstelveen, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Lisette Jewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
| | - Kathrin Cresswell
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
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Manojlovich M, Ameling JM, Forman J, Judkins S, Quinn M, Meddings J. Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use. Am J Crit Care 2019; 28:290-298. [PMID: 31263012 PMCID: PMC6760297 DOI: 10.4037/ajcc2019372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians. OBJECTIVES To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters. METHODS Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity. RESULTS Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity. CONCLUSIONS Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.
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Affiliation(s)
- Milisa Manojlovich
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.
| | - Jessica M Ameling
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Jane Forman
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Samantha Judkins
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Martha Quinn
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Jennifer Meddings
- Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
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Islind AS, Snis UL, Lindroth T, Lundin J, Cerna K, Steineck G. The Virtual Clinic: Two-sided Affordances in Consultation Practice. Comput Support Coop Work 2019. [DOI: 10.1007/s10606-019-09350-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Patel MR, Friese CR, Mendelsohn-Victor K, Fauer AJ, Ghosh B, Bedard L, Griggs JJ, Manojlovich M. Clinician Perspectives on Electronic Health Records, Communication, and Patient Safety Across Diverse Medical Oncology Practices. J Oncol Pract 2019; 15:e529-e536. [PMID: 31009284 DOI: 10.1200/jop.18.00507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We know little about how increased technological sophistication of clinical practices affects safety of chemotherapy delivery in the outpatient setting. This study investigated to what degree electronic health records (EHRs), satisfaction with technology, and quality of clinician-to-clinician communication enable a safety culture. METHODS We measured actions consistent with a safety culture, satisfaction with practice technology, and quality of clinician communication using validated instruments among 297 oncology nurses and prescribers in a statewide collaborative. We constructed an index to reflect practice reliance on EHRs (1 = "all paper" to 5 = "all electronic"). Linear regression models (with robust SEs to account for clustering) examined relationships between independent variables of interest and safety. Models were adjusted for clinician age. RESULTS The survey response rate was 68% (76% for nurses and 59% for prescribers). The mean (standard deviation) safety score was 5.3 (1.1), with a practice-level range of 4.9 to 5.4. Prescribers reported fewer safety actions than nurses. Higher satisfaction with technology and higher-quality clinician communication were significantly associated with increased safety actions, whereas increased reliance on EHRs was significantly associated with lower safety actions. CONCLUSION Practices vary in their performance of patient safety actions. Supporting clinicians to integrate technology and strengthen communication are promising intervention targets. The inverse relationship between reliance on EHRs and safety suggests that technology may not facilitate clinicians' ability to attend to patient safety. Efforts to improve cancer care quality should focus on more seamless integration of EHRs into routine care delivery and emphasize increasing the capacity of all care clinicians to communicate effectively and coordinate efforts when administering high-risk treatments in ambulatory settings.
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Affiliation(s)
- Minal R Patel
- 1 University of Michigan School of Public Health, Ann Arbor, MI.,2 University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Christopher R Friese
- 1 University of Michigan School of Public Health, Ann Arbor, MI.,2 University of Michigan Rogel Cancer Center, Ann Arbor, MI.,3 University of Michigan School of Nursing, Ann Arbor, MI
| | | | - Alex J Fauer
- 3 University of Michigan School of Nursing, Ann Arbor, MI
| | - Bidisha Ghosh
- 3 University of Michigan School of Nursing, Ann Arbor, MI
| | - Louise Bedard
- 4 Michigan Oncology Quality Consortium, Ann Arbor, MI
| | - Jennifer J Griggs
- 1 University of Michigan School of Public Health, Ann Arbor, MI.,2 University of Michigan Rogel Cancer Center, Ann Arbor, MI.,4 Michigan Oncology Quality Consortium, Ann Arbor, MI.,5 University of Michigan, Ann Arbor, MI
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IT-Enabled Clinical Decision Support: An Empirical Study on Antecedents and Mechanisms. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2018:6945498. [PMID: 30651945 PMCID: PMC6311880 DOI: 10.1155/2018/6945498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022]
Abstract
Modern hospitals increasingly make use of innovations and information technology (IT) to improve workflow and patient's clinical journey. Typical innovative solutions include patient records and clinical decision support systems to enhance the process of decision making by doctors and other healthcare practitioners. However, currently, it remains unclear how hospitals could facilitate and enable such a decision support capability in clinical practice. We ground our work on the resource-based view of the firm and put forth the notion of IT-enabled capabilities which emphasizes critical IT investment and capability development areas that hospitals could exploit in their quest to improve clinical decision support. We develop a research model that explains how “health information exchange” and enhanced “information capability” collectively drive a hospital's “clinical decision support capability.” We used partial least squares path modeling on large-scale cross-sectional data from 720 European hospitals. Outcomes suggest that health information exchange positively impacts information capability. In turn, information capability complementary partially mediates the relationship between information exchange and clinical decision support. Hence, this research contributes to the literature on clinical decision support and provides valuable insights into how to support such innovative technologies and capabilities in clinical practice. We conclude with a discussion and conclusion. Also, we outline the inherent limitations of this study and outline directions for future research.
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Crawford PR, Lehmann HP, Sockolow PS. Health Services Research Evaluation Principles. Methods Inf Med 2018; 51:122-30. [DOI: 10.3414/me10-01-0066] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 04/04/2011] [Indexed: 11/09/2022]
Abstract
SummaryBackground: Our forthcoming national experiment in increased health information technology (HIT) adoption funded by the American Recovery and Reinvestment Act of 2009 will require a comprehensive approach to evaluating HIT. The quality of evaluation studies of HIT to date reveals a need for broader evaluation frameworks that limits the generalizability of findings and the depth of lessons learned.Objective: Develop an informatics evaluation framework for health information technology (HIT) integrating components of health services research (HSR) evaluation and informatics evaluation to address identified shortcomings in available HIT evaluation frameworks.Method: A systematic literature review updated and expanded the exhaustive review by Ammenwerth and deKeizer (AdK). From retained studies, criteria were elicited and organized into classes within a framework. The resulting Health Information Technology Research-based Evaluation Framework (HITREF) was used to guide clinician satisfaction survey construction, multi-dimensional analysis of data, and interpretation of findings in an evaluation of a vanguard community health care EHR.Results: The updated review identified 128 electronic health record (EHR) evaluation studies and seven evaluation criteria not in AdK: EHR Selection/Development/Training; Patient Privacy Concerns; Unintended Consequences/ Benefits; Functionality; Patient Satisfaction with EHR; Barriers/Facilitators to Adoption; and Patient Satisfaction with Care. HITREF was used productively and was a complete evaluation framework which included all themes that emerged.Conclusions: We can recommend to future EHR evaluators that they consider adding a complete, research-based HIT evaluation framework, such as HITREF, to their evaluation tools suite to monitor HIT challenges as the federal government strives to increase HIT adoption.
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Raymond L, Paré G, Maillet É. IT-based clinical knowledge management in primary health care: A conceptual framework. KNOWLEDGE AND PROCESS MANAGEMENT 2017. [DOI: 10.1002/kpm.1545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Louis Raymond
- Institut de recherche sur les PME; Université du Québec à Trois-Rivières; Trois-Rivières Québec Canada
| | - Guy Paré
- Institut de recherche sur les PME; Université du Québec à Trois-Rivières; Trois-Rivières Québec Canada
| | - Éric Maillet
- Institut de recherche sur les PME; Université du Québec à Trois-Rivières; Trois-Rivières Québec Canada
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Engineering sustainable mHealth: the role of Action Research. AI & SOCIETY 2017. [DOI: 10.1007/s00146-015-0640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haried P, Claybaugh C, Dai H. Evaluation of health information systems research in information systems research: A meta-analysis. Health Informatics J 2017; 25:186-202. [DOI: 10.1177/1460458217704259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Given the importance of the health-care industry and the promise of health information systems, researchers are encouraged to build on the shoulders of giants as the saying goes. The health information systems field has a unique opportunity to learn from and extend the work that has already been done by the highly correlated information systems field. As a result, this research article presents a past, present and future meta-analysis of health information systems research in information systems journals over the 2000–2015 time period. Our analysis reviewed 126 articles on a variety of topics related to health information systems research published in the “Senior Scholars” list of the top eight ranked information systems academic journals. Across the selected information systems academic journals, our findings compare research methodologies applied, health information systems topic areas investigated and research trends. Interesting results emerge in the range and evolution of health information systems research and opportunities for health information systems researchers and practitioners to consider moving forward.
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Affiliation(s)
| | | | - Hua Dai
- California State University Channel Islands, USA
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Adaba GB, Kebebew Y. Improving a health information system for real-time data entries: An action research project using socio-technical systems theory. Inform Health Soc Care 2017; 43:159-171. [PMID: 28350236 DOI: 10.1080/17538157.2017.1290638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE This paper presents the findings of an action research (AR) project to improve a health information system (HIS) at the Operating Theater Department (OTD) of a National Health Service (NHS) hospital in South East England, the UK. METHODS Informed by socio-technical systems (STS) theory, AR was used to design an intervention to enhance an existing patient administration system (PAS) to enable data entries in real time while contributing to the literature. The study analyzed qualitative data collected through interviews, participant observations, and document reviews. RESULTS The study found that the design of the PAS was unsuitable to the work of the three units of the OTD. Based on the diagnoses and STS theory, the project developed and implemented a successful intervention to enhance the legacy system for data entries in real time. CONCLUSIONS The study demonstrates the value of AR from a socio-technical perspective for improving existing systems in healthcare settings. The steps adopted in this study could be applied to improve similar systems. A follow-up study will be essential to assess the sustainability of the improved system.
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Affiliation(s)
- Godfried Bakiyem Adaba
- a Birkbeck, University of London , Department of Computer Science and Information Systems , London , United Kingdom
| | - Yohannes Kebebew
- a Birkbeck, University of London , Department of Computer Science and Information Systems , London , United Kingdom
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Holmgren AJ, Pfeifer E, Manojlovich M, Adler-Milstein J. A Novel Survey to Examine the Relationship between Health IT Adoption and Nurse-Physician Communication. Appl Clin Inform 2016; 7:1182-1201. [PMID: 27999841 DOI: 10.4338/aci-2016-08-ra-0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As EHR adoption in US hospitals becomes ubiquitous, a wide range of IT options are theoretically available to facilitate physician-nurse communication, but we know little about the adoption rate of specific technologies or the impact of their use. OBJECTIVES To measure adoption of hardware, software, and telephony relevant to nurse-physician communication in US hospitals. To assess the relationship between non-IT communication practices and hardware, software, and telephony adoption. To identify hospital characteristics associated with greater adoption of hardware, software, telephony, and non-IT communication practices. METHODS We conducted a survey of 105 hospitals in the National Nursing Practice Network. The survey captured adoption of hardware, software, and telephony to support nurse-physician communication, along with non-IT communication practices. We calculated descriptive statistics and then created four indices, one for each category, by scoring degree of adoption of technologies or practices within each category. Next, we examined correlations between the three technology indices and the non-IT communication practices index. We used multivariate OLS regression to assess whether certain types of hospitals had higher index scores. RESULTS The majority of hospitals surveyed have a range of hardware, software, and telephony tools available to support nurse-physician communication; we found substantial heterogeneity across hospitals in non-IT communication practices. More intensive non-IT communication was associated with greater adoption of software (r=0.31, p=0.01), but was not correlated with hardware or telephony. Medium-sized hospitals had lower adoption of software (r =-1.14,p=0.04) in comparison to small hospitals, while federally-owned hospitals had lower software (r=-2.57, p=0.02) and hardware adoption (r=-1.63, p=0.01). CONCLUSIONS The positive relationship between non-IT communication and level of software adoption suggests that there is a complementary, rather than substitutive, relationship. Our results suggest that some technologies with the potential to further enhance communication, such as CPOE and secure messaging, are not being utilized to their full potential in many hospitals.
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Eslami Andargoli A, Scheepers H, Rajendran D, Sohal A. Health information systems evaluation frameworks: A systematic review. Int J Med Inform 2016; 97:195-209. [PMID: 27919378 DOI: 10.1016/j.ijmedinf.2016.10.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evaluation of health information systems (HISs) is complicated because of the complex nature of the health care domain. Various studies have proposed different frameworks to reduce the complexity in the assessment of these systems. The aim of these frameworks is to provide a set of guidelines for the evaluation of the adequacy of health care information systems. OBJECTIVE This paper aims to analyse studies on the evaluation of HISs by applying a content, context and process (CCP) framework to address the 'who', 'what', 'how', 'when', and 'why' of the evaluation processes used. This will allow for a better understanding of the relative strengths and weaknesses of various HISs evaluation frameworks, and will pave the way for developing a more complete framework for HISs. METHOD A systematic literature review on HIS evaluation studies was undertaken to identify the currently available HIS evaluation frameworks. Five academic databases were selected to conduct this systematic literature review. RESULTS Most of the studies only address some, but not all, of the five main questions, i.e. the who, what, how, when, why, and that there was a lack of consensus in the way these questions were addressed. The critical role of context was also largely neglected in these studies. CONCLUSIONS Evaluation of HISs is complex. The health care domain is highly context sensitive and in order to have a complete assessment of HISs, consideration of contextual factors is necessary. Specifically, to have the right set of criteria to measure the 'what', the answer to the 'who' of the evaluation is necessary.
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Affiliation(s)
| | - Helana Scheepers
- Faculty of Business and Law, Swinburne University of Technology, Melbourne, Australia
| | - Diana Rajendran
- Faculty of Business and Law, Swinburne University of Technology, Melbourne, Australia
| | - Amrik Sohal
- Department of Management, Monash Business School, Monash University, Melbourne, Australia
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Rahman MS, Ko M, Warren J, Carpenter D. Healthcare Technology Self-Efficacy (HTSE) and its influence on individual attitude: An empirical study. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2015.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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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Manojlovich M, Adler-Milstein J, Harrod M, Sales A, Hofer TP, Saint S, Krein SL. The Effect of Health Information Technology on Health Care Provider Communication: A Mixed-Method Protocol. JMIR Res Protoc 2015; 4:e72. [PMID: 26068442 PMCID: PMC4526935 DOI: 10.2196/resprot.4463] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 12/31/2022] Open
Abstract
Background Communication failures between physicians and nurses are one of the most common causes of adverse events for hospitalized patients, as well as a major root cause of all sentinel events. Communication technology (ie, the electronic medical record, computerized provider order entry, email, and pagers), which is a component of health information technology (HIT), may help reduce some communication failures but increase others because of an inadequate understanding of how communication technology is used. Increasing use of health information and communication technologies is likely to affect communication between nurses and physicians. Objective The purpose of this study is to describe, in detail, how health information and communication technologies facilitate or hinder communication between nurses and physicians with the ultimate goal of identifying how we can optimize the use of these technologies to support effective communication. Effective communication is the process of developing shared understanding between communicators by establishing, testing, and maintaining relationships. Our theoretical model, based in communication and sociology theories, describes how health information and communication technologies affect communication through communication practices (ie, use of rich media; the location and availability of computers) and work relationships (ie, hierarchies and team stability). Therefore we seek to (1) identify the range of health information and communication technologies used in a national sample of medical-surgical acute care units, (2) describe communication practices and work relationships that may be influenced by health information and communication technologies in these same settings, and (3) explore how differences in health information and communication technologies, communication practices, and work relationships between physicians and nurses influence communication. Methods This 4-year study uses a sequential mixed-methods design, beginning with a quantitative survey followed by a two-part qualitative phase. Survey results from aim 1 will provide a detailed assessment of health information and communication technologies in use and help identify sites with variation in health information and communication technologies for the qualitative phase of the study. In aim 2, we will conduct telephone interviews with hospital personnel in up to 8 hospitals to gather in-depth information about communication practices and work relationships on medical-surgical units. In aim 3, we will collect data in 4 hospitals (selected from telephone interview results) via observation, shadowing, focus groups, and artifacts to learn how health information and communication technologies, communication practices, and work relationships affect communication. Results Results from aim 1 will be published in 2016. Results from aims 2 and 3 will be published in subsequent years. Conclusions As the majority of US hospitals do not yet have HIT fully implemented, results from our study will inform future development and implementation of health information and communication technologies to support effective communication between nurses and physicians.
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Affiliation(s)
- Milisa Manojlovich
- University of Michigan, School of Nursing, Ann Arbor, MI, United States.
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Abstract
OBJECTIVE The aim of the article is to describe the process of implementing the Estonian national second generation electronic prescription service (e-prescription) and determine if the objectives set by the Estonian government were fulfilled. MATERIALS AND METHODS The study presents an analysis of both retrospective and current data in the evaluation phase of a design research project. Sources include, among others, publicly available documents and previous evaluation studies. RESULTS According to all of the major stakeholders, the Estonian e-prescription service has very high usability and user satisfaction scores have been high. There is only little empirical evidence available to confirm if the benefits aimed for in the creation of the service were achieved. From a public administration viewpoint, the implementation of e-prescription has led to potential efficiency gains. CONCLUSION The Estonian second-generation e-prescription system is widely used by citizens, healthcare providers and administrators alike. However, there are gaps in measuring the impact of the service, especially with respect to time savings and enhanced healthcare quality. Additional functionalities will be key drivers in creating benefits for all stakeholders. Future nationwide e-health services should have a more rigorous evaluation process carried out during the design and implementation stages.
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Affiliation(s)
- Liisa Parv
- a Department of Technomedicum , Tallinn University of Technology , Tallinn , Estonia
| | - Priit Kruus
- b Praxis Centre for Policy Studies , Tallinn , Estonia , and
| | - Kaie Mõtte
- c Estonian Health Insurance Fund , Tallinn , Estonia
| | - Peeter Ross
- a Department of Technomedicum , Tallinn University of Technology , Tallinn , Estonia
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Trkman M, Trkman P. Actors’ misaligned interests to explain the low impact of an information system – A case study. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2014. [DOI: 10.1016/j.ijinfomgt.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fontainha E, Martins JT, Vasconcelos AC. Exploring the Determinants of PAS, EDMS, and PACS Adoption in European Hospitals. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.protcy.2014.10.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lanham HJ, Sittig DF, Leykum LK, Parchman ML, Pugh JA, McDaniel RR. Understanding differences in electronic health record (EHR) use: linking individual physicians' perceptions of uncertainty and EHR use patterns in ambulatory care. J Am Med Inform Assoc 2014; 21:73-81. [PMID: 23698256 PMCID: PMC3912724 DOI: 10.1136/amiajnl-2012-001377] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/28/2013] [Accepted: 04/21/2013] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Electronic health records (EHR) hold great promise for managing patient information in ways that improve healthcare delivery. Physicians differ, however, in their use of this health information technology (IT), and these differences are not well understood. The authors study the differences in individual physicians' EHR use patterns and identify perceptions of uncertainty as an important new variable in understanding EHR use. DESIGN Qualitative study using semi-structured interviews and direct observation of physicians (n=28) working in a multispecialty outpatient care organization. MEASUREMENTS We identified physicians' perceptions of uncertainty as an important variable in understanding differences in EHR use patterns. Drawing on theories from the medical and organizational literatures, we identified three categories of perceptions of uncertainty: reduction, absorption, and hybrid. We used an existing model of EHR use to categorize physician EHR use patterns as high, medium, and low based on degree of feature use, level of EHR-enabled communication, and frequency that EHR use patterns change. RESULTS Physicians' perceptions of uncertainty were distinctly associated with their EHR use patterns. Uncertainty reductionists tended to exhibit high levels of EHR use, uncertainty absorbers tended to exhibit low levels of EHR use, and physicians demonstrating both perspectives of uncertainty (hybrids) tended to exhibit medium levels of EHR use. CONCLUSIONS We find evidence linking physicians' perceptions of uncertainty with EHR use patterns. Study findings have implications for health IT research, practice, and policy, particularly in terms of impacting health IT design and implementation efforts in ways that consider differences in physicians' perceptions of uncertainty.
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Affiliation(s)
- Holly Jordan Lanham
- SouthTexas Veterans Health Care System, Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT), Austin, Texas, USA
- Department of Medicine, Department of Family and Community Medicine, The University of Texas Health Science Center at San Antonio, Austin, Texas, USA
- Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA
| | - Dean F Sittig
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- University of Texas-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
| | - Luci K Leykum
- SouthTexas Veterans Health Care System, Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT), Austin, Texas, USA
- Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA
- Department of Medicine, Department of Surgery, The University of Texas Health Science Center at San Antonio, Austin, Texas, USA
| | - Michael L Parchman
- MacColl Center for Health Care Innovation at Group Health Research Institute, Seattle, Washington, USA
| | - Jacqueline A Pugh
- SouthTexas Veterans Health Care System, Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT), Austin, Texas, USA
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Reuben R McDaniel
- Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA
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van Gurp J, Hasselaar J, van Leeuwen E, Hoek P, Vissers K, van Selm M. Connecting with patients and instilling realism in an era of emerging communication possibilities: a review on palliative care communication heading to telecare practice. PATIENT EDUCATION AND COUNSELING 2013; 93:504-514. [PMID: 23906650 DOI: 10.1016/j.pec.2013.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Appropriate palliative care communication is pivotal to optimizing the quality of life in dying patients and their families. This review aims at describing communication patterns in palliative care and discussing potential relations between communication patterns and upcoming telecare in the practice of palliative care. METHODS This review builds on a systematic five-step qualitative analysis of the selected articles: 1. Development of a 'descriptive table of studies reviewed' based on the concept of genre, 2. Open coding of table content and first broad clustering of codes, 3. Intracluster categorization of inductive codes into substantive categories, 4. Constant inter- and intracluster comparison results in identification of genres, and 5. Labeling of genres. RESULTS This review includes 71 articles. In the analysis, two communication genres in palliative care proved to be dominant: the conversation to connect, about creating and maintaining a professional-patient/family relationship, and the conversation to instill realism, about telling a clinical truth without diminishing hope. CONCLUSION The abovementioned two genres clarify a logical intertwinement between communicative purposes, the socio-ethical background underlying palliative care practice and elements of form. PRACTICE IMPLICATIONS Our study supports understanding of current communication in palliative care and anticipates future communicative actions in an era of new communication technologies.
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Affiliation(s)
- Jelle van Gurp
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.
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Yaraghi N, Du AY, Sharman R, Gopal RD, Ramesh R, Singh R, Singh G. Professional and geographical network effects on healthcare information exchange growth: does proximity really matter? J Am Med Inform Assoc 2013; 21:671-8. [PMID: 24287171 DOI: 10.1136/amiajnl-2012-001293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE We postulate that professional proximity due to common patients and geographical proximity among practice locations are significant factors influencing the adoption of health information exchange (HIE) services by healthcare providers. The objective of this study is to investigate the direct and indirect network effects of these drivers on HIE diffusion. DESIGN Multi-dimensional scaling and clustering are first used to create different clusters of physicians based on their professional and geographical proximities. Extending the Bass diffusion model to capture direct and indirect network effects among groups, the growth of HIE among these clusters is modeled and studied. The network effects among the clusters are investigated using adoption data over a 3-year period for an HIE based in Western New York. MEASUREMENT HIE adoption parameters-external sources of influence as well as direct and indirect network coefficients-are estimated by the extended version of the Bass diffusion model. RESULTS Direct network effects caused by common patients among physicians are much more influential on HIE adoption as compared with previously investigated social contagion and external factors. Professional proximity due to common patients does influence adoption decisions; geographical proximity is also influential, but its effect is more on rural than urban physicians. CONCLUSIONS Flow of patients among different groups of physicians is a powerful factor in HIE adoption. Rather than merely following the market trend, physicians appear to be influenced by other physicians with whom they interact with and have common patients.
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Affiliation(s)
- Niam Yaraghi
- Department of Management Science and Systems, School of Management, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA
| | - Anna Ye Du
- Department of Management Science and Systems, School of Management, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA
| | - Raj Sharman
- Department of Management Science and Systems, School of Management, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA
| | - Ram D Gopal
- Department of Management Science and Systems, School of Management, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA
| | - R Ramesh
- School of Business, University of Connecticut, Storrs, Connecticut 06269, USA
| | - Ranjit Singh
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA UB Patient Safety Research Center, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA
| | - Gurdev Singh
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA UB Patient Safety Research Center, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA
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Campion TR, Edwards AM, Johnson SB, Kaushal R. Health information exchange system usage patterns in three communities: Practice sites, users, patients, and data. Int J Med Inform 2013; 82:810-20. [DOI: 10.1016/j.ijmedinf.2013.05.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 11/25/2022]
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Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: Impact on professional practice. Int J Med Inform 2013; 82:684-95. [DOI: 10.1016/j.ijmedinf.2013.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 04/26/2013] [Accepted: 04/29/2013] [Indexed: 11/27/2022]
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Marsan J, Paré G. Antecedents of open source software adoption in health care organizations: A qualitative survey of experts in Canada. Int J Med Inform 2013; 82:731-41. [DOI: 10.1016/j.ijmedinf.2013.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 03/30/2013] [Accepted: 04/01/2013] [Indexed: 10/26/2022]
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Koumaditis K, Themistocleous M, Rupino Da Cunha P. SOA implementation critical success factors in healthcare. JOURNAL OF ENTERPRISE INFORMATION MANAGEMENT 2013. [DOI: 10.1108/jeim-06-2012-0036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cresswell KM, Worth A, Sheikh A. Comparative case study investigating sociotechnical processes of change in the context of a national electronic health record implementation. Health Informatics J 2012; 18:251-70. [PMID: 23257056 DOI: 10.1177/1460458212445399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of electronic health records (EHRs) lies at the heart of many international efforts to improve the safety and quality of healthcare. England has attempted to introduce nationally procured EHR software--the first country in the world to do so. In this qualitative comparative case study tracing local developments over time we sought to generate a detailed picture of the implementation landscape characterising this first attempt at implementing nationally procured software through studying three purposefully selected hospitals. Despite differences in relation to demographic considerations and local implementation strategies, implementing hospitals faced similar technical and political challenges. These were coped with differently by the various organisations and individual stakeholders, their responses being shaped by contextual contingencies. We conclude that national implementation efforts need to allow effective technology adoption to occur locally before considering larger-scale interoperability. This should involve the allocation of sufficient time for individual users and organisations to adjust to the complex changes that often accompany such service re-design initiatives.
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Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J Med Inform 2012; 82:e73-86. [PMID: 23146626 DOI: 10.1016/j.ijmedinf.2012.10.007] [Citation(s) in RCA: 234] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 10/10/2012] [Accepted: 10/14/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE Implementations of health information technologies are notoriously difficult, which is due to a range of inter-related technical, social and organizational factors that need to be considered. In the light of an apparent lack of empirically based integrated accounts surrounding these issues, this interpretative review aims to provide an overview and extract potentially generalizable findings across settings. METHODS We conducted a systematic search and critique of the empirical literature published between 1997 and 2010. In doing so, we searched a range of medical databases to identify review papers that related to the implementation and adoption of eHealth applications in organizational settings. We qualitatively synthesized this literature extracting data relating to technologies, contexts, stakeholders, and their inter-relationships. RESULTS From a total body of 121 systematic reviews, we identified 13 systematic reviews encompassing organizational issues surrounding health information technology implementations. By and large, the evidence indicates that there are a range of technical, social and organizational considerations that need to be deliberated when attempting to ensure that technological innovations are useful for both individuals and organizational processes. However, these dimensions are inter-related, requiring a careful balancing act of strategic implementation decisions in order to ensure that unintended consequences resulting from technology introduction do not pose a threat to patients. CONCLUSIONS Organizational issues surrounding technology implementations in healthcare settings are crucially important, but have as yet not received adequate research attention. This may in part be due to the subjective nature of factors, but also due to a lack of coordinated efforts toward more theoretically-informed work. Our findings may be used as the basis for the development of best practice guidelines in this area.
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Fitzpatrick G, Ellingsen G. A Review of 25 Years of CSCW Research in Healthcare: Contributions, Challenges and Future Agendas. Comput Support Coop Work 2012. [DOI: 10.1007/s10606-012-9168-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Heiro E, Mäntymäki M. Managing medication information with electronic patient records – a Finnish clinicians’ perspective. HEALTH AND TECHNOLOGY 2012. [DOI: 10.1007/s12553-012-0025-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Electronic medical record quality and its impact on user satisfaction — Healthcare providers' point of view. GOVERNMENT INFORMATION QUARTERLY 2012. [DOI: 10.1016/j.giq.2011.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Huang JC, Lee YC. Predicting telecare adoption on senior citizens in institution: Application of the technology acceptance model. JOURNAL OF STATISTICS & MANAGEMENT SYSTEMS 2012. [DOI: 10.1080/09720510.2012.10701614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Campion TR, Waitman LR, Lorenzi NM, May AK, Gadd CS. Barriers and facilitators to the use of computer-based intensive insulin therapy. Int J Med Inform 2011; 80:863-71. [PMID: 22019280 DOI: 10.1016/j.ijmedinf.2011.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 08/15/2011] [Accepted: 10/03/2011] [Indexed: 01/04/2023]
Abstract
PURPOSE Computerized clinical decision support systems (CDSSs) for intensive insulin therapy (IIT) are increasingly common. However, recent studies question IIT's safety and mortality benefit. Researchers have identified factors influencing IIT performance, but little is known about how workflow affects computer-based IIT. We used ethnographic methods to evaluate IIT CDSS with respect to other clinical information systems and care processes. METHODS We conducted direct observation of and unstructured interviews with nurses using IIT CDSS in the surgical and trauma intensive care units at an academic medical center. We observed 49h of intensive care unit workflow including 49 instances of nurses using IIT CDSS embedded in a provider order entry system. Observations focused on the interaction of people, process, and technology. By analyzing qualitative field note data through an inductive approach, we identified barriers and facilitators to IIT CDSS use. RESULTS Barriers included (1) workload tradeoffs between computer system use and direct patient care, especially related to electronic nursing documentation, (2) lack of IIT CDSS protocol reminders, (3) inaccurate user interface design assumptions, and (4) potential for error in operating medical devices. Facilitators included (1) nurse trust in IIT CDSS combined with clinical judgment, (2) nurse resilience, and (3) paper serving as an intermediary between patient bedside and IIT CDSS. CONCLUSION This analysis revealed sociotechnical interactions affecting IIT CDSS that previous studies have not addressed. These issues may influence protocol performance at other institutions. Findings have implications for IIT CDSS user interface design and alerts, and may contribute to nascent general CDSS theory.
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Affiliation(s)
- Thomas R Campion
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, United States.
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Lanham HJ, Leykum LK, McDaniel RR. Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting. J Am Med Inform Assoc 2011; 19:382-91. [PMID: 21846780 PMCID: PMC3341779 DOI: 10.1136/amiajnl-2011-000263] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Design Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. Measurements An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group—including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Results Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and respectful interaction, whereas practices that were furthest from achieving standardized EHR use exhibited low levels of mindfulness and respectful interaction. Conclusion Within-practice communication patterns provide a unique perspective for exploring the issue of standardization in EHR use. A major fallacy of setting homogeneous EHR use as the goal for practice-level EHR use is that practices with uniformly low EHR use could be considered successful. Achieving uniformly high EHR use across all users in a practice is more consistent with the goals of current EHR adoption and use efforts. It was found that some communication patterns among practice members may enable more standardized EHR use than others. Understanding the linkage between communication patterns and EHR use can inform understanding of the human element in EHR use and may provide key lessons for the implementation of EHRs and other health information technologies.
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Affiliation(s)
- Holly Jordan Lanham
- Veterans Evidence Based Research Dissemination and Implementation Center-VERDICT, South Texas Veterans Health Care System, San Antonio, Texas, USA.
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From cacophony to harmony: A case study about the IS implementation process as an opportunity for organizational transformation at Sentara Healthcare. JOURNAL OF STRATEGIC INFORMATION SYSTEMS 2011. [DOI: 10.1016/j.jsis.2011.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cresswell KM, Worth A, Sheikh A. Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC Med Inform Decis Mak 2010; 10:67. [PMID: 21040575 PMCID: PMC2988706 DOI: 10.1186/1472-6947-10-67] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 11/01/2010] [Indexed: 11/10/2022] Open
Abstract
Background Actor-Network Theory (ANT) is an increasingly influential, but still deeply contested, approach to understand humans and their interactions with inanimate objects. We argue that health services research, and in particular evaluations of complex IT systems in health service organisations, may benefit from being informed by Actor-Network Theory perspectives. Discussion Despite some limitations, an Actor-Network Theory-based approach is conceptually useful in helping to appreciate the complexity of reality (including the complexity of organisations) and the active role of technology in this context. This can prove helpful in understanding how social effects are generated as a result of associations between different actors in a network. Of central importance in this respect is that Actor-Network Theory provides a lens through which to view the role of technology in shaping social processes. Attention to this shaping role can contribute to a more holistic appreciation of the complexity of technology introduction in healthcare settings. It can also prove practically useful in providing a theoretically informed approach to sampling (by drawing on informants that are related to the technology in question) and analysis (by providing a conceptual tool and vocabulary that can form the basis for interpretations). We draw on existing empirical work in this area and our ongoing work investigating the integration of electronic health record systems introduced as part of England's National Programme for Information Technology to illustrate salient points. Summary Actor-Network Theory needs to be used pragmatically with an appreciation of its shortcomings. Our experiences suggest it can be helpful in investigating technology implementations in healthcare settings.
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Affiliation(s)
- Kathrin M Cresswell
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
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Ellingsen G, Røed K. The Role of Integration in Health-Based Information Infrastructures. Comput Support Coop Work 2010. [DOI: 10.1007/s10606-010-9122-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Greenhalgh T, Potts HWW, Wong G, Bark P, Swinglehurst D. Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. Milbank Q 2009; 87:729-88. [PMID: 20021585 PMCID: PMC2888022 DOI: 10.1111/j.1468-0009.2009.00578.x] [Citation(s) in RCA: 326] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
CONTEXT The extensive research literature on electronic patient records (EPRs) presents challenges to systematic reviewers because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. METHODS Using the meta-narrative method and searching beyond the Medline-indexed literature, this review used "conflicting" findings to address higher-order questions about how researchers had differently conceptualized and studied the EPR and its implementation. FINDINGS Twenty-four previous systematic reviews and ninety-four further primary studies were considered. Key tensions in the literature centered on (1) the EPR ("container" or "itinerary"); (2) the EPR user ("information-processer" or "member of socio-technical network"); (3) organizational context ("the setting within which the EPR is implemented" or "the EPR-in-use"); (4) clinical work ("decision making" or "situated practice"); (5) the process of change ("the logic of determinism" or "the logic of opposition"); (6) implementation success ("objectively defined" or "socially negotiated"); and (7) complexity and scale ("the bigger the better" or "small is beautiful"). CONCLUSIONS The findings suggest that EPR use will always require human input to recontextualize knowledge; that even though secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper may offer a unique degree of ecological flexibility; and that smaller EPR systems may sometimes be more efficient and effective than larger ones. We suggest an agenda for further research.
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Oroviogoicoechea C, Watson R. A quantitative analysis of the impact of a computerised information system on nurses' clinical practice using a realistic evaluation framework. Int J Med Inform 2009; 78:839-49. [PMID: 19767235 DOI: 10.1016/j.ijmedinf.2009.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 08/31/2009] [Accepted: 08/31/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore nurses' perceptions of the impact on clinical practice of the use of a computerised hospital information system. DESIGN A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. This is a theory-driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes (CMO) configurations. MEASUREMENTS A questionnaire was distributed to all nurses working in in-patient units of a university hospital in Spain (n=227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), was used for cross-tabulation of variables searching for CMO relationships. RESULTS Nurses (n=179) participated in the study (78.8% response rate). Overall satisfaction with the IT system was positive. Comparisons with context variables show how nursing units' context had greater influence on perceptions than users' characteristics. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. CONCLUSION Results from the study looking at subtle variations in users and units provide insight into how important professional culture and working practices could be in IT (information technology) implementation. The socio-technical approach on IT systems evaluation suggested in the recent literature appears to be an adequate theoretical underpinning for IT evaluation research. Realistic evaluation has proven to be an adequate method for IT evaluation.
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Bush M, Lederer AL, Li X, Palmisano J, Rao S. The alignment of information systems with organizational objectives and strategies in health care. Int J Med Inform 2009; 78:446-56. [PMID: 19307148 DOI: 10.1016/j.ijmedinf.2009.02.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 02/05/2009] [Accepted: 02/12/2009] [Indexed: 12/01/2022]
Abstract
PURPOSE The alignment of information systems with organizational objectives and strategies is a key, contemporary challenge to organizations in general and the health care industry in particular. Researchers and managers alike believe that the selection of new information systems to support objectives and strategies focuses the organization on accomplishing its objectives and realizing the value of the investments in the systems. The purpose of this study was to help understand alignment in health care so that health care information systems planners can better achieve it. METHODS Structured interviews with 15 top information systems managers in health care organizations of various sizes and types inquired about organizational objectives and strategies, the process for choosing new information systems to support those objectives and strategies, and the concomitant facilitating and hindering managerial actions and organizational characteristics. RESULTS In addition to identifying and elucidating specific objectives, strategies, processes for choosing new systems, and facilitating and hindering actions and characteristics, the study used the data to characterize a generalized process of alignment in health care organizations. CONCLUSIONS The study contributes by confirming that alignment is a significant issue in health care organizations, and that such organizations make deliberate efforts to achieve it. The study further contributes by providing tables of actions and characteristics that managers might use as checklists in current and future alignment efforts as well as in generally cultivating broad support for alignment. Finally, it contributes by suggesting future study of alignment's predictors and effects in health care organizations.
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Affiliation(s)
- Marianne Bush
- University of Kentucky, Lexington, KY 40506-0034, USA
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De Rouck S, Jacobs A, Leys M. A methodology for shifting the focus of e-health support design onto user needs. Int J Med Inform 2008; 77:589-601. [DOI: 10.1016/j.ijmedinf.2007.11.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 09/09/2007] [Accepted: 11/19/2007] [Indexed: 11/28/2022]
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From user needs to system specifications: multi-disciplinary thematic seminars as a collaborative design method for development of health information systems. J Biomed Inform 2008; 41:557-69. [PMID: 18394969 DOI: 10.1016/j.jbi.2008.01.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 12/28/2007] [Accepted: 01/20/2008] [Indexed: 11/23/2022]
Abstract
This paper presents a new multi-disciplinary method for user needs analysis and requirements specification in the context of health information systems based on established theories from the fields of participatory design and computer supported cooperative work (CSCW). Whereas conventional methods imply a separate, sequential needs analysis for each profession, the "multi-disciplinary thematic seminar" (MdTS) method uses a collaborative design process. Application of the method in elderly homecare resulted in prototypes that were well adapted to the intended user groups. Vital information in the points of intersection between different care professions was elicited and a holistic view of the entire care process was obtained. Health informatics-usability specialists and clinical domain experts are necessary to apply the method. Although user needs acquisition can be time-consuming, MdTS was perceived to efficiently identify in-context user needs, and transformed these directly into requirements specifications. Consequently the method was perceived to expedite the entire ICT implementation process.
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