An importance-performance analysis of hospital information system attributes: A nurses' perspective

Psychological resilience factors in intensive care nursing: a hybrid multi-criteria decision-making model

PURPOSE

To analyze the key factors influencing the psychological resilience of intensive care unit (ICU) nurses during the COVID-19 pandemic and put forward suggestions promoting resilience based on key improvement factors and clinical experience.

METHODS

Data were collected from 35 ICU nurses in a hospital in Zhejiang Province, China, through a questionnaire survey conducted between January and February 2023. The Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was then used to construct and visualize the relationship structure between the factors. The DEMATEL-based Analytical Network Process (DANP) was applied to determine the influential weights of all factors. Finally, the key improvement factors were identified using importance-performance analysis (IPA).

RESULTS

Based on the cause-effect impact network diagram (CEIND), it was concluded that (C 11), (C 22), and (C 32) are the key factors that promote the improvement of psychological resilience among ICU nurses. Additionally, these factors were the key factors that influence psychological resilience. The confidence levels of these results and the gap were 99.6% and 0.4%, respectively, which exceed the threshold value of 95%, indicating good stability. Finally, for the case hospitals, (C 13) was identified as the key improvement factor.

CONCLUSIONS

Hospital administrators should support ICU nurses in enhancing their psychological resilience during major epidemics by: (i) Providing training on comprehensive protective measures and nursing skills; (ii) Effectively managing the human resources of nurses in the hospital to reduce their workload; (iii) Increasing social and organizational support for nurses to alleviate anxiety caused by large-scale public health events and improve their psychological resilience.

Research on collaborative development mechanism of multiple stakeholders in medical institutions based on rough set

Reducing doctor-patient conflict is an important part of coordinating doctor-patient disputes and easing doctor-patient relationship, which is conducive to building a harmonious medical environment and promoting the healthy development of medical undertakings. This paper constructs a multi-decision-maker mixed conflict model based on rough set theory, puts forward the matrix operation expression of the conflict degree theory in the Pawlak model, and gives a more objective and scientific evaluation function. Combined with hot issues of doctor-patient conflict, the proposed multi-decision-maker mixed conflict model is applied to doctor-patient conflict, examines the doctor-patient relationship in the medical institution system from multiple internal perspectives, and calculates feasible solutions in the conflict system. The results show that high medical quality, high standardize medication, high institutional efficiency, high staff efficiency, high hospital benefits, high hospital revenue, medium employee development, medium equipment development, or high medical quality, high standardize medication, high institutional efficiency, medium staff efficiency, medium hospital benefits, high hospital revenue, high employee development, and high equipment development are important conditions for building a harmonious medical environment and reducing doctor-patient conflicts.

Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: a nationwide retrospective cohort study

BACKGROUND

In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya.

METHODS

We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Completeness refers to the presence of the appropriate amount of data. Consistency refers to uniformity of data across multiple indicators. Discrepancy (measured on a Z-scale) refers to the degree of alignment (or lack thereof) of data with rules that defined the possible valid values for the data.

RESULTS

A total of 5,610 unique facility-quarters were extracted from KHIS. The mean completeness score was 61.1% [standard deviation (SD) = 27%]. The mean consistency score was 80% (SD = 16.4%). The mean discrepancy score was 0.07 (SD = 0.22). A strong and positive correlation was identified between the consistency score and discrepancy score (correlation coefficient = 0.77), whereas the correlation of either score with the completeness score was low with a correlation coefficient of -0.12 (with consistency score) and -0.36 (with discrepancy score). General HIV indicators were more complete, but less consistent, and less plausible than PMTCT indicators.

CONCLUSION

We observed a lack of correlation between the completeness score and the other two scores. As such, for a holistic DQA, completeness assessment should be paired with the measurement of either consistency or discrepancy to reflect distinct dimensions of data quality. Given the complexity of the discrepancy score, we recommend the simpler consistency score, since they were highly correlated. Routine use of composite scores on KHIS data could enhance efficiencies in DQA at scale as digitization of health information expands and could be applied to other health sectors beyondHIV clinics.

How Nurses Develop Standardized Care Plans Under a Clinical Decision Support System: A Mixed-Methods Study

Standardized care plans are being increasingly introduced to health facilities; however, their level of adoption remains unsatisfactory. Little is known about nurses' use of standardized care plans in China. This study aims to investigate acute care nurses' practices and experiences of care planning within a clinical decision support system embedded with standardized nursing languages. We explored the importance and performance of nursing interventions by retrospective analysis of 400 standardized care plans (performance) and a survey among nurses (importance). Semistructured interviews were conducted to supplement quantitative findings and delve deeper into nurses' experience with standardized care plans. A total of six core nursing diagnoses were determined, each corresponding to seven to 15 nursing interventions. The correlations between nurses' perceived importance and actual performance of nursing interventions in the care plan were weak. Qualitative interviews identified three themes: negative attitudes toward the care plan, uncertainty regarding care planning, and new routines with the care plan. Our findings indicate that nurses' care planning may not reflect their professional judgments. Effective leadership from nurse administrators is warranted to engage nurses with standardized care plan implementation. The content of the standardized nursing language embedded-knowledge base should be continuously adapted to clinical needs to facilitate nurses' care planning practices.

Identification of critical quality factors and critical satisfaction gaps in emergency training courses for new nurses by the multi-criteria network structure model

OBJECTIVE

To identify critical quality factors and critical satisfaction gaps in emergency training courses for new nurses through a systematic decision-making model.

METHODS

Firstly, the service quality (SERVQUAL) was used in the evaluation index system of this study. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to analyze the relationship structure and the corresponding weights between the indicators. Finally, the importance-performance analysis (IPA) method was used to identify the categories of all indicators and the corresponding strategic directions. Fifteen new nurses in Taizhou Hospital of Zhejiang Province were selected as participants in this study.

RESULTS

The IPA results showed that "(C₁₃)," "(C₂₂)," "(C₅₂)," "(C₅₃)," "(C₅₄)," "(C₅₅)," "(C₅₆),"and "(C₅₇)" are critical satisfaction gaps. From the results of influence network and weight, empathy (C₅) was the critical quality factor of the entire training course. The influence network relationship structure and weight had a 98.1% significant confidence level, indicating good stability.

CONCLUSION

Teachers' empathy is key to the learning outcomes of new nurses in emergency nursing training courses. Hence, teachers should be attentive to the empathetic quality of their teaching methods to help new nurses gain knowledge and experience in emergency care, especially when they come from different professions and departments.

Identifying the value of a clinical information system during the COVID-19 pandemic

The COVID-19 pandemic has significantly augmented the urgency for service providers to identify and develop clinically urgent system alterations into healthcare systems to facilitate antibody testing and treatment interventions. However, it has been difficult to determine how users assess the value of an information system in terms of its functionality and features. Conversely, the system development process to address urgent user requirements, for example, developing new functionality for COVID antibody testing, has been beset by a myriad of difficulties as research to understand the value of specific aspects of clinical information systems has been elusive. This study addresses this knowledge gap by identifying specific aspects of a national clinical information system in Wales, UK. Through a series of semi-structured interviews, a quantitative study of 559 clinical users and a focus group, the study deconstructs system-related value into 14 unique attributes that have been found to vary according to different types of user roles and geographic location.

Attribution theory is identified in this study as a novel and effective way to study this multifaceted concept of system value. The identification of component attributes of the value of a clinical information system provides insights for service users, system developers, and organization managers to prioritize and focus their system development activity by using an importance ranking identified through this study.

An artificial intelligence-based risk prediction model of myocardial infarction

BACKGROUND

Myocardial infarction can lead to malignant arrhythmia, heart failure, and sudden death. Clinical studies have shown that early identification of and timely intervention for acute MI can significantly reduce mortality. The traditional MI risk assessment models are subjective, and the data that go into them are difficult to obtain. Generally, the assessment is only conducted among high-risk patient groups.

OBJECTIVE

To construct an artificial intelligence-based risk prediction model of myocardial infarction (MI) for continuous and active monitoring of inpatients, especially those in noncardiovascular departments, and early warning of MI.

METHODS

The imbalanced data contain 59 features, which were constructed into a specific dataset through proportional division, upsampling, downsampling, easy ensemble, and w-easy ensemble. Then, the dataset was traversed using supervised machine learning, with recursive feature elimination as the top-layer algorithm and random forest, gradient boosting decision tree (GBDT), logistic regression, and support vector machine as the bottom-layer algorithms, to select the best model out of many through a variety of evaluation indices.

RESULTS

GBDT was the best bottom-layer algorithm, and downsampling was the best dataset construction method. In the validation set, the F1 score and accuracy of the 24-feature downsampling GBDT model were both 0.84. In the test set, the F1 score and accuracy of the 24-feature downsampling GBDT model were both 0.83, and the area under the curve was 0.91.

CONCLUSION

Compared with traditional models, artificial intelligence-based machine learning models have better accuracy and real-time performance and can reduce the occurrence of in-hospital MI from a data-driven perspective, thereby increasing the cure rate of patients and improving their prognosis.

Important-performance analysis to conceptualize goal priorities in community dwelling stroke survivors

BACKGROUND

It is important for clinicians to have a better understanding of stroke survivor's goals. Important performance analysis (IPA) is a tool that could be utilized to identify goal priorities in rehabilitation.

OBJECTIVES

To examine the utility of the IPA method to identify goal priorities in a diverse group of community dwelling stroke survivors.

METHODS

Thirty-eight stroke survivors completed private structured interviews and were asked to rate their perceived importance and performance of 37 goal areas. Important-performance analysis (IPA) was utilized to determine goal priorities for the overall sample. Different IPA methods used to identify goal priorities were compared. Goal priorities were also compared by age (dichotomized as <65 and ≥65 years) and sex (male or female).

RESULTS

The IPA method effectively separated the goals into the four quadrants, and distinguished which goals were a priority for the sample of stroke survivors. The five goals that were consistently identified as a focus area were: hand function, driving, balance, memory, and arm strength. Men rated mood control as more important than women (p = .046). The two goals rated as being more important for those older than 65 were home accessibility (p = .008) and skin health (p < .001).

CONCLUSIONS

Stroke survivors continue to have goals related to their stroke recovery in the years after their stroke. Both current performance as well as perceived importance should be considered during goal discussions with stroke survivors. IPA can help identify goal priorities in this population.

E-Health System Characteristics, Medical Performance, and Healthcare Quality at Jordan's Health Centers

This research explores how e-health systems' features (information quality, quality of the system, usability perceived, and perceived usefulness) contribute to improving medical personnel performance in medical centers, patient care, and physician-patient interactions in Jordan. The objective is to evaluate a single integrated model consisting of the technology acceptance model. This study used the logical research method and approach. A collection of data from 212 medical personnel working in 19 healthcare facilities throughout Jordan were gathered. To analyze the data collected and test the hypotheses of the research, a partially square/structural equation modeling method has been employed. The study found that the health information system (HIS) information quality has a direct and indirect beneficial effect on the performance of the staff, beneficial effects on patient care alone, and only favorable, indirect effects on the doctor-patient relationship. On the contrary, system quality was shown to influence directly and indirectly and to have a direct and indirect beneficial effect both on the connection between doctors and patients. Remember that the HIS has accessibility, speed, and mistake detection and avoids error issues. These shortcomings are suggested to be rectified in conjunction with improved user perception towards easy usage and utilization of the system.

Identification and Classification of Usability Problems in a Nursing Information System: A Heuristic Evaluation

Nursing information system is a system that nurses are required to use in order to perform their daily activities. Poor user interface design of nursing information system can cause problems in nurses' interaction with the system. This research aimed to evaluate the usability of nursing information system. During this study, five evaluators examined the nursing information system with the heuristic evaluation method and by using the checklist of Nielsen usability principles. Then, the identified problems were categorized into 10 Nielsen usability principles, and the severity of the problems was determined. They also attributed each problem to one of usability attributes. A total of 104 unique problems were identified. Most of the problems were related to the principle of "consistency and standards." More than a third of the identified problems were classed as major and catastrophe, with the highest severity in the average problems of "help and documentation" and "error prevention." Most of the identified problems were attributed to effectiveness and satisfaction. Because a significant number of identified usability problems in nursing information system were major and catastrophe and were attributed to effectiveness and satisfaction, being able to remedy the problems could improve nurses' interaction with the system user interface and increase satisfaction and effectiveness of nurses.

Ten statements to support nurse leaders implement e-health tools for nursing work in hospitals: A modified Delphi study

AIM

To use expert consensus to develop guidance for nurse leaders implementing e-health tools to support nursing work in hospitals.

BACKGROUND

Nurse leaders are increasingly required to make decisions about the selection, development, implementation and optimisation of e-health tools for nursing work in hospitals. Guidance in this rapidly evolving and complex space is limited.

DESIGN

A two-phase modified Delphi study.

METHODS

Phase one involved in-depth interviews with five nursing informatics experts. Analysis used the qualitative framework method, informed by the Theoretical Domains Framework (TDF), to develop statements for an anonymous online Delphi scoring survey. This was distributed using snowball sampling methods to Australian nurse informatics leaders and experts. Final analysis involved synthesis of qualitative and quantitative data. The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist.

RESULTS

Ten guidance statements to support nurse leaders to implement e-health tools in hospitals were developed from the synthesis of qualitative interview data and 29 experts' responses to the 55-item Delphi response survey.

CONCLUSION

Implementation of e-health tools for nursing work is complex in health settings and requires careful examination of multiple factors and interactions between clinicians, tools, service users and the health organisation. This research proposes ten statements to support nurse leaders with decisions about implementing e-health tools to support nursing work in hospitals.

RELEVANCE TO CLINICAL PRACTICE

The ten statements developed by this research provide a resource to assist policy and practice decisions about e-tools to ensure they are suited to supporting nursing work. Nurse leaders can use the ten statements for guidance in the selection, development, implementation and optimisation of e-health tools to ensure suitability and adaptation for nursing work in hospitals.

Factors Influencing User Satisfaction with Information Systems: A Systematic Review

User satisfaction has been considered as the measure of information system effectiveness success. User satisfaction is difficult to define but is considered an evaluation construct. Globally health organizations, particularly hospitals, invest a huge amount of money on information system projects. If hospital information systems (HISs) are to be successful, factors influencing or related to user satisfaction should be taken into account at the time of designing, developing or adopting such systems. The current study aimed to provide a comprehensive review of factors related to user satisfaction with information systems. The researchers systematically searched PubMed, Science Direct, and IEEE electronic databases for articles published from January 1990 to June 2016. A search strategy was developed using a combination of the following keywords: "model," "user satisfaction," "information system," "measurement," "instrument," and " tool." Reported dimensions, factors, and their possible influence on user satisfaction with information systems were extracted from the studies wherever was possible. Overall factors influencing user satisfaction with information systems can be categorized in seven dimensions: Information quality, system quality, vendor support quality, system use, perceived usefulness, user characteristics, and organizational structure & management style. If all these factors are considered properly in the process of developing, designing, implementing, or purchasing information systems, the higher user satisfaction with the system will be likely. Otherwise, it would end up with unsatisfied users that will finally contribute to the system failure.

E-health system characteristics, medical performance and healthcare quality at UNRWA-Palestine health centers

Purpose

This study aims to investigate how e-health system characteristics (information quality, system quality, perceived ease of use, perceived usefulness) contribute to the enhancement of medical staff performance, patient care, and doctor–patient relationships at UNRWA-Gaza healthcare centers. It aims at testing an integrative single model comprising Technology Acceptance Model (TAM), D&M model and e-health system utilization.

Design/methodology/approach

This study followed the quantitative methodology and the deductive research approach. Data were collected from 241 medical staff who use the system employed in 19 different healthcare centers across the Gaza Strip. Partial least square/structural equation modeling technique was used to analyze the collected data and to test study hypotheses.

Findings

Study concluded that information quality of the adopted Health Information System (HIS) has both direct and indirect positive impact on staff performance, only direct positive impact on patient care and only positive indirect impact on doctor–patient relationship. System quality, on the other hand, was found to have negative direct impact and positive indirect impact on staff performance and has both direct and indirect positive impact on both doctor-patient relationship and patient care.

Research limitations/implications

Noteworthy that HIS has availability, speed and error detection and error prevention issues. It is recommended that these shortfalls be addressed together with improving user perception towards ease of use and usefulness of the system.

Practical implications

Management should also work to raise confidence in its medical staff to improve the effect of HIS on medical performance and patient care. It is also recommended that UNRWA should implement crowed management techniques such as queuing systems and on-phone booking to minimize patient waiting time.

Originality/value

The importance of the study stems from its context being conducted in a developing region (Gaza Strip-Palestine) which has a fragile economic, political and social environment with many other complexities. It is also conducted at United Nations Relief and Work Agency (UNRWA) healthcare centers, which provide medical services to Palestinian refugees. In addition, this study is among the few studies that address the impact of individual e-health success factors on both doctor-patient relationship and patient care constructs. Most previous studies concentrated on the impact of health system adoption as a whole on these two subject variables and one can hardly ever stop at studies that address effect of individual success factors on them. It also integrated both D&M system success model and TAM model with some additional amendments creating and tested a new model.

Methodologies for Determining the Service Quality of the Intercity Rail Service Based on Users’ Perceptions and Expectations in Thailand

There is a significant need to change people’s travel mode from personal cars to public rail, because rail transport is a more environmentally friendly travel mode. Over the past decade, the number of rail passengers has reduced because of service quality problems. Thus, this study aims to propose guidelines for precise service quality (SQ) improvements of intercity rail services in Thailand. Data were collected from 615 train passengers by distributing questionnaires at train stations in six provinces, covering all regions of Thailand. Cluster analysis (CA), factor analysis (FA), and importance-performance analysis (IPA) were applied in this research, which were used based on gap analysis. As a result of CA and FA, the 45 quality indicators were grouped into four factors, namely, vehicles, staff, services, and infrastructures/stations. The FA results seem more appropriate than those of CA in terms of providing factor loadings that indicate the importance of each indicator. The results of IPA show that the seven indicators that were analyzed fell into the “concentrate here” quadrant. To summarize the current policy, the factor most in need of rapid improvement in order to increase the quality of the intercity rail service in Thailand is that of the train car variables group; on the other hand, the main strength of the current services relates to the services provided by staff.

Technical requirements framework of hospital information systems: design and evaluation

BACKGROUND

Implementing the health information system (HIS) is more complex and costly than implementing other information systems. The present study was conducted to design and evaluate technical requirements for the HIS.

METHODS

The present study was conducted in 2016 by determining technical requirements for the HIS using the Delphi technique and then evaluating this system using a checklist based on the approved requirements.

RESULTS

The first part of the study designed a 73-item final list of technical requirements for the HIS in four domains, i.e. communication service, system architecture, security service and system response time. The evaluation results obtained in the second part showed that communication service was met in 63.8% of the HIS programs, system architecture in 65.5%, security service in 72.4% and system response time in 76.3%.

CONCLUSIONS

A technical evaluation tool was designed and used to select and evaluate the HIS. The evaluation results suggested the study HIS was poorer in terms of communication service and system architecture than in the other two dimensions.

Evaluation of the Integrated Health Information System (IHIS) in Public Hospitals in Cyprus Utilizing the DIPSA Framework

INTRODUCTION

The Ministry of Health of the Republic of Cyprus has implemented an Integrated Health Information System (IHIS) in two hospitals. However, no evaluation of IHIS has been conducted to assess its safety, efficiency and effectiveness. The proper utilization of IHIS is essential for the provision of quality healthcare services.

AIM

The purpose of this study was to evaluate the current IHIS in public hospitals in Cyprus utilizing the DIPSA evaluation framework.

METHODS

A total of 309 subjects, including doctors, nurses and other healthcare professionals, participated in the study. The DIPSA evaluation framework assessed the users' perception in five categories namely, satisfaction, collaboration, system quality, safety and procedures, using Likert scale and 3 open questions. Correlation between the categories was assessed using the Pearson correlation coefficient, and multiple regression analysis was used to examine the relationship between the demographic characteristics and categories. Data analysis was done using SPSS v24.

RESULTS

All five categories were rated moderately, between 2.5 and 3, by the participants. All categories were correlated (P < 0.01). Multiple regression analysis indicated the need for improvement between the professionals (mainly doctors and nurses) and the categories. The open questions pointed out the need for improvement in all 3 factors examined (Technology, Human Factor, Organization).

DISCUSSION

The moderately rated categories, in the Cyprus IHIS, suggest that there is a lot of room for improvement. Some interventions are suggested that could positively and simultaneously affect one or more categories.

Reform of Chinese Universities in the Context of Sustainable Development: Teacher Evaluation and Improvement Based on Hybrid Multiple Criteria Decision-Making Model

China is pushing universities to implement reforms in order to achieve the sustainable development goals, but with the development level of teachers becoming the key restricting factor. In this sense, teacher evaluation and improvement act as positive factors for China to achieve the 2030 sustainable development goals. Previous studies on teacher evaluation have usually assumed that the relationship between the evaluation criteria is independent, with the weights of each standard derived from this assumption. However, this assumption is often not in line with the actual situation. Decisions based on these studies are likely to waste resources and may negatively impact the efficiency and effectiveness of teachers’ sustainable development. This study developed an integrated model for the evaluation and improvement of teachers based on the official teacher evaluation criteria of China’s International Scholarly Exchange Curriculum (ISEC) programme and a multiple criteria decision-making methodology. First, a decision-making trial and a laboratory-based analytical network process were used to establish an influential network-relation diagram (INRD) and influential weights under ISEC standards. Next, an important performance analysis was used to integrate the weight and performance of each standard to produce a worst-performance criterion set for each university teacher. Finally, the worst performance set used an INRD to derive an improvement strategy with a cause–effect relationship for each teacher. This study chose a Chinese university that has implemented teaching reform for our case study. The results show that our developed model can assist decision-makers to improve their current evaluations of teachers and to provide a cause–effect improvement strategy for education reform committees and higher education institutions.

Development process of a mobile electronic medical record for nurses: a single case study

Background

With the growing shortage of nurses, labor-saving technology has become more important. In health care practice, however, the fit with innovations is not easy. The aim of this study is to analyze the development of a mobile input device for electronic medical records (MEMR), a potentially labor-saving application supported by nurses, that failed to meet the needs of nurses after development.

Method

In a case study, we used an axiomatic design framework as an evaluation tool to visualize the mismatches between customer needs and the design parameters of the MEMR, and trace these mismatches back to (preliminary) decisions in the development process. We applied a mixed-method research design that consisted of analyzing of 118 external and internal files and working documents, 29 interviews and shorter inquiries, a user test, and an observation of use. By factoring and grouping the findings, we analyzed the relevant categories of mismatches.

Results

The involvement of nurses during the development was extensive, but not all feedback was, or could not be, used effectively to improve the MEMR. The mismatches with the most impact were found to be: (1) suboptimal supportive technology, (2) limited functionality of the app and input device, and (3) disruption of nurses’ workflow. Most mismatches were known by the IT department when the MEMR was offered to the units as a product. Development of the MEMR came to a halt because of limited use.

Conclusion

Choices for design parameters, made during the development of labor-saving technology for nurses, may conflict with the customer needs of nurses. Even though the causes of mismatches were mentioned by the IT department, the nurse managers acquired the MEMR based on the idea behind the app. The effects of the chosen design parameters should not only be compared to the customer needs, but also be assessed with nurses and nurse managers for the expected effect on the workflow.

Electronic supplementary material

The online version of this article (10.1186/s12911-018-0726-3) contains supplementary material, which is available to authorized users.

Use of Health Information Technology in Patients Care Management: a Mixed Methods Study in Iran

Introduction

New technologies, including health information technologies, play an important role in effectiveness of management and nursing care services.

Aim

This study was aimed to determining the use of health information technology in patient care management in a case study in Iran.

Methods

This Mixed method study was conducted in 2018 in Kowsar Hospital of Semnan, Iran. Data gathered by an observational checklist and one questionnaire included two main parts, one demographic and another assessment of information technology use in care management of inpatients. The researcher prepared the questionnaire and its validity was verified. The data were organized and analyzed in the form of a descriptive analytic report. In the process of data collection, 10 participants including nurses, head nurses, physicians, radiology experts and Information Technology (IT) managers were interviewed and data analyzed using Directed Content Analysis.

Results

Nurses were satisfied with the computerized system and believed it can facilitate the affair. From the nurse's viewpoint, the most common use of the Health Information Technology (HIT) were access (observation) of patients admit and discharge information (100%), providing medicine and equipment, transfer of patients (92.3%). The least of them were retrieve of evidence in the care process (0 %) and judgment and analysis of radiological diagnostic procedures (0%). The potential of electronic record is not still applicable.

Conclusion

Use of modern information and communication technology in hospitals facilitates access and transfer of information, and also accelerates patient's admission and discharge process, relation between hospital units, providing medical equipment supporting affairs' process and diagnostic procedures. However, modifying organizational policies, improve the infrastructure and enhancing nurses' motivation in documenting nursing reports can be effective in increasing the impact of information technology in care management processes especially in electronic record and nurse's clinical judgment and evidence-based care.

Strategic Improvement for Quality and Satisfaction of Hospital Information Systems

The purpose of our study aimed to identify attributes capable of improving physicians' satisfaction levels with the use of a hospital information system (HIS). A model inclusive of system quality, information quality, and service quality related to an HIS is used to form antecedents of user satisfaction. Survey methodology was used to collect an attributive set representing the system quality, information quality, and service quality made available from 150 physicians at a large health-care system in southern Taiwan. Responses were segmented into low and high satisfaction and analyzed with partial least squares and importance-performance analysis. The results reveal that system quality, information quality, and service quality may be used to significantly predict physicians' satisfaction. Two system quality attributes (reliability and response time) were identified as the highest priorities for intervention by low- and high-satisfaction users. Low-satisfaction users further expect improvement of the HIS service quality to take place. The subject health-care system should produce coping interventions for those high priorities to enhance the satisfaction of physicians.

Recommended care received by geriatric hip fracture patients: where are we now and where are we heading?

INTRODUCTION

Despite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance-performance analysis for prioritizing interventions to improve the in-hospital management of these patients.

MATERIALS AND METHODS

A secondary data analysis was conducted on the in-hospital treatment of 540 geriatric hip fracture patients in 34 hospitals in Belgium, Italy, and Portugal. First, we assessed the level of expert consensus on the process indicators composing international guidelines on hip fracture treatment. Second, guideline adherence on in-hospital care was evaluated within and across hospitals. Third, an importance-performance analysis was conducted, linking expert consensus to guideline adherence.

RESULTS

Level of expert consensus was high (above 75%) for 12 of 22 process indicators identified from the literature. There is large between and within hospital variation in guideline adherence for these indicators and for none of the 540 patients were all 22 process indicators adhered to. Importance-performance analysis demonstrated that three indicators that had a high level of expert consensus also had a high level of adherence (above 80%). Nine indicators, most of which have been previously linked to patient outcomes, had a high level of expert consensus but a consistently low level of adherence across hospitals and are identified as priority areas for improvement.

CONCLUSIONS

Guideline adherence for the treatment of geriatric hip fracture patients is remarkably suboptimal. Importance-performance analysis is a useful strategic approach to assist practitioners and healthcare managers to improve the quality of care.

The Effectiveness of Health Care Information Technologies: Evaluation of Trust, Security Beliefs, and Privacy as Determinants of Health Care Outcomes

Background

The diffusion of health information technologies (HITs) within the health care sector continues to grow. However, there is no theory explaining how success of HITs influences patient care outcomes. With the increase in data breaches, HITs’ success now hinges on the effectiveness of data protection solutions. Still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance.

Objective

The objective of this study was to study the effectiveness of HITs using the DeLone and McLean Information Systems Success Model (DMISSM). We examined the role of information assurance constructs (ie, the role of information security beliefs, privacy concerns, and trust in health information) as measures of HIT effectiveness. We also investigated the relationships between information assurance and three aspects of system success: attitude toward health information exchange (HIE), patient access to health records, and perceived patient care quality.

Methods

Using structural equation modeling, we analyzed the data from a sample of 3677 cancer patients from a public dataset. We used R software (R Project for Statistical Computing) and the Lavaan package to test the hypothesized relationships.

Results

Our extension of the DMISSM to health care was supported. We found that increased privacy concerns reduce the frequency of patient access to health records use, positive attitudes toward HIE, and perceptions of patient care quality. Also, belief in the effectiveness of information security increases the frequency of patient access to health records and positive attitude toward HIE. Trust in health information had a positive association with attitudes toward HIE and perceived patient care quality. Trust in health information had no direct effect on patient access to health records; however, it had an indirect relationship through privacy concerns.

Conclusions

Trust in health information and belief in the effectiveness of information security safeguards increases perceptions of patient care quality. Privacy concerns reduce patients’ frequency of accessing health records, patients’ positive attitudes toward HIE exchange, and overall perceived patient care quality. Health care organizations are encouraged to implement security safeguards to increase trust, the frequency of health record use, and reduce privacy concerns, consequently increasing patient care quality.

Nurses' satisfaction with use of a personal digital assistants with a mobile nursing information system in China

BACKGROUND

Personal digital assistants, technology with various functions, have been applied in international clinical practice. Great benefits in reducing medical errors and enhancing the efficiency of clinical work have been achieved, but little research has investigated nurses' satisfaction with the use of personal digital assistants.

AIM

To investigate nurses' satisfaction with use of personal digital assistants, and to explore the predictors of this.

DESIGN

This is a cross-sectional descriptive study.

METHODS

We conducted a cross-sectional survey targeting nurses who used personal digital assistants in a comprehensive tertiary hospital in Beijing.

RESULTS

A total of 383 nurses were recruited in this survey in 2015. The total score of nurses' satisfaction with use of personal digital assistants was 238.91 (SD 39.25). Nurses were less satisfied with the function of documentation, compared with the function of administering medical orders. The time length of using personal digital assistants, academic degree, and different departments predicted nurses' satisfaction towards personal digital assistant use (all P < 0.05).

CONCLUSION

Nurses were satisfied with the accuracy of administering medical orders and the safety of recording data. The stability of the wireless network and efficiency related to nursing work were less promising. To some extent, nurses with higher education and longer working time with personal digital assistants were more satisfied with them.

Applying the Theoretical Domains Framework to identify barriers and targeted interventions to enhance nurses' use of electronic medication management systems in two Australian hospitals

Background

Medication errors harm hospitalised patients and increase health care costs. Electronic Medication Management Systems (EMMS) have been shown to reduce medication errors. However, nurses do not always use EMMS as intended, largely because implementation of such patient safety strategies requires clinicians to change their existing practices, routines and behaviour. This study uses the Theoretical Domains Framework (TDF) to identify barriers and targeted interventions to enhance nurses’ appropriate use of EMMS in two Australian hospitals.

Methods

This qualitative study draws on in-depth interviews with 19 acute care nurses who used EMMS. A convenience sampling approach was used. Nurses working on the study units (N = 6) in two hospitals were invited to participate if available during the data collection period. Interviews inductively explored nurses’ experiences of using EMMS (step 1). Data were analysed using the TDF to identify theory-derived barriers to nurses’ appropriate use of EMMS (step 2). Relevant behaviour change techniques (BCTs) were identified to overcome key barriers to using EMMS (step 3) followed by the identification of potential literature-informed targeted intervention strategies to operationalise the identified BCTs (step 4).

Results

Barriers to nurses’ use of EMMS in acute care were represented by nine domains of the TDF. Two closely linked domains emerged as major barriers to EMMS use: Environmental Context and Resources (availability and properties of computers on wheels (COWs); technology characteristics; specific contexts; competing demands and time pressure) and Social/Professional Role and Identity (conflict between using EMMS appropriately and executing behaviours critical to nurses’ professional role and identity).

The study identified three potential BCTs to address the Environmental Context and Resources domain barrier: adding objects to the environment; restructuring the physical environment; and prompts and cues. Seven BCTs to address Social/Professional Role and Identity were identified: social process of encouragement; pressure or support; information about others’ approval; incompatible beliefs; identification of self as role model; framing/reframing; social comparison; and demonstration of behaviour. It proposes several targeted interventions to deliver these BCTs.

Conclusions

The TDF provides a useful approach to identify barriers to nurses’ prescribed use of EMMS, and can inform the design of targeted theory-based interventions to improve EMMS implementation.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-017-0572-1) contains supplementary material, which is available to authorized users.

The Design and Validation of a Child Developmental e-Screening System

An effective screening test could significantly impact identification of developmental delays at an early age. However, many studies have shown that delay screenings still use text-based screening survey questionnaires. Unfortunately, the traditional text-based screening method tends to be fairly passive. In addition, the advantages of using an interactive system and animation have been shown to lead to positive effects on learning in medical research. Therefore, a multimedia screening system is necessary. This study constructs a system architecture to develop an e-screening system for child developmental delays. To validate the system after development, this study conducted an experiment and employed a questionnaire to survey users. Five experts and 120 subjects participated in the experiment. After the experiment, the results of the system evaluation revealed excellent agreement between the text-based and multimedia version of Taipei II. A total of 118 (98%) participants preferred the multimedia version or had no preference, and only 2 (2%) preferred the paper version. Regular text-based screening sometimes excludes those with low literacy and those whose native language is different from the text. In addition, text-based screening tools lose users' attention easily. The current study successfully developed a multimedia text-based screening system. Feedback from the participants showed that the e-screening system was well accepted and more easily accessible than the original. In this study, a child developmental delays e-screening system was developed. After the experiment, the subjects indicated that the developmental delay e-screening system increased their comprehension and kept them interested in the screening.

Nurses' perceptions, acceptance, and use of a novel in-room pediatric ICU technology: testing an expanded technology acceptance model

BACKGROUND

The value of health information technology (IT) ultimately depends on end users accepting and appropriately using it for patient care. This study examined pediatric intensive care unit nurses' perceptions, acceptance, and use of a novel health IT, the Large Customizable Interactive Monitor.

METHODS

An expanded technology acceptance model was tested by applying stepwise linear regression to data from a standardized survey of 167 nurses.

RESULTS

Nurses reported low-moderate ratings of the novel IT's ease of use and low to very low ratings of usefulness, social influence, and training. Perceived ease of use, usefulness for patient/family involvement, and usefulness for care delivery were associated with system satisfaction (R2 = 70%). Perceived usefulness for care delivery and patient/family social influence were associated with intention to use the system (R2 = 65%). Satisfaction and intention were associated with actual system use (R2 = 51%).

CONCLUSIONS

The findings have implications for research, design, implementation, and policies for nursing informatics, particularly novel nursing IT. Several changes are recommended to improve the design and implementation of the studied IT.

Empirically testing some factors affecting HMS usage

Purpose - Without use the expected benefits from healthcare management systems (HMS) cannot be derived. Thus, while use alone may not guarantee success, one can safely assume that the more use the better. HMS has been instrumental in facilitating care providers' work. However, many hospitals have encountered usage problems and some user-related factors have been recognized in the literature as potentially important to make HMS more successful. The purpose of this paper is to test the importance of the factors proposed in the literature as important determinants of HMS usage measured by the number of hours used and the frequency of use. Design/methodology/approach - Several user-related variables such as user participation, user expertise, and user training previously studied separately by different authors are brought together into an integrated model to be tested empirically. Data from 213 nurses using their hospital HMS have been used to test proposed relationships between the independent variables and HMS usage results. Findings - The results confirm the importance of these factors and provide the basis for managerial recommendations. Hospital managers can use the resources validated by this study to improve their own operations and improve the likelihood of success implementing HMS. Future research projects may identify other possible factors important for HMS implementation success to improve the model proposed here. Originality/value - HMS is a very widely used and an important system for hospitals, but has been neglected in research. This is one of the first rigorous studies of HMS, and the results provide new practical insights for hospital administrators.