Technology alignment in the presence of regulatory changes: The case of meaningful use of information technology in healthcare

Agility adaptability and alignment in start-ups

Purpose

When coping with uncertainties, three characteristics distinguish firms: agility, adaptability and alignment (triple-A). Based on significant field research, the triple-A highlights the significance of coordinating agility, adaptability and alignment. Start-ups are facing a lot of challenges in this turbulent environment. However, this sector is undergoing a major transformation. Agility, adaptability and alignment concepts have had a major influence on the supply chain, but their implementation in start-ups has been less visible. This paper aims to identify, analyze and categorize the enablers for agility, adaptability and alignment in start-ups using the total interpretive structural modeling (TISM) approach.

Design/methodology/approach

In addition to the scheduled interview, a closed-ended questionnaire was used to collect data. To identify how the factors interact, the TISM technique is used, and the Matriced’Impacts Croises-Multipication Applique’ and Classment method is used to rank and categorize the agility, adaptability and alignment enablers.

Findings

This study identified ten agility, adaptability and alignment factors for start-ups. It has been found that the key importance should be given to management involvement, conflict management, collaboration and information integration.

Research limitations/implications

This study primarily focused on the agility, adaptability and alignment factors in start-ups.

Practical implications

This study will help academics and key stakeholders understand the aspects that lead to agility, adaptability and alignment in start-ups.

Originality/value

Agility, adaptability and alignment concepts have had a major influence on the supply chain, but their implementation in start-ups has been less visible. Therefore, this is a novel attempt in this industry’s agility, adaptability and alignment.

Accuracy of the electronic health record's problem list in describing multimorbidity in patients with heart failure in the emergency department

Patients with heart failure (HF) often suffer from multimorbidity. Rapid assessment of multimorbidity is important for minimizing the risk of harmful drug-disease and drug-drug interactions. We assessed the accuracy of using the electronic health record (EHR) problem list to identify comorbid conditions among patients with chronic HF in the emergency department (ED). A retrospective chart review study was performed on a random sample of 200 patients age ≥65 years with a diagnosis of HF presenting to an academic ED in 2019. We assessed participant chronic conditions using: (1) structured chart review (gold standard) and (2) an EHR-based algorithm using the problem list. Chronic conditions were classified into 37 disease domains using the Agency for Healthcare Research Quality's Elixhauser Comorbidity Software. For each disease domain, we report the sensitivity, specificity, positive predictive value, and negative predictive of using an EHR-based algorithm. We calculated the intra-class correlation coefficient (ICC) to assess overall agreement on Elixhauser domain count between chart review and problem list. Patients with HF had a mean of 5.4 chronic conditions (SD 2.1) in the chart review and a mean of 4.1 chronic conditions (SD 2.1) in the EHR-based problem list. The five most prevalent domains were uncomplicated hypertension (90%), obesity (42%), chronic pulmonary disease (38%), deficiency anemias (33%), and diabetes with chronic complications (30.5%). The positive predictive value and negative predictive value of using the EHR-based problem list was greater than 90% for 24/37 and 32/37 disease domains, respectively. The EHR-based problem list correctly identified 3.7 domains per patient and misclassified 2.0 domains per patient. Overall, the ICC in comparing Elixhauser domain count was 0.77 (95% CI: 0.71-0.82). The EHR-based problem list captures multimorbidity with moderate-to-good accuracy in patient with HF in the ED.

Information Technology Ambidexterity, Digital Dynamic Capability, and Knowledge Processes as Enablers of Patient Agility: Empirical Study

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.

Bridging Policy and Service Performance of Hospital-Based Nutrition Support by Healthcare Information Technology

Although the healthcare policy was implemented to incentivize the multidisciplinary services of hospital-based nutrition support team (NST) in South Korea, timely completion of the services has been challenging in the hospitals. We enhanced NST healthcare information technology (NST-HIT) to bridge the gap between policy implementation and seamless execution of the policy in the hospital system. A 48 month pre-test-post-test study was performed, including a 12 month pre-intervention period, a six month intervention period, and a 30 month post-intervention period. The enhanced NST-HIT provided sufficient patient data and streamlined communication processes among end-users. A Student's t-test showed that the timely completion rate of NST consultations, the reimbursement rate of NST consultations, average response times of NST physicians and nurses, and length of hospital stay significantly improved during the post-intervention period. A segmented regression analysis of interrupted time series showed that the average response times of NST physicians had sustained after the interventions. We believe that well-structured, multi-pronged initiatives with leadership support from the hospital improved service performance of hospital NST in response to national-level healthcare policy changes.

Literature review: technological interventions and their impact on quality of life for people living with dementia

OBJECTIVES

Rapid technology-driven innovation in the healthcare sector has led to an increasing ability to effectively respond to health challenges. However, the cognitive challenges faced by a person with dementia exacerbate the difficulty of designing enduring technological dementia care solutions. Despite this, and in the absence of a cure, facilitating well-being and improved quality of life becomes pivotal for those living with dementia and their caregivers. This review aimed to identify and consolidate the provision of technological solutions for dementia care, and how these are perceived to impact the quality of life of a person with dementia.

METHODS

Articles and journals were identified using keywords including those relating to quality of life, assistive technologies and technology adoption and acceptance. Greater priority was given to resources published after 2010 due to the speed of technological advancement, and peer-reviewed articles were preferred.

RESULTS

91 resources were identified, with 38 contributing to the final review. In addition to multiple quality of life measurement tools, the literature identified a large variety of solutions that fell into three categories: those used 'by', 'with' or 'on' a person with dementia.

CONCLUSIONS

This review concludes that the 'one size fits all' approach to many solutions reflects the lack of supporting evidence, negatively impacting trust in their usefulness among caregivers and their subsequent adoption rates. This could be attributed to limited involvement of people with dementia in studies of effectiveness and adoption. Additional research is recommended to further consolidate research on quality of life and to understand the individuality and progression of dementia and its influence on dementia care solutions.