Healthcare information systems: a patient-user perspective

Securing healthcare information system through fuzzy based decision-making methodology

The purpose of the healthcare Information System (HIS) is to replace the conventional method of data gathering and organization in hospitals into a modern method of systematic data collection, maintenance and dissemination. There has been an unprecedented rise in the malware and cyber-attacks on HIS recently. Cyber-attacks have become a major crisis for the healthcare industry. To address this scenario, the present paper conducts a study on the security factors integral to the healthcare information system and conducts the performance analysis of these factors. For this intent, the study has employed the Fuzzy Analytic Hierarchy Process (F.AHP) integrated with Technique Order Preference by Similarity to Ideal Solution (TOPSIS) integrated framework for evaluating the performance of each factor. Thereafter, the factors that play a vital role in healthcare data security breaches have been prioritized as per their security weights. Furthermore, the validity of the results obtained by the stated methodology has been established by conducting the sensitivity analysis and comparison of results with the other methods by using the same data set. Based on results thus obtained, the access control and software security have been identified as the most promising security factors.

Sharing Frailty-related information in perioperative care: an analysis from a temporal perspective

BACKGROUND

Especially patients older than 65 years undergoing surgery are prone to develop frailty-related complications that may go far beyond the index hospitalization (e.g., cognitive impairment following postoperative delirium). However, aging-relevant information are currently not fully integrated into hospitals' perioperative processes.

METHODS

We introduce a temporal perspective, which focuses on the social construction of time, to better understand existing barriers to the exchange of frailty-related data, targeting complexity research. Our chosen context is perioperative care provided by a tertiary hospital in Germany that has implemented a special track for patients over 65 years old undergoing elective surgery. The research followed a participatory modelling approach between domain and modelling experts with the goal of creating a feedback loop model of the relevant system relationships and dynamics.

RESULTS

The results of the study show how disparate temporal regimes, understood as frameworks for organizing actions in the light of time constraints, time pressure, and deadlines, across different clinical, ambulant, and geriatric care sectors create disincentives to cooperate in frailty-related data exchanges. Moreover, we find that shifting baselines, meaning continuous increases in cost and time pressure in individual sectors, may unintentionally reinforce - rather than discourage - disparate temporal regimes.

CONCLUSIONS

Together, these results may (1) help to increase awareness of the importance of frailty-related data exchanges, and (2) impel efforts aiming to transform treatment processes to go beyond sectoral boundaries, taking into account the potential benefits for frail patients arising from integrated care processes using information technology.

Impact assessment on patients' satisfaction and healthcare professionals' commitment of software supporting Directly Observed Treatment, Short-course: A protocol proposal

Doctors, nurses, and other healthcare professionals use software that affects the patients. Directly Observed Treatment, Short-course is the name given to the tuberculosis control strategy recommended by the World Health Organization. The main goal of this work is to propose a protocol for evaluating the impact of healthcare software supporting Directly Observed Treatment, Short-course on patients, healthcare professionals, and services. The proposed protocol consists of a set of instruments and steps. The instruments are reliable and validated existing questionnaires to be applied before and after using the software tool. The literature points out the need for standards on the software assessment. This is particularly critical when software affects patients directly. The present protocol is a universal tool to assess the impact of software used to support the fight against the tragedy of tuberculosis where a rigorous evaluation of IT in healthcare is highly recommended and of great importance.

Waste in health information systems: a systematic review

Purpose

The purpose of this paper is to discuss a systematic review on waste identification related to health information systems (HIS) in Lean transformation.

Design/methodology/approach

A systematic review was conducted on 19 studies to evaluate Lean transformation and tools used to remove waste related to HIS in clinical settings.

Findings

Ten waste categories were identified, along with their relationships and applications of Lean tool types related to HIS. Different Lean tools were used at the early and final stages of Lean transformation; the tool selection depended on the waste characteristic. Nine studies reported a positive impact from Lean transformation in improving daily work processes. The selection of Lean tools should be made based on the timing, purpose and characteristics of waste to be removed.

Research limitations/implications

Overview of waste and its category within HIS and its analysis from socio-technical perspectives enabled the identification of its root cause in a holistic and rigorous manner.

Practical implications

Understanding waste types, their root cause and review of Lean tools could subsequently lead to the identification of mitigation approach to prevent future error occurrence.

Originality/value

Specific waste models for HIS settings are yet to be developed. Hence, the identification of the waste categories could guide future implementation of Lean transformations in HIS settings.

Improving a health information system for real-time data entries: An action research project using socio-technical systems theory

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.

A case study evaluation of a Critical Care Information System adoption using the socio-technical and fit approach

BACKGROUND

Clinical information systems have long been used in intensive care units but reports on their adoption and benefits are limited. This study evaluated a Critical Care Information System implementation.

METHODS

A case study summative evaluation was conducted, employing observation, interview, and document analysis in operating theatres and 16-bed adult intensive care units in a 400-bed Malaysian tertiary referral centre from the perspectives of users (nurses and physicians), management, and information technology staff. System implementation, factors influencing adoption, fit between these factors, and the impact of the Critical Care Information System were evaluated after eight months of operation.

RESULTS

Positive influences on system adoption were associated with technical factors, including system ease of use, usefulness, and information relevancy; human factors, particularly user attitude; and organisational factors, namely clinical process-technology alignment and champions. Organisational factors such as planning, project management, training, technology support, turnover rate, clinical workload, and communication were barriers to system implementation and use. Recommendations to improve the current system problems were discussed. Most nursing staff positively perceived the system's reduction of documentation and data access time, giving them more time with patients. System acceptance varied among doctors. System use also had positive impacts on timesaving, data quality, and clinical workflow.

CONCLUSIONS

Critical Care Information Systems is crucial and has great potentials in enhancing and delivering critical care. However, the case study findings showed that the system faced complex challenges and was underutilised despite its potential. The role of socio-technical factors and their fit in realizing the potential of Critical Care Information Systems requires continuous, in-depth evaluation and stakeholder understanding and acknowledgement. The comprehensive and specific evaluation measures of the Human-Organisation-Technology Fit framework can flexibly evaluate Critical Care Information Systems.

Mobile health data collection at primary health care in Ethiopia: a feasible challenge

OBJECTIVES

Feasibility assessment of mobile health (mHealth) data collection at primary health care in Ethiopia.

STUDY DESIGN AND SETTING

A total of 14 health workers were recruited from 12 primary health care facilities to use smartphones, installed with customized data collection application and electronic maternal health care forms for assessing pregnant women's health for 6 months. Qualitative approaches comprising in-depth interviews and field notes were used to document the users' perception and experience in using the application and forms.

RESULTS

All health workers had never had previous exposure to smartphones and electronic forms, but they got used to them easily. Over 6 months, all health workers completed a total of 952 patient records using the forms on smartphones. Health workers' acceptability and demand for the application and forms were high. In introducing the application, nontechnical challenges were more difficult to solve than technical challenges.

CONCLUSION

Introducing an mHealth application at primary health care for routine collection of health data relevant to maternal health at a small scale was feasible. Nonetheless, implementing a system of assigning unique and consistent patient identifier, standardization of health services, and improving mobile network coverage would be prerequisites for scaled-up usage of such an application.