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Yusof MM, Takeda T, Shimai Y, Mihara N, Matsumura Y. Evaluating health information systems-related errors using the human, organization, process, technology-fit (HOPT-fit) framework. Health Informatics J 2024; 30:14604582241252763. [PMID: 38805345 DOI: 10.1177/14604582241252763] [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: 05/30/2024]
Abstract
Complex socio-technical health information systems (HIS) issues can create new error risks. Therefore, we evaluated the management of HIS-related errors using the proposed human, organization, process, and technology-fit framework to identify the lessons learned. Qualitative case study methodology through observation, interview, and document analysis was conducted at a 1000-bed Japanese specialist teaching hospital. Effective management of HIS-related errors was attributable to many socio-technical factors including continuous improvement, safety culture, strong management and leadership, effective communication, preventive and corrective mechanisms, an incident reporting system, and closed feedback loops. Enablers of medication errors include system sophistication and process factors like workarounds, variance, clinical workload, slips and mistakes, and miscommunication. The case management effectiveness in handling the HIS-related errors can guide other clinical settings. The potential of HIS to minimize errors can be achieved through continual, systematic, and structured evaluation. The case study validated the applicability of the proposed evaluation framework that can be applied flexibly according to study contexts to inform HIS stakeholders in decision-making. The comprehensive and specific measures of the proposed framework and approach can be a useful guide for evaluating complex HIS-related errors. Leaner and fitter socio-technical components of HIS can yield safer system use.
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Affiliation(s)
- Maryati Mohd Yusof
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia(UKM), Bangi, Malaysia
| | - Toshihiro Takeda
- Department of Medical Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshie Shimai
- Department of Medical Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naoki Mihara
- Medical Informatics & Systems Management, Hiroshima UniversityHospital, Hiroshima, Japan
| | - Yasuhsi Matsumura
- National Hospital Organization, Osaka National Hospital, Osaka, Japan
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Epizitone A, Moyane SP, Agbehadji IE. A Data-Driven Paradigm for a Resilient and Sustainable Integrated Health Information Systems for Health Care Applications. J Multidiscip Healthc 2023; 16:4015-4025. [PMID: 38107085 PMCID: PMC10725635 DOI: 10.2147/jmdh.s433299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Many transformations and uncertainties, such as the fourth industrial revolution and pandemics, have propelled healthcare acceptance and deployment of health information systems (HIS). External and internal determinants aligning with the global course influence their deployments. At the epic is digitalization, which generates endless data that has permeated healthcare. The continuous proliferation of complex and dynamic healthcare data is the digitalization frontier in healthcare that necessitates attention. Objective This study explores the existing body of information on HIS for healthcare through the data lens to present a data-driven paradigm for healthcare augmentation paramount to attaining a sustainable and resilient HIS. Method Preferred Reporting Items for Systematic Reviews and Meta-Analyses: PRISMA-compliant in-depth literature review was conducted systematically to synthesize and analyze the literature content to ascertain the value disposition of HIS data in healthcare delivery. Results This study details the aspects of a data-driven paradigm for robust and sustainable HIS for health care applications. Data source, data action and decisions, data sciences techniques, serialization of data sciences techniques in the HIS, and data insight implementation and application are data-driven features expounded. These are essential data-driven paradigm building blocks that need iteration to succeed. Discussions Existing literature considers insurgent data in healthcare challenging, disruptive, and potentially revolutionary. This view echoes the current healthcare quandary of good and bad data availability. Thus, data-driven insights are essential for building a resilient and sustainable HIS. People, technology, and tasks dominated prior HIS frameworks, with few data-centric facets. Improving healthcare and the HIS requires identifying and integrating crucial data elements. Conclusion The paper presented a data-driven paradigm for a resilient and sustainable HIS. The findings show that data-driven track and components are essential to improve healthcare using data analytics insights. It provides an integrated footing for data analytics to support and effectively assist health care delivery.
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Affiliation(s)
- Ayogeboh Epizitone
- ICT and Society Research Group, Department of Information and Corporate Management, Durban University of Technology, Durban, South Africa
| | - Smangele Pretty Moyane
- Department of Information and Corporate Management, Durban University of Technology, Durban, South Africa
| | - Israel Edem Agbehadji
- Centre for Transformative Agricultural and Food Systems, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Pei-Ying KO, Chen-Shie HO, Pei-Hung LIAO. The impact of a multilevel interactive nursing quality control and audit application on nursing quality management. BMC Nurs 2021; 20:243. [PMID: 34872533 PMCID: PMC8647066 DOI: 10.1186/s12912-021-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background This study aims to investigate the effects of a nursing quality control and audit application (app) on the autonomous learning of nursing staff and nursing quality management by nursing supervisors. A multilevel interactive app is developed to assist nursing staff in conducting online autonomous learning and nursing supervisors in identifying problems and creating nursing quality improvement plans. The app could also present the different evaluation results of wards in visual charts for supervisors to review. Methods A single-group pre- and post-test design was applied. Data were collected from 131 nurses between October 2019 and October 2020 to analyze the differences between nursing staffs’ willingness to engage in autonomous learning and the integrity of nursing quality improvement plan writing before and after the intervention. The structured questionnaires included open-ended questions that cover aspects of nursing quality control, the audit app, and the information acceptance intention of nurses. Results The participants’ age and job title are negatively correlated with the app’s usability, while the ability to use 3C (Computer, Communication, and Consumer Electronics products including mobile phones and laptops) equipment is positively correlated with the willingness to use the app. Nurses’ satisfaction with the convenience of the online autonomous learning method is 92%, which indicates that the app could improve their willingness to learn. Following the intervention of the app, nursing supervisors’ satisfaction with the integrity of nursing quality improvement plan writing increased from 41 to 88%. Conclusions Using information technology products to assist in nursing quality management in clinical practice has a significant effect on nurses’ load reduction and head nurses’ satisfaction. Multilevel interactive nursing quality control and audit apps can improve nursing staff’s willingness to learn independently, nursing quality, and the integrity of plan writing. Thus, nursing quality control and audit apps can be considered as suitable nursing quality control tools.
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Affiliation(s)
- K O Pei-Ying
- Department of Nursing, School of Nursing, Cheng Hsin General Hospital and National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - H O Chen-Shie
- Department of Healthcare Administration, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - L I A O Pei-Hung
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming-te Road, Peitou District, Taipei City, 112, Taiwan.
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Reis LP, Fernandes JM, Armellini F. Leveraging a Process-Oriented Perspective on Frugal Innovation Through the Linkage of Lean Product Development (LPD) Practices and Waste. INTERNATIONAL JOURNAL OF INNOVATION AND TECHNOLOGY MANAGEMENT 2021. [DOI: 10.1142/s0219877021300044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Frugal innovation aims to attain significantly cheaper solutions on the market. The literature points out a lack of studies addressing frugal innovation from a process-oriented (ex-ante) perspective, as well as how to structure and leverage the frugal product development process. This paper explores how lean principles and fundamentals, and more particularly lean product development (LPD) can help fill this gap. The incidence of different types of waste has been observed throughout the new product development (NPD) process, and their mitigation could certainly leverage frugal innovation from the process perspective. However, to operationalize waste mitigation, an evaluation of how different types of waste are related to the various existing LPD practices is necessary. We accordingly build a relationship matrix between LPD practices and waste mitigation throughout the NPD process, based on a literature review encompassing 310 studies. By correlating LPD practices and waste, this paper proposes and discusses a conceptual model that brings insights to understanding how LPD can drive frugal innovations from an ex-ante perspective. The contributions of this paper are the categorization and classification of waste within NPD; the assessment and classification of the lean practices most studied in the literature; the association of the categories of waste with the corresponding lean practices; and the discussion of the possible contribution of LPD literature to leverage frugal innovation from a process-oriented perspective.
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Affiliation(s)
- Luciana Paula Reis
- Department of Production Engineering, Federal University of Ouro Preto, João Monlevade, Brazil
| | - June Marques Fernandes
- Department of Production Engineering, Federal University of Ouro Preto, João Monlevade, Brazil
| | - Fabiano Armellini
- Department of Mathematics and Industrial Engineering, Polytechnique Montréal, Montréal, Canada
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Olakotan OO, Mohd Yusof M. The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review. Health Informatics J 2021; 27:14604582211007536. [PMID: 33853395 DOI: 10.1177/14604582211007536] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A CDSS generates a high number of inappropriate alerts that interrupt the clinical workflow. As a result, clinicians silence, disable, or ignore alerts, thereby undermining patient safety. Therefore, the effectiveness and appropriateness of CDSS alerts need to be evaluated. A systematic review was carried out to identify the factors that affect CDSS alert appropriateness in supporting clinical workflow. Seven electronic databases (PubMed, Scopus, ACM, Science Direct, IEEE, Ovid Medline, and Ebscohost) were searched for English language articles published between 1997 and 2018. Seventy six papers met the inclusion criteria, of which 26, 24, 15, and 11 papers are retrospective cohort, qualitative, quantitative, and mixed-method studies, respectively. The review highlights various factors influencing the appropriateness and efficiencies of CDSS alerts. These factors are categorized into technology, human, organization, and process aspects using a combination of approaches, including socio-technical framework, five rights of CDSS, and Lean. Most CDSS alerts were not properly designed based on human factor methods and principles, explaining high alert overrides in clinical practices. The identified factors and recommendations from the review may offer valuable insights into how CDSS alerts can be designed appropriately to support clinical workflow.
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Olakotan OO, Yusof MM. Evaluating the appropriateness of clinical decision support alerts: A case study. J Eval Clin Pract 2021; 27:868-876. [PMID: 33009698 DOI: 10.1111/jep.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical decision support (CDS) generates excessive alerts that disrupt the workflow of clinicians. Therefore, inefficient clinical processes that contribute to the misfit between CDS alert and workflow must be evaluated. This study evaluates the appropriateness of CDS alerts in supporting clinical workflow from a socio-technical perspective. METHOD A qualitative case study evaluation was conducted at a 620-bed public teaching hospital in Malaysia using interview, observation, and document analysis to investigate the features and functions of alert appropriateness and workflow-related issues in cardiological and dermatological settings. The current state map for medication prescribing process was also modelled to identify problems pertinent to CDS alert appropriateness. RESULTS The main findings showed that CDS was not well designed to fit into a clinician's workflow due to influencing factors such as technology (usability, alert content, and alert timing), human (training, perception, knowledge, and skills), organizational (rules and regulations, privacy, and security), and processes (documenting patient information, overriding default option, waste, and delay) impeding the use of CDS with its alert function. We illustrated how alert affect workflow in clinical processes using a Lean tool known as value stream mapping. This study also proposes how CDS alerts should be integrated into clinical workflows to optimize their potential to enhance patient safety. CONCLUSION The design and implementation of CDS alerts should be aligned with and incorporate socio-technical factors. Process improvement methods such as Lean can be used to enhance the appropriateness of CDS alerts by identifying inefficient clinical processes that impede the fit of these alerts into clinical workflow.
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Affiliation(s)
- Olufisayo O Olakotan
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Maryati M Yusof
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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Olakotan OO, Yusof MM. Evaluating the alert appropriateness of clinical decision support systems in supporting clinical workflow. J Biomed Inform 2020; 106:103453. [PMID: 32417444 DOI: 10.1016/j.jbi.2020.103453] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 02/06/2023]
Abstract
The overwhelming number of medication alerts generated by clinical decision support systems (CDSS) has led to inappropriate alert overrides, which may lead to unintended patient harm. This review highlights the factors affecting the alert appropriateness of CDSS and barriers to the fit of CDSS alert with clinical workflow. A literature review was conducted to identify features and functions pertinent to CDSS alert appropriateness using the five rights of CDSS. Moreover, a process improvement method, namely, Lean, was used as a tool to optimise clinical workflows, and the appropriate design for CDSS alert using a human automation interaction (HAI) model was recommended. Evaluating the appropriateness of CDSS alert and its impact on workflow provided insights into how alerts can be designed and triggered effectively to support clinical workflow. The application of Lean methods and tools to analyse alert efficiencies in supporting workflow in this study provides an in-depth understanding of alert-workflow fit problems and their root cause, which is required for improving CDSS design. The application of the HAI model is recommended in the design of CDSS alerts to support various levels and stages of alert automations, namely, information acquisition and analysis, decision action and action implementation.
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Affiliation(s)
| | - Maryati Mohd Yusof
- Faculty of Information Science & Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia.
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Abstract
PURPOSE The purpose of this paper is to present a review of health information system (HIS)-induced errors and its management. This paper concludes that the occurrence of errors is inevitable but it can be minimised with preventive measures. The review of classifications can be used to evaluate medical errors related to HISs using a socio-technical approach. The evaluation could provide an understanding of errors as a learning process in managing medical errors. DESIGN/METHODOLOGY/APPROACH A literature review was performed on issues, sources, management and approaches to HISs-induced errors. A critical review of selected models was performed in order to identify medical error dimensions and elements based on human, process, technology and organisation factors. FINDINGS Various error classifications have resulted in the difficulty to understand the overall error incidents. Most classifications are based on clinical processes and settings. Medical errors are attributed to human, process, technology and organisation factors that influenced and need to be aligned with each other. Although most medical errors are caused by humans, they also originate from other latent factors such as poor system design and training. Existing evaluation models emphasise different aspects of medical errors and could be combined into a comprehensive evaluation model. RESEARCH LIMITATIONS/IMPLICATIONS Overview of the issues and discourses in HIS-induced errors could divulge its complexity and enable its causal analysis. PRACTICAL IMPLICATIONS This paper helps in understanding various types of HIS-induced errors and promising prevention and management approaches that call for further studies and improvement leading to good practices that help prevent medical errors. ORIGINALITY/VALUE Classification of HIS-induced errors and its management, which incorporates a socio-technical and multi-disciplinary approach, could guide researchers and practitioners to conduct a holistic and systematic evaluation.
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Hackl WO, Hoerbst A. On the Way to Close the Loop in Information Logistics: Data from the Patient - Value for the Patient. Yearb Med Inform 2018; 27:91-97. [PMID: 30157511 PMCID: PMC6115236 DOI: 10.1055/s-0038-1667076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To summarize recent research and to propose a selection of best papers published in 2017 in the field of Clinical Information Systems (CIS). METHOD Each year a systematic process is carried out to retrieve articles and to select a set of best papers for the CIS section of the International Medical Informatics Association (IMIA) Yearbook of Medical Informatics. The query aiming at identifying relevant publications in the field of CIS was refined by the section editors during the last years. For three years now, the query is stable. It comprises search terms from the Medical Subject Headings (MeSH) thesaurus as well as additional free text search terms from PubMed and Web of Science®. The retrieved articles were categorized in a multi-pass review carried out by the two section editors. The final selection of candidate papers was then peer-reviewed by Yearbook editors and external reviewers. Based on the review results, the best papers were then selected by the IMIA Yearbook editorial board. Text mining, and term co-occurrence mapping techniques were used to get an overview on the content of the retrieved articles. RESULTS The query was carried out in mid-January 2018, yielding a consolidated result set of 2,255 articles which had been published in 939 different journals. Out of them, 15 papers were nominated as candidate best papers and four of them were finally selected as best papers in the CIS section. Again, the content analysis of the articles revealed the broad spectrum of topics which is covered by CIS research. CONCLUSIONS Modern clinical information systems serve as backbone for a very complex, trans-institutional information logistics process. Data that is produced by, documented in, shared via, organized in, presented by, and stored within clinical information systems is more and more reused for multiple purposes. We found a lot of examples showing the benefits of such data reuse with various novel approaches implemented to tackle the challenges of this process. We also found that the patient moves in the focus of interest of CIS research. So the loop of information logistics begins to close: data from the patients is used to produce value for the patients.
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Affiliation(s)
- Werner O Hackl
- Institute of Medical Informatics, UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Alexander Hoerbst
- eHealth Research and Innovation Unit, UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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