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Reider-Demer M, Raja P, Martin N, Schwinger M, Babayan D. Prospective and retrospective study of videoconference telemedicine follow-up after elective neurosurgery: results of a pilot program. Neurosurg Rev 2017; 41:497-501. [PMID: 28735437 DOI: 10.1007/s10143-017-0878-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/05/2017] [Accepted: 07/02/2017] [Indexed: 01/01/2023]
Abstract
Existing literature suggests that use of telemedicine during postoperative appointments can increase access to care and is valued by patients and providers alike. While research examining the clinical equivalency of telemedicine visits for postoperative care has been growing, few studies have reported on telemedicine follow-up after neurosurgery. This study examined if a videoconferencing visit could substitute for an in-person clinic visit for elective neurosurgical cases in the USA. This was a single-center prospective study of patients who underwent elective neurosurgical procedures (aneurysm clipping, resection of cavernous angiomas, resection of arterial venous malformation, microvascular decompression for trigeminal neuralgia and hemifacial spasm, and certain benign brain tumors) and were offered telemedicine follow-up care by an allied health professional during the first 90 days after neurosurgery. Prospective data was compared to a historical group of patients who underwent the same procedures and received in-person postoperative follow-up. Patients in the prospective group were contacted by telephone 2-6 weeks after surgery by a nurse practitioner and assessed using a standard template that included incidence of reported postoperative seizures, fever, and performance of activities of daily living. Primary outcome measures included percentage of patients accepting telemedicine, clinical and functional status, complications, patient satisfaction, patient travel time and distance, and rates of emergency room care or hospitalization within 90 days of discharge. Ninety-nine patients were included in the study, with 57 in the prospective group and 42 in the historical group. Of the 57 prospective patients, 47 accepted telemedicine in lieu of an in-person clinic visit. Emergency room visits and readmission rates at 30 and 90 days postoperatively did not differ significantly between the study groups, nor was there any significant difference in clinical variables that were recorded in the electronic medical record more than 80% of the time. This study demonstrates the safety and value of telemedicine as an alternative method of postoperative clinical care for patients undergoing elective neurosurgery. Telemedicine avoids unnecessary travel time and was welcomed by the majority of patients without compromising clinical or functional outcomes.
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Affiliation(s)
- Melissa Reider-Demer
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.
| | - Pushpa Raja
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.,VA National Quality Scholars Program, VA Greater Los Angeles System, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavorial Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Neil Martin
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Mariel Schwinger
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Diana Babayan
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
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Robinson RF, Dillard DA, Hiratsuka VY, Smith JJ, Tierney S, Avey JP, Buchwald DS. Formative Evaluation to Assess Communication Technology Access and Health Communication Preferences of Alaska Native People. INTERNATIONAL JOURNAL OF INDIGENOUS HEALTH 2015; 10:88-101. [PMID: 27169131 DOI: 10.18357/ijih.102201515042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Information technology can improve the quality, safety, and efficiency of healthcare delivery by improving provider and patient access to health information. We conducted a nonrandomized, cross-sectional, self-report survey to determine whether Alaska Native and American Indian (AN/AI) people have access to the health communication technologies available through a patient-centered medical home. METHODS In 2011, we administered a self-report survey in an urban, tribally owned and operated primary care center serving AN/AI adults. Patients in the center's waiting rooms completed the survey on paper; center staff completed it electronically. RESULTS Approximately 98% (n = 654) of respondents reported computer access, 97% (n = 650) email access, and 94% (n = 631) mobile phone use. Among mobile phone users, 60% had Internet access through their phones. Rates of computer access (p = .011) and email use (p = .005) were higher among women than men, but we found no significant gender difference in mobile phone access to the Internet or text messaging. Respondents in the oldest age category (65-80 years of age) were significantly less likely to anticipate using the Internet to schedule appointments, refill medications, or communicate with their health care providers (all p < .001). CONCLUSION Information on use of health communication technologies enables administrators to deploy these technologies more efficiently to address health concerns in AN/AI communities. Our results will drive future research on health communication for chronic disease screening and health management.
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Carney TJ, Weaver M, McDaniel AM, Jones J, Haggstrom DA. Organizational Factors Influencing the Use of Clinical Decision Support for Improving Cancer Screening Within Community Health Centers. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2014. [DOI: 10.4018/ijhisi.2014010101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adoption of clinical decision support (CDS) systems leads to improved clinical performance through improved clinician decision making, adherence to evidence-based guidelines, medical error reduction, and more efficient information transfer and to reduction in health care disparities in under-resourced settings. However, little information on CDS use in the community health care (CHC) setting exists. This study examines if organizational, provider, or patient level factors can successfully predict the level of CDS use in the CHC setting with regard to breast, cervical, and colorectal cancer screening. This study relied upon 37 summary measures obtained from the 2005 Cancer Health Disparities Collaborative (HDCC) national survey of 44 randomly selected community health centers. A multi-level framework was designed that employed an all-subsets linear regression to discover relationships between organizational/practice setting, provider, and patient characteristics and the outcome variable, a composite measure of community health center CDS intensity-of-use. Several organizational and provider level factors from our conceptual model were identified to be positively associated with CDS level of use in community health centers. The level of CDS use (e.g., computerized reminders, provider prompts at point-of-care) in support of breast, cervical, and colorectal cancer screening rate improvement in vulnerable populations is determined by both organizational/practice setting and provider factors. Such insights can better facilitate the increased uptake of CDS in CHCs that allows for improved patient tracking, disease management, and early detection in cancer prevention and control within vulnerable populations.
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Affiliation(s)
- Timothy Jay Carney
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Weaver
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Anna M. McDaniel
- Indiana University School of Informatics (IUPUI) & Indiana University School of Nursing, Indianapolis, IN, USA
| | - Josette Jones
- Indiana University School of Informatics (IUPUI), Indianapolis, IN, USA
| | - David A. Haggstrom
- VA HSR&D Center of Excellence on Implementing Evidence-based Practice & Roudebush VA Medical Center Regenstrief Institute Inc. & Division of General Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Weitzman ER, Kelemen S, Kaci L, Mandl KD. Willingness to share personal health record data for care improvement and public health: a survey of experienced personal health record users. BMC Med Inform Decis Mak 2012; 12:39. [PMID: 22616619 PMCID: PMC3403895 DOI: 10.1186/1472-6947-12-39] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 05/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data stored in personally controlled health records (PCHRs) may hold value for clinicians and public health entities, if patients and their families will share them. We sought to characterize consumer willingness and unwillingness (reticence) to share PCHR data across health topics, and with different stakeholders, to advance understanding of this issue. METHODS Cross-sectional 2009 Web survey of repeat PCHR users who were patients over 18 years old or parents of patients, to assess willingness to share their PCHR data with an-out-of-hospital provider to support care, and the state/local public health authority to support monitoring; the odds of reticence to share PCHR information about ten exemplary health topics were estimated using a repeated measures approach. RESULTS Of 261 respondents (56% response rate), more reported they would share all information with the state/local public health authority (63.3%) than with an out-of-hospital provider (54.1%) (OR 1.5, 95% CI 1.1, 1.9; p = .005); few would not share any information with these parties (respectively, 7.9% and 5.2%). For public health sharing, reticence was higher for most topics compared to contagious illness (ORs 4.9 to 1.4, all p-values < .05), and reflected concern about anonymity (47.2%), government insensitivity (41.5%), discrimination (24%). For provider sharing, reticence was higher for all topics compared to contagious illness (ORs 6.3 to 1.5, all p-values < .05), and reflected concern for relevance (52%), disclosure to insurance (47.6%) and/or family (20.5%). CONCLUSIONS Pediatric patients and their families are often willing to share electronic health information to support health improvement, but remain cautious. Robust trust models for PCHR sharing are needed.
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Affiliation(s)
- Elissa R Weitzman
- Children's Hospital Informatics Program, Children's Hospital Boston, Boston, MA, USA.
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Hikmet N, Banerjee S, Burns MB. State of Content: Healthcare Executive’s Role in Information Technology Adoption. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jssm.2012.52016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Honoré PA, Wright D, Berwick DM, Clancy CM, Lee P, Nowinski J, Koh HK. Creating a framework for getting quality into the public health system. Health Aff (Millwood) 2011; 30:737-45. [PMID: 21471496 DOI: 10.1377/hlthaff.2011.0129] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The US health care system has undertaken concerted efforts to improve the quality of care that Americans receive, using well-documented strategies and new incentives found in the Affordable Care Act of 2010. Applying quality concepts to public health has lagged these efforts, however. This article describes two reports from the Department of Health and Human Services: Consensus Statement on Quality in the Public Health System and Priority Areas for Improvement of Quality in Public Health. These reports define what is meant by public health quality, establish quality aims, and highlight priority areas needing improvement. We describe how these developments relate to the Affordable Care Act and serve as a call to action for ensuring a better future for population health. We present real-world examples of how a framework of quality concepts can be applied in the National Vaccine Safety Program and in a state office of minority health.
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Affiliation(s)
- Peggy A Honoré
- Public Health Systems, Finance, and Quality Program in the Office of Healthcare Quality/Office of the Assistant Secretary for Health, Department of Health and Human Services (HHS), Washington, DC, USA.
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Palacio C, Harrison JP, Garets D. Benchmarking electronic medical records initiatives in the US: a conceptual model. J Med Syst 2010; 34:273-9. [PMID: 20503611 DOI: 10.1007/s10916-008-9238-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article provides a conceptual model for benchmarking the use of clinical information systems within healthcare organizations. Additionally, it addresses the benefits of clinical information systems which include the reduction of errors, improvement in clinical decision-making and real time access to patient information. The literature suggests that clinical information systems provide financial benefits due to cost-savings from improved efficiency and reduction of errors. As a result, healthcare organizations should adopt such clinical information systems to improve quality of care and stay competitive in the marketplace. Our research clearly documents the increased adoption of electronic medical records in U.S. hospitals from 2005 to 2007. This is important because the electronic medical record provides an opportunity for integration of patient information and improvements in efficiency and quality of care across a wide range of patient populations. This was supported by recent federal initiatives such as the establishment of the Office of the National Coordinator of Health Information Technology (ONCHIT) to create an interoperable health information infrastructure. Potential barriers to the implementation of health information technology include cost, a lack of financial incentives for providers, and a need for interoperable systems. As a result, future government involvement and leadership may serve to accelerate widespread adoption of interoperable clinical information systems.
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Affiliation(s)
- Carlos Palacio
- Department of Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
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Organisational influences on nurses’ use of clinical decision support systems. Int J Med Inform 2010; 79:412-21. [DOI: 10.1016/j.ijmedinf.2010.02.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 12/29/2009] [Accepted: 02/16/2010] [Indexed: 11/20/2022]
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Information technology capacities assessment tool in hospitals: Instrument development and validation. Int J Technol Assess Health Care 2009; 25:97-106. [DOI: 10.1017/s0266462309090138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:This research integrates existing literature on information technology (IT) in hospitals, and proposes and validates a comprehensive IT capacities assessment tool in these settings.Methods:A comprehensive literature review was conducted on Medline until September 2006 to identify studies that used specific IT measures in hospitals. The results were mapped and used as a basis for the development of the proposed instrument, which was tested through a survey of Canadian healthcare organizations (N= 221).Results:A total of seventeen studies provided indicators of clinical and administrative IT capacities in hospitals. Based on the mapping of these indicators, a comprehensive IT capacities assessment instrument was developed including thirty-four items exploring computerized processes, thirteen items assessing contemporary technologies, and eleven items investigating internal and external information sharing. A time frame was inserted in the tool to reflect “plans for” versus “current” implementation of IT; in the latter, the extent of current use of computerized processes and technologies was measured on a (1–7) scale. Overall, the survey yielded a total of 106 responses (52.2 percent response rate), and the results demonstrated a good level of reliability and validity of the instrument.Conclusions:This study unifies existing work in this area, and presents the psychometric properties of an IT capacities assessment tool in hospitals. By developing scores for capturing IT capacities in hospitals, it is possible to further address important research questions related to the determinants and impacts of IT sophistication in these settings.
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Menachemi N, Brooks RG, Schwalenstocker E, Simpson L. Use of health information technology by children's hospitals in the United States. Pediatrics 2009; 123 Suppl 2:S80-4. [PMID: 19088234 DOI: 10.1542/peds.2008-1755f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the adoption of health information technology by children's hospitals and to document barriers and priorities as they relate to health information technology adoption. METHODS Primary data of interest were obtained through the use of a survey instrument distributed to the chief information officers of 199 children's hospitals in the United States. Data were collected on current and future use of a variety of clinical health information technology and telemedicine applications, organizational priorities, barriers to use of health information technology, and hospital and chief information officer characteristics. RESULTS Among the 109 responding hospitals (55%), common clinical applications included clinical scheduling (86.2%), transcription (85.3%), and pharmacy (81.9%) and laboratory (80.7%) information. Electronic health records (48.6%), computerized order entry (40.4%), and clinical decision support systems (35.8%) were less common. The most common barriers to health information technology adoption were vendors' inability to deliver products or services to satisfaction (85.4%), lack of staffing resources (82.3%), and difficulty in achieving end-user acceptance (80.2%). The most frequent priority for hospitals was to implement technology to reduce medical errors or to promote safety (72.5%). CONCLUSION This first national look at health information technology use by children's hospitals demonstrates the progress in health information technology adoption, current barriers, and priorities for these institutions. In addition, the findings can serve as important benchmarks for future study in this area.
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Affiliation(s)
- Nir Menachemi
- aDepartment of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Bahensky JA, Jaana M, Ward MM. Health Care Information Technology in Rural America: Electronic Medical Record Adoption Status in Meeting the National Agenda. J Rural Health 2008; 24:101-5. [DOI: 10.1111/j.1748-0361.2008.00145.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Piette JD. Interactive behavior change technology to support diabetes self-management: where do we stand? Diabetes Care 2007; 30:2425-32. [PMID: 17586735 DOI: 10.2337/dc07-1046] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Menachemi N, Hikmet N, Bhattacherjee A, Chukmaitov A, Brooks RG. The effect of payer mix on the adoption of information technologies by hospitals. Health Care Manage Rev 2007; 32:102-10. [PMID: 17438393 DOI: 10.1097/01.hmr.0000267787.71567.3f] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Numerous studies have examined the relationship between organization characteristics and hospital adoption of information technology (IT). However, no known study has examined whether patient characteristics of those treated at a given hospital influences the decision to adopt IT. PURPOSE The present study combines primary and secondary data to examine the effect of payer mix (the combination of payers that make up a given hospital's patient discharges) on IT adoption in hospitals. METHODS Survey data from Florida hospitals were combined with the state's hospital discharge database. Multiple regression analyses were used to analyze the data. RESULTS When examining Medicare, Medicaid, traditional commercial insurance, and managed-care plans, only an increase of managed-care patients, as a percentage of hospital discharges, was associated with a significant increased likelihood to adopt clinical and administrative IT applications by hospitals. PRACTICE IMPLICATIONS Our results suggest that increasing cost pressures associated with managed-care environments are driving hospitals' adoption of clinical and administrative IT systems as such adoption is expected to improve hospital efficiency and lower costs. Given that such cost pressures are also emergent in Medicare, Medicaid, and traditional third-party payment environments, an opportunity exists for these parties to motivate hospital IT adoption as a means for cost reduction.
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Affiliation(s)
- Nir Menachemi
- College of Medicine, Florida State University, Tallahassee, FL, USA.
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Menachemi N, Brooks RG, Simpson L. The relationship between pediatric volume and information technology adoption in hospitals. Qual Manag Health Care 2007; 16:146-52. [PMID: 17426613 DOI: 10.1097/01.qmh.0000267452.85994.db] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Numerous studies have identified organizational factors related to the adoption of information technology (IT) by hospitals. However, no study has examined whether patient characteristics of hospitals are related to the adoption of health IT. This study examines IT adoption in hospitals that care for either a large number or a large proportion of children. METHODS Primary data from an IT survey of acute care hospitals were combined with secondary data on hospital discharges. Pediatric volume was both categorically and continuously operationalized in several ways. IT adoption was examined both at the individual IT application level and in several aggregate measures of organizational adoption. Univariate and linear regression models were used to analyze the data. Regression models controlled for average patient severity of illness (case mix), public insurance volume, bed size, and system affiliation for each hospital. RESULTS All 98 acute care hospitals that participated in the survey were matched to the hospital discharge data. Analyses suggest that IT adoption is positively correlated with a higher absolute number of pediatric discharges from hospitals. Similarly, as children make up a higher percentage of a given hospital's discharges, the propensity to adopt clinical and nonclinical IT applications increases significantly as well. CONCLUSION Acute care hospitals caring for a large number, or a large proportion, of children are more likely to adopt health IT. This relationship may be because children, when hospitalized, are more likely to seek care in technologically and clinically advanced facilities. However, it is unclear whether the IT adopted is calibrated for optimal pediatric use. More research on the use of IT is needed and should focus on other pediatric clinical settings as well.
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Affiliation(s)
- Nir Menachemi
- Center for Patient Safety, Florida State University College of Medicine, Tallahassee, FL 32312, USA.
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Abstract
BACKGROUND Outsourcing of information technology (IT) functions is a popular strategy with both potential benefits and risks for hospitals. Anecdotal evidence, based on case studies, suggests that outsourcing may be associated with significant cost savings. However, no generalizable evidence exists to support such assertions. PURPOSE This study examines whether outsourcing IT functions is related to improved financial performance in hospitals. METHODOLOGY Primary survey data on IT outsourcing behavior were combined with secondary data on hospital financial performance. Regression analyses examined the relationship between outsourcing and various measures of financial performance while controlling for bed size, average patient acuity, geographic location, and overall IT adoption. FINDINGS Complete data from a total of 83 Florida hospitals were available for analyses. Findings suggest that the decision to outsource IT functions is not related to any of the hospital financial performance measures that were examined. Specifically, outsourcing of IT functions did not correlate with net inpatient revenue, net patient revenue, hospital expenses, total expenses, cash flow ratio, operating margin, or total margin. PRACTICE IMPLICATIONS In most cases, IT outsourcing is not necessarily a cost-lowering strategy, but instead, a cost-neutral manner in which to accomplish an organizational strategy.
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Burke D, Menachemi N, Brooks R. Health care CIOs: assessing their fit in the organizational hierarchy and their influence on information technology capability. Health Care Manag (Frederick) 2006; 25:167-72. [PMID: 16699332 DOI: 10.1097/00126450-200604000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the continuing interest in the importance of health care information technology adoption, very little is known about chief information officers (CIOs), the individuals who manage this effort. The present study surveyed hospital CIOs to understand their backgrounds, their organizational status, and their influence in hospital health care information technology adoption. Survey responses from 98 organizations suggest that the CIO position varies significantly according to the profit status of the hospital. Further, regression analyses suggest that CIO tenure is associated with greater health care information technology adoption, whereas the reporting structure of the CIO is not. Management implications of the findings are discussed.
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Affiliation(s)
- Darrell Burke
- Medical Informatics, College of Information, Florida State University, Tallahassee, FL 32106-2100, USA.
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Menachemi N, Shewchuk RM, O'Connor SJ, Berner ES, Allison JJ. Perceptions of Medical Errors by Internal Medicine Residents. Qual Manag Health Care 2005; 14:144-54. [PMID: 16027592 DOI: 10.1097/00019514-200507000-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Efforts to identify the underlying structure of 40 survey items dealing with perceptions of medical errors are reported on the basis of responses from 195 medical residents. Factor analysis revealed that the medical errors perceptions were represented by a 10-factor solution. The external validity of these factors was examined relative to perceptions about the cost of medical errors, the cost of errors to health care, and the need for education and interventions to address errors. Results indicated that 13.9% of the variation in the perceived cost of medical errors and 17.1% of the variation in the perceived need for additional physician education was explained by the factor structure.
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Affiliation(s)
- Nir Menachemi
- Florida State University, College of Medicine, Tallahassee, USA
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