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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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Baraku A, Ramadani N, Bal R. Technical Factors Influencing the Health Information System in Kosova. Acta Inform Med 2023; 31:265-269. [PMID: 38379686 PMCID: PMC10875932 DOI: 10.5455/aim.2023.31.265-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 02/22/2024] Open
Abstract
Background Health information systems (HIS) are considered a vital tool to strengthen Low- and Middle-Income Countries' (LMIC) health systems. Unfortunately, little is known about the technical factors of HIS in LMIC. Objective This study aimed to make an empirical contribution, using the case of Kosova to find out about HIS development, trying to identify dysfunctional areas and opportunities for improvement. Methods Technical factors of the PRISM framework were analyzed via document analysis, and semi-structured interviews were held with 15 respondents from the Ministry of Health, the National Institute of Public Health of Kosova, and the Hospital Clinical University Services of Kosova. Interviews were transcribed and coded deductively, using the defined theoretical framework to guide the content analysis. Results The results indicate that MoH considered technical factors while developing HIS in Kosova. Nevertheless, HIS fulfills only some of the essential functions. Barriers to efficient HIS among technical factors are lengthy, time-consuming manual HIS forms, inadequate data from HIS forms for NIPHK analysis, difficulties when changing software and HIS economic operators, and the complexity of HIS functioning. Conclusion Kosova still faces technical difficulties with an efficient and sustainable HIS system. Complex processes of extensive efforts have yet to produce the desired results, which prevent evidence-based health analysis and informed decision-making in Kosovar healthcare. More research is needed into organizational and behavioral factors influencing HIS efficiency in LMIC.
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Affiliation(s)
- Ardita Baraku
- National Institute of Public Health, Prishtina, Kosova
| | - Naser Ramadani
- National Institute of Public Health, Prishtina, Kosova
- Medical Faculty, University of Prishtina “Hasan Prishtina”, Prishtina, Kosova
| | - Roland Bal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Alqahtani N. Reducing potential errors associated with insulin administration: An integrative review. J Eval Clin Pract 2022; 28:1037-1049. [PMID: 35179287 DOI: 10.1111/jep.13668] [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: 12/01/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, OBJECTIVES Around one-third of medication errors resulting in death within 48 h involve insulin therapy. Despite a growing number of interventional strategies that have been published over the past decade, it remains unclear which of these interventions is effective in reducing insulin errors. Therefore, the study aimed to synthesize interventions to reduce the frequency of insulin errors in either home or health care settings. METHODS This integrative review was conducted based on Whittemore and Knafl's four steps, which includes problem identification, literature search, data analysis and presentation. Six databases including Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PubMed, Scopus, PsychInfo and Cochrane were searched from January 2010 through July 2021. The level of evidence quality was assessed according to the Johns Hopkins Nursing Evidence-Based Practice grading scale. RESULTS Sixteen studies meeting inclusion criteria were reviewed. The results provide strong support for teaching patients how to use automated bolus calculators and educating patients to self-administer insulin to prevent insulin errors in the home setting. Computerized protocols, education and double-checking procedures were also found to be effective strategies for minimizing insulin errors in healthcare settings. CONCLUSION While the strategies might be effective in reducing insulin administration errors in the home settings, computerized protocols, continuing education and the manual validation of insulin products appear to be the most effective strategies for reducing such insulin errors in healthcare settings. Understanding these findings may help clinicians and patients to decrease the number of insulin errors administration.
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Affiliation(s)
- Naji Alqahtani
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Lundereng ED, Nes AAG, Holmen H, Winger A, Thygesen H, Jøranson N, Borge CR, Dajani O, Mariussen KL, Steindal SA. Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: A Scoping Review (Preprint). J Med Internet Res 2022; 25:e43429. [PMID: 36989024 PMCID: PMC10131609 DOI: 10.2196/43429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients' homes, reduce hospital admissions, enhance patients' feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. OBJECTIVE The aim of this review was to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in HBPC. METHODS A scoping review was conducted using the methodology of Arksey and O'Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs' experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. RESULTS This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. CONCLUSIONS Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs' point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33305.
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Affiliation(s)
- Elias David Lundereng
- Lovisenberg Diaconal University College, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Hilde Thygesen
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
| | - Nina Jøranson
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Christine Råheim Borge
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Simen A Steindal
- Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Feature Extraction Approach for Speaker Verification to Support Healthcare System Using Blockchain Security for Data Privacy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8717263. [PMID: 35924113 PMCID: PMC9343193 DOI: 10.1155/2022/8717263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/19/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Speech is one form of biometric that combines both physiological and behavioral features. It is beneficial for remote-access transactions over telecommunication networks. Presently, this task is the most challenging one for researchers. People’s mental status in the form of emotions is quite complex, and its complexity depends upon internal behavior. Emotion and facial behavior are essential characteristics through which human internal thought can be predicted. Speech is one of the mechanisms through which human’s various internal reflections can be expected and extracted by focusing on the vocal track, the flow of voice, voice frequency, etc. Human voice specimens of different ages can be emotions that can be predicted through a deep learning approach using feature removal behavior prediction that will help build a step intelligent healthcare system strong and provide data to various doctors of medical institutes and hospitals to understand the physiological behavior of humans. Healthcare is a clinical area with data concentrated where many details are accessed, generated, and circulated periodically. Healthcare systems with many existing approaches like tracing and tracking continuously disclose the system’s constraints in controlling patient data privacy and security. In the healthcare system, majority of the work involves swapping or using decisively confidential and personal data. A key issue is the modeling of approaches that guarantee the value of health-related data while protecting privacy and observing high behavioral standards. This will encourage large-scale perception, especially as healthcare information collection is expected to continue far off this current ongoing pandemic. So, the research section is looking for a privacy-preserving, secure, and sustainable system by using a technology called Blockchain. Data related to healthcare and distribution among institutions is a very challenging task. Storage of facts in the centralized form is a targeted choice for cyber hackers and initiates an accordant sight of patients’ facts which will cause a problem in sharing information over a network. So, this research paper’s approach based on Blockchain for sharing sufferer data in a secured manner is presented. Finally, the proposed model for extracting optimum value in error rate and accuracy was analyzed using different feature removal approaches to determine which feature removal performs better with different voice specimen variations. The proposed method increases the rate of correct evidence collection and minimizes the loss and authentication issues and using feature extraction based on text validation increases the sustainability of the healthcare system.
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Di Pelino S, Lamarche L, Carr T, Datta J, Gaber J, Oliver D, Gallagher J, Dragos S, Price D, Mangin D. Lessons Learned Through Two Phases of Developing and Implementing a Technology Supporting Integrated Care: Case Study. JMIR Form Res 2022; 6:e34899. [PMID: 35404253 PMCID: PMC9039817 DOI: 10.2196/34899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As health care becomes more fragmented, it is even more important to focus on the provision of integrated, coordinated care between health and social care systems. With the aging population, this coordination is even more vital. Information and communication technology (ICT) can support integrated care if the form of technology follows and supports functional integration. Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) is a program centered on the health of older adults, supported by volunteers, primary care teams, community engagement and connections, and an ICT known as the Health TAPESTRY application (TAP-App), a web-based application that supports volunteers in completing client surveys, volunteer coordinators in managing the volunteer program, and primary care teams in requesting and receiving information. OBJECTIVE This paper describes the development, evolution, and implementation of the TAP-App ICT to share the lessons learned. METHODS A case study was conducted with the TAP-App as the case and the perspectives of end users and stakeholders as the units of analysis. The data consisted of researchers' perspectives on the TAP-App from their own experiences, as well as feedback from other stakeholders and end user groups. Data were collected through written retrospective reflection with the program manager, a specific interview with the technology lead, key emailed questions to the TAP-App developer, and viewpoints and feedback during paper drafting from other research team members. There were 2 iterations of Health TAPESTRY and the TAP-App and we focused on learnings from the second implementation (2018-2020) which was a pragmatic implementation scale-up trial using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework at 6 primary care sites across Ontario, Canada. RESULTS TAP-App (version 1.0), which was iteratively developed, was introduced as a tool to schedule volunteer and client visits and collect survey data using a tablet computer. TAP-App (version 2.0) was developed based on this initial experience and a desire for a program management tool that focused more on dual flow among users and provided better support for research. The themes of the lessons learned were as follows: iterative feedback is valuable; if ICT will be used for research, develop it with research in mind; prepare for challenges in the integration of ICT into the existing workflow; ask whether interoperability should be a goal; and know that technology cannot do it alone yet-the importance of human touch points. CONCLUSIONS Health TAPESTRY is human-centered. The TAP-App does not replace these elements but rather helps enable them. Despite this shift in supporting integrated care, barriers remained to the uptake of the TAP-App that would have allowed a full flow of information between health and social settings in supporting patient care. This indicates the need for an ongoing focus on the human use of ICT in similar programs.
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Affiliation(s)
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Tracey Carr
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Julie Datta
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Jay Gallagher
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Steven Dragos
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - David Price
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Kedwan F. Health Information Systems Integration Project Using Rhapsody Engine (Preprint). JMIR Med Inform 2022. [DOI: 10.2196/37156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rouidi M, Elouadi A, Hamdoune A. Acceptance and use of telemedicine technology by health professionals: Development of a conceptual model. Digit Health 2022; 8:20552076221081693. [PMID: 35223077 PMCID: PMC8864260 DOI: 10.1177/20552076221081693] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/30/2022] [Indexed: 11/16/2022] Open
Abstract
Recent developments in information technology (IT) in health are extended to highly specialized services, an example is telemedicine technology, understood as the use of IT to enable the transfer of medical information for diagnostic purposes, therapeutic and educational. Despite the benefits of implementing such technology, healthcare professionals, as end users, do not fully utilize it. The Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT), are among the models applied to assess and predict the acceptance and use of telemedicine. This article aims to identify the relevant literature related to these two models, to review and summarize the methodologies and results, and propose a conceptual model for the acceptance and use of telemedicine technology by healthcare professionals.
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Affiliation(s)
- Mohammed Rouidi
- Ensak, Ibn Tofail University, B.P 242 Kenitra, Kénitra, Morocco
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Bulut S, Bilgener E. Evaluation of turkish pharmaceutical track and trace system (ITS): perspective of community pharmacists. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Heponiemi T, Gluschkoff K, Vehko T, Kaihlanen AM, Saranto K, Nissinen S, Nadav J, Kujala S. Electronic Health Record Implementations and Insufficient Training Endanger Nurses' Well-being: Cross-sectional Survey Study. J Med Internet Res 2021; 23:e27096. [PMID: 34941546 PMCID: PMC8738988 DOI: 10.2196/27096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/22/2021] [Accepted: 11/10/2021] [Indexed: 01/26/2023] Open
Abstract
Background High expectations have been set for the implementations of health information systems (HIS) in health care. However, nurses have been dissatisfied after implementations of HIS. In particular, poorly functioning electronic health records (EHRs) have been found to induce stress and cognitive workload. Moreover, the need to learn new systems may require considerable effort from nurses. Thus, EHR implementations may have an effect on the well-being of nurses. Objective This study aimed to examine the associations of EHR-to-EHR implementations and the sufficiency of related training with perceived stress related to information systems (SRIS), time pressure, and cognitive failures among registered nurses. Moreover, we examined the moderating effect of the employment sector (hospital, primary care, social services, and others) on these associations. Methods This study was a cross-sectional survey study of 3610 registered Finnish nurses in 2020. EHR implementation was measured by assessing whether the work unit of each respondent had implemented or will implement a new EHR (1) within the last 6 months, (2) within the last 12 months, (3) in the next 12 months, and (4) at no point within the last 12 months or in the forthcoming 12 months. The associations were examined using analyses of covariance adjusted for age, gender, and employment sector. Results The highest levels of SRIS (adjusted mean 4.07, SE 0.05) and time pressure (adjusted mean 4.55, SE 0.06) were observed among those who had experienced an EHR implementation within the last 6 months. The lowest levels of SRIS (adjusted mean 3.26, SE 0.04), time pressure (adjusted mean 4.41, SE 0.05), and cognitive failures (adjusted mean 1.84, SE 0.02) were observed among those who did not experience any completed or forthcoming implementations within 12 months. Nurses who perceived that they had received sufficient implementation-related training experienced less SRIS (F1=153.40, P<.001), time pressure (F1=80.95, P<.001), and cognitive failures (F1=34.96, P<.001) than those who had received insufficient training. Recent implementations and insufficient training were especially strongly associated with high levels of SRIS in hospitals. Conclusions EHR implementations and insufficient training related to these implementations may endanger the well-being of nurses and even lead to errors. Thus, it is extremely important for organizations to offer comprehensive training before, during, and after implementations. Moreover, easy-to-use systems that allow transition periods, a re-engineering approach, and user involvement may be beneficial to nurses in the implementation process. Training and other improvements would be especially important in hospitals.
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Affiliation(s)
| | - Kia Gluschkoff
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuulikki Vehko
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | - Janna Nadav
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Cresswell K, Sheikh A, Franklin BD, Hinder S, Nguyen HT, Krasuska M, Lane W, Mozaffar H, Mason K, Eason S, Potts HWW, Williams R. Benefits realization management in the context of a national digital transformation initiative in English provider organizations. J Am Med Inform Assoc 2021; 29:536-545. [PMID: 34927692 PMCID: PMC8800528 DOI: 10.1093/jamia/ocab283] [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: 06/14/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background The Global Digital Exemplar (GDE) Programme is a national initiative to promote digitally enabled transformation in English provider organizations. The Programme applied benefits realization management techniques to promote and demonstrate transformative outcomes. This work was part of an independent national evaluation of the GDE Programme. Aims We explored how benefits realization management was approached and conceptualized in the GDE Programme. Methods We conducted a series of 36 longitudinal case studies of provider organizations participating in the GDE Programme, 12 of which were in depth. Data collection included a combination of 628 interviews (with implementation staff in provider organizations, national programme management staff, and suppliers), 499 documents (of national and local implementation plans and lessons learned), and 190 nonparticipant observations (of national and local programme management meetings to develop insights into the broader context of benefits realization activities, tensions arising, and how these were negotiated). Data were coded drawing on a sociotechnical framework developed in related work and thematically analyzed, initially within and then across cases, with the help of NVivo 11 software. Results Most stakeholders broadly agreed with the rationale of benefits realization in the GDE Programme to show due diligence that public money was appropriately spent, and to develop an evidence base supporting the value of digitally enabled transformation. Differing national and local reporting purposes, however, created tensions. Central requirements, for progress reporting and tracking high-level benefits, had limited perceived local value and were seen to impose an unnecessary burden on provider organizations. This was accentuated by the lack of harmonization of reporting requirements to different stakeholders (which differed in content and timing). There were tensions between the desire for early evidence of outcomes and the slow processes of infrastructural change (which created problems of attribution of benefits to causes as benefits emerged gradually and over long timeframes), and also between reporting immediately visible local changes and showing how these flowed through to high level organization wide benefits (eg, in terms of health outcomes or cost savings/return on investment). The attempt to fulfill these diverging agendas and informational needs within a single reporting tool had limited success. These difficulties were mitigated by efforts to simplify reporting requirements and to support targeted collection of key national outcome measures. Although progress was hampered by an initial lack of benefits realization expertise in provider organizations, some providers subsequently retained these skills for their own change management purposes. Conclusions There is a need to recognize the limitations and cost of benefits realization management practices in the context of healthcare digitalization where benefits may materialize over long timeframes and in unanticipated ways. Although diverse stakeholder information needs may create tensions, prior agreement about rationales for collecting information and a targeted approach to tracking local and high-level benefits may enhance local relevance, reduce perceived reporting burdens, and improve acceptance/effectiveness. A single integrated reporting mechanism is unlikely to fulfill both national and local requirements.
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Affiliation(s)
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Hung The Nguyen
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Marta Krasuska
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Wendy Lane
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, UK
| | - Kathy Mason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Sally Eason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
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A blockchain based patient centric electronic health record storage and integrity management for e-Health systems. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Moukénet A, de Cola MA, Ward C, Beakgoubé H, Baker K, Donovan L, Laoukolé J, Richardson S. Health management information system (HMIS) data quality and associated factors in Massaguet district, Chad. BMC Med Inform Decis Mak 2021; 21:326. [PMID: 34809622 PMCID: PMC8609810 DOI: 10.1186/s12911-021-01684-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
Background Quality data from Health Management Information Systems (HMIS) are important for tracking the effectiveness of malaria control interventions. However, HMIS data in many resource-limited settings do not currently meet standards set by the World Health Organization (WHO). We aimed to assess HMIS data quality and associated factors in Chad. Methods A cross-sectional study was conducted in 14 health facilities in Massaguet district. Data on children under 15 years were obtained from the HMIS and from the external patient register covering the period January–December 2018. An additional questionnaire was administered to 16 health centre managers to collect data on contextual variables. Patient registry data were aggregated and compared with the HMIS database at district and health centre level. Completeness and accuracy indicators were calculated as per WHO guidelines. Multivariate logistic regressions were performed on the Verification Factor for attendance, suspected and confirmed malaria cases for three age groups (1 to < 12 months, 1 to < 5 years and 5 to < 15 years) to identify associations between health centre characteristics and data accuracy. Results Health centres achieved a high level of data completeness in HMIS. Malaria data were over-reported in HMIS for children aged under 15 years. There was an association between workload and higher odds of inaccuracy in reporting of attendance among children aged 1 to < 5 years (Odds ratio [OR]: 10.57, 95% CI 2.32–48.19) and 5– < 15 years (OR: 6.64, 95% CI 1.38–32.04). Similar association was found between workload and stock-outs in register books, and inaccuracy in reporting of malaria confirmed cases. Meanwhile, we found that presence of a health technician, and of dedicated staff for data management, were associated with lower inaccuracy in reporting of clinic attendance in children aged under five years. Conclusion Data completeness was high while the accuracy was low. Factors associated with data inaccuracy included high workload and the unavailability of required data collection tools. The results suggest that improvement in working conditions for clinic personnel may improve HMIS data quality. Upgrading from paper-based forms to a web-based HMIS may provide a solution for improving data accuracy and its utility for future evaluations of health interventions. Results from this study can inform the Ministry of Health and it partners on the precautions to be taken in the use of HMIS data and inform initiatives for improving its quality. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01684-7.
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Affiliation(s)
- Azoukalné Moukénet
- Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad
| | - Monica Anna de Cola
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Charlotte Ward
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Honoré Beakgoubé
- Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad
| | - Kevin Baker
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Laura Donovan
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | | | - Sol Richardson
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK.
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Adoption of health technologies for effective health information system: Need of the hour for Pakistan. PLoS One 2021; 16:e0258081. [PMID: 34618842 PMCID: PMC8496784 DOI: 10.1371/journal.pone.0258081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/20/2021] [Indexed: 11/28/2022] Open
Abstract
Health information technology systems have the capacity to improve health outcomes for the patients thus ensuring quality and efficient services. Health information systems (HIS) are important tools in guidance towards patient safety and better outcomes. However, still, morbidity and mortality attributed to medical errors remain an important issue that needs to be addressed. The objective of the present study was to assess the health information system in terms of technological, environmental, organizational and human factors affecting the adoption as well as the perceptions of stakeholders along with barriers and constraints related to successful implementation. A descriptive cross-sectional study design was used. Prospective data was collected from primary sources by self-administering the pre-validated questionnaires as well as by physical verification of the availability of equipment. After data collection, data was analyzed to assess the health information management systems. The results of the present study showed that the health information system in Pakistan is not up to the mark. The equipment was mostly unavailable at the primary healthcare facilities. The staff was also unsatisfied with the available services. Administrative, financial and human constraints were identified as the major barriers towards successful implementation and management of HIS. The present study concluded that the health information system of Pakistan needs to be revamped. Health information management system partially existed at district and sub-district offices, while was completely absent at tertiary, secondary and primary healthcare levels. The poor adoption of health information technology systems at healthcare facilities might largely be attributed to insufficient human resources with limited resources and budget allocation for health in Pakistan. Effective and timely strategies involving all important stakeholders and healthcare professionals must be designed and implemented at the National level to restructure an affordable, resilient and quality healthcare system.
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15
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Evaluation of health information systems with ISO 9241-10 standard: A systematic review and meta-analysis. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Nawaz R, Khan SA, Khattak T, Nasir F, Abbas K. Interventional Study for Improving Health Information System in Khyber Pakhtunkhwa, Pakistan. Cureus 2020; 12:e11785. [PMID: 33409032 PMCID: PMC7779156 DOI: 10.7759/cureus.11785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To assess the improvement in the health information system in the district Nowshera by integrating the data reporting of the Expanded Program on Immunization (EPI) and Lady Health Worker (LHW) programs in the existing system. Methodology The study was conducted at district Nowshera and Swabi, Pakistan between May 2015 and May 2016 for a duration of one year. The data collection instruments used in the study were adapted from the Performance of Routine Information System Management (PRISM) tool package. The study was conducted in three phases during a period of one year. The first three months were utilized for baseline assessment. The next six months were being used for implementing the integration of the EPI and LHW, and the next three months were being used for the post-intervention evaluation. Microsoft Excel software was used to enter and analyze the data. A p < 0.05 was considered as the cut-off value for significance. Results The results indicated that the integration of data from the EPI and LHW with that of the existing Health Information System (HIS) is possible and has the potential for improving the existing system. The least significant results were produced by the use of information, which depicts that the utilization of data in decision making or policy making is still needed to be improved. Moreover, we reported a lack of enforcement and regulation by the authorities in monitoring the feedback system in the HIS. Conclusion The current study revealed significant improvements in the use of information, data quality, and behavior of staff. It is essential to properly train the team on how to operate the District Health Information System (DHIS) to gain adequate and timely data on health status and determinants. Additionally, the integration would benefit in managing the data at not only the national level but at the district level too.
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Affiliation(s)
- Rab Nawaz
- Community Medicine, Pak International Medical College, Peshawar, PAK
| | | | - Tayyaba Khattak
- Community Medicine, Pak International Medical College, Peshawar, PAK
| | - Fatima Nasir
- Community Medicine, Pak International Medical College, Peshawar, PAK
| | - Kiran Abbas
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.,Medicine and Surgery, Sindh Medical College, Karachi, PAK
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Wangdi K, Sarma H, Leaburi J, McBryde E, Clements ACA. Evaluation of the malaria reporting system supported by the District Health Information System 2 in Solomon Islands. Malar J 2020; 19:372. [PMID: 33069245 PMCID: PMC7568381 DOI: 10.1186/s12936-020-03442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background District Health Information Systems 2 (DHIS2) is used for supporting health information management in 67 countries, including Solomon Islands. However, there have been few published evaluations of the performance of DHIS2-enhanced disease reporting systems, in particular for monitoring infectious diseases such as malaria. The aim of this study was to evaluate DHIS2 supported malaria reporting in Solomon Islands and to develop recommendations for improving the system. Methods The evaluation was conducted in three administrative areas of Solomon Islands: Honoria City Council, and Malaita and Guadalcanal Provinces. Records of nine malaria indicators including report submission date, total malaria cases, Plasmodium falciparum case record, Plasmodium vivax case record, clinical malaria, malaria diagnosed with microscopy, malaria diagnosed with (rapid diagnostic test) (RDT), record of drug stocks and records of RDT stocks from 1st January to 31st December 2016 were extracted from the DHIS2 database. The indicators permitted assessment in four core areas: availability, completeness, timeliness and reliability. To explore perceptions and point of view of the stakeholders on the performance of the malaria case reporting system, focus group discussions were conducted with health centre nurses, whilst in-depth interviews were conducted with stakeholder representatives from government (province and national) staff and World Health Organization officials who were users of DHIS2. Results Data were extracted from nine health centres in Honoria City Council and 64 health centres in Malaita Province. The completeness and timeliness from the two provinces of all nine indicators were 28.2% and 5.1%, respectively. The most reliable indicator in DHIS2 was ‘clinical malaria’ (i.e. numbers of clinically diagnosed malaria cases) with 62.4% reliability. Challenges to completeness were a lack of supervision, limited feedback, high workload, and a lack of training and refresher courses. Health centres located in geographically remote areas, a lack of regular transport, high workload and too many variables in the reporting forms led to delays in timely reporting. Reliability of reports was impacted by a lack of technical professionals such as statisticians and unavailability of tally sheets and reporting forms. Conclusion The availability, completeness, timeliness and reliability of nine malaria indicators collected in DHIS2 were variable within the study area, but generally low. Continued onsite support, supervision, feedback and additional enhancements, such as electronic reporting will be required to further improve the malaria reporting system.
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Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, The Australian National University, 62 Mills Road, Canberra, ACT 2601, Australia.
| | - Haribondu Sarma
- National Centre of Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - John Leaburi
- National Vector Borne Disease Control Programme, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Emma McBryde
- Australian Institute of Tropical Health & Medicine, Centre for Biosecurity in Tropical Infectious Diseases, James Cooks University, Townsville, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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18
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Richter Lagha R, Burningham Z, Sauer BC, Leng J, Peters C, Huynh T, Patel S, Halwani AS, Kramer BJ. Usability Testing a Potentially Inappropriate Medication Dashboard: A Core Component of the Dashboard Development Process. Appl Clin Inform 2020; 11:528-534. [PMID: 32785904 PMCID: PMC7425799 DOI: 10.1055/s-0040-1714693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background
With the increased usage of dashboard reporting systems to monitor and track patient panels by clinical users, developers must ensure that the information displays they produce are accurate and intuitive. When evaluating usability of a clinical dashboard among potential end users, developers oftentimes rely on methods such as questionnaires as opposed to other, more time-intensive strategies that incorporate direct observation.
Objectives
Prior to release of the potentially inappropriate medication (PIM) clinical dashboard, designed to facilitate completion of a quality improvement project by clinician scholars enrolled in the Veterans Affairs (VA) workforce development Geriatric Scholars Program (GSP), we evaluated the usability of the system. This article describes the process of usability testing a dashboard reporting system with clinicians using direct observation and think-aloud moderating techniques.
Methods
We developed a structured interview protocol that combines virtual observation, think-aloud moderating techniques, and retrospective questioning of the overall user experience, including use of the System Usability Scale (SUS). Thematic analysis was used to analyze field notes from the interviews of three GSP alumni.
Results
Our structured approach to usability testing identified specific functional problems with the dashboard reporting system that were missed by results from the SUS. Usability testing lead to overall improvements in the intuitive use of the system, increased data transparency, and clarification of the dashboard's purpose.
Conclusion
Reliance solely on questionnaires and surveys at the end stages of dashboard development can mask potential functional problems that will impede proper usage and lead to misinterpretation of results. A structured approach to usability testing in the developmental phase is an important tool for developers of clinician friendly systems for displaying easily digested information and tracking outcomes for the purpose of quality improvement.
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Affiliation(s)
- Regina Richter Lagha
- Veterans Affairs Greater Los Angeles Medical Center, Geriatric Research Education and Clinical Center, Los Angeles, California, United States
| | - Zachary Burningham
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Salt Lake City Veterans Affairs Medical Center, Health Services Research and Development Center, Salt Lake City, Utah, United States
| | - Brian C Sauer
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Salt Lake City Veterans Affairs Medical Center, Health Services Research and Development Center, Salt Lake City, Utah, United States
| | - Jianwei Leng
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Salt Lake City Veterans Affairs Medical Center, Health Services Research and Development Center, Salt Lake City, Utah, United States
| | - Celena Peters
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Salt Lake City Veterans Affairs Medical Center, Health Services Research and Development Center, Salt Lake City, Utah, United States
| | - Tina Huynh
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Salt Lake City Veterans Affairs Medical Center, Health Services Research and Development Center, Salt Lake City, Utah, United States
| | - Shardool Patel
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Salt Lake City Veterans Affairs Medical Center, Health Services Research and Development Center, Salt Lake City, Utah, United States
| | - Ahmad S Halwani
- Salt Lake City Veterans Affairs Medical Center, Health Services Research and Development Center, Salt Lake City, Utah, United States.,Division of Epidemiology, Department of Hematology, University of Utah, Salt Lake City, Utah, United States
| | - B Josea Kramer
- Veterans Affairs Greater Los Angeles Medical Center, Geriatric Research Education and Clinical Center, Los Angeles, California, United States.,Division of Geriatric Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
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19
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Leon N, Balakrishna Y, Hohlfeld A, Odendaal WA, Schmidt BM, Zweigenthal V, Anstey Watkins J, Daniels K. Routine Health Information System (RHIS) improvements for strengthened health system management. Cochrane Database Syst Rev 2020; 8:CD012012. [PMID: 32803893 PMCID: PMC8094584 DOI: 10.1002/14651858.cd012012.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND A well-functioning routine health information system (RHIS) can provide the information needed for health system management, for governance, accountability, planning, policy making, surveillance and quality improvement, but poor information support has been identified as a major obstacle for improving health system management. OBJECTIVES To assess the effects of interventions to improve routine health information systems in terms of RHIS performance, and also, in terms of improved health system management performance, and improved patient and population health outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE Ovid and Embase Ovid in May 2019. We searched Global Health, Ovid and PsycInfo in April 2016. In January 2020 we searched for grey literature in the Grey Literature Report and in OpenGrey, and for ongoing trials using the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov. In October 2019 we also did a cited reference search using Web of Science, and a 'similar articles' search in PubMed. SELECTION CRITERIA Randomised and non-randomised trials, controlled before-after studies and time-series studies comparing routine health information system interventions, with controls, in primary, hospital or community health care settings. Participants included clinical staff and management, district management and community health workers using routine information systems. DATA COLLECTION AND ANALYSIS Two authors independently reviewed records to identify studies for inclusion, extracted data from the included studies and assessed the risk of bias. Interventions and outcomes were too varied across studies to allow for pooled risk analysis. We present a 'Summary of findings' table for each intervention comparisons broadly categorised into Technical and Organisational (or a combination), and report outcomes on data quality and service quality. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included six studies: four cluster randomised trials and two controlled before-after studies, from Africa and South America. Three studies evaluated technical interventions, one study evaluated an organisational intervention, and two studies evaluated a combination of technical and organisational interventions. Four studies reported on data quality and six studies reported on service quality. In terms of data quality, a web-based electronic TB laboratory information system probably reduces the length of time to reporting of TB test results, and probably reduces the overall rate of recording errors of TB test results, compared to a paper-based system (moderate certainty evidence). We are uncertain about the effect of the electronic laboratory information system on the recording rate of serious (misidentification) errors for TB test results compared to a paper-based system (very low certainty evidence). Misidentification errors are inaccuracies in transferring test results between an electronic register and patients' clinical charts. We are also uncertain about the effect of the intervention on service quality (timeliness of starting or changing a patient's TB treatment) (very low certainty evidence). A hand-held electronic device probably improves the length of time to report TB test results, and probably reduces the total frequency of recording errors in TB test results between the laboratory notebook and the electronic information record system, compared to a paper-based system (moderate-certainty evidence). We are, however, uncertain about the effect of the intervention on the frequency of serious (misidentification) errors in recording between the laboratory notebook and the electronic information record, compared to a paper-based system (very low certainty evidence). We are uncertain about the effect of a hospital electronic health information system on service quality (length of time outpatients spend at hospital, length of hospital stay, and hospital revenue collection), compared to a paper-based system (very low certainty evidence). High-intensity brief text messaging (SMS) may make little or no difference to data quality (in terms of completeness of documentation of pregnancy outcomes), compared to low-intensity brief text messaging (low-certainty evidence). We are uncertain about the effect of electronic drug stock notification (with either data management support or product transfer support) on service quality (in terms of transporting stock and stock levels), compared to paper-based stock notification (very low certainty evidence). We are uncertain about the effect of health information strengthening (where it is part of comprehensive service quality improvement intervention) on service quality (health worker motivation, receipt of training by health workers, health information index scores, quality of clinical observation of children and adults) (very low certainty evidence). AUTHORS' CONCLUSIONS The review indicates mixed effects of mainly technical interventions to improve data quality, with gaps in evidence on interventions aimed at enhancing data-informed health system management. There is a gap in interventions studying information support beyond clinical management, such as for human resources, finances, drug supply and governance. We need to have a better understanding of the causal mechanisms by which information support may affect change in management decision-making, to inform robust intervention design and evaluation methods.
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Affiliation(s)
- Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Ameer Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Willem A Odendaal
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Virginia Zweigenthal
- Health Impact Assessment Directorate, Department of Health: Western Cape Province, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Adrian M, Coifman J, Pullmann MD, Blossom JB, Chandler C, Coppersmith G, Thompson P, Lyon AR. Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study. JMIR Ment Health 2020; 7:e16338. [PMID: 32706691 PMCID: PMC7399956 DOI: 10.2196/16338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/31/2020] [Accepted: 02/21/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential. OBJECTIVE This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting. METHODS A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES. RESULTS Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care. CONCLUSIONS Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.
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Affiliation(s)
- Molly Adrian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jessica Coifman
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - Casey Chandler
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - Paul Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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21
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Kabukye JK, de Keizer N, Cornet R. Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey. PLoS One 2020; 15:e0234711. [PMID: 32544214 PMCID: PMC7297346 DOI: 10.1371/journal.pone.0234711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/31/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Organizational readiness for change is a key factor in success or failure of electronic health record (EHR) system implementations. Readiness is a multifaceted and multilevel abstract construct encompassing individual and organizational aspects, which makes it difficult to assess. Available tools for assessing readiness need to be tested in different contexts. OBJECTIVE To identify and assess relevant variables that determine readiness to implement an EHR in oncology in a low-and-middle income setting. METHODS At the Uganda Cancer Institute (UCI), a 100-bed tertiary oncology center in Uganda,we conducted a cross-sectional survey using the Paré model. This model has 39 indicator variables (Likert-scale items) for measuring 9 latent variables that contribute to readiness. We analyzed data using partial least squares structural equation modeling (PLS-SEM). In addition, we collected comments that we analyzed by qualitative content analysis and sentiment analysis as a way of triangulating the Likert-scale survey responses. RESULTS One hundred and forty-six clinical and non-clinical staff completed the survey, and 116 responses were included in the model. The measurement model showed good indicator reliability, discriminant validity, and internal consistency. Path coefficients for 6 of the 9 latent variables (i.e. vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy) were statistically significant at p < 0.05. The R2 for the outcome variable (organizational readiness) was 0.67. The sentiments were generally positive and correlated well with the survey scores (Pearson's r = 0.73). Perceived benefits of an EHR included improved quality, security and accessibility of clinical data, improved care coordination, reduction of errors, and time and cost saving. Recommended considerations for successful implementation include sensitization, training, resolution of organizational conflicts and computer infrastructure. CONCLUSION Change management during EHR implementation in oncology in low- and middle- income setting should focus on attributes of the change and the change targets, including vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy. Particularly, issues of training, computer skills of staff, computer infrastructure, sensitization and strategic implementation need consideration.
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Affiliation(s)
- Johnblack K. Kabukye
- Uganda Cancer Institute, Kampala, Uganda
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC—Location AMC, Amsterdam, The Netherlands
| | - Nicolet de Keizer
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC—Location AMC, Amsterdam, The Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC—Location AMC, Amsterdam, The Netherlands
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22
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Morquin D. [Legitimate resistance without technophobia: Analysis of electronic medical records impacts on the medical profession]. Rev Med Interne 2020; 41:617-621. [PMID: 32467002 DOI: 10.1016/j.revmed.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/09/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
The objective of this short narrative literature review is to highlight the different difficulties encountered by medical doctor in the daily use of EMR. We show that these are not simple transitional phenomena related to a "resistance to change", but rather the fact of a deeper and unfinished transformation. Beyond the "perception of misfit with work processes" or the threat of a loss of autonomy, we propose to analyze this so-called "resistance" in relation to the formalization of medical work induced by EMR. Our question concerns the compatibility of the multiple objectives of EMR, the potential influence of computerization on the steps of entering and consulting medical information, the impact on the clinical reasoning, the reality of assistance to medical "performance". The question is not so much what EMRs do less well than the paper record, but to provide insights into how tomorrow's EMRs will do better than today's.
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Affiliation(s)
- D Morquin
- Département des Maladies Infectieuses et Tropicales - CHU de Montpellier, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier, France; Délégation à l'Usage clinique du Numérique, CHU de Montpellier - Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier, France.
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Sayyadi Tooranloo H, Saghafi S. Assessing the risk of hospital information system implementation using IVIF FMEA approach. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2019.1688504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Etim A, Etim DN, Scott J. Mobile Health and Telemedicine. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2020. [DOI: 10.4018/ijhisi.2020010105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In 2016, the U.S. Government health expenditures reached $3.35 trillion and the cost per person stood at $10,345. Health is seen as impacting both one's quality of life and finances. The Affordable Care Act (ACA) (2008 - 2016) brought the issue of cost to the forefront for all people especially those in the health disparate communities. Advances in health informatics coupled with new approaches to healthcare delivery may hold promise for this large industry in the USA that critically needs to be cost effective in order to sustain itself. This paper reports a study that investigated importance of health, mobile health (m-Health) and telemedicine awareness along with its adoption in a health disparate community that has one of the Historical Black Colleges & Universities (HBCUs) in the country. The findings were that, all participants owned a mobile (cell) phone with smart features. Although a large number them indicated that their health was very important to them, there was lack of awareness and adoption of m-Health and telemedicine.
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Affiliation(s)
- Alice Etim
- Winston Salem State University, Winston-Salem, USA
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25
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Campbell S, Morton D, Grobler A. Transitioning from analogue to digital imaging: Challenges of South African analogue-trained radiographers. Radiography (Lond) 2019; 25:e39-e44. [DOI: 10.1016/j.radi.2018.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/07/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022]
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Khumalo NB, Mnjama N. The Effect of eHealth Information Systems on Health Information Management in Hospitals in Bulawayo, Zimbabwe. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2019. [DOI: 10.4018/ijhisi.2019040102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
EHealth information systems have brought about a lot of positives which include timeous reporting, efficient data analysis, better decision making, coordination and better work processes. Zimbabwe has also adopted the eHealth information systems and this study sought to establish the effects of eHealth information systems on the management of health information in hospitals in Bulawayo, Zimbabwe. The study applies a qualitative research methodology in which a case study research design and a purposive sampling technique were used. Document analysis and face to face interviews were held with a total of eleven research participants.
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Kitzmiller RR, Vaughan A, Skeeles-Worley A, Keim-Malpass J, Yap TL, Lindberg C, Kennerly S, Mitchell C, Tai R, Sullivan BA, Anderson R, Moorman JR. Diffusing an Innovation: Clinician Perceptions of Continuous Predictive Analytics Monitoring in Intensive Care. Appl Clin Inform 2019; 10:295-306. [PMID: 31042807 PMCID: PMC6494616 DOI: 10.1055/s-0039-1688478] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/18/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The purpose of this article is to describe neonatal intensive care unit clinician perceptions of a continuous predictive analytics technology and how those perceptions influenced clinician adoption. Adopting and integrating new technology into care is notoriously slow and difficult; realizing expected gains remain a challenge. METHODS Semistructured interviews from a cross-section of neonatal physicians (n = 14) and nurses (n = 8) from a single U.S. medical center were collected 18 months following the conclusion of the predictive monitoring technology randomized control trial. Following qualitative descriptive analysis, innovation attributes from Diffusion of Innovation Theory-guided thematic development. RESULTS Results suggest that the combination of physical location as well as lack of integration into work flow or methods of using data in care decisionmaking may have delayed clinicians from routinely paying attention to the data. Once data were routinely collected, documented, and reported during patient rounds and patient handoffs, clinicians came to view data as another vital sign. Through clinicians' observation of senior physicians and nurses, and ongoing dialogue about data trends and patient status, clinicians learned how to integrate these data in care decision making (e.g., differential diagnosis) and came to value the technology as beneficial to care delivery. DISCUSSION The use of newly created predictive technologies that provide early warning of illness may require implementation strategies that acknowledge the risk-benefit of treatment clinicians must balance and take advantage of existing clinician training methods.
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Affiliation(s)
- Rebecca R. Kitzmiller
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Ashley Vaughan
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Angela Skeeles-Worley
- Curry School of Education and Human Development, University of Virginia, Charlottesville, Virginia, United States
| | - Jessica Keim-Malpass
- School of Nursing, University of Virginia, Charlottesville, Virginia, United States
| | - Tracey L. Yap
- School of Nursing, Duke University, Durham, North Carolina, United States
| | | | - Susan Kennerly
- College of Nursing, East Carolina University, Greenville, North Carolina¸ United States
| | - Claire Mitchell
- Curry School of Education and Human Development, University of Virginia, Charlottesville, Virginia, United States
| | - Robert Tai
- Curry School of Education and Human Development, University of Virginia, Charlottesville, Virginia, United States
| | - Brynne A. Sullivan
- Division of Neonatology, University of Virginia, Charlottesville, Virginia, United States
| | - Ruth Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Joseph R. Moorman
- Departments of Cardiology and Biomedical Engineering, University of Virginia, Charlottesville, Virginia, United States
- Center for Advanced Medical Analytics, University of Virginia, Charlottesville, Virginia, United States
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Harle CA, Apathy NC, Cook RL, Danielson EC, DiIulio J, Downs SM, Hurley RW, Mamlin BW, Militello LG, Anders S. Information Needs and Requirements for Decision Support in Primary Care: An Analysis of Chronic Pain Care. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:527-534. [PMID: 30815093 PMCID: PMC6371256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Decision support system designs often do not align with the information environments in which clinicians work. These work environments may increase Clinicians' cognitive workload and harm their decision making. The objective of this study was to identify information needs and decision support requirements for assessing, diagnosing, and treating chronic noncancer pain in primary care. We conducted a qualitative study involving 30 interviews with 10 primary care clinicians and a subsequent multidisciplinary systems design workshop. Our analysis identified four key decision requirements, eight clinical information needs, and four decision support design seeds. Our findings indicate that clinicians caring for chronic pain need decision support that aggregates many disparate information elements and helps them navigate and contextualize that information. By attending to the needs identified in this study, decision support designers may improve Clinicians' efficiency, reduce mental workload, and positively affect patient care quality and outcomes.
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Affiliation(s)
- Christopher A Harle
- Indiana University, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | | | | | | | | | | | | | - Burke W Mamlin
- Indiana University, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
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Baumann LA, Baker J, Elshaug AG. The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy 2018; 122:827-836. [PMID: 29895467 DOI: 10.1016/j.healthpol.2018.05.014] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation. METHODS A systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time. RESULTS Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians' documentation time increased from 16% (95% confidence interval (CI) 11-22%) to 28% (95% CI 19-37%), nurses from 9% (95% CI 6-12%) to 23% (95% CI 15-32%) and interns from 20% (95% CI 7-32%) to 26% (95% CI 10-42%). CONCLUSIONS There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow.
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Affiliation(s)
- Lisa Ann Baumann
- University of Bremen, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Jannah Baker
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia.
| | - Adam G Elshaug
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia.
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Barriers for the Using of Information Systems in Hospitals: A Qualitative Study. ACTA ACUST UNITED AC 2018. [DOI: 10.5812/semj.66180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Purpose
This paper aims to report some findings of a study that investigated health information systems (HISs) in Namibia with a view of establishing the nature of these systems and coming up with recommendations on how these could be enhanced.
Design/methodology/approach
This study applied a mixed methods research approach, using interviews and survey questionnaire to collect data. Survey data were analysed for descriptive statistics using SPSS and data from interviews were analysed applying content analysis for data analysis.
Findings
The findings of this study indicate fragmented HISs resulting in duplication of diagnosis, tests and treatment. The findings show that there were errors in capturing data into the systems, which could compromise the reliability of the data and compromise service delivery.
Research limitations/implications
This study was limited to two (Khomas and Oshana) of the fourteen regions in Namibia; therefore, further studies could look at other regions, as the study findings cannot be generalised to the entire country.
Practical implications
The findings and recommendations, particularly those relating to the public health sector, could inform policies and procedures, especially those relating to the patient health passport (card), and the way health information is shared within and across health sectors.
Originality/value
This study focused on health information sharing, whereas a previous study on HISs concentrated on quality of healthcare.
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A computer-supported management of photographic documentation in plastic surgery - System development and its clinical application. Comput Biol Med 2017; 86:1-5. [DOI: 10.1016/j.compbiomed.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/24/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
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Rau HH, Wu YS, Chu CM, Wang FC, Hsu MH, Chang CW, Chen KH, Lee YL, Kao S, Chiu YL, Wen HC, Fuad A, Hsu CY, Chiu HW. Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey. J Med Internet Res 2017; 19:e131. [PMID: 28450273 PMCID: PMC5427249 DOI: 10.2196/jmir.7065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/18/2017] [Accepted: 03/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background Empowering personal health records (PHRs) provides basic human right, awareness, and intention for health promotion. As health care delivery changes toward patient-centered services, PHRs become an indispensable platform for consumers and providers. Recently, the government introduced “My health bank,” a Web-based electronic medical records (EMRs) repository for consumers. However, it is not yet a PHR. To date, we do not have a platform that can let patients manage their own PHR. Objective This study creates a vision of a value-added platform for personal health data analysis and manages their health record based on the contents of the "My health bank." This study aimed to examine consumer expectation regarding PHR, using the importance-performance analysis. The purpose of this study was to explore consumer perception regarding this type of a platform: it would try to identify the key success factors and important aspects by using the importance-performance analysis, and give some suggestions for future development based on it. Methods This is a cross-sectional study conducted in Taiwan. Web-based invitation to participate in this study was distributed through Facebook. Respondents were asked to watch an introductory movie regarding PHR before filling in the questionnaire. The questionnaire was focused on 2 aspects, including (1) system functions, and (2) system design and security and privacy. The questionnaire would employ 12 and 7 questions respectively. The questionnaire was designed following 5-points Likert scale ranging from 1 (“disagree strongly”) to 5 (“Agree strongly”). Afterwards, the questionnaire data was sorted using IBM SPSS Statistics 21 for descriptive statistics and the importance-performance analysis. Results This research received 350 valid questionnaires. Most respondents were female (219 of 350 participants, 62.6%), 21-30 years old (238 of 350 participants, 68.0%), with a university degree (228 of 350 participants, 65.1%). They were still students (195 out of 350 participants, 56.6%), with a monthly income of less than NT $30,000 (230 of 350 participants, 65.7%), and living in the North Taiwan (236 of 350 participants, 67.4%), with a good self-identified health status (171 of 350 participants, 48.9%). After performing the importance-performance analysis, we found the following: (1) instead of complex functions, people just want to have a platform that can let them integrate and manage their medical visit, health examination, and life behavior records; (2) they do not care whether their PHR is shared with others; and (3) most of the participants think the system security design is not important, but they also do not feel satisfied with the current security design. Conclusions Overall, the issues receiving the most user attention were the system functions, circulation, integrity, ease of use, and continuity of the PHRs, data security, and privacy protection.
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Affiliation(s)
- Hsiao-Hsien Rau
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Yi-Syuan Wu
- Administration Department, Healthconn Corp, Taipei, Taiwan.,Institute of Medical Informatics, Department of Computer Science of Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Ming Chu
- School Of Public Health, National Defence Medical Center, Taipei, Taiwan
| | - Fu-Chung Wang
- National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Min-Huei Hsu
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Chi-Wen Chang
- School of Nursing, College of Medicine, Chang Gung University, Linkou, Taiwan.,Division of Endocrinology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Yen-Liang Lee
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.,Internet of Things Laboratory, Chunghwa Telecom Laboratories, TaoYuen, Taiwan
| | - Senyeong Kao
- School Of Public Health, National Defence Medical Center, Taipei, Taiwan
| | - Yu-Lung Chiu
- School Of Public Health, National Defence Medical Center, Taipei, Taiwan
| | - Hsyien-Chia Wen
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Anis Fuad
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Chien-Yeh Hsu
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.,Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Master Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Hung-Wen Chiu
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
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Militello LG, Diiulio JB, Borders MR, Sushereba CE, Saleem JJ, Haverkamp D, Imperiale TF. Evaluating a Modular Decision Support Application For Colorectal Cancer Screening. Appl Clin Inform 2017; 8:162-179. [PMID: 28197619 PMCID: PMC5373761 DOI: 10.4338/aci-2016-09-ra-0152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a need for health information technology evaluation that goes beyond randomized controlled trials to include consideration of usability, cognition, feedback from representative users, and impact on efficiency, data quality, and clinical workflow. This article presents an evaluation illustrating one approach to this need using the Decision-Centered Design framework. OBJECTIVE To evaluate, through a Decision-Centered Design framework, the ability of the Screening and Surveillance App to support primary care clinicians in tracking and managing colorectal cancer testing. METHODS We leveraged two evaluation formats, online and in-person, to obtain feedback from a range primary care clinicians and obtain comparative data. Both the online and in-person evaluations used mock patient data to simulate challenging patient scenarios. Primary care clinicians responded to a series of colorectal cancer-related questions about each patient and made recommendations for screening. We collected data on performance, perceived workload, and usability. Key elements of Decision-Centered Design include evaluation in the context of realistic, challenging scenarios and measures designed to explore impact on cognitive performance. RESULTS Comparison of means revealed increases in accuracy, efficiency, and usability and decreases in perceived mental effort and workload when using the Screening and Surveillance App. CONCLUSION The results speak to the benefits of using the Decision-Centered Design approach in the analysis, design, and evaluation of Health Information Technology. Furthermore, the Screening and Surveillance App shows promise for filling decision support gaps in current electronic health records.
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Affiliation(s)
- Laura G Militello
- Laura G. Militello, MA, Applied Decision Science, 5335 Far Hills Avenue, Suite 217, Dayton, Ohio 45429, , (937) 602-7844
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Kummer TF, Recker J, Bick M. Technology-induced anxiety: Manifestations, cultural influences, and its effect on the adoption of sensor-based technology in German and Australian hospitals. INFORMATION & MANAGEMENT 2017. [DOI: 10.1016/j.im.2016.04.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Paavola T, Mäkelä K, Pyykkö V, Perälä S. A national Finnish e-health development project ‘ProViisikko’. J Telemed Telecare 2016. [DOI: 10.1258/135763306779379987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The ProViisikko project comprises the pilot projects of the five hospital districts in Finland. The work concerns the development of tools for controlling and monitoring care chains and the development of interactive tools for steering service demand. Five hospital districts, businesses, research institutes, universities, NGOs and other key partners are concentrating, each in their own region, on implementing a specific entity which, together, will produce an overall solution which can be expanded for national or international use, either as a whole or in modular form. Routine functions related to the provision of information will eventually be performed by clients themselves on a variety of terminals rather than at visits to health centres. Call-centres and interactive portals will direct demand accurately to the appropriate social welfare and health care resources. Close cooperation between hospital districts local authorities and development organizations will permit the development of services and products with a population base of 1.2 million and also ensure comparability between regions.
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Affiliation(s)
- Teemu Paavola
- LifelT Plc, Seinäjoki, Finland
- Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Kari Mäkelä
- LifelT Plc, Seinäjoki, Finland
- Seinäjoki Central Hospital, Seinäjoki, Finland
- Tampere University of Technology, Tampere, Finland
| | | | - Sami Perälä
- LifelT Plc, Seinäjoki, Finland
- South Ostrobothnia Telemedical Centre (Eptek), Finland
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38
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Ruxwana N, Herselman M, Pottas D. A Generic Quality Assurance Model (GQAM) for successful e-health implementation in rural hospitals in South Africa. Health Inf Manag 2016; 43:26-36. [PMID: 27010686 DOI: 10.1177/183335831404300104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although e-health can potentially facilitate the management of scarce resources and improve the quality of healthcare services, implementation of e-health programs continues to fail or not fulfil expectations. A key contributor to the failure of e-health implementation in rural hospitals is poor quality management of projects. Based on a survey 35 participants from five rural hospitals in the Eastern Cape Province of South Africa, and using a qualitative case study research methodology, this article attempted to answer the question: does the adoption of quality assurance (QA) models add value and help to ensure success of information technology projects, especially in rural health settings? The study identified several weaknesses in the application of QA in these hospitals; however, findings also showed that the QA methods used, in spite of not being formally applied in a standardised manner, did nonetheless contribute to the success of some projects. The authors outline a generic quality assurance model (GQAM), developed to enhance the potential for successful acquisition of e-health solutions in rural hospitals, in order to improve the quality of care and service delivery in these hospitals.
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Affiliation(s)
| | - Marlien Herselman
- Nelson Mandela Metropolitan University & Mareka Institute, CSIR South Africa
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39
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Jeddi FR, Hajbaghery MA, Akbari H, Esmaili S. Technological Feasibility of a Nursing Clinical Information System. Electron Physician 2016; 8:2942-2949. [PMID: 27790348 PMCID: PMC5074754 DOI: 10.19082/2942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/22/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction A successful implementation of an information system is impossible without sufficient knowledge of available technical resources of an institute. The aim of this study was to determine technical feasibility of a nursing clinical information system (NCIS) in Mazandaran province, Iran, 2015. Methods This cross-sectional study was conducted in three steps. In the first step, a data gathering tool was developed through an unsystematic literature review. In the second step, a questionnaire was developed and validity of the tool was confirmed by receiving opinions of faculty members and calculating indices of Content Validity Index (CVI) and Content Validity Ratio (CVR). The questionnaire reliability was confirmed by calculating Cronbach’s alpha coefficient (α= 0.72). In the third step, the feasibility of implementation of NCIS was evaluated by forming a panel of IT experts (n= 30), and through a questionnaire. Data were collected by 5-point Likert scale, very low to very high (scoring 1–5). Scores of each item were calculated and score percentage was determined. Chi-square and Fisher Exact tests were used. Results Maximum possibility of implementing NCIS were in the hardware area, additional equipment (92.6%), in the area of software, financial software (99.4%), in the area of network equipment, the possibility of integration with other internal systems, (92.6%) and in the area of network security, the possibility of backup version for security purposes (97.4%). Type of employment was statistically significant according to IT experts’ opinions (p= 0.014) Conclusion Hardware and software infrastructures for implementation of NCIS were desirable. The provision of more portable computers, advanced equipment such as barcode scanner, Radio-frequency identification (RFID), some approaches for increase accessibility of the system and essential databases from other resources and also increase of network lines’ speed are necessary.
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Affiliation(s)
- Fatemeh Rangraz Jeddi
- Ph.D. of Health Information Management, Associate Professor, Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Adib Hajbaghery
- Ph.D. of Nursing, Professor, Department of Medical-Surgical Nursing, School of Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Ph.D. of Biostatistics, Assistant Professor, Department of Biostatistics and Public Health, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Soheila Esmaili
- M.Sc. of Health Information Management, Kashan University of Medical Sciences, Kashan, Iran
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Sligo J, Gauld R, Roberts V, Villa L. A literature review for large-scale health information system project planning, implementation and evaluation. Int J Med Inform 2016; 97:86-97. [PMID: 27919399 DOI: 10.1016/j.ijmedinf.2016.09.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/06/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Information technology is perceived as a potential panacea for healthcare organisations to manage pressure to improve services in the face of increased demand. However, the implementation and evaluation of health information systems (HIS) is plagued with problems and implementation shortcomings and failures are rife. HIS implementation is complex and relies on organisational, structural, technological, and human factors to be successful. It also requires reflective, nuanced, multidimensional evaluation to provide ongoing feedback to ensure success. This article provides a comprehensive review of the literature about evaluating and implementing HIS, detailing the challenges and recommendations for both evaluators and healthcare organisations. The factors that inhibit or promote successful HIS implementation are identified and effective evaluation strategies are described with the goal of informing teams evaluating complex HIS.
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Affiliation(s)
- Judith Sligo
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Robin Gauld
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Vaughan Roberts
- Healthy Together 2020 Technology Programme, Counties Manukau Health, New Zealand
| | - Luis Villa
- Research and Evaluation Office, Health Intelligence and Informatics, Ko Awatea, New Zealand
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41
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Upadhaya N, Jordans MJD, Abdulmalik J, Ahuja S, Alem A, Hanlon C, Kigozi F, Kizza D, Lund C, Semrau M, Shidhaye R, Thornicroft G, Komproe IH, Gureje O. Information systems for mental health in six low and middle income countries: cross country situation analysis. Int J Ment Health Syst 2016; 10:60. [PMID: 27708697 PMCID: PMC5037904 DOI: 10.1186/s13033-016-0094-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on information systems for mental health in low and middle income countries (LMICs) is scarce. As a result, there is a lack of reliable information on mental health service needs, treatment coverage and the quality of services provided. METHODS With the aim of informing the development and implementation of a mental health information sub-system that includes reliable and measurable indicators on mental health within the Health Management Information Systems (HMIS), a cross-country situation analysis of HMIS was conducted in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda), participating in the 'Emerging mental health systems in low and middle income countries' (Emerald) research programme. A situation analysis tool was developed to obtain and chart information from documents in the public domain. In circumstances when information was inadequate, key government officials were contacted to verify the data collected. In this paper we compare the baseline policy context, human resources situation as well as the processes and mechanisms of collecting, verifying, reporting and disseminating mental health related HMIS data. RESULTS The findings suggest that countries face substantial policy, human resource and health governance challenges for mental health HMIS, many of which are common across sites. In particular, the specific policies and plans for the governance and implementation of mental health data collection, reporting and dissemination are absent. Across sites there is inadequate infrastructure, few HMIS experts, and inadequate technical support and supervision to junior staff, particularly in the area of mental health. Nonetheless there are also strengths in existing HMIS where a few mental health morbidity, mortality, and system level indicators are collected and reported. CONCLUSIONS Our study indicates the need for greater technical and resources input to strengthen routine HMIS and develop standardized HMIS indicators for mental health, focusing in particular on indicators of coverage and quality to facilitate the implementation of the WHO mental health action plan 2013-2020.
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Affiliation(s)
| | - Mark J D Jordans
- Department of Research and Development, HealthNet TPO, Amsterdam, The Netherlands.,Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College London, London, UK
| | - Jibril Abdulmalik
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Shalini Ahuja
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College London, London, UK.,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fred Kigozi
- Butabika National Mental Hospital, Kampala, Uganda
| | | | - Crick Lund
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College London, London, UK.,Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Maya Semrau
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rahul Shidhaye
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College London, London, UK.,Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College London, London, UK
| | - Ivan H Komproe
- Department of Research and Development, HealthNet TPO, Amsterdam, The Netherlands.,Utrecht University, Utrecht, The Netherlands
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Nicol E, Dudley L, Bradshaw D. Assessing the quality of routine data for the prevention of mother-to-child transmission of HIV: An analytical observational study in two health districts with high HIV prevalence in South Africa. Int J Med Inform 2016; 95:60-70. [PMID: 27697233 DOI: 10.1016/j.ijmedinf.2016.09.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 07/22/2016] [Accepted: 09/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevention of mother-to-child transmission of HIV (PMTCT) is a key maternal and child-health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programmes have been incorporated in the routine District Health Management Information System (DHMIS) which collects monthly facility-based data to support the management of public-health services. To date, there has been no comprehensive evaluation of the PMTCT information system. OBJECTIVES This study seeks to evaluate the quality of output indicators for monitoring PMTCT interventions in two health districts with high HIV prevalence. METHODS An analytical observational study was undertaken based on the Performance of Routine Information System Management (PRISM) framework and tools, including an assessment of the routine PMTCT data for quality in terms of accuracy and completeness. Data were collected from 57 public health facilities for six pre-defined PMTCT data elements by comparing the source registers with the routine monthly report (RMR), and the RMR with the DMHIS for January and April 2012. This was supplemented by the analysis of the monthly data reported routinely in the DMHIS for the period 2009-2012. Descriptive statistics, analysis of variance (ANOVA) and Bland Altman analysis were conducted using STATA® Version 13. RESULTS Although completeness was relatively high at 91% (95% CI: 78-100%) at facility level and 96% (95% CI: 92-100%) at district level, the study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and RMR of 51% (95% CI: 44-58%) and between the RMR and DHMIS database of 84% (95% CI: 78-91%). We observed differences in the data accuracy by organisational authority. The poor quality of the data was attributed partly to insufficient competencies of health information personnel. CONCLUSIONS The study suggests that the primary point of departure for accurate data transfer is during the collation process. Institutional capacity to improve data quality at the facility level and ensure core competencies for routine health information system (RHIS)-related tasks are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, RHIS processes, training and leadership are needed. In particular understanding is needed about how individual actions can bring about changes in institutional routines.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, South Africa; Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Lilian Dudley
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, South Africa; School of Public Health and Family Medicine, University of Cape Town, CapeTown, South Africa
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Middleton B, Sittig DF, Wright A. Clinical Decision Support: a 25 Year Retrospective and a 25 Year Vision. Yearb Med Inform 2016; Suppl 1:S103-16. [PMID: 27488402 DOI: 10.15265/iys-2016-s034] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The objective of this review is to summarize the state of the art of clinical decision support (CDS) circa 1990, review progress in the 25 year interval from that time, and provide a vision of what CDS might look like 25 years hence, or circa 2040. METHOD Informal review of the medical literature with iterative review and discussion among the authors to arrive at six axes (data, knowledge, inference, architecture and technology, implementation and integration, and users) to frame the review and discussion of selected barriers and facilitators to the effective use of CDS. RESULT In each of the six axes, significant progress has been made. Key advances in structuring and encoding standardized data with an increased availability of data, development of knowledge bases for CDS, and improvement of capabilities to share knowledge artifacts, explosion of methods analyzing and inferring from clinical data, evolution of information technologies and architectures to facilitate the broad application of CDS, improvement of methods to implement CDS and integrate CDS into the clinical workflow, and increasing sophistication of the end-user, all have played a role in improving the effective use of CDS in healthcare delivery. CONCLUSION CDS has evolved dramatically over the past 25 years and will likely evolve just as dramatically or more so over the next 25 years. Increasingly, the clinical encounter between a clinician and a patient will be supported by a wide variety of cognitive aides to support diagnosis, treatment, care-coordination, surveillance and prevention, and health maintenance or wellness.
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Affiliation(s)
- B Middleton
- Blackford Middleton, Cell: +1 617 335 7098, E-Mail:
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Shahmoradi L, Ahmadi M, Haghani H. Determining the Most Important Evaluation Indicators of Healthcare Information Systems (HCIS) in Iran. HEALTH INF MANAG J 2016; 36:13-22. [DOI: 10.1177/183335830703600103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Accurate evaluation of healthcare information systems (HCIS) relies upon the choice of appropriate indicators. Iranian healthcare and health industry professionals were surveyed, by means of a descriptive cross sectional study, in order to identify the indicators they considered most relevant to the evaluation of healthcare information systems currently in use in Iran. It was concluded that effective evaluation of HCIS should encompass a variety of perspectives and methodologies (including qualitative methodologies), focus upon technical, economic and organisational concerns, and involve diversely constituted research teams.
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Eivazzadeh S, Anderberg P, Larsson TC, Fricker SA, Berglund J. Evaluating Health Information Systems Using Ontologies. JMIR Med Inform 2016; 4:e20. [PMID: 27311735 PMCID: PMC4929349 DOI: 10.2196/medinform.5185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 04/14/2016] [Accepted: 05/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are several frameworks that attempt to address the challenges of evaluation of health information systems by offering models, methods, and guidelines about what to evaluate, how to evaluate, and how to report the evaluation results. Model-based evaluation frameworks usually suggest universally applicable evaluation aspects but do not consider case-specific aspects. On the other hand, evaluation frameworks that are case specific, by eliciting user requirements, limit their output to the evaluation aspects suggested by the users in the early phases of system development. In addition, these case-specific approaches extract different sets of evaluation aspects from each case, making it challenging to collectively compare, unify, or aggregate the evaluation of a set of heterogeneous health information systems. OBJECTIVES The aim of this paper is to find a method capable of suggesting evaluation aspects for a set of one or more health information systems-whether similar or heterogeneous-by organizing, unifying, and aggregating the quality attributes extracted from those systems and from an external evaluation framework. METHODS On the basis of the available literature in semantic networks and ontologies, a method (called Unified eValuation using Ontology; UVON) was developed that can organize, unify, and aggregate the quality attributes of several health information systems into a tree-style ontology structure. The method was extended to integrate its generated ontology with the evaluation aspects suggested by model-based evaluation frameworks. An approach was developed to extract evaluation aspects from the ontology that also considers evaluation case practicalities such as the maximum number of evaluation aspects to be measured or their required degree of specificity. The method was applied and tested in Future Internet Social and Technological Alignment Research (FI-STAR), a project of 7 cloud-based eHealth applications that were developed and deployed across European Union countries. RESULTS The relevance of the evaluation aspects created by the UVON method for the FI-STAR project was validated by the corresponding stakeholders of each case. These evaluation aspects were extracted from a UVON-generated ontology structure that reflects both the internally declared required quality attributes in the 7 eHealth applications of the FI-STAR project and the evaluation aspects recommended by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. The extracted evaluation aspects were used to create questionnaires (for the corresponding patients and health professionals) to evaluate each individual case and the whole of the FI-STAR project. CONCLUSIONS The UVON method can provide a relevant set of evaluation aspects for a heterogeneous set of health information systems by organizing, unifying, and aggregating the quality attributes through ontological structures. Those quality attributes can be either suggested by evaluation models or elicited from the stakeholders of those systems in the form of system requirements. The method continues to be systematic, context sensitive, and relevant across a heterogeneous set of health information systems.
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Affiliation(s)
- Shahryar Eivazzadeh
- Department of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.
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Lyon AR, Koerner K. User-Centered Design for Psychosocial Intervention Development and Implementation. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016; 23:180-200. [PMID: 29456295 PMCID: PMC5812700 DOI: 10.1111/cpsp.12154] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current paper articulates how common difficulties encountered when attempting to implement or scale-up evidence-based treatments are exacerbated by fundamental design problems, which may be addressed by a set of principles and methods drawn from the contemporary field of user-centered design. User-centered design is an approach to product development that grounds the process in information collected about the individuals and settings where products will ultimately be used. To demonstrate the utility of this perspective, we present four design concepts and methods: (a) clear identification of end users and their needs, (b) prototyping/rapid iteration, (c) simplifying existing intervention parameters/procedures, and (d) exploiting natural constraints. We conclude with a brief design-focused research agenda for the developers and implementers of evidence-based treatments.
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Lyon AR, Lewis CC. Designing Health Information Technologies for Uptake: Development and Implementation of Measurement Feedback Systems in Mental Health Service Delivery. Introduction to the Special Section. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:344-9. [PMID: 26658691 PMCID: PMC4833610 DOI: 10.1007/s10488-015-0704-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA.
| | - Cara C Lewis
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
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Mozaffar H, Cresswell KM, Lee L, Williams R, Sheikh A. Taxonomy of delays in the implementation of hospital computerized physician order entry and clinical decision support systems for prescribing: a longitudinal qualitative study. BMC Med Inform Decis Mak 2016; 16:25. [PMID: 26911288 PMCID: PMC4766744 DOI: 10.1186/s12911-016-0263-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation delays are common in health information technology (HIT) projects. In this paper, we sought to explore the reasons for delays in implementing major hospital-based HIT, through studying computerized physician order entry (CPOE) and clinical decision support (CDS) systems for prescribing and to develop a provisional taxonomy of causes of implementation delays. METHODS We undertook a series of longitudinal, qualitative case studies to investigate the implementation and adoption of CPOE and CDS systems for prescribing in hospitals in the U.K. We used a combination of semi-structured interviews from six case study sites and two whole day expert roundtable discussions to collect data. Interviews were carried out with users, implementers and suppliers of CPOE/CDS systems. We used thematic analysis to examine the results, drawing on perspectives surrounding the biography of artefacts. RESULTS We identified 15 major factors contributing to delays in implementation of CPOE and CDS systems. These were then categorized in a two-by-two delay classification matrix: one axis distinguishing tactical versus unintended causes of delay, and the second axis illustrating internal i.e., (the adopting hospital) versus external (i.e., suppliers, other hospitals, policymakers) related causes. CONCLUSIONS Our taxonomy of delays in HIT implementation should enable system developers, implementers and policymakers to better plan and manage future implementations. More detailed planning at the outset, considering long-term strategies, sustained user engagement, and phased implementation approaches appeared to reduce the risks of delays. It should however be noted that whilst some delays are likely to be preventable, other delays cannot be easily avoided and taking steps to minimize these may negatively affect the longer-term use of the system.
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Affiliation(s)
- Hajar Mozaffar
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Kathrin M Cresswell
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Lisa Lee
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK
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Professional Facing Coercive Work Formalization: Vicious Circle of the Electronic Medical Record (EMR) Implementation and Appropriation. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.procs.2016.09.207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Safdari R, Ghazisaeidi M, Jebraeily M. Electronic health records: critical success factors in implementation. Acta Inform Med 2015; 23:102-4. [PMID: 26005276 PMCID: PMC4430004 DOI: 10.5455/aim.2015.23.102-104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/05/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction: EHR implementation results in the improved quality of care, customer-orientation and timely access to complete information. Despite the potential benefits of EHR, its implementation is a difficult and complex task whose success depends on many factors. The purpose of this research is indeed to identify the key success factors of EHR. Method and materials: This is a cross-sectional survey conducted with participation of 340 work forces from different types of job from Hospitals of TUMS in 2014. Data were collected using a self-structured questionnaire which was estimated as both reliable and valid. The data were analyzed by SPSS software descriptive statistics and analytical statistics. Results: 58.2% of respondents were female and their mean age and work experience were 37.7 and 11.2 years, respectively and most respondents (52.5%) was bachelor. In terms of job, the maximum rate was related to nursing (33 %) and physician (21 %). the main category of critical success factors in Implementation EHRs, the highest rate related to Project Management (4.62) and lowest related to Organizational factors (3.98). Conclusion: success in implementation EHRs requirement more centralization to project management and human factors. Therefore must be Creating to EHR roadmap implementation, establishment teamwork to participation of end-users and select prepare leadership, users obtains sufficient training to use of system and also prepare support from maintain and promotion system.
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Affiliation(s)
- Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran
| | - Marjan Ghazisaeidi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran
| | - Mohamad Jebraeily
- Department of Health Information Management, School of Allied Medical Sciences, Tehran
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