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Pradhan R, Dayama N, Morris M, Elliott K, Felix H. Enhancing nursing home quality through electronic health record implementation. HEALTH INF MANAG J 2024:18333583241274010. [PMID: 39183673 DOI: 10.1177/18333583241274010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background: The quality of care in nursing homes (NHs) in the United States has long been a matter of policy concern. Although electronic health records (EHRs) are argued to improve quality, implementation has lagged due to various factors such as financial constraints and limited research on their impact on NH quality. Objective: This study examined the relationship between EHR implementation and NH quality using Donabedian's structure-process-outcome model. Method: Data on EHR implementation were collected via a 2018 survey of all Federally certified Arkansas NHs (n = 223). Of the 63 responding NHs, 48 reported EHR implementation. Survey data were merged with secondary sources such as Certification and Survey Provider Enhanced Reporting. A total of 744 NH-years for the period 2008-2020 were included in the final sample. A pre-post negative binomial panel data regression was used to examine the relationship between EHR implementation (dichotomous variable) and NH deficiencies (dependent count variable) with facility/community-level control variables. Results were reported as incidence rate ratios (IRR). Results: NHs that had implemented EHR experienced an 18% reduction in the rate of deficiencies compared to those without EHR systems (IRR = 0.82, 95% CI [0.70, 0.99], p = 0.035). Conclusion: EHR implementation had a favourable impact on NH quality. Implications: Past research suggests that higher NH quality may be associated with improved financial performance. Therefore, EHR implementation has the potential to address two critical challenges: enhancing care quality and improving financial outcomes. However, government financial incentives may be necessary to address the high-cost of implementing EHR systems.
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Affiliation(s)
| | | | | | | | - Holly Felix
- University of Arkansas for Medical Sciences, USA
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2
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Tan AJ, Rusli KD, McKenna L, Tan LL, Liaw SY. Telemedicine experiences and perspectives of healthcare providers in long-term care: A scoping review. J Telemed Telecare 2024; 30:230-249. [PMID: 34666535 DOI: 10.1177/1357633x211049206] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To consolidate existing evidence on experiences and perspectives of healthcare providers involved in telemedicine services in long-term residential care. METHODS A scoping review was conducted. A systematic search for articles published in 2000-2021 was performed in CINAHL, Web of Science, PubMed, EMBASE and Scopus; further, relevant journals and grey literature websites were hand searched. Key search terms included 'telemedicine', 'telehealth' and 'nursing homes'. RESULTS Twenty-six articles were included. A narrative synthesis of evidence was conducted. The review identified four themes: (1) Presence of multidisciplinary care, (2) perceived usefulness of telemedicine, (3) perceived ease of use and (4) expanded role of nursing home staff. The presence of multidisciplinary care providers provided a wide range of telemedicine services to residents and promoted interprofessional collaboration between acute and long-term care. Telemedicine was perceived to increase timely onsite management by remote specialists, which enabled care quality improvement. However, technical problems associated with equipment usage reduced the ease of use of telemedicine. Concerns emerged from the expanded role of nursing home staff, which could negatively affect clinical decision-making and create medico-legal risks. CONCLUSION AND IMPLICATIONS Telemedicine is valuable in distance-based care, especially in the current 2019 coronavirus pandemic, for supporting continuity of care to nursing home residents. This review provided evidence from multiple healthcare providers' perspectives. Further research can elucidate their specific roles and responsibilities in telemedicine and challenges in work processes, which will facilitate developing evidence-based competencies and improving technical infrastructure, thus contributing to personal and organisational readiness for telemedicine integration.
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Affiliation(s)
- Apphia Jq Tan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Khairul Db Rusli
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Laurence Lc Tan
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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3
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Huang SS, Stenner SP, Rosenbloom ST. The 21st Century Cures Act Information Blocking Rule in Post-Acute Long-Term Care. J Am Med Dir Assoc 2024; 25:58-60. [PMID: 37402466 DOI: 10.1016/j.jamda.2023.05.030] [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] [Received: 03/06/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023]
Abstract
Included as part of the 21st Century Cures Act, the information blocking rule entered the first compliance phase in April 2021. Under this rule, post-acute long-term care (PALTC) facilities must not engage in any activity that interferes with accessing, using, or exchanging electronic health information. In addition, facilities must respond to information requests in a timely fashion and allow records to be readily available to patients and their delegates. Although hospitals have been slow to adapt to these changes, skilled nursing and other PALTC centers have been even slower. With a Final Rule enacted in recent years, awareness of the information-blocking rules became more crucial. We believe this commentary will help our colleagues interpret the rule for the PALTC setting. In addition, we provide points of emphasis to help guide those providers and administrative staff workers toward compliance and avoid potential penalties.
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Affiliation(s)
- Sean S Huang
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Shane P Stenner
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Hakimjavadi R, Karunananthan S, Alexander G, Fung C, Gazarin M, Houghton D, Hsu AT, LaPlante J, Levi C, Tanuseputro P, Liddy C. What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol. BMJ Open 2023; 13:e064745. [PMID: 36764709 PMCID: PMC9923326 DOI: 10.1136/bmjopen-2022-064745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION The number of Canadians 75 years and older is expected to double over the next 20 years, putting continuing care systems such as long-term care (LTC) homes under increasing pressure. Health information technology (IT) has been found to improve the quality, safety and efficiency of care in numerous clinical settings and could help optimise LTC for residents. However, the level of health IT adoption in Ontario's LTC homes is unknown and, as a result, requires an accurate assessment to provide a baseline understanding for future planning. METHODS AND ANALYSIS We will use a cross-sectional design to investigate the level of IT maturity in Ontario's LTC homes. IT maturity will be assessed with the LTC IT Maturity Instrument, a validated survey examining IT capabilities, the extent of IT use and degree of internal/external IT integration across the domains of resident care, clinical support and administrative activities. All LTC homes in Ontario will be invited to participate. The Director of Care for each home will be directly contacted for recruitment. The survey will be distributed online (or by paper, if preferred) to LTC homes and completed by a staff member designated by the LTC to be knowledgeable about its IT systems. Analyses will consist of descriptive statistics characterising IT maturity across LTC homes and inferential statistics to examine the association between key facility-level characteristics (size, ownership, rurality) and IT maturity. ETHICS AND DISSEMINATION This study was reviewed by the Ottawa Health Science Network Research Ethics Board and was exempt from full ethics review. Findings will be disseminated through peer-reviewed publication and presentations to the scientific community and stakeholders. Dissemination of our findings will not only inform provincial planning for harnessing the potential of technology in LTC but may also enable quality improvement initiatives in individual LTC homes.
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Affiliation(s)
- Ramtin Hakimjavadi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Celeste Fung
- St. Patrick's Home of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohamed Gazarin
- Centre of Excellence for Rural Health and Education, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Deanne Houghton
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Amy T Hsu
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - James LaPlante
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
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Alexander GL, McMullen T. Probing into Federal Policies and National Academies' Recommendations to Adopt Health Information Technology in All U.S. Nursing Homes. J Am Geriatr Soc 2023; 71:349-356. [PMID: 36795635 DOI: 10.1111/jgs.18259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/17/2023]
Affiliation(s)
| | - Tara McMullen
- Master's in Aging and Health Program, Georgetown University, Washington, DC, USA
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6
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Sillner AY, Berish D, Mailhot T, Sweeder L, Fick DM, Kolanowski AM. Delirium superimposed on dementia in post-acute care: Nurse documentation of symptoms and interventions. Geriatr Nurs 2023; 49:122-126. [PMID: 36495794 PMCID: PMC9892266 DOI: 10.1016/j.gerinurse.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
Delirium superimposed on dementia (DSD) is common in older adults being discharged to post-acute care settings (PAC). Nurse documentation remains poorly understood. Aims were to describe nurse documentation and to determine associations in a secondary data analysis of a large, single-blinded randomized controlled trial (Recreational Stimulation For Elders As A Vehicle To Resolve DSD (Reserve For DSD). Just under 75% of the sample had at least one symptom of delirium documented by the nursing staff, while 25.9% had none despite being CAM positive by expert adjudication. Only 32% had an intervention documented. Number of documented interventions were significantly associated with number of documented symptoms. There is a need for research and innovation related to nurse documentation and communication of DSD symptoms and interventions in an efficient and accurate manner to impact care for vulnerable older adults in these settings.
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Affiliation(s)
- Andrea Yevchak Sillner
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA.
| | - Diane Berish
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Tanya Mailhot
- Montreal Heart Institute Research Center, Université de Montréal: Montreal, QC, CA
| | - Logan Sweeder
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Ann M Kolanowski
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
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7
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An empirical study for blockchain-based information sharing systems in electronic health records: A mediation perspective. COMPUTERS IN HUMAN BEHAVIOR 2023. [DOI: 10.1016/j.chb.2022.107471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Sadeghi R. JK, Prybutok VR, Sauser B. Theoretical and practical applications of blockchain in healthcare information management. INFORMATION & MANAGEMENT 2022. [DOI: 10.1016/j.im.2022.103649] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Soleimani J, Marquez A, Fathma S, Weister TJ, Barwise AK. Detecting professional interpreter use among patients with limited English proficiency: Derivation and validation study. SAGE Open Med 2022; 10:20503121221098146. [PMID: 35600712 PMCID: PMC9118401 DOI: 10.1177/20503121221098146] [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: 07/16/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives The objective of this derivation and validation study was to develop and validate a search strategy algorithm to detect patients who used professional interpreter services. Methods We identified all adults who had at least one intensive care unit admission during their hospital stay across the Mayo Clinic Enterprise between 1 January 2015 and 30 June 2020. Three random subsets of 100 patients were extracted from 60,268 patients to develop the search strategy algorithm. Two physician reviewers conducted gold standard manual chart review and any discrepancies were resolved by a third reviewer. These results were compared with the search strategy algorithm each time it was refined. Sensitivity and specificity were calculated during each phase by comparing the search strategy results to the reference gold standard for both derivation cohorts and the final validation cohort. Results The first search strategy resulted in a sensitivity of 100% and a specificity of 89%. The second revised search strategy achieved a sensitivity of 100% and a specificity of 87%. The final version of the search strategy was applied to the validation subset and sensitivity and specificity were 100% and 89%, respectively. Conclusion We derived and validated a search strategy algorithm to assess interpreter use among hospitalized patients. Using a search strategy algorithm with high sensitivity and specificity can reduce the time required to abstract data from the electronic medical records compared with manual data abstraction.
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Affiliation(s)
- Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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10
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Kariotis TC, Prictor M, Chang S, Gray K. Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review. J Med Internet Res 2022; 24:e30405. [PMID: 35507393 PMCID: PMC9118021 DOI: 10.2196/30405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/14/2021] [Accepted: 01/13/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. OBJECTIVE This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. METHODS We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies' results and address the research questions. RESULTS The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health-related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. CONCLUSIONS We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.
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Affiliation(s)
- Timothy Charles Kariotis
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
- Melbourne School of Government, The University of Melbourne, Carlton, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Carlton, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
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Thiruchelvam K, Byles J, Hasan SS, Kairuz T. Innovating medication reviews through a technology-enabled process. Res Social Adm Pharm 2022; 18:2700-2705. [PMID: 34326004 PMCID: PMC8847068 DOI: 10.1016/j.sapharm.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 10/31/2022]
Abstract
Medication reviews are effective in improving the quality of medication use among older people. However, they are conducted to various standards resulting in a wide range of outcomes which limit generalisability of findings arising from research studies. There also appear to be funding and time constraints, lack of data storage for quality improvement purposes, and non-standardised reporting of outcomes, especially clinically relevant outcomes. Furthermore, the coronavirus disease-19 (COVID-19) pandemic has restricted many face-to-face activities, including medication reviews. This article introduces a technology-enabled approach to medication reviews that may overcome some limitations with current medication review processes, and also make it possible to conduct medication reviews during the COVID-19 pandemic by providing an alternate platform. The possible advantages of this technology-enabled approach, legislative considerations and possible implementation in practice are discussed.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom.
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
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Alexander GL, Deroche CB, Powell KR, Mosa ASM, Popejoy L, Koopman RJ, Liu J. Development and Pilot Analysis of the Nursing Home Health Information Technology Maturity Survey and Staging Model. Res Gerontol Nurs 2022; 15:93-99. [PMID: 35312439 DOI: 10.3928/19404921-20220218-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current research includes a psychometric test of a nursing home (NH) health information technology (HIT) maturity survey and staging model. NHs were assembled based on HIT survey scores from a prior study representing NHs with low (20%), medium (60%), and high (20%) HIT scores. Inclusion criteria were NHs that completed at least two annual surveys over 4 years. NH administrators were excluded who participated in the Delphi panel responsible for instrument recommendations. Recruitment occurred from January to May 2019. Administrators from 121 of 429 facilities completed surveys. NHs were characteristically for-profit, medium bed size, and metropolitan. A covariance matrix demonstrated that all dimensions and domains were significantly correlated, except HIT capabilities and integration in administrative activities. Cronbach's alpha was very good (0.86). Principal component analysis revealed all items loaded intuitively onto four components, explaining 80% variance. The HIT maturity survey and staging model can be used to assess nine dimensions and domains, total HIT maturity, and stage, leading to reliable assumptions about NH HIT. [Research in Gerontological Nursing, 15(2), 93-99.].
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Alexander GL, Liu J, Powell KR, Stone PW. Examining Structural Disparities in U.S. Nursing Homes: A National Survey of Health Information Technology Maturity (Preprint). JMIR Aging 2022; 5:e37482. [PMID: 35998030 PMCID: PMC9449826 DOI: 10.2196/37482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/07/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods NHs (n=6123, >20%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes.
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Affiliation(s)
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY, United States
| | - Kimberly R Powell
- Sinclair School of Nursing, University of Missouri, Jefferson City, MO, United States
| | - Patricia W Stone
- School of Nursing, Columbia University, New York, NY, United States
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14
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Ngugi PN, Were MC, Babic A. Users' perception on factors contributing to electronic medical records systems use: a focus group discussion study in healthcare facilities setting in Kenya. BMC Med Inform Decis Mak 2021; 21:362. [PMID: 34955098 PMCID: PMC8710176 DOI: 10.1186/s12911-021-01737-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Electronic medical records systems (EMRs) adoption in healthcare to facilitate work processes have become common in many countries. Although EMRs are associated with quality patient care, patient safety, and cost reduction, their adoption rates are comparatively low. Understanding factors associated with the use of the implemented EMRs are critical for advancing successful implementations and scale-up sustainable initiatives. The aim of this study was to explore end users’ perceptions and experiences on factors facilitating and hindering EMRs use in healthcare facilities in Kenya, a low- and middle-income country. Methods Two focus group discussions were conducted with EMRs users (n = 20) each representing a healthcare facility determined by the performance of the EMRs implementation. Content analysis was performed on the transcribed data and relevant themes derived. Results Six thematic categories for both facilitators and barriers emerged, and these related to (1) system functionalities; (2) training; (3) technical support; (4) human factors; (5) infrastructure, and (6) EMRs operation mode. The identified facilitators included: easiness of use and learning of the system complemented by EMRs upgrades, efficiency of EMRs in patient data management, responsive information technology (IT) and collegial support, and user training. The identified barriers included: frequent power blackouts, inadequate computers, retrospective data entry EMRs operation mode, lack of continuous training on system upgrades, and delayed IT support. Conclusions Users generally believed that the EMRs improved the work process, with multiple factors identified as facilitators and barriers to their use. Most users perceived system functionalities and training as motivators to EMRs use, while infrastructural issues posed as the greatest barrier. No specific EMRs use facilitators and/or barriers could be attributed to facility performance levels. Continuous evaluations are necessary to assess improvements of the identified factors as well as determine emerging issues. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01737-x.
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Affiliation(s)
- Philomena N Ngugi
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway.
| | - Martin C Were
- Vanderbilt University Medical Center, Nashville, USA
| | - Ankica Babic
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
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Wronikowska MW, Malycha J, Morgan LJ, Westgate V, Petrinic T, Young JD, Watkinson PJ. Systematic review of applied usability metrics within usability evaluation methods for hospital electronic healthcare record systems: Metrics and Evaluation Methods for eHealth Systems. J Eval Clin Pract 2021; 27:1403-1416. [PMID: 33982356 PMCID: PMC9438452 DOI: 10.1111/jep.13582] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Electronic healthcare records have become central to patient care. Evaluation of new systems include a variety of usability evaluation methods or usability metrics (often referred to interchangeably as usability components or usability attributes). This study reviews the breadth of usability evaluation methods, metrics, and associated measurement techniques that have been reported to assess systems designed for hospital staff to assess inpatient clinical condition. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we searched Medline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Open Grey from 1986 to 2019. For included studies, we recorded usability evaluation methods or usability metrics as appropriate, and any measurement techniques applied to illustrate these. We classified and described all usability evaluation methods, usability metrics, and measurement techniques. Study quality was evaluated using a modified Downs and Black checklist. RESULTS The search identified 1336 studies. After abstract screening, 130 full texts were reviewed. In the 51 included studies 11 distinct usability evaluation methods were identified. Within these usability evaluation methods, seven usability metrics were reported. The most common metrics were ISO9241-11 and Nielsen's components. An additional "usefulness" metric was reported in almost 40% of included studies. We identified 70 measurement techniques used to evaluate systems. Overall study quality was reflected in a mean modified Downs and Black checklist score of 6.8/10 (range 1-9) 33% studies classified as "high-quality" (scoring eight or higher), 51% studies "moderate-quality" (scoring 6-7), and the remaining 16% (scoring below five) were "low-quality." CONCLUSION There is little consistency within the field of electronic health record systems evaluation. This review highlights the variability within usability methods, metrics, and reporting. Standardized processes may improve evaluation and comparison electronic health record systems and improve their development and implementation.
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Affiliation(s)
| | - James Malycha
- Critical Care Research Group, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Department of Acute Care MedicineUniversity of AdelaideAdelaideAustralia
| | - Lauren J. Morgan
- Nuffield Department of Surgical SciencesUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Verity Westgate
- Critical Care Research Group, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Tatjana Petrinic
- Bodleian Health Care LibrariesJohn Radcliffe Hospital, University of OxfordOxfordUK
| | - J Duncan Young
- Critical Care Research Group, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Peter J. Watkinson
- Critical Care Research Group, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
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16
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Do Market Characteristics Matter? Factors Associated with Health Information Exchange. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211976. [PMID: 34831731 PMCID: PMC8624939 DOI: 10.3390/ijerph182211976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/26/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Abstract
This study explores factors associated with the breadth (extent) and depth (level of detail) of digital information exchange among stakeholders in health information technology (IT) systems. Annual and IT surveys of the American Hospital Association and the U.S. Census Bureau’s small-area income and poverty estimates from 2014–2016 were analyzed for associations between key factors and breadth and depth of information exchange. OLS Regression was used with a sample consisting of 10,040 year-hospital observations. We found that hospital-level variables such as size, ownership type, system affiliation, physician-hospital arrangement, and revenue model affect information exchange. We further found that market-level variables such as concentration ratio, urbanness, and median household income, although they directly affect information exchange, do not moderate the relationship between hospital-level variables and information exchange. Our study fills a gap in the previous literature arising from the lack of research on the determinants of health information exchange.
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17
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Zanotto BS, Beck da Silva Etges AP, Dal Bosco A, Cortes EG, Ruschel R, De Souza AC, Andrade CMV, Viegas F, Canuto S, Luiz W, Ouriques Martins S, Vieira R, Polanczyk C, André Gonçalves M. Stroke Outcome Measurements From Electronic Medical Records: Cross-sectional Study on the Effectiveness of Neural and Nonneural Classifiers. JMIR Med Inform 2021; 9:e29120. [PMID: 34723829 PMCID: PMC8593798 DOI: 10.2196/29120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/27/2021] [Accepted: 08/05/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND With the rapid adoption of electronic medical records (EMRs), there is an ever-increasing opportunity to collect data and extract knowledge from EMRs to support patient-centered stroke management. OBJECTIVE This study aims to compare the effectiveness of state-of-the-art automatic text classification methods in classifying data to support the prediction of clinical patient outcomes and the extraction of patient characteristics from EMRs. METHODS Our study addressed the computational problems of information extraction and automatic text classification. We identified essential tasks to be considered in an ischemic stroke value-based program. The 30 selected tasks were classified (manually labeled by specialists) according to the following value agenda: tier 1 (achieved health care status), tier 2 (recovery process), care related (clinical management and risk scores), and baseline characteristics. The analyzed data set was retrospectively extracted from the EMRs of patients with stroke from a private Brazilian hospital between 2018 and 2019. A total of 44,206 sentences from free-text medical records in Portuguese were used to train and develop 10 supervised computational machine learning methods, including state-of-the-art neural and nonneural methods, along with ontological rules. As an experimental protocol, we used a 5-fold cross-validation procedure repeated 6 times, along with subject-wise sampling. A heatmap was used to display comparative result analyses according to the best algorithmic effectiveness (F1 score), supported by statistical significance tests. A feature importance analysis was conducted to provide insights into the results. RESULTS The top-performing models were support vector machines trained with lexical and semantic textual features, showing the importance of dealing with noise in EMR textual representations. The support vector machine models produced statistically superior results in 71% (17/24) of tasks, with an F1 score >80% regarding care-related tasks (patient treatment location, fall risk, thrombolytic therapy, and pressure ulcer risk), the process of recovery (ability to feed orally or ambulate and communicate), health care status achieved (mortality), and baseline characteristics (diabetes, obesity, dyslipidemia, and smoking status). Neural methods were largely outperformed by more traditional nonneural methods, given the characteristics of the data set. Ontological rules were also effective in tasks such as baseline characteristics (alcoholism, atrial fibrillation, and coronary artery disease) and the Rankin scale. The complementarity in effectiveness among models suggests that a combination of models could enhance the results and cover more tasks in the future. CONCLUSIONS Advances in information technology capacity are essential for scalability and agility in measuring health status outcomes. This study allowed us to measure effectiveness and identify opportunities for automating the classification of outcomes of specific tasks related to clinical conditions of stroke victims, and thus ultimately assess the possibility of proactively using these machine learning techniques in real-world situations.
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Affiliation(s)
- Bruna Stella Zanotto
- National Institute of Health Technology Assessment - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Paula Beck da Silva Etges
- National Institute of Health Technology Assessment - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Avner Dal Bosco
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Gabriel Cortes
- Graduate Program of Computer Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata Ruschel
- National Institute of Health Technology Assessment - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Claudio M V Andrade
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Viegas
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sergio Canuto
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Washington Luiz
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Renata Vieira
- Centro Interdisciplinar de História, Culturas e Sociedades (CIDEHUS), Universidade de Évora, Évora, Portugal
| | - Carisi Polanczyk
- National Institute of Health Technology Assessment - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcos André Gonçalves
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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18
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Ngugi P, Babic A, Were MC. A multivariate statistical evaluation of actual use of electronic health record systems implementations in Kenya. PLoS One 2021; 16:e0256799. [PMID: 34492070 PMCID: PMC8423313 DOI: 10.1371/journal.pone.0256799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Health facilities in developing countries are increasingly adopting Electronic Health Records systems (EHRs) to support healthcare processes. However, only limited studies are available that assess the actual use of the EHRs once adopted in these settings. We assessed the state of the 376 KenyaEMR system (national EHRs) implementations in healthcare facilities offering HIV services in Kenya. Methods The study focused on seven EHRs use indicators. Six of the seven indicators were programmed and packaged into a query script for execution within each KenyaEMR system (KeEMRs) implementation to collect monthly server-log data for each indicator for the period 2012–2019. The indicators included: Staff system use, observations (clinical data volume), data exchange, standardized terminologies, patient identification, and automatic reports. The seventh indicator (EHR variable Completeness) was derived from routine data quality report within the EHRs. Data were analysed using descriptive statistics, and multiple linear regression analysis was used to examine how individual facility characteristics affected the use of the system. Results 213 facilities spanning 19 counties participated in the study. The mean number of authorized users who actively used the KeEMRs was 18.1% (SD = 13.1%, p<0.001) across the facilities. On average, the volume of clinical data (observations) captured in the EHRs was 3363 (SD = 4259). Only a few facilities(14.1%) had health data exchange capability. 97.6% of EHRs concept dictionary terms mapped to standardized terminologies such as CIEL. Within the facility EHRs, only 50.5% (SD = 35.4%, p< 0.001) of patients had the nationally-endorsed patient identifier number recorded. Multiple regression analysis indicated the need for improvement on the mode of EHRs use of implementation. Conclusion The standard EHRs use indicators can effectively measure EHRs use and consequently determine success of the EHRs implementations. The results suggest that most of the EHRs use areas assessed need improvement, especially in relation to active usage of the system and data exchange readiness.
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Affiliation(s)
- Philomena Ngugi
- Department of Information Science and Media studies, University of Bergen, Bergen, Norway
- Institute of Biomedical Informatics, Moi University, Eldoret, Kenya
- * E-mail:
| | - Ankica Babic
- Department of Information Science and Media studies, University of Bergen, Bergen, Norway
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Martin C. Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
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19
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Moldskred PS, Snibsøer AK, Espehaug B. Improving the quality of nursing documentation at a residential care home: a clinical audit. BMC Nurs 2021; 20:103. [PMID: 34154606 PMCID: PMC8215798 DOI: 10.1186/s12912-021-00629-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background Quality in nursing documentation holds promise to increase patient safety and quality of care. While high-quality nursing documentation implies a comprehensive documentation of the nursing process, nursing records do not always adhere to these documentation criteria. The aim of this quality improvement project was to assess the quality of electronic nursing records in a residential care home using a standardized audit tool and, if necessary, implement a tailored strategy to improve documentation practice. Methods A criteria-based clinical audit was performed in a residential care home in Norway. Quantitative criteria in the N-Catch II audit instrument was used to give an assessment of electronic nursing records on the following: nursing assessment on admission, nursing diagnoses, aims for nursing care, nursing interventions, and evaluation/progress reports. Each criterium was scored on a 0–3 point scale, with standard (complete documentation) coinciding with the highest score. A retrospective audit was conducted on 38 patient records from January to March 2018, followed by the development and execution of an implementation strategy tailored to local barriers. A re-audit was performed on 38 patient records from March to June 2019. Results None of the investigated patient records at audit fulfilled standards for recommended nursing documentation practice. Mean scores at audit varied from 0.4 (95 % confidence interval 0.3–0.6) for “aims for nursing care” to 1.1 (0.9–1.3) for “nursing diagnoses”. After implementation of a tailored multifaceted intervention strategy, an improvement (p < 0.001) was noted for all criteria except for “evaluation/progress reports” (p = 0.6). The improvement did not lead to standards being met at re-audit, where mean scores varied from 0.9 (0.8–1.1) for “evaluation/progress reports” to 1.9 (1.5–2.2) for “nursing assessment on admission”. Conclusions A criteria-based clinical audit with multifaceted tailored interventions that addresses determinants of practice may improve the quality of nursing documentation, but further cycles of the clinical audit process are needed before standards are met and focus can be shifted to sustainment of knowledge use.
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Affiliation(s)
- Preben Søvik Moldskred
- Luranetunet Care Centre, Solstrandvegen 39, 5200, Os, Norway. .,Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway.
| | - Anne Kristin Snibsøer
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway.,Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway
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20
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Hazazi A, Wilson A. Leveraging electronic health records to improve management of noncommunicable diseases at primary healthcare centres in Saudi Arabia: a qualitative study. BMC FAMILY PRACTICE 2021; 22:106. [PMID: 34044767 PMCID: PMC8157615 DOI: 10.1186/s12875-021-01456-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/10/2021] [Indexed: 12/04/2022]
Abstract
Background Electronic Health Records (EHRs) can contribute to the earlier detection and better treatment of chronic diseases by improving accuracy and accessibility of patient data. The Saudi Ministry of Health (MOH) implemented an EHR system in all primary health care clinics (PHCs) as part of measures to improve their performance in managing chronic disease. This study examined the perspective of physicians on the current scope and content of NCDs management at PHCs including the contribution of the EHR system. Methods Semi-structured interviews were conducted with 22 physicians working in chronic disease clinics at PHCs covering a range of locations and clinic sizes. The participants were selected based on their expertise using a combination of purposive and convenience sampling. The interviews were transcribed, analyzed and coded into the key themes. Results Physicians indicated that the availability of the EHR helped organise their work and positively influenced NCDs patient encounters in their PHCs. They emphasised the multiple benefits of EHR in terms of efficiency, including the accuracy of patient documentation and the availability of patient information. Shortcomings identified included the lack of a patient portal to allow patients to access information about their health and lack of capacity to facilitate multi-disciplinary care for example through referral to allied health services. Access to the EHR was limited to MOH primary healthcare centres and clinicians noted that patients also received care in private clinics and hospitals. Conclusion While well regarded by clinicians, the EHR system impact on patient care at chronic disease clinics is not being fully realised. Enabling patient access to their EHR would be help promote self-management, a core attribute of effective NCD management. Co-ordination of care is another core attribute and in the Saudi health system with multiple public and private providers, this may be substantially improved if the patients EHR was accessible wherever care was provided. There is also a need for enhanced capacity to support improving patient’s nutrition and physical activity.
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Affiliation(s)
- Ahmed Hazazi
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia. .,Department of Public Health, Faculty of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia.
| | - Andrew Wilson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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21
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Cartier Y, Fichtenberg C, Gottlieb LM. Implementing Community Resource Referral Technology: Facilitators And Barriers Described By Early Adopters. Health Aff (Millwood) 2021; 39:662-669. [PMID: 32250665 DOI: 10.1377/hlthaff.2019.01588] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health care organizations are increasingly implementing programs to address patients' social conditions. To support these efforts, new technology platforms have emerged to facilitate referrals to community social services organizations. To understand the functionalities of these platforms and identify the lessons learned by their early adopters in health care, we reviewed nine platforms that were on the market in 2018 and interviewed representatives from thirty-five early-adopter health care organizations. We identified key informants through solicited expert recommendations and web searches. With minor variations, all platforms in the sample provided similar core functionalities: screening for social risks, a resource directory, referral management, care coordination, privacy protection, systems integration, and reporting and analytics. Early adopters reported three key implementation challenges: engaging community partners, managing internal change processes, and ensuring compliance with privacy regulations. We conclude that early engagement with social services partners, funding models that support both direct and indirect costs, and stronger evidence of effectiveness together could help advance platform adoption.
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Affiliation(s)
- Yuri Cartier
- Yuri Cartier ( yuri. cartier@ucsf. edu ) is a research associate in the Social Interventions Research and Evaluation Network, University of California San Francisco
| | - Caroline Fichtenberg
- Caroline Fichtenberg is managing director of the Social Interventions Research and Evaluation Network and a research scientist in the Department of Family and Community Medicine, University of California San Francisco
| | - Laura M Gottlieb
- Laura M. Gottlieb is director of the Social Interventions Research and Evaluation Network and an associate professor in the Department of Family and Community Medicine, University of California San Francisco
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22
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Ausserhofer D, Favez L, Simon M, Zúñiga F. Electronic Health Record Use in Swiss Nursing Homes and Its Association With Implicit Rationing of Nursing Care Documentation: Multicenter Cross-sectional Survey Study. JMIR Med Inform 2021; 9:e22974. [PMID: 33650983 PMCID: PMC7967228 DOI: 10.2196/22974] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/30/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nursing homes (NHs) are increasingly implementing electronic health records (EHRs); however, little information is available on EHR use in NH settings. It remains unclear how care workers perceive its safety, quality, and efficiency, and whether EHR use might ease the burden of documentation, thereby reducing its implicit rationing. OBJECTIVE This study aims to describe nurses' perceptions regarding the usefulness of the EHR system and whether sufficient numbers of computers are available in Swiss NHs, and to explore the system's association with implicit rationing of nursing care documentation. METHODS This was a multicenter cross-sectional study using survey data from the Swiss Nursing Homes Human Resources Project 2018. It includes a convenience sample of 107 NHs, 302 care units, and 1975 care workers (ie, registered nurses and licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the level of implicit rationing of nursing care documentation, their perceptions of the EHR system's usefulness and of how sufficient the number of available computers was, staffing and resource adequacy, leadership ability, and teamwork and safety climate. For analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics. RESULTS Overall, the care workers perceived the EHR systems as useful; ratings ranged from 69.42% (1362/1962; guarantees safe care and treatment) to 78.32% (1535/1960; allows quick access to relevant information on the residents). However, less than half (914/1961, 46.61%) of the care workers reported sufficient computers on their unit to allow timely documentation. Half of the care workers responded that they sometimes or often had to ration the documentation of care. After adjusting for work environment factors and safety and teamwork climate, both higher care worker ratings of the EHR system's usefulness (β=-.12; 95% CI -0.17 to -0.06) and sufficient numbers of computers (β=-.09; 95% CI -0.12 to -0.06) were consistently associated with lower implicit rationing of nursing care documentation. CONCLUSIONS Both the usefulness of the EHR system and the number of computers available were important explanatory factors for care workers leaving care activities (eg, developing or updating nursing care plans) unfinished. NH managers should carefully select and implement their information technology infrastructure with greater involvement and attention to the needs of their care workers and residents. Further research is needed to develop and implement user-friendly information technology infrastructure in NHs and to evaluate their impact on care processes as well as resident and care worker outcomes.
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Affiliation(s)
- Dietmar Ausserhofer
- College of Health Care-Professions Claudiana, Bolzano-Bozen, Italy.,Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Lauriane Favez
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Nursing Research Unit, Inselspital Bern University Hospital, Bern, Switzerland
| | - Franziska Zúñiga
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
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23
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Fennelly O, Cunningham C, Grogan L, Cronin H, O'Shea C, Roche M, Lawlor F, O'Hare N. Successfully implementing a national electronic health record: a rapid umbrella review. Int J Med Inform 2020; 144:104281. [PMID: 33017724 PMCID: PMC7510429 DOI: 10.1016/j.ijmedinf.2020.104281] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 11/03/2022]
Abstract
AIM To summarize the findings from literature reviews with a view to identifying and exploring the key factors which impact on the success of an EHR implementation across different healthcare contexts. INTRODUCTION Despite the widely recognised benefits of electronic health records (EHRs), their full potential has not always been achieved, often as a consequence of the implementation process. As more countries launch national EHR programmes, it is critical that the most up-to-date and relevant international learnings are shared with key stakeholders. METHODS A rapid umbrella review was undertaken in collaboration with a multidisciplinary panel of knowledge-users and experts from Ireland. A comprehensive literature review was completed (2019) across several search engines (PubMed, CINAHL, Scopus, Embase, Web of Science, IEEE Xplore, ACM Digital Library, ProQuest, Cochrane) and Gray literature. Identified studies (n = 5,040) were subject to eligibility criterion and identified barriers and facilitators were analysed, reviewed, discussed and interpreted by the expert panel. RESULTS Twenty-seven literature reviews were identified which captured the key organizational, human and technological factors for a successful EHR implementation according to various stakeholders across different settings. Although the size, type and culture of the healthcare setting impacted on the organizational factors, each was deemed important for EHR success; Governance, leadership and culture, End-user involvement, Training, Support, Resourcing, and Workflows. As well as organizational differences, individual end-users have varying Skills and characteristics, Perceived benefits and incentives, and Perceived changes to the health ecosystem which were also critical to success. Finally, the success of the EHR technology depended on Usability, Interoperability, Adaptability, Infrastructure, Regulation, standards and policies, and Testing. CONCLUSION Fifteen inter-linked organizational, human and technological factors emerged as important for successful EHR implementations across primary, secondary and long-term care settings. In determining how to employ these factors, the local context, individual end-users and advancing technology must also be considered.
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Affiliation(s)
- Orna Fennelly
- Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland.
| | | | - Conor O'Shea
- Irish College of General Practitioners, Ireland..
| | - Miriam Roche
- Maternal and Newborn Clinical Management System National Project Team, HSE, Ireland.
| | | | - Neil O'Hare
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland; Ireland East Hospital Group, HSE, Ireland.
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24
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Schoville R, Titler MG. Integrated Technology Implementation Model: Examination and Enhancements. Comput Inform Nurs 2020; 38:579-589. [PMID: 32520784 DOI: 10.1097/cin.0000000000000632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Integrated Technology Implementation Model introduced in 2015 highlighted elements that affect the process of integrating technology into healthcare practice and guide the selection of interventions leading the user to adopt. The Integrated Technology Implementation Model provides a conceptual guide for nursing leadership, vendors, and engineers to focus their work on technology adoption. The purpose of this exploratory qualitative study was to examine organizational and individual implementation themes and whether these themes were represented in the Integrated Technology Implementation Model. The study used focus groups and one-on-one interviews. The unit of analysis was the informants focusing on experiences of electronic health record technology implementation, leading to the adoption of a certified, Web-hosted electronic health record enterprise system. The study setting was three Michigan nonprofit long-term care facilities. The population consisted of nursing directors, nurses (RNs and LPNs), and certified nurse aides. The recruitment target was 30 participants, which was attained in the study. The ground theory method approach was used to analyze the data. From the data analysis, it was determined that workflow was not a comprehensive enough concept. The model was enhanced by adding the new work process concept, which is described as the sequence of activities and use of technology to achieve quality care for patients.
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Affiliation(s)
- Rhonda Schoville
- Author Affiliations: Systems, Populations and Leadership Department, University of Michigan School of Nursing, Ann Arbor
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25
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Wong MC, Huang J, Chan PS, Lok V, Leung C, Wang J, Cheung CS, Wong WN, Cheung NT, Ho CP, Yeoh EK. The Perceptions of and Factors Associated With the Adoption of the Electronic Health Record Sharing System Among Patients and Physicians: Cross-Sectional Survey. JMIR Med Inform 2020; 8:e17452. [PMID: 32436855 PMCID: PMC7273237 DOI: 10.2196/17452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background
The electronic health record sharing system (eHRSS) was implemented as a new health care delivery platform to facilitate two-way communication between the public and private sectors in Hong Kong.
Objective
This study aimed to investigate the perceptions of and factors associated with the adoption of eHRSS among patients, the general public, and private physicians.
Methods
Telephone interviews were conducted in 2018 by using a simple random sampling strategy from a list of patients who had enrolled in the eHRSS and a territory-wide telephone directory for nonenrolled residents. We completed 2000 surveys (1000 each for enrolled and nonenrolled individuals). Private physicians completed self-administered questionnaires, including 762 valid questionnaires from 454 enrolled physicians and 308 nonenrolled physicians.
Results
Most participants (707/1000, 70.70%) were satisfied with the overall performance of the eHRSS. Regarding registration status, most nonenrolled patients (647/1000, 64.70%) reported that “no recommendation from their physicians and family members” was the major barrier, whereas more than half of the physicians (536/1000, 53.60%) expressed concerns on “additional workload due to use of eHRSS.” A multivariate regression analysis showed that patients were more likely to register when they reported “other service providers could view the medical records” (adjusted odds ratio [aOR] 6.09, 95% CI 4.87-7.63; P<.001) and “friends’ or family’s recommendation or assistance in registration” (aOR 3.51, 95% CI 2.04-6.03; P=.001). Physicians were more likely to register when they believed that the eHRSS could improve the quality of health care service (aOR 4.70, 95% CI 1.77-12.51; P=.002) and were aware that the eHRSS could reduce duplicated tests and treatments (aOR 4.16, 95% CI 1.73-9.97; P=.001).
Conclusions
Increasing the possibility of viewing patients' personal medical record, expanding the sharable data scope for patients, and highlighting the benefits of the system for physicians could be effective to enhance the adoption of the eHRSS.
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Affiliation(s)
- Martin Cs Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Paul Sf Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Veeleah Lok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Colette Leung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Clement Sk Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Wing Nam Wong
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Ngai Tseung Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Chung Ping Ho
- Information Technology Committee, Hong Kong Medical Association, Hong Kong
| | - Eng Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Hu X, Qu H, Houser SH, Chen H, Zhou J, Yu M. Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals. Risk Manag Healthc Policy 2020; 13:295-301. [PMID: 32308512 PMCID: PMC7135123 DOI: 10.2147/rmhp.s241553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/14/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the relationship between hospital characteristics and certified electronic health record (EHR) adoption in psychiatric hospitals in the US. Methods Data were drawn from the American Hospital Association Annual Survey Database and the Centers for Medicare and Medicaid Services Hospital Compare data sets in 2016. Binary logistic regression analysis and χ2 tests were performed to examine the relationship between certified EHR adoption and hospital characteristics. Results Of 1,059 psychiatric hospitals in the US, 502 (47.4%) have adopted certified EHR technology. Large hospitals (OR 2.29, 95% CI 1.52–3.44; p<0.001), not-for-profit hospitals (OR 1.74, 95% CI 1.22–2.49; p=0.008), and hospitals participating in a network (OR 1.78, 95% CI 1.34–2.37; p<0.001) were more likely to adopt certified EHRs. Hospitals in the northeast were less likely to implement certified EHRs compared to other regions. However, there was no significant association found between EHR utilization and system affiliation, urban location, teaching status, or participation of health-maintenance organizations and preferred provider organizations. Conclusion The study results suggested variations in EHR adoption according to hospital location, size, ownership, and network participation. This study fills a gap in previous work on certified EHR adoption that focused exclusively on general hospitals, but overlooked psychiatric hospitals. Future policies designed to influence the implementation of certified EHRs should take into consideration how hospital size, ownership, and network-affiliation status affect certified EHR adoption among psychiatric hospitals.
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Affiliation(s)
- Xuejun Hu
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon H Houser
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huoliang Chen
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Jinming Zhou
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Min Yu
- Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, People's Republic of China
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Dugas M, Gao GG, Agarwal R. Unpacking mHealth interventions: A systematic review of behavior change techniques used in randomized controlled trials assessing mHealth effectiveness. Digit Health 2020; 6:2055207620905411. [PMID: 32128233 PMCID: PMC7036494 DOI: 10.1177/2055207620905411] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 01/15/2020] [Indexed: 01/05/2023] Open
Abstract
Objective Mobile health interventions have surged in popularity but their
implementation varies widely and evidence of effectiveness is mixed. We
sought to advance understanding of the diversity of behavior change
techniques in mHealth interventions, especially those that leverage advanced
mobile technologies. Methods We conducted a systematic review of articles published between 2007 and 2017
in high-impact journals in medicine, medical informatics, and health
psychology to identify randomized controlled trials in which the
effectiveness of an mobile health intervention was tested. Search terms
included a mix of general (e.g. mobile health), hardware (e.g. Android,
iPhone), and format (e.g. SMS, application) terms. Results In a systematic review of 21 studies, we found the techniques of
personalization, feedback and monitoring, and associations were most
commonly used in mobile health interventions, but there remains considerable
opportunity to leverage more sophisticated aspects of ubiquitous computing.
We found that prompts and cues were the most common behavior change
techniques used in effective trials, but there was notable overlap in
behavior change techniques used in ineffective trials. Conclusions Our results identify techniques that are commonly used in mobile health
interventions and highlight pathways to advance the science of mobile
health.
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Affiliation(s)
- Michelle Dugas
- Center for Health Information and Decision Systems, University of Maryland, USA
| | - Guodong Gordon Gao
- Center for Health Information and Decision Systems, University of Maryland, USA.,Department of Decisions, Operations, and Information Technologies, University of Maryland, USA
| | - Ritu Agarwal
- Center for Health Information and Decision Systems, University of Maryland, USA.,Department of Decisions, Operations, and Information Technologies, University of Maryland, USA
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Sieck CJ, Pearl N, Bright TJ, Yen PY. A qualitative study of physician perspectives on adaptation to electronic health records. BMC Med Inform Decis Mak 2020; 20:25. [PMID: 32039728 PMCID: PMC7008538 DOI: 10.1186/s12911-020-1030-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation. Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 min, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis. Results We identified 4 major themes related to EHR adaptation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adaptation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation. Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.
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Affiliation(s)
- Cynthia J Sieck
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, 43201, USA. .,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, Columbus, OH, USA.
| | - Nicole Pearl
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA.,Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO, USA
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Abstract
BACKGROUND The electronic medical record (EMR) is considered to be a vital tool of information and communication technology (ICT) to improve the quality of medical care, but the limited adoption of EMR by physicians results in a considerable warning to its successful implementation. The purpose of the present review is to explore and identify the potential barriers perceived by physicians in the adoption of EMR. METHODS The systematic review was carried out based on literature published in 5 databases: PubMed, Web of Science, Scopus, The Cochrane Library, and ProQuest from 2014 to 2018, concerning barriers perceived by physicians to the adoption of EMR. RESULTS The present study incorporates 26 articles based on their appropriateness out of 1354 for the final analysis. Authors explore 25 barriers that appeared 112 times in the literature for the present review; the top 5 frequently mentioned barriers are privacy and security concerns, high start-up cost, workflow changes, system complexity, lack of reliability, and interoperability. CONCLUSION The systematic review explores that physicians deal with different barriers as they intend to adopt EMR. The barriers explored in the present review are the potential to play as references for the implementer of the EMR system. Thus an attentive analysis of the definitive condition is needed before relevant intervention is determined as the implementation of EMR must be considered as a behavioral change in medical practice.
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Alexander GL, Georgiou A, Doughty K, Hornblow A, Livingstone A, Dougherty M, Jacobs S, Fisk MJ. Advancing health information technology roadmaps in long term care. Int J Med Inform 2020; 136:104088. [PMID: 32120318 DOI: 10.1016/j.ijmedinf.2020.104088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/11/2019] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Our purpose is to provide evidence that health information technology should be a mainstay of all future health and social support services for older people globally, both within and across community and residential care services. METHODS This work was conducted in two phases. In phase I, the authors conducted a focused exploration by selecting a convenience sample of four long term care health information technology roadmaps, developed by members of four different long term care health information technology collaboratives in United States, Australia, United Kingdom, and New Zealand. During Phase II the research team carried out an extensive systematic review of existing literature sources (2000-2018) to support roadmap assumptions. RESULTS Using converging domains and content, we offer recommendations among five aged care roadmap domains: Strategy/Vision, Continuing Care Community, Services and Support Provided, External Clinical Support, and Administrative. Within these domains we provide recommendations in five content areas: Innovation, Policy, Evaluation, Delivery Systems and Human Resources. We recommend future strategies for LTC HIT roadmaps that include 61 emphasis areas in aged care in these content areas and domains. CONCLUSIONS The roadmap provides a navigation tool for LTC leaders to take a strategic and comprehensive approach as they harness the potential of health information technologies to address the challenges and opportunities of LTC in the future.
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Affiliation(s)
- Gregory L Alexander
- University of Missouri, Sinclair School of Nursing S415, Columbia, MO 65211.
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW Australia 2109.
| | - Kevin Doughty
- Director at i-Centre for Usable Home Technology, Caernarfon, Gwynedd United Kingdom.
| | | | - Anne Livingstone
- Research and Development Lead, Global Community Resourcing, 1/747 Lytton Road, Murarrie, QLD 4172.
| | - Michelle Dougherty
- Sr. Health Informatics Research Scientist, RTI International, Digital Health Policy & Standards.
| | - Stephen Jacobs
- Senior Lecturer, The School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92-019, Auckland Mail Centre, Auckland NZ 1142.
| | - Malcolm J Fisk
- Senior Research Fellow, Centre for Computing and Social Responsibility, De Montfort University, Leicester., Director, Telehealth Quality Group EEIG.
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Mogensen F. Implementering af elektronisk omsorgsjournal i kommunal setting. TIDSSKRIFT FOR OMSORGSFORSKNING 2019. [DOI: 10.18261/issn.2387-5984-2019-03-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Filipec M, Brumini G. Attitude of physiotherapists toward electronic health record in Croatia. Arch Physiother 2019; 9:10. [PMID: 31660205 PMCID: PMC6805644 DOI: 10.1186/s40945-019-0062-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 09/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Electronic health record can facilitate everyday clinical practice of physiotherapists. The aim of this study is to determine attitude of physiotherapists towards implementation of information technology in their work and the differences in attitude in relation to gender, age, level of education and type of health institutions. METHODS This study is a cross-sectional survey of Croatian physiotherapists. The questionnaire ″Attitude of physiotherapists towards implementation of electronic health record included 12 items scored on a Likert-type scale from 1 to 5 and presented the award values as "Disagree", "Neither agree nor disagree" and "Agree". Croatian physiotherapists were (n = 267) recruited from 13 health care institutions. For analysis chi square test, t-test, one-way analysis of variance and as a post-hoc Tukey test were used. RESULTS Explanatory factorial analysis confirmed two factors: Satisfaction in the work of physiotherapists using computers (SAT) and Necessity of computers in the work of physiotherapists (NEC). Most physiotherapists agree on (SAT) (47.9%) and on (NEC) (51.3%). Male physiotherapists were significantly more likely to disagree with statements related to SAT (p < 0.001) and NEC (p = 0.035) than female physiotherapists. Physiotherapists aged between 46 and 55 years were significantly more like to disagree on NEC in comparison to all the other groups of participants (p < 0.001). Physiotherapists with secondary school degree were significantly more like to disagree on NEC as compared with participants with bachelor's degree (p = 0.009), as well as in comparison with physiotherapists with a university degree (p = 0.002). Most of the physiotherapists who are employed in Clinical hospitals and in the Speciality hospital agree with that statement (all p > 0.05). CONCLUSION The attitude of Croatian physiotherapists towards electronic health record differs according to the age, gender, level of education and type of health care institutions. This finding can facilitate implementation of electronic health record in physiotherapy. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Manuela Filipec
- Department of Physical Medicine and Rehabilitation, Clinical Hospital, Sveti Duh 64, 10 000 Zagreb, Croatia
| | - Gordana Brumini
- Department of Medical Informatics, Rijeka University School of Medicine, Rijeka, Croatia
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Kruse CS. Writing a Systematic Review for Publication in a Health-Related Degree Program. JMIR Res Protoc 2019; 8:e15490. [PMID: 31527018 PMCID: PMC6914304 DOI: 10.2196/15490] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/02/2019] [Accepted: 08/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The protocol in this manuscript was designed to help graduate students publish. It is the result of a challenge from our provost in 2013. I developed this protocol over the last 6 years and have exercised the protocol for the last 5 years. The current version of the protocol has remained mostly static for the last 2 years-only small changes have been made to the process. OBJECTIVE The objective of this protocol is to enable students to learn a valuable skill of conducting a systematic review and to write the review in a way that can be published. I have designed the protocol to fit into the schedule of a traditional semester, but also used it in compressed semesters. METHODS An image map was created in HTML 5.0 and imported into a learning management system. It augments traditional instruction by providing references to published articles, examples, and previously recorded instructional videos. Students use the image map outside the classroom after traditional instruction. The image map helps students create manuscripts that follow established practice and are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and whose authorship follows guidelines by the International Committee of Medical Journal Editors. RESULTS Since its inception, this protocol has helped 77 students publish 27 systematic reviews in nine journals worldwide. Some manuscripts take multiple years to progress through multiple review processes at multiple journals submitted in sequence. Two other professors in the School of Health Administration have used this protocol in their classes. CONCLUSIONS So far, this method has helped 51% of graduate students who used it in my graduate courses publish articles (with more manuscripts under consideration whose numbers have remained uncounted in this sum). I wish success to others who might use this protocol.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
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Alexander GL, Madsen R. A National Report of Nursing Home Quality and Information Technology: Two-Year Trends. J Nurs Care Qual 2019; 33:200-207. [PMID: 29787455 PMCID: PMC7268780 DOI: 10.1097/ncq.0000000000000328] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Health Information Technology is transforming healthcare delivery. This research report describes 2 year trends in technology adoption, called information technology sophistication, defined as capabilities, extent of use, and integration of technology. Trends are identified using a validated annual survey. In Year 1, 815 facilities participated in the survey; in Year 2, 484 nursing homes repeated the survey representing every US state. Statistically significant increases in information technology sophistication were found in resident care and total scores. Sample homes tended to be smaller and from small town/rural areas. There were more information technology gains than losses in technology sophistication over the 2 years in the sample. Significant correlations were identified between differences in information technology sophistication and 12 different quality measures.
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Affiliation(s)
- Gregory L Alexander
- University of Missouri, Sinclair School of Nursing, Columbia (Dr Alexander); and University of Missouri, Medical Research Office, Columbia (Dr Madsen)
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Krick T, Huter K, Domhoff D, Schmidt A, Rothgang H, Wolf-Ostermann K. Digital technology and nursing care: a scoping review on acceptance, effectiveness and efficiency studies of informal and formal care technologies. BMC Health Serv Res 2019; 19:400. [PMID: 31221133 PMCID: PMC6585079 DOI: 10.1186/s12913-019-4238-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The existence, usage and benefits of digital technologies in nursing care are relevant topics in the light of the current discussion on technologies as possible solutions to problems such as the shortage of skilled workers and the increasing demand for long-term care. A lack of good empirical overviews of existing technologies in the present literature prompted us to conduct this review. Its purpose was to map the field of digital technologies for informal and formal care that have already been explored in terms of acceptance, effectiveness and efficiency (AEE), and to show the scope of the used methods, target settings, target groups and fields of support. METHODS A systematic literature search was conducted using Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. In addition, project websites were manually screened for relevant publications. RESULTS Seven hundred fifteen papers were included in the review. Effectiveness studies have been most frequently performed for ICT, robots and sensors. Acceptance studies often focussed on ICT, robots and EHR/EMR. Efficiency studies were generally rare. Many studies were found to have a low level of evidence. Experimental designs with small numbers and without control groups were the most common methods used to evaluate acceptance and effectiveness. Study designs with high evidence levels were most commonly found for ICT, robots and e-learning. Technologies evaluated for informal caregivers and children or indicated for formal care at home or in cross-sectoral care were rare. CONCLUSION We recommend producing high-quality evaluations on existing digital technologies for AEE in real-life settings rather than systematic reviews with low-quality studies. More focus should be placed on research into efficiency. Future research should be devoted to a closer examination of the applied AEE evaluation methods. Policymakers should provide funding to enable large-scale, long-term evaluations of technologies in the practice of care, filling the research gaps for technologies, target settings and target groups identified in this review.
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Affiliation(s)
- Tobias Krick
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, 28359 Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Kai Huter
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, 28359 Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Dominik Domhoff
- Institute for Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Annika Schmidt
- Institute for Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, 28359 Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Karin Wolf-Ostermann
- Institute for Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
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Croff R, Hoffman K, Alanis-Hirsch K, Ford J, McCarty D, Schmidt L. Overcoming Barriers to Adopting and Implementing Pharmacotherapy: the Medication Research Partnership. J Behav Health Serv Res 2019; 46:330-339. [PMID: 29845513 PMCID: PMC6265123 DOI: 10.1007/s11414-018-9616-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pharmacotherapy includes a growing number of clinically effective medications for substance use disorder, yet there are significant barriers to its adoption and implementation in routine clinical practice. The Medication Research Partnership (MRP) was a successful effort to promote adoption of pharmacotherapy for opioid and alcohol use disorders in nine substance abuse treatment centers and a commercial health plan. This qualitative analysis of interviews (n = 39) conducted with change leaders at baseline and at the end/beginning of 6-month change cycles explains how treatment centers overcame obstacles to the adoption, implementation, and sustainability of pharmacotherapy. Results show that barriers to adopting, implementing, and sustaining pharmacotherapy can be overcome through incremental testing of organizational change strategies, accompanied by expert coaching and a learning community of like-minded professionals. The greatest challenges lie in overcoming abstinence-only philosophies, establishing a business case for pharmacotherapy, and working with payers and pharmaceutical representatives.
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Affiliation(s)
- Raina Croff
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA
| | - Kim Hoffman
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA.
| | | | - Jay Ford
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 610 Walnut St, Madison, WI, 53726, USA
| | - Dennis McCarty
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA
| | - Laura Schmidt
- School of Medicine, University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
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Sadoughi F, Khodaveisi T, Ahmadi H. The used theories for the adoption of electronic health record: a systematic literature review. HEALTH AND TECHNOLOGY 2018. [DOI: 10.1007/s12553-018-0277-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making. METHODS This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015. The constant comparative method (CCM) of joint coding was used for data analysis. RESULTS Nine RNs from six LTC facilities participated in the study. The RN practice environment includes two essential RN information management aspects: information resources and information spaces. Ten commonly used information resources by RNs included: (1) RN-personal notes; (2) facility-specific templates/forms; (3) nursing processes/tasks; (4) paper-based resident profile; (5) daily care plans; (6) RN-notebooks; (7) medication administration records (MARs); (8) reporting software application (RAI-MDS); (9) people (care providers); and (10) references (i.e., books). Nurses used a combination of shared information spaces, such as the Nurses Station or RN-notebook, and personal information spaces, such as personal notebooks or "sticky" notes. Four essential RN information management functions were identified: collection, classification, storage, and distribution. Six sets of information were necessary to perform RN care tasks and communication, including: (1) admission, discharge, and transfer (ADT); (2) assessment; (3) care plan; (4) intervention (with two subsets: medication and care procedure); (5) report; and (6) reference. Based on the RN information management system requirements, a graphic information flow model was constructed. CONCLUSION This baseline study identified key components of a current LTC nursing information management system. The information flow model may assist health information technology (HIT) developers to consolidate the design of HIT solutions for LTC, and serve as a communication tool between nurses and information technology (IT) staff to refine requirements and support further LTC HIT research.
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Affiliation(s)
- Quan Wei
- Alberta Health Services, Calgary, Alberta, Canada
| | - Karen L Courtney
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Bezboruah KC, Hamann D. Health IT Adoption in Nursing Homes: The Role of IT Vendors. INTERNATIONAL JOURNAL OF INNOVATION AND TECHNOLOGY MANAGEMENT 2018. [DOI: 10.1142/s0219877018500013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Applying exploratory qualitative methodologies such as interviews and focus groups, we examine the role of IT vendors in health IT adoption in nursing homes in Texas. We identify three roles pertaining to IT vendors in various adoption stages — information sources and financiers, strategic consultants, and educators in the initiation, implementation, and the institutionalization phases, respectively. Thus, vendors could be a critical factor in the health IT adoption, but nursing home management must critically evaluate not only the services, but also the strategic partnerships offered by the vendors. This is because their business interests may not address nursing homes’ distinctive need, and may prevent integration and institutionalization of health IT. As such, this research has important implications for technology adoption by nursing facilities.
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Yusif S, Hafeez-Baig A, Soar J. e-Health readiness assessment factors and measuring tools: A systematic review. Int J Med Inform 2017; 107:56-64. [PMID: 29029692 DOI: 10.1016/j.ijmedinf.2017.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The evolving, adoption and high failure nature of health information technology (HIT)/IS/T systems requires effective readiness assessment to avert increasing failures while increasing system benefits. However, literature on HIT readiness assessment is myriad and fragmented. This review bares the contours of the available literature concluding in a set of manageable and usable recommendations for policymakers, researchers, individuals and organizations intending to assess readiness for any HIT implementation. OBJECTIVES Identify studies, analyze readiness factors and offer recommendations. METHOD Published articles 1995-2016 were searched using Medline/PubMed, Cinahl, Web of Science, PsychInfo, ProQuest. Studies were included if they were assessing IS/T/mHealth readiness in the context of HIT. Articles not written in English were excluded. Themes that emerged in the process of the data synthesis were thematically analysed and interpreted. RESULTS Analyzed themes were found across 63 articles. In accordance with their prevalence of use, they included but not limited to "Technological readiness", 30 (46%); "Core/Need/Motivational readiness", 23 (37%); "Acceptance and use readiness", 19 (29%); "Organizational readiness", 20 (21%); "IT skills/Training/Learning readiness" (18%), "Engagement readiness", 16 (24%) and "Societal readiness" (14%). Despite their prevalence in use, "Technological readiness", "Motivational readiness" and "Engagement readiness" all had myriad and unreliable measuring tools. Core readiness had relatively reliable measuring tools, which repeatedly been used in various readiness assessment studies CONCLUSION: Thus, there is the need for reliable measuring tools for even the most commonly used readiness assessment factors/constructs: Core readiness, Engagement and buy-ins readiness, Technological readiness and IT Skills readiness as this could serve as an immediate step in conducting effective/reliable e-Health readiness assessment, which could lead to reduced HIT implementation failures.
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Affiliation(s)
- Salifu Yusif
- BELA, School of Management Enterprise, University of Southern Queensland, Springfield Campus, QLD, 4300, Australia.
| | - Abdul Hafeez-Baig
- School of Management and Enterprise, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Jeffrey Soar
- School of Management and Enterprise, University of Southern Queensland, Toowoomba, QLD 4350, Australia
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Allen JD, Towne SD, Maxwell AE, DiMartino L, Leyva B, Bowen DJ, Linnan L, Weiner BJ. Meausures of organizational characteristics associated with adoption and/or implementation of innovations: A systematic review. BMC Health Serv Res 2017; 17:591. [PMID: 28835273 PMCID: PMC5569532 DOI: 10.1186/s12913-017-2459-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/18/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This paper identifies and describes measures of constructs relevant to the adoption or implementation of innovations (i.e., new policies, programs or practices) at the organizational-level. This work is intended to advance the field of dissemination and implementation research by aiding scientists in the identification of existing measures and highlighting methodological issues that require additional attention. METHODS We searched for published studies (1973-2013) in 11 bibliographic databases for quantitative, empirical studies that presented outcome data related to adoption and/or implementation of an innovation. Included studies had to assess latent constructs related to the "inner setting" of the organization, as defined by the Consolidated Framework for Implementation Research. RESULTS Of the 76 studies included, most (86%) were cross sectional and nearly half (49%) were conducted in health care settings. Nearly half (46%) involved implementation of evidence-based or "best practice" strategies; roughly a quarter (26%) examined use of new technologies. Primary outcomes most often assessed were innovation implementation (57%) and adoption (34%); while 4% of included studies assessed both outcomes. There was wide variability in conceptual and operational definitions of organizational constructs. The two most frequently assessed constructs included "organizational climate" and "readiness for implementation." More than half (55%) of the studies did not articulate an organizational theory or conceptual framework guiding the inquiry; about a third (34%) referenced Diffusion of Innovations theory. Overall, only 46% of articles reported psychometric properties of measures assessing latent organizational characteristics. Of these, 94% (33/35) described reliability and 71% (25/35) reported on validity. CONCLUSIONS The lack of clarity associated with construct definitions, inconsistent use of theory, absence of standardized reporting criteria for implementation research, and the fact that few measures have demonstrated reliability or validity were among the limitations highlighted in our review. Given these findings, we recommend that increased attention be devoted toward the development or refinement of measures using common psychometric standards. In addition, there is a need for measure development and testing across diverse settings, among diverse population samples, and for a variety of types of innovations.
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Affiliation(s)
- Jennifer D. Allen
- Department of Community Health, Tufts University, 574 Boston Avenue, Medford, MA 02155 USA
| | - Samuel D. Towne
- Texas A&M University, School of Public Health, 1266 TAMU, College Station, TX 77843-1266 USA
| | - Annette E. Maxwell
- University of California Los Angeles, Fielding School of Public Health, 650 Charles Young Drive South, Los Angeles, CA 90095-6900 USA
| | - Lisa DiMartino
- Department of Health Policy and Management CB#7411, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514-7411 USA
| | - Bryan Leyva
- Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, 1107 ne 45th street #305, Seattle, WA 98105 USA
| | - Laura Linnan
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, NC 27599-7440 USA
| | - Bryan J. Weiner
- Department of Health Policy and Management, University of North Carolina Gillings School of Public Health, University of North Carolina at Chapel Hill, CB #7411, Chapel Hill, NC 27599-7400 USA
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Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open 2017; 7:e016242. [PMID: 28775188 PMCID: PMC5629741 DOI: 10.1136/bmjopen-2017-016242] [Citation(s) in RCA: 638] [Impact Index Per Article: 91.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations. OBJECTIVE The objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency. METHODS Boolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE. RESULTS 2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences. CONCLUSION This review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.
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Affiliation(s)
| | | | | | - Lan Tran
- Texas State University, San Marcos, Texas, USA
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Bjarnadottir RI, Herzig CT, Travers JL, Castle NG, Stone PW. Implementation of Electronic Health Records in US Nursing Homes. Comput Inform Nurs 2017; 35:417-424. [PMID: 28800581 PMCID: PMC5555048 DOI: 10.1097/cin.0000000000000344] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.
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Affiliation(s)
- Ragnhildur I. Bjarnadottir
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Carolyn T.A. Herzig
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 Street, New York, NY, 10032, USA
| | - Jasmine L. Travers
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Nicholas G. Castle
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
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Medication Reconciliation in Long-Term Care and Assisted Living Facilities: Opportunity for Pharmacists to Minimize Risks Associated with Transitions of Care. Clin Geriatr Med 2017; 33:225-239. [PMID: 28364993 DOI: 10.1016/j.cger.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The transitions of care process involves pharmacists and other members of the health care team who are in a position to collect, review, and analyze medications lists to help improve health care outcomes. Medication reconciliation is a complex process, especially when providing care to elderly population due to increased medication use, the movement of the patient from one health care setting to another, the number of acute and chronic illnesses, and the intervention of multiple health care providers in different facilities. The use of electronic health records can provide many benefits.
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Barriers to Electronic Health Record System Implementation and Information Systems Resources: A Structured Review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.procs.2017.12.188] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Alexander GL, Madsen RW, Miller EL, Schaumberg MK, Holm AE, Alexander RL, Wise KK, Dougherty ML, Gugerty B. A national report of nursing home information technology: year 1 results. J Am Med Inform Assoc 2017; 24:67-73. [PMID: 27107444 PMCID: PMC7654080 DOI: 10.1093/jamia/ocw051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/25/2016] [Accepted: 03/12/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To provide a report on year 1 results of a national study investigating nursing home information technology (IT) adoption, called IT sophistication. METHODS A reliable and valid survey was used to measure IT sophistication. The target goal was 10% from each state in the United States, 1570 nursing homes. A random sample of homes from each state was recruited from Nursing Home Compare. RESULTS The team reached 2627 nursing home administrators, among whom 1799 administrators agreed to participate and were sent a survey. A total of 815 surveys were completed (45.3% response rate), which was below the goal. Facilities in the participating sample have similar demographic characteristics (ownership, total population in a location, and bed size) to the remaining homes not participating. There are greater IT capabilities in resident care and administrative activities, less in clinical support. The extent of use of these capabilities appears to be highest in administrative activities and lowest in clinical support. IT in resident care appears to be the most integrated with internal and external stakeholders. IT capabilities appear to be greater than IT extent of use in all health domains, with the greatest difference in resident care. DISCUSSION National evaluations of nursing home IT are rare. Measuring trends in IT adoption in a nationally representative sample provides meaningful analytics that could be more useful for policy makers and nursing home leaders in the future. CONCLUSION Discovering national baseline assessments is a first step toward recognizing nursing home trends in IT adoption.
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Affiliation(s)
- Gregory L Alexander
- University of Missouri, S415 Sinclair School of Nursing, Columbia, MO 65211, USA
| | - Richard W Madsen
- Medical Research Office, University of Missouri, Columbia, MO, USA
| | - Erin L Miller
- Department of Anthropology, University of Missouri, Columbia, MO, USA
| | | | - Allison E Holm
- Department of Health Management and Informatics, University of Missouri, Columbia, MO, USA
| | | | - Keely K Wise
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | | | - Brian Gugerty
- Clinical Informatics Division, GiC Informatics, LLC, Annapolis, MD, USA
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Cross DA, Adler-Milstein J. Investing in Post-Acute Care Transitions: Electronic Information Exchange Between Hospitals and Long-Term Care Facilities. J Am Med Dir Assoc 2017; 18:30-34. [DOI: 10.1016/j.jamda.2016.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/22/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022]
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Mariani E, Chattat R, Vernooij-Dassen M, Koopmans R, Engels Y. Care Plan Improvement in Nursing Homes: An Integrative Review. J Alzheimers Dis 2016; 55:1621-1638. [DOI: 10.3233/jad-160559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elena Mariani
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
- Kalorama Foundation, Beek-Ubbergen, The Netherlands
- Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
- Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Barriers to Electronic Health Record Adoption: a Systematic Literature Review. J Med Syst 2016; 40:252. [PMID: 27714560 PMCID: PMC5054043 DOI: 10.1007/s10916-016-0628-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/26/2016] [Indexed: 12/16/2022]
Abstract
Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.
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50
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Alexander GL, Popejoy L, Lyons V, Shumate S, Mueller J, Galambos C, Vogelsmeier A, Rantz M, Flesner M. Exploring Health Information Exchange Implementation Using Qualitative Assessments of Nursing Home Leaders. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2016; 13:1f. [PMID: 27843423 PMCID: PMC5075234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Limited research exists on nursing home information technologies, such as health information exchange (HIE) systems. Capturing the experiences of early HIE adopters provides vital information about how these systems are used. In this study, we conduct a secondary analysis of qualitative data captured during interviews with 15 nursing home leaders representing 14 nursing homes in the midwestern United States that are part of the Missouri Quality Improvement Initiative (MOQI) national demonstration project. METHODS The interviews were conducted as part of an external evaluation of the HIE vendor contracting with the MOQI initiative with the purpose of understanding the challenges and successes of HIE implementation, with a particular focus on Direct HIE services. RESULTS Emerging themes included (1) incorporating HIE into existing work processes, (2) participation inside and outside the facility, (3) appropriate training and retraining, (4) getting others to use the HIE, (5) getting the HIE operational, and 6) putting policies for technology into place. DISCUSSION Three essential areas should be considered for nursing homes considering HIE adoption: readiness to adopt technology, availability of technology resources, and matching of new clinical workflows.
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Affiliation(s)
| | - Lori Popejoy
- University of Missouri Sinclair School of Nursing in Columbia, MO
| | - Vanessa Lyons
- University of Missouri Sinclair School of Nursing in Columbia, MO
| | | | - Jessica Mueller
- University of Missouri Sinclair School of Nursing in Columbia, MO
| | | | - Amy Vogelsmeier
- University of Missouri Sinclair School of Nursing in Columbia, MO
| | - Marilyn Rantz
- University of Missouri Sinclair School of Nursing in Columbia, MO
| | - Marcia Flesner
- University of Missouri Sinclair School of Nursing in Columbia, MO
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