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Nguyen KH, Comans T, Nguyen TT, Simpson D, Woods L, Wright C, Green D, McNeil K, Sullivan C. Cashing in: cost-benefit analysis framework for digital hospitals. BMC Health Serv Res 2024; 24:694. [PMID: 38822341 PMCID: PMC11143650 DOI: 10.1186/s12913-024-11132-7] [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: 01/10/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND For many countries, especially those outside the USA without incentive payments, implementing and maintaining electronic medical records (EMR) is expensive and can be controversial given the large amounts of investment. Evaluating the value of EMR implementation is necessary to understand whether or not, such investment, especially when it comes from the public source, is an efficient allocation of healthcare resources. Nonetheless, most countries have struggled to measure the return on EMR investment due to the lack of appropriate evaluation frameworks. METHODS This paper outlines the development of an evidence-based digital health cost-benefit analysis (eHealth-CBA) framework to calculate the total economic value of the EMR implementation over time. A net positive benefit indicates such investment represents improved efficiency, and a net negative is considered a wasteful use of public resources. RESULTS We developed a three-stage process that takes into account the complexity of the healthcare system and its stakeholders, the investment appraisal and evaluation practice, and the existing knowledge of EMR implementation. The three stages include (1) literature review, (2) stakeholder consultation, and (3) CBA framework development. The framework maps the impacts of the EMR to the quadruple aim of healthcare and clearly creates a method for value assessment. CONCLUSIONS The proposed framework is the first step toward developing a comprehensive evaluation framework for EMRs to inform health decision-makers about the economic value of digital investments rather than just the financial value.
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Affiliation(s)
- Kim-Huong Nguyen
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tracy Comans
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Thi Thao Nguyen
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- School of the Environment, The University of Queensland, Brisbane, Australia.
| | - Digby Simpson
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Leanna Woods
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Chad Wright
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Keith McNeil
- Queensland Department of Health, Brisbane, Australia
| | - Clair Sullivan
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Service, Herston, Australia
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2
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Koo YR, Kim EJ, Nam IC. Development of a communication platform for patients with head and neck cancer for effective information delivery and improvement of doctor-patient relationship: application of treatment journey-based service blueprint. BMC Med Inform Decis Mak 2024; 24:81. [PMID: 38509511 PMCID: PMC10956258 DOI: 10.1186/s12911-024-02477-4] [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: 06/05/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Effective communication and information delivery enhance doctor-patient relationships, improves adherence to treatment, reduces work burden, and supports decision-making. The study developed a head and neck cancer (HNC) communication platform to support effective delivery of information about HNC treatment and improve the doctor-patient relationship. METHODS This study was structured in three main phases: 1) The requirement elicitation phase sought an understanding of the HNC treatment journey and service failure points (FPs) obtained through patient/medical staff interviews and observations, along with a review of the electronic health record system; 2) The development phase involved core needs analysis, solutions development through a co-creation workshop, and validation of the solutions through focus groups; and 3) the proposed HNC communication platform was integrated with the current treatment system, and the flow and mechanism of the interacting services were structured using a service blueprint (SB). RESULTS Twenty-two service FPs identified through interviews and observations were consolidated into four core needs, and solutions were proposed to address each need: an HNC treatment journey map, cancer survivor stories, operation consent redesign with surgical illustrations, and a non-verbal communication toolkit. The communication platform was designed through the SB in terms of the stage at which the solution was applied and the actions and interactions of the service providers. CONCLUSIONS The developed platform has practical significance, reflecting a tangible service improvement for both patients and medical staff, making it applicable in hospital settings.
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Affiliation(s)
- Yoo-Ri Koo
- Department of Service Design, Graduate School of Industrial Arts, Hongik University, Seoul, 04066, Korea
| | - Eun-Jeong Kim
- Department of Industry-Academic Cooperation Foundation, The Catholic University of Korea, Seoul, 06591, Korea
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, 21431, Korea.
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Scheel-Sailer A, Koligi K, Lampart P, Fähndrich C, Gmünder HP, Metzger S, Schaefer D, Schmitt K, Stalder S, Wettstein R, Gemperli A. Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study. BMC Health Serv Res 2023; 23:103. [PMID: 36721265 PMCID: PMC9890825 DOI: 10.1186/s12913-023-09045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stage III and IV pressure injuries (PIs) in patients with spinal cord injury (SCI) require complex interdisciplinary and interprofessional treatment approaches that are difficult to implement. Practical aspects, such as information exchange and coordination, remain challenging. We investigated whether a computerized decision support system (CDSS) could increase treatment adherence and improve clinical outcomes and interprofessional collaboration. METHOD In this feasibility study, a core team developed the initial treatment process and adapted it based on several discussions with clinical experts and information technologists. The CDSS followed the Basel Decubitus Approach and was used in a clinic specializing in SCI. Thirty patients with SCI admitted for stage III/IV PI between July 2016 and May 2017 were randomly allocated to standard or CDSS-supported care. Between-group differences in treatment adherence, complication rates, length of stay, and costs were analyzed using descriptive statistics. The use of the CDSS and potential barriers and facilitators were evaluated through interprofessional focus groups, transcribed verbatim, and thematically analyzed (30 participants). RESULTS No differences in SCI characteristics, comorbidities, or PI characteristics (localization: ischium [number (n) = 19 PI, 63%], sacrum [n = 10 PI, 33%], recurrent PI [n = 21, 70%]) were found between the two groups. Furthermore, no statistically significant differences were observed in treatment adherence, frequency of major (20% vs. 13% between CDSS and control group) and minor (33% vs 27%) complications, and length of stay (98 [±28] vs 81 [±23] days). Healthcare professionals found the CDSS to be helpful for visualizing the treatment process. However, the high workload and difficulties in the information technology processes, such as missing reminders, slow computer performance and data processing, and poor accessibility, hindered the effective implementation of the CDSS. CONCLUSION The implementation of the CDSS to support the treatment of stage III/IV PI in patients with SCI was feasible and included definitions of milestones, interventions, and outcomes. However, to assess the impact of the CDSS, a longer observation period is required. Further, the technical difficulties must be addressed, and solid integration of the CDSS into the clinical information system is necessary. TRIAL REGISTRATION This quality improvement project received a declaration of no objection from the Ethics Committee of Northwest and Central Switzerland (EKNZ UBE-16/003), and ethical approval was received for the focus groups (EKNZ Req-2017-00860).
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Affiliation(s)
- Anke Scheel-Sailer
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland ,grid.449852.60000 0001 1456 7938Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Kamran Koligi
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Patricia Lampart
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Carina Fähndrich
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Hans Peter Gmünder
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Stefan Metzger
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Dirk Schaefer
- grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Klaus Schmitt
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Stefan Stalder
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Reto Wettstein
- grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Armin Gemperli
- grid.449852.60000 0001 1456 7938Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland ,grid.419770.cSwiss Paraplegic Research, Nottwil, Switzerland
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Abstract
Clinical informatics can support quality improvement and patient safety in the pediatric intensive care unit (PICU) in several ways including data extraction, analysis, and decision support enabled by electronic health records (EHRs), and databases and registries. Clinical decision support (CDS), embedded in EHRs, now an integral part of the workflow in the PICU, includes several tools and is increasingly leveraging artificial intelligence (AI). Understanding the opportunities and challenges can improve the engagement of clinicians with the design, validation, and implementation of CDS, improve satisfaction with CDS, and improve patient safety, care quality, and value.
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Jung SY, Lee K, Hwang H. Recent trends of healthcare information and communication technologies in pediatrics: a systematic review. Clin Exp Pediatr 2022; 65:291-299. [PMID: 34922424 PMCID: PMC9171461 DOI: 10.3345/cep.2020.01333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2021] [Indexed: 11/27/2022] Open
Abstract
As information communication technology (ICT) has advanced, the healthcare industry has embraced it to reduce medical costs, improve health outcomes, and increase patient satisfaction. Healthcare ICT revolutionizes pediatric healthcare. This study aimed to categorize and synthesize findings from the literature regarding the application of ICT in pediatric patients. This systematic review is based on a comprehensive search of Embase, MEDLINE, and Google Scholar. Study selection and coding were performed independently by 2 researchers, followed by narrative categorization. To reflect current trends in ICT for pediatrics, we adopted the Hype cycle technology classification developed by the advisory and information technology firm, Gartner, and the classification of digital health interventions by the World Health Organization. This study included a total of 135 studies. The analysis revealed 7 main types of ICT for pediatrics: (1) telehealth (39 papers), (2) precision medicine (2 papers), (3) automated decision support systems (17 papers), (4) electronic health records (7 papers), (5) patient portals (7 papers), (6) artificial intelligence (AI) (39 papers), and (7) mobile and wearable technologies (20 papers). In particular, we consistently found references to ICT for pediatrics as well as changing and improving healthcare for children. Further studies are required to determine how we can improve ICT productivity for pediatrics, particularly through AI. This study's results will help healthcare delivery organizations and technology companies consider the future direction of pediatric healthcare.
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Affiliation(s)
- Se Young Jung
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keehyuck Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Hwang
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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Yung A, Kay J, Beale P, Gibson KA, Shaw T. Computer-Based Decision Tools for Shared Therapeutic Decision-making in Oncology: Systematic Review. JMIR Cancer 2021; 7:e31616. [PMID: 34544680 PMCID: PMC8579220 DOI: 10.2196/31616] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Therapeutic decision-making in oncology is a complex process because physicians must consider many forms of medical data and protocols. Another challenge for physicians is to clearly communicate their decision-making process to patients to ensure informed consent. Computer-based decision tools have the potential to play a valuable role in supporting this process. OBJECTIVE This systematic review aims to investigate the extent to which computer-based decision tools have been successfully adopted in oncology consultations to improve patient-physician joint therapeutic decision-making. METHODS This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist and guidelines. A literature search was conducted on February 4, 2021, across the Cochrane Database of Systematic Reviews (from 2005 to January 28, 2021), the Cochrane Central Register of Controlled Trials (December 2020), MEDLINE (from 1946 to February 4, 2021), Embase (from 1947 to February 4, 2021), Web of Science (from 1900 to 2021), Scopus (from 1969 to 2021), and PubMed (from 1991 to 2021). We used a snowball approach to identify additional studies by searching the reference lists of the studies included for full-text review. Additional supplementary searches of relevant journals and gray literature websites were conducted. The reviewers screened the articles eligible for review for quality and inclusion before data extraction. RESULTS There are relatively few studies looking at the use of computer-based decision tools in oncology consultations. Of the 4431 unique articles obtained from the searches, only 10 (0.22%) satisfied the selection criteria. From the 10 selected studies, 8 computer-based decision tools were identified. Of the 10 studies, 6 (60%) were conducted in the United States. Communication and information-sharing were improved between physicians and patients. However, physicians did not change their habits to take advantage of computer-assisted decision-making tools or the information they provide. On average, the use of these computer-based decision tools added approximately 5 minutes to the total length of consultations. In addition, some physicians felt that the technology increased patients' anxiety. CONCLUSIONS Of the 10 selected studies, 6 (60%) demonstrated positive outcomes, 1 (10%) showed negative results, and 3 (30%) were neutral. Adoption of computer-based decision tools during oncology consultations continues to be low. This review shows that information-sharing and communication between physicians and patients can be improved with the assistance of technology. However, the lack of integration with electronic health records is a barrier. This review provides key requirements for enhancing the chance of success of future computer-based decision tools. However, it does not show the effects of health care policies, regulations, or business administration on physicians' propensity to adopt the technology. Nevertheless, it is important that future research address the influence of these higher-level factors as well. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021226087; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226087.
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Affiliation(s)
- Alan Yung
- Research in Implementation Science and eHealth, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Judy Kay
- Human Centred Technology Cluster, School of Computer Science, The University of Sydney, Sydney, Australia
| | - Philip Beale
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, Australia
| | - Tim Shaw
- Research in Implementation Science and eHealth, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Catalyst Translational Cancer Research Centre, The University of Sydney, Sydney, Australia
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Saigí-Rubió F, Pereyra-Rodríguez JJ, Torrent-Sellens J, Eguia H, Azzopardi-Muscat N, Novillo-Ortiz D. Routine Health Information Systems in the European Context: A Systematic Review of Systematic Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4622. [PMID: 33925384 PMCID: PMC8123776 DOI: 10.3390/ijerph18094622] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022]
Abstract
(1) Background: The aim of this study is to provide a better understanding of the requirements to improve routine health information systems (RHISs) for the management of health systems, including the identification of best practices, opportunities, and challenges in the 53 countries and territories of the WHO European region. (2) Methods: We conducted an overview of systematics reviews and searched the literature in the databases MEDLINE/PubMed, Cochrane, EMBASE, and Web of Science electronic databases. After a meticulous screening, we identified 20 that met the inclusion criteria, and RHIS evaluation results were presented according to the Performance of Routine Information System Management (PRISM) framework. (3) Results: The reviews were published between 2007 and 2020, focusing on the use of different systems or technologies and aimed to analyze interventions on professionals, centers, or patients' outcomes. All reviews examined showed variability in results in accordance with the variability of interventions and target populations. We have found different areas for improvement for RHISs according to the three determinants of the PRISM framework that influence the configuration of RHISs: technical, organizational, or behavioral elements. (4) Conclusions: RHIS interventions in the European region are promising. However, new global and international strategies and the development of tools and mechanisms should be promoted to highly integrate platforms among European countries.
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Affiliation(s)
- Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain; (F.S.-R.); (H.E.)
- Interdisciplinary Research Group on ICTs, 08035 Barcelona, Spain;
| | | | - Joan Torrent-Sellens
- Interdisciplinary Research Group on ICTs, 08035 Barcelona, Spain;
- Faculty of Economics and Business, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain
| | - Hans Eguia
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain; (F.S.-R.); (H.E.)
- SEMERGEN New Technologies Working Group, 28009 Madrid, Spain
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, Regional Office for Europe, World Health Organization, 2100 Copenhagen, Denmark;
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, Regional Office for Europe, World Health Organization, 2100 Copenhagen, Denmark;
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Mebrahtu TF, Bloor K, Ledward A, Keenan AM, Andre D, Randell R, Skyrme S, Yang H, King H, Thompson CA. Effects of computerised clinical decision support systems (CDSS) on nursing and allied health professional performance and patient outcomes. Hippokratia 2021. [DOI: 10.1002/14651858.cd014699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Karen Bloor
- Department of Health Sciences; University of York; York UK
| | | | | | - Deirdre Andre
- University of Leeds Library; University of Leeds; Leeds UK
| | - Rebecca Randell
- Faculty of Health Studies; University of Bradford; Bradford UK
| | - Sarah Skyrme
- School of Healthcare; University of Leeds; Leeds UK
| | - Huiqin Yang
- School of Healthcare; University of Leeds; Leeds UK
| | - Henry King
- School of Healthcare; University of Leeds; Leeds UK
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9
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Measures of success of computerized clinical decision support systems: An overview of systematic reviews. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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10
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Drevin G, Albutt K, Baluku M, Tuhumwiire C, Deng H, Musinguzi N, Modest V, Ngonzi J, Ttendo S, Firth P. Outcome Measurement at a Ugandan Referral Hospital: Validation of the Mbarara Surgical Services Quality Assurance Database. World J Surg 2021; 44:2550-2556. [PMID: 32333160 DOI: 10.1007/s00268-020-05537-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Five billion people lack access to surgery. Accurate and complete data have been identified as essential to the global scale-up of perioperative care. This study retrospectively validates the Mbarara Surgical Services Quality Assurance Database (SQUAD), an electronic outcomes database at a Ugandan secondary referral hospital. METHODS SQUAD data were compared to paper records from August 2013 to January 2017. To assess data entry accuracy, two researchers independently extracted 24 patient variables from 170 charts. To assess completeness of patient capture, SQUAD entries were compared to a sample of charts returned to the Medical Records Department, and to a sample of entries in ward and operating room logbooks. Two-tailed binomial proportions with 95% CI were calculated from the comparative results of patient observations, against a predefined accuracy of 0.85-0.95. RESULTS Agreement between completed validation observations from charts and SQUAD data was 91.5% (n = 3734/4080 data points). Binomial tests indicated that 15 variables had higher than 95% accuracy. A total 19 of 24 variables had ≥ 85% accuracy. The completeness of SQUAD patient capture was 98.2% (n = 167/170) of charts returned to the Medical Records Department, 97.5% (n = 198/203) of operating logbook entries, and 100% (n = 111/111) of ward logbook entries, respectively. CONCLUSION SQUAD closely reflects the primary surgical and anaesthetic data at a Ugandan secondary hospital. Data accuracy of key variables and completeness of population capture were comparable to those of databases in high-income countries and outperformed those of other low- and middle-income countries.
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Affiliation(s)
- Gustaf Drevin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department for Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Moris Baluku
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caleb Tuhumwiire
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Nicholas Musinguzi
- Harvard-Mbarara University of Science and Technology Collaborative, Mbarara, Uganda
| | - Vicki Modest
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Ttendo
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul Firth
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Avdagovska M, Menon D, Stafinski T. Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review. J Med Internet Res 2020; 22:e24568. [PMID: 33289677 PMCID: PMC7755541 DOI: 10.2196/24568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 01/18/2023] Open
Abstract
Background Despite extensive and continuing research in the area of patient portals, measuring the impact of patient portals remains a convoluted process. Objective This study aims to explore what is known about patient portal evaluations and to provide recommendations for future endeavors. The focus is on mapping the measures used to assess the impact of patient portals on the dimensions of the Quadruple Aim (QA) framework and the Canada Health Infoway’s Benefits Evaluation (BE) framework. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) extension for scoping reviews. A systematic and comprehensive search was conducted using the Ovid platform, and the following databases were searched: Ovid MEDLINE (R) ALL (including epub ahead of print, in-process, and other nonindexed citations), EMBASE, and PsycINFO. CINAHL on the EBSCO platform and Web of Science were searched for studies published between March 2015 and June 2020. A systematic gray literature search was conducted using the Google search engine. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest. Results A total of 96 studies were included for data extraction. The studies were categorized based on the QA dimensions, with strict adherence to the definitions for each dimension. From the patients’ perspective, it was determined that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on the increase in population outreach, decrease in disparities related to access to care services, and improvement in quality of care. From the health care workforce perspective, the evaluations focused on the impact of patients accessing medical records, impact on workflow, impact of bidirectional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decreases in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on health care use. Overall, 77 peer-reviewed studies were mapped on the expanded version of the BE framework. The mapping was performed using subdimensions to create a more precise representation of the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one subdimension. Conclusions The QA and BE frameworks provide guidance in identifying gaps in the current literature by providing a way to show how an impact was assessed. This study highlights the need to appropriately plan how the impact will be assessed and how the findings will be translated into effective adaptations.
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Affiliation(s)
- Melita Avdagovska
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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12
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Abstract
RATIONALE Implementation of electronic health records may improve the quality, accuracy, timeliness, and availability of documentation. Thus, our institution developed a system that integrated EEG ordering, scheduling, standardized reporting, and billing. Given the importance of user perceptions for successful implementation, we performed a quality improvement study to evaluate electroencephalographer satisfaction with the new EEG report system. METHODS We implemented an EEG report system that was integrated in an electronic health record. In this single-center quality improvement study, we surveyed electroencephalographers regarding overall acceptability, report standardization, workflow efficiency, documentation quality, and fellow education using a 0 to 5 scale (with 5 denoting best). RESULTS Eighteen electroencephalographers responded to the survey. The median score for recommending the overall system to a colleague was 5 (range 3-5), which indicated good overall satisfaction and acceptance of the system. The median scores for report standardization (4; 3-5) and workflow efficiency (4.5; 3-5) indicated that respondents perceived the system as useful and easy to use for documentation tasks. The median scores for quality of documentation (4.5; 1-5) and fellow education (4; 1-5) indicated that although most respondents believed the system provided good quality reports and helped with fellow education, a small number of respondents had substantially different views (ratings of 1). CONCLUSIONS Overall electroencephalographer satisfaction with the new EEG report system was high, as were the scores for perceived usefulness (assessed as standardization, documentation quality, and education) and ease of use (assessed as workflow efficiency). Future study is needed to determine whether implementation yields useful data for clinical research and quality improvement studies or improves EEG report standardization.
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Antonio MG, Petrovskaya O, Lau F. The State of Evidence in Patient Portals: Umbrella Review. J Med Internet Res 2020; 22:e23851. [PMID: 33174851 PMCID: PMC7688386 DOI: 10.2196/23851] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Abstract
Background Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. Objective This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. Methods For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. Results Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. Conclusions Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.
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Affiliation(s)
| | | | - Francis Lau
- University of Victoria, Victoria, BC, Canada
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14
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Leon N, Balakrishna Y, Hohlfeld A, Odendaal WA, Schmidt BM, Zweigenthal V, Anstey Watkins J, Daniels K. Routine Health Information System (RHIS) improvements for strengthened health system management. Cochrane Database Syst Rev 2020; 8:CD012012. [PMID: 32803893 PMCID: PMC8094584 DOI: 10.1002/14651858.cd012012.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND A well-functioning routine health information system (RHIS) can provide the information needed for health system management, for governance, accountability, planning, policy making, surveillance and quality improvement, but poor information support has been identified as a major obstacle for improving health system management. OBJECTIVES To assess the effects of interventions to improve routine health information systems in terms of RHIS performance, and also, in terms of improved health system management performance, and improved patient and population health outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE Ovid and Embase Ovid in May 2019. We searched Global Health, Ovid and PsycInfo in April 2016. In January 2020 we searched for grey literature in the Grey Literature Report and in OpenGrey, and for ongoing trials using the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov. In October 2019 we also did a cited reference search using Web of Science, and a 'similar articles' search in PubMed. SELECTION CRITERIA Randomised and non-randomised trials, controlled before-after studies and time-series studies comparing routine health information system interventions, with controls, in primary, hospital or community health care settings. Participants included clinical staff and management, district management and community health workers using routine information systems. DATA COLLECTION AND ANALYSIS Two authors independently reviewed records to identify studies for inclusion, extracted data from the included studies and assessed the risk of bias. Interventions and outcomes were too varied across studies to allow for pooled risk analysis. We present a 'Summary of findings' table for each intervention comparisons broadly categorised into Technical and Organisational (or a combination), and report outcomes on data quality and service quality. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included six studies: four cluster randomised trials and two controlled before-after studies, from Africa and South America. Three studies evaluated technical interventions, one study evaluated an organisational intervention, and two studies evaluated a combination of technical and organisational interventions. Four studies reported on data quality and six studies reported on service quality. In terms of data quality, a web-based electronic TB laboratory information system probably reduces the length of time to reporting of TB test results, and probably reduces the overall rate of recording errors of TB test results, compared to a paper-based system (moderate certainty evidence). We are uncertain about the effect of the electronic laboratory information system on the recording rate of serious (misidentification) errors for TB test results compared to a paper-based system (very low certainty evidence). Misidentification errors are inaccuracies in transferring test results between an electronic register and patients' clinical charts. We are also uncertain about the effect of the intervention on service quality (timeliness of starting or changing a patient's TB treatment) (very low certainty evidence). A hand-held electronic device probably improves the length of time to report TB test results, and probably reduces the total frequency of recording errors in TB test results between the laboratory notebook and the electronic information record system, compared to a paper-based system (moderate-certainty evidence). We are, however, uncertain about the effect of the intervention on the frequency of serious (misidentification) errors in recording between the laboratory notebook and the electronic information record, compared to a paper-based system (very low certainty evidence). We are uncertain about the effect of a hospital electronic health information system on service quality (length of time outpatients spend at hospital, length of hospital stay, and hospital revenue collection), compared to a paper-based system (very low certainty evidence). High-intensity brief text messaging (SMS) may make little or no difference to data quality (in terms of completeness of documentation of pregnancy outcomes), compared to low-intensity brief text messaging (low-certainty evidence). We are uncertain about the effect of electronic drug stock notification (with either data management support or product transfer support) on service quality (in terms of transporting stock and stock levels), compared to paper-based stock notification (very low certainty evidence). We are uncertain about the effect of health information strengthening (where it is part of comprehensive service quality improvement intervention) on service quality (health worker motivation, receipt of training by health workers, health information index scores, quality of clinical observation of children and adults) (very low certainty evidence). AUTHORS' CONCLUSIONS The review indicates mixed effects of mainly technical interventions to improve data quality, with gaps in evidence on interventions aimed at enhancing data-informed health system management. There is a gap in interventions studying information support beyond clinical management, such as for human resources, finances, drug supply and governance. We need to have a better understanding of the causal mechanisms by which information support may affect change in management decision-making, to inform robust intervention design and evaluation methods.
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Affiliation(s)
- Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Ameer Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Willem A Odendaal
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Virginia Zweigenthal
- Health Impact Assessment Directorate, Department of Health: Western Cape Province, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Baashar Y, Alhussian H, Patel A, Alkawsi G, Alzahrani AI, Alfarraj O, Hayder G. Customer relationship management systems (CRMS) in the healthcare environment: A systematic literature review. COMPUTER STANDARDS & INTERFACES 2020; 71:103442. [PMID: 34170994 PMCID: PMC7194637 DOI: 10.1016/j.csi.2020.103442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 05/15/2023]
Abstract
Customer relationship management (CRM) is an innovative technology that seeks to improve customer satisfaction, loyalty, and profitability by acquiring, developing, and maintaining effective customer relationships and interactions with stakeholders. Numerous researches on CRM have made significant progress in several areas such as telecommunications, banking, and manufacturing, but research specific to the healthcare environment is very limited. This systematic review aims to categorise, summarise, synthesise, and appraise the research on CRM in the healthcare environment, considering the absence of coherent and comprehensive scholarship of disparate data on CRM. Various databases were used to conduct a comprehensive search of studies that examine CRM in the healthcare environment (including hospitals, clinics, medical centres, and nursing homes). Analysis and evaluation of 19 carefully selected studies revealed three main research categories: (i) social CRM 'eCRM'; (ii) implementing CRMS; and (iii) adopting CRMS; with positive outcomes for CRM both in terms of patients relationship/communication with hospital, satisfaction, medical treatment/outcomes and empowerment and hospitals medical operation, productivity, cost, performance, efficiency and service quality. This is the first systematic review to comprehensively synthesise and summarise empirical evidence from disparate CRM research data (quantitative, qualitative, and mixed) in the healthcare environment. Our results revealed that substantial gaps exist in the knowledge of using CRM in the healthcare environment. Future research should focus on exploring: (i) other potential factors, such as patient characteristics, culture (of both the patient and hospital), knowledge management, trust, security, and privacy for implementing and adopting CRMS and (ii) other CRM categories, such as mobile CRM (mCRM) and data mining CRM.
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Affiliation(s)
- Yahia Baashar
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
- Corresponding author.
| | - Hitham Alhussian
- Center for Research in Data Science (CERDAS), Institute of Autonomous Systems, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Malaysia
| | - Ahmed Patel
- Computer Networks and Security Laboratory, State University of Ceara, Fortaleza 60020-181, Brazil
| | - Gamal Alkawsi
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
| | | | - Osama Alfarraj
- Computer Science Department, King Saud University, Riyadh 11451, Saudi Arabia
| | - Gasim Hayder
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
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Redley B, Douglas T, Botti M. Methods used to examine technology in relation to the quality of nursing work in acute care: A systematic integrative review. J Clin Nurs 2020; 29:1477-1487. [PMID: 32045059 DOI: 10.1111/jocn.15213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/09/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To systematically locate, assess and synthesise research to describe methods used to examine technology in relation to the quality of nursing work in acute care. Specific objectives were to (a) describe the types of nursing work examined; (b) describe methods used to examine technology in nursing work; (c) identify outcomes used to evaluate technology in relation to the quality of nursing work; and (d) make recommendations for future research. BACKGROUND New technologies can offer numerous benefits to nurses; however, it is challenging to evaluate health information technologies in relation to the quality of nurses' complex day-to-day work. DESIGN A systematic integrative review using a five-step process. METHODS Five databases were searched using search terms "nurs*," "workload," "task," "time." Data screening, extraction and interpretation were conducted independently by at least two authors and agreement verified by discussion. Data extraction followed PRISMA guidelines. RESULTS Of the 41 studies included, most (87.8%, n = 36) examined physical dimensions of nursing work; 31.7% (n = 13) organisational dimensions; 17.1% (n = 8) cognitive dimensions; and only 12.2% (n = 5) emotional dimensions. More than half (58.5%, n = 24) examined only one dimension; one captured all four dimensions. Most frequently examined technologies were electronic medical/health records (36.5%) and electronic medication management (19.5%). Direct observation (58.8%, n = 28) and multiple methods (19.5%, n = 8) were the most common methods; nurse tasks, frequency, duration and time distribution were variables most often measured. CONCLUSIONS Examinations of technology in nursing work often failed to capture the multiple dimensions of this work nor did they recognise the complexity of day-to-day nursing work in acute care. There is a paucity of literature to inform how and what technology should be measured in relation to the quality of nursing care. RELEVANCE TO CLINICAL PRACTICE The outcomes inform useful research methods to comprehensively examine technology to enhance the quality of complex nursing work.
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Affiliation(s)
- Bernice Redley
- Centre for Quality and Patient Safety Research - Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Tracy Douglas
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Mari Botti
- Centre for Quality and Patient Safety Research - Epworth Healthcare Partnership, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
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Gagnon MP, Ndiaye MA, Larouche A, Chabot G, Chabot C, Buyl R, Fortin JP, Giguère A, Leblanc A, Légaré F, Motulsky A, Sicotte C, Witteman HO, Kavanagh E, Lépinay F, Roberge J, Délétroz C, Abbasgholizadeh-Rahimi S. Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial. BMJ Open 2019; 9:e028554. [PMID: 30944143 PMCID: PMC6500232 DOI: 10.1136/bmjopen-2018-028554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Multimorbidity increases care needs and primary care use among people with chronic diseases. The Concerto Health Program (CHP) has been developed to optimise chronic disease management in primary care services. However, in its current version, the CHP primarily targets clinicians and does not aim to answer directly patients' and their informal caregivers' needs for chronic disease management. Various studies have shown that interventions that increase patient activation level are associated with better health outcomes. Furthermore, educational tools must be adapted to patients and caregivers in terms of health literacy and usability. This project aims to develop, implement and evaluate a user-centred, multifunctional and personalised eHealth platform (CONCERTO+) to promote a more active patient role in chronic disease management and decision-making. METHODS AND ANALYSIS This project uses a collaborative research approach, aiming at the personalisation of CHP through three phases: (1) the development of one module of an eHealth platform based on scientific evidence and user-centred design; (2) a feasibility study of CONCERTO+ through a pilot cluster randomised controlled trial where patients with chronic diseases from a primary healthcare practice will receive CONCERTO+ during 6 months and be compared to patients from a control practice receiving usual care and (3) an analysis of CONCERTO+ potential for scaling up. To do so, we will conduct two focus groups with patients and informal caregivers and individual interviews with health professionals at the two study sites, as well as health care managers, information officers and representatives of the Ministry of Health. ETHICS AND DISSEMINATION This study received ethical approval from Ethics Committee of Université Laval. The findings will be used to inform the effectiveness of CONCERTO+ to improve management care in chronic diseases. We will disseminate findings through presentations in scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03628963; Pre-results.
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Affiliation(s)
- Marie-Pierre Gagnon
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Faculty of Nursing Sciences, Université Laval, Quebec City, QC, Canada
| | - Mame Awa Ndiaye
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
| | | | | | | | - Ronald Buyl
- Faculty of Medicine and Pharmacy, VrjeUniversiteit, Brussel, Belgium
| | - Jean-Paul Fortin
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Anik Giguère
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Annie Leblanc
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - France Légaré
- Centre de Recherche sur les Soins et les Services de Première Ligne de l’Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Aude Motulsky
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Claude Sicotte
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Eric Kavanagh
- École de design, Université Laval, Quebec City, QC, Canada
| | | | | | - Carole Délétroz
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Lausanne, Switzerland
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Abstract
INTRODUCTION Over the last two decades, patient portals have emerged as a noticeable eHealth strategy. To date, research on patient portals has been rapidly increasing. Our umbrella review aims to provide a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews (SRs). METHODS We will employ a modified version of the Joanna Briggs Institute umbrella review method. The search strategy encompasses multiple databases. The inclusion criterion is specific to SRs focused on patient portal. Patients or public were not involved in this work. ANALYSIS Two researchers will independently screen titles/abstracts and then full-text articles against the inclusion/exclusion criteria. Methodological quality of included reviews will be assessed and data will be extracted from the final selection of reviews. These reviews will be categorised into quantitative, qualitative and/or mixed-synthesis groups based on information about the design of primary studies provided in the reviews. Correspondingly, we will create quantitative, qualitative and/or mixed-synthesis Excel data-extraction tables. Within each table, data will be extracted with the reference to primary studies as reported in the reviews, and will be synthesised into themes and then a smaller number of findings/outcomes. Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence in the Evidence from Reviews of Qualitative research (CERQual) tools will be applied to assess the strength of evidence at the level of each finding/outcome. The output of our umbrella review will consist of summary of findings tables and evidence profile tables. A narrative meta-level synthesis will be provided. We will use the clinical adoption meta-model as an organising framework. ETHICS AND DISSEMINATION As an outcome of this review, we will create a guidance and roadmap to be used in a future Delphi study to gather feedback from Canadian eHealth stakeholders. We will also present at conferences and publish the final report. The umbrella review does not require ethical approval. PROSPERO REGISTRATION NUMBER CRD42018096657.
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Affiliation(s)
- Olga Petrovskaya
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Francis Lau
- School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
| | - Marcy Antonio
- School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
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Graham TA, Ballermann M, Lang E, Bullard MJ, Parsons D, Mercuur G, San Agustin P, Ali S. Emergency Physician Use of the Alberta Netcare Portal, a Province-Wide Interoperable Electronic Health Record: Multi-Method Observational Study. JMIR Med Inform 2018; 6:e10184. [PMID: 30274967 PMCID: PMC6231720 DOI: 10.2196/10184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 11/21/2022] Open
Abstract
Background The adoption and use of an electronic health record (EHR) can facilitate real-time access to key health information and support improved outcomes. Many Canadian provinces use interoperable EHRs (iEHRs) to facilitate health information exchange, but the clinical use and utility of iEHRs has not been well described. Objective The aim of this study was to describe the use of a provincial iEHR known as the Alberta Netcare Portal (ANP) in 4 urban Alberta emergency departments. The secondary objectives were to characterize the time spent using the respective electronic tools and identify the aspects that were perceived as most useful by emergency department physicians. Methods In this study, we have included 4 emergency departments, 2 using paper-based ordering (University of Alberta Hospital [UAH] and Grey Nuns Community Hospital [GNCH]) and 2 using a commercial vendor clinical information system (Peter Lougheed Centre [PLC] and Foothills Medical Centre [FMC]). Structured clinical observations of ANP use and system audit logs analysis were compared at the 4 sites from October 2014 to March 2016. Results Observers followed 142 physicians for a total of 566 hours over 376 occasions. The median percentage of observed time spent using ANP was 8.5% at UAH (interquartile range, IQR, 3.7%-13.3%), 4.4% at GNCH (IQR 2.4%-4.4%), 4.6% at FMC (IQR 2.4%-7.6%), and 5.1% at PLC (IQR 3.0%-7.7%). By combining administrative and access audit data, the median number of ANP screens (ie, results and reports displayed on a screen) accessed per patient visit were 20 at UAH (IQR 6-67), 9 at GNCH (IQR 4-29), 7 at FMC (IQR 2-18), and 5 at PLC (IQR 2-14). When compared with the structured clinical observations, the statistical analysis of screen access data showed that ANP was used more at UAH than the other sites. Conclusions This study shows that the iEHR is well utilized at the 4 sites studied, and the usage patterns implied clinical value. Use of the ANP was highest in a paper-based academic center and lower in the centers using a commercial emergency department clinical information system. More study about the clinical impacts of using iEHRs in the Canadian context including longer term impacts on quality of practice and safety are required.
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Affiliation(s)
- Timothy Ad Graham
- Alberta Health Services, Edmonton, AB, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mark Ballermann
- Alberta Health Services, Edmonton, AB, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael J Bullard
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Denise Parsons
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Gabriella Mercuur
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Pat San Agustin
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
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Kim Y, Park JE, Lee BW, Jung CH, Park DA. Comparative effectiveness of telemonitoring versus usual care for type 2 diabetes: A systematic review and meta-analysis. J Telemed Telecare 2018; 25:587-601. [PMID: 30012042 DOI: 10.1177/1357633x18782599] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS This study evaluated clinical effectiveness of telemonitoring on the management of patients with type 2 diabetes. METHODS We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane Library to identify randomized controlled trials that compared telemonitoring and usual care in patients with type 2 diabetes. RESULTS Thirty-eight studies (6855 patients) were included. Telemonitoring was associated with a significant decrease in glycated haemoglobin levels compared to usual care (weighted mean difference -0.42%, 95% confidence interval -0.56 to -0.27) but there was evidence of heterogeneity (I2 = 96.9%). Telemonitoring was associated with a significant glycated haemoglobin reduction when biological data were transmitted through a web-based device weekly, when voice feedback was performed daily or immediately and when patients were provided with counselling. Telemonitoring also reduced glycated haemoglobin level in studies that monitored patients' medication adherence, provided counselling, education and alarm message. The rate of achieving glycated haemoglobin levels of < 7% was 1.8 times higher in the telemonitoring group compared to the usual care group (risk ratio 1.83, 95% confidence interval 1.35 to 2.47, I2 = 0%). There was also significant reduction in systolic blood pressure (weighted mean difference -1.33 mm Hg) and body mass index (weighted mean difference -0.25 kg/m2), but the clinical relevance of these results can be questioned. The data available on patient satisfaction, quality of life, medication adherence, prescription changes, stress and depression were limited. CONCLUSIONS Telemonitoring interventions may be a better option than usual care in improving glycated haemoglobin control of patients with type 2 diabetes. Further studies should assess clinical benefit according to specific delivery modes of the intervention and patient-reported outcomes.
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Affiliation(s)
- Yunjung Kim
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Korea
| | - Jeong-Eun Park
- Division of Research Planning and Coordination, National Evidence-based Healthcare Collaborating Agency, Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Yonsei University College of Medicine, South Korea
| | - Chang-Hee Jung
- Division of Endocrinology and Metabolism, University of Ulsan College of Medicine, South Korea
| | - Dong-Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Korea
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Ware P, Seto E, Ross HJ. Accounting for Complexity in Home Telemonitoring: A Need for Context-Centred Evidence. Can J Cardiol 2018; 34:897-904. [DOI: 10.1016/j.cjca.2018.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 01/17/2023] Open
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Reis WC, Bonetti AF, Bottacin WE, Reis AS, Souza TT, Pontarolo R, Correr CJ, Fernandez-Llimos F. Impact on process results of clinical decision support systems (CDSSs) applied to medication use: overview of systematic reviews. Pharm Pract (Granada) 2017; 15:1036. [PMID: 29317919 PMCID: PMC5741996 DOI: 10.18549/pharmpract.2017.04.1036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/27/2017] [Indexed: 02/04/2023] Open
Abstract
Objective The purpose of this overview (systematic review of systematic reviews) is to evaluate the impact of clinical decision support systems (CDSS) applied to medication use in the care process. Methods A search for systematic reviews that address CDSS was performed on Medline following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. Terms related to CDSS and systematic reviews were used in combination with Boolean operators and search field tags to build the electronic search strategy. There was no limitation of date or language for inclusion. We included revisions that investigated, as a main or secondary objective, changes in process outcomes. The Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) score was used to evaluate the quality of the studies. Results The search retrieved 954 articles. Five articles were added through manual search, totaling an initial sample of 959 articles. After screening and reading in full, 44 systematic reviews met the inclusion criteria. In the medication-use processes where CDSS was used, the most common stages were prescribing (n=38 (86.36%) and administering (n=12 (27.27%)). Most of the systematic reviews demonstrated improvement in the health care process (30/44 - 68.2%). The main positive results were related to improvement of the quality of prescription by the physicians (14/30 - 46.6%) and reduction of errors in prescribing (5/30 - 16.6%). However, the quality of the studies was poor, according to the score used. Conclusion CDSSs represent a promising technology to optimize the medication-use process, especially related to improvement in the quality of prescriptions and reduction of prescribing errors, although higher quality studies are needed to establish the predictors of success in these systems.
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Affiliation(s)
- Wálleri C Reis
- Department of Pharmacy, Federal University of Paraiba, João Pessoa (Brazil).
| | - Aline F Bonetti
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana. Curitiba (Brazil).
| | - Wallace E Bottacin
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana. Curitiba (Brazil).
| | - Alcindo S Reis
- Specialist-Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana. Curitiba (Brazil).
| | - Thaís T Souza
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana, Curitiba (Brazil).
| | - Roberto Pontarolo
- Professor, Postgraduate Program in Pharmaceutical Sciences, Department of Pharmacy, Federal University of Parana. Curitiba (Brazil).
| | - Cassyano J Correr
- PhD - Professor, Postgraduate Program in Pharmaceutical Sciences, Department of Pharmacy, Federal University of Parana. Curitiba (Brazil).
| | - Fernando Fernandez-Llimos
- Institute for Medicines Research (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon. Lisbon (Portugal).
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Nguyen L, Wickramasinghe N, Redley B, Haddad P, Muhammad I, Botti M. Exploring nurses’ reactions to electronic nursing documentation at the point of care. INFORMATION TECHNOLOGY & PEOPLE 2017. [DOI: 10.1108/itp-10-2015-0269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to investigate nurses’ attitudes, perceptions, and reactions to a new point-of-care information system for documenting nursing care.
Design/methodology/approach
A design science research methodology (DSRM) was used to examine the feasibility and usability of a novel nursing informatics solution in the context of acute hospital care. Data were collected using focus groups and non-participant observations. Analyses were guided by the theoretical lens of actor-network theory (ANT).
Findings
The findings unpack an understanding of the potential value of a new technology, rather than a binary understanding of positive or negative value. Using the ANT lens, the study reveals the dynamics of the nurse-technology relationships and consequent disruptions throughout the translation process. The findings highlight the central role of negotiation in the socio-technical construction of the hybrid actor-network during the implementation of new technology in acute hospital contexts.
Research limitations/implications
Further studies are needed to investigate the dynamics and complexity of the translation process that occurs during technology adoption, reactions of the involved actors to the emerging network and impacts on their role and work process.
Practical implications
Engaging nurses early during development and testing; aligning the new system’s functionality and interface with nurses’ interests and work practices; and supporting changes to clinical work process to enable an effective heterogeneous actor-network to emerge and become stable.
Originality/value
This study presents a novel use of ANT in a DSRM to understand an enterprise-wide system involving nurses and real clinical settings. The emerged actor-network provides insights into the translation process when nurses adapt to using new technology in their work.
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Abu Raddaha AH. Nurses’ perceptions about and confidence in using an electronic medical record system. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817732585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Nurses are among the largest potential users of electronic medical record (EMR) systems in health care settings. Yet little is known about their perceptions and confidence toward using such systems. This study explored nurses’ perceptions toward and confidence in using the EMR system. Predictors for confidence status in using the system among nurses were postulated. Methods: A cross-sectional survey design was used. A sample of 169 nurses were recruited from a general governmental university hospital in Muscat, Oman. Results: Most of study participants did not have prior experience with EMR systems elsewhere. About half (52.1%) perceived that they were confident in using the system. A logistic regression model showed nurses who (a) had six or more years of experience in using the system, (b) perceived that their suggestions regarding improving the system were taken into consideration by the system managing team, (c) perceived that the changes introduced in the system were important to their work, and (d) perceived that the information retrieved through the system was updated, to be more likely confident in using the system. Discussion: When customizing the EMR system, the informatics team that manages the system is invited to more consider suggestions for improvement that are raised by nurses. More training on the system is suggested to increase confidence among nurses who had little experience in using the system. In order to enhance the preparation of future nurses with contemporary technology-driven health care practices, nursing schools officials are encouraged to include general computer information technology training into nursing curricula.
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Affiliation(s)
- Ahmad H Abu Raddaha
- Head of Nursing Department, and Assistant Professor College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia
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Hoerbst A, Schweitzer M. A Systematic Investigation on Barriers and Critical Success Factors for Clinical Information Systems in Integrated Care Settings. Yearb Med Inform 2017; 10:79-89. [PMID: 26293853 DOI: 10.15265/iy-2015-018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Clinical Information Systems (CIS) have ever since the introduction of information technology in healthcare played an important role to support healthcare professionals and the process of treatment. With the rise of the concept of integrated care organizational borders, the sole focus on data aggregation or healthcare professionals as users disappear more and more. The manuscript discusses the concept of CISs and investigates critical success factors for CISs in the context of integrated care and in the course of time. METHODS In order to identify critical success factors and barriers for CISs a systematic literature review was conducted based on the results from PubMed and Cochrane, using MaxQDA. Search results were thereby limited to reviews or meta-analysis. RESULTS We have found 1919 references of which 40 met the inclusion criteria. The analysis of the manuscripts resulted in a comprehensive list of success factors and barriers related to CISs in integrated care settings. Most barriers were user-related whereas for the success factors an even distribution of organizational, technical and user-related factors was observed. The vast majority of publications was focused on healthcare professionals. CONCLUSION It is important to incorporate experiences made/ collected over time, as the problems encountered seem to remain almost unvaried. In order to support further systematic investigations on the topic it is necessary to rethink existing concepts and definitions to realign them with the ideas of integrated care.
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Affiliation(s)
- A Hoerbst
- Alexander Hörbst, Research Division eHealth and Telemedicine, University for Health Sciences, Medical Informatics, and, Technology (UMIT), Eduard-Wallnoefer-Zentrum 1, 6060 Hall in Tirol, Austria, Tel.: +43 50 8648 3814, Fax: +43 50 8648 67 3814, E-mail: , Web: http://ehealth.umit.at
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Price M, Davies I, Rusk R, Lesperance M, Weber J. Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality. JMIR Med Inform 2017; 5:e15. [PMID: 28619704 PMCID: PMC5491896 DOI: 10.2196/medinform.6226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 03/21/2017] [Accepted: 04/28/2017] [Indexed: 11/24/2022] Open
Abstract
Background Potentially Inappropriate Prescriptions (PIPs) are a common cause of morbidity, particularly in the elderly. Objective We sought to understand how the Screening Tool of Older People’s Prescriptions (STOPP) prescribing criteria, implemented in a routinely used primary care Electronic Medical Record (EMR), could impact PIP rates in community (non-academic) primary care practices. Methods We conducted a mixed-method, pragmatic, cluster, randomized control trial in research naïve primary care practices. Phase 1: In the randomized controlled trial, 40 fully automated STOPP rules were implemented as EMR alerts during a 16-week intervention period. The control group did not receive the 40 STOPP rules (but received other alerts). Participants were recruited through the OSCAR EMR user group mailing list and in person at user group meetings. Results were assessed by querying EMR data PIPs. EMR data quality probes were included. Phase 2: physicians were invited to participate in 1-hour semi-structured interviews to discuss the results. Results In the EMR, 40 STOPP rules were successfully implemented. Phase 1: A total of 28 physicians from 8 practices were recruited (16 in intervention and 12 in control groups). The calculated PIP rate was 2.6% (138/5308) (control) and 4.11% (768/18,668) (intervention) at baseline. No change in PIPs was observed through the intervention (P=.80). Data quality probes generally showed low use of problem list and medication list. Phase 2: A total of 5 physicians participated. All the participants felt that they were aware of the alerts but commented on workflow and presentation challenges. Conclusions The calculated PIP rate was markedly less than the expected rate found in literature (2.6% and 4.0% vs 20% in literature). Data quality probes highlighted issues related to completeness of data in areas of the EMR used for PIP reporting and by the decision support such as problem and medication lists. Users also highlighted areas for better integration of STOPP guidelines with prescribing workflows. Many of the STOPP criteria can be implemented in EMRs using simple logic. However, data quality in EMRs continues to be a challenge and was a limiting step in the effectiveness of the decision support in this study. This is important as decision makers continue to fund implementation and adoption of EMRs with the expectation of the use of advanced tools (such as decision support) without ongoing review of data quality and improvement. Trial Registration Clinicaltrials.gov NCT02130895; https://clinicaltrials.gov/ct2/show/NCT02130895 (Archived by WebCite at http://www.webcitation.org/6qyFigSYT)
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Affiliation(s)
- Morgan Price
- LEAD Lab, Department of Family Practice, Island Medical Program, University of British Columbia, Victoria, BC, Canada.,University of Victoria, Victoria, BC, Canada
| | - Iryna Davies
- LEAD Lab, Department of Family Practice, Island Medical Program, University of British Columbia, Victoria, BC, Canada
| | - Raymond Rusk
- LEAD Lab, Department of Family Practice, Island Medical Program, University of British Columbia, Victoria, BC, Canada
| | | | - Jens Weber
- LEAD Lab, Department of Family Practice, Island Medical Program, University of British Columbia, Victoria, BC, Canada.,University of Victoria, Victoria, BC, Canada
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Singer A, Kroeker AL, Yakubovich S, Duarte R, Dufault B, Katz A. Data quality in electronic medical records in Manitoba: Do problem lists reflect chronic disease as defined by prescriptions? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:382-389. [PMID: 28500199 PMCID: PMC5429058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine if the problem list (health conditions) in primary care electronic medical records (EMRs) accurately reflects the conditions for which chronic medications are prescribed in the EMR. DESIGN A retrospective analysis of EMR data. SETTING Eighteen primary care clinics across rural and urban Manitoba using the Accuro EMR. PARTICIPANTS Data from the EMRs of active patients seen in an 18-month period (December 18, 2011, to June 18, 2013, or December 3, 2012, to June 3, 2014) were used. MAIN OUTCOME MEASURES The likelihood of documentation in the EMR problem list of those specific chronic diseases for which drug prescriptions were documented in the EMR. Regression modeling was performed to determine the effect of clinic patient load and remuneration type on the completeness of EMR problem lists. RESULTS Overall problem-list completeness was low but was highest for diabetes and lowest for insomnia. Fee-for-service clinics generally had lower problem-list completeness than salaried clinics did for all prescription medications examined. Panel size did not affect problem-list completeness rates. CONCLUSION The low EMR problem-list completeness suggests that this field is not reliable for use in quality improvement initiatives or research until higher reliability has been demonstrated. Further research is recommended to explore the reasons for the poor quality and to support improvement efforts.
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Affiliation(s)
- Alexander Singer
- Family physician, Assistant Professor in the Department of Family Medicine at the University of Manitoba in Winnipeg, and a network director for the Manitoba Primary Care Research Network.
| | - Andrea L Kroeker
- Research associate in the Department of Immunology at the University of Manitoba
| | - Sari Yakubovich
- Medical student at the University of Manitoba at the time of the study and is currently an anesthesia resident at McMaster University in Hamilton, Ont
| | | | - Brenden Dufault
- Biostatistical consultant for the Biostatistics Group at the University of Manitoba
| | - Alan Katz
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Manitoba, Director of the Manitoba Centre for Health Policy, and Manitoba Heart and Stroke Chair in Primary Prevention Research
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Zelmer J, Ronchi E, Hyppönen H, Lupiáñez-Villanueva F, Codagnone C, Nøhr C, Huebner U, Fazzalari A, Adler-Milstein J. International health IT benchmarking: learning from cross-country comparisons. J Am Med Inform Assoc 2017; 24:371-379. [PMID: 27554825 PMCID: PMC7651944 DOI: 10.1093/jamia/ocw111] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/15/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning. MATERIALS AND METHODS A prior Organization for Economic Cooperation and Development-led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking. RESULTS While electronic records are widely used to store and manage patient information at the point of care-all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%-patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist. DISCUSSION Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons. CONCLUSION While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.
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Affiliation(s)
- Jennifer Zelmer
- Azimuth Health Group, Toronto, Ontario, Canada
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Elettra Ronchi
- Organization for Economic Cooperation and Development, Paris, France
| | - Hannele Hyppönen
- Information services department, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Cristiano Codagnone
- Information and Communication Department, Universitat Oberta de Catalunya, Spain
- Dipartimento di Scienze Sociali e Politiche, Università degli Studi di Milano, Italy
| | - Christian Nøhr
- Danish Centre for Health Informatics, Aalborg University, Aalborg, Denmark
| | - Ursula Huebner
- Health Informatics Research Group, Hochschule Osnabrueck, Osnabrueck, Germany
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Cook DA, Teixeira MT, Heale BSE, Cimino JJ, Del Fiol G. Context-sensitive decision support (infobuttons) in electronic health records: a systematic review. J Am Med Inform Assoc 2017; 24:460-468. [PMID: 27497794 PMCID: PMC6080678 DOI: 10.1093/jamia/ocw104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/05/2016] [Accepted: 05/27/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Infobuttons appear as small icons adjacent to electronic health record (EHR) data (e.g., medications, diagnoses, or test results) that, when clicked, access online knowledge resources tailored to the patient, care setting, or task. Infobuttons are required for "Meaningful Use" certification of US EHRs. We sought to evaluate infobuttons' impact on clinical practice and identify features associated with improved outcomes. METHODS We conducted a systematic review, searching MEDLINE, EMBASE, and other databases from inception to July 6, 2015. We included and cataloged all original research in any language describing implementation of infobuttons or other context-sensitive links. Studies evaluating clinical implementations with outcomes of usage or impact were reviewed in greater detail. Reviewers worked in duplicate to select articles, evaluate quality, and abstract information. RESULTS Of 599 potential articles, 77 described infobutton implementation. The 17 studies meriting detailed review, including 3 randomized trials, yielded the following findings. Infobutton usage frequency ranged from 0.3 to 7.4 uses per month per potential user. Usage appeared to be influenced by EHR task. Five studies found that infobuttons are used less often than non-context-sensitive links (proportionate usage 0.20-0.34). In 3 studies, users answered their clinical question in > 69% of infobutton sessions. Seven studies evaluated alternative approaches to infobutton design and implementation. No studies isolated the impact of infobuttons on objectively measured patient outcomes. CONCLUSIONS Weak evidence suggests that infobuttons can help providers answer clinical questions. Research on optimal infobutton design and implementation, and on the impact on patient outcomes and provider behaviors, is needed.
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Affiliation(s)
- David A Cook
- Knowledge Delivery Center, Mayo Clinic College of Medicine, Rochester, MN, USA
- Mayo Clinic Online Learning, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Bret SE Heale
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - James J Cimino
- Informatics Institute, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
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Keasberry J, Scott IA, Sullivan C, Staib A, Ashby R. Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice. AUST HEALTH REV 2017; 41:646-664. [DOI: 10.1071/ah16233] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022]
Abstract
Objective
The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes.
Methods
Systematic reviews and reviews of systematic reviews of eHealth technologies published in PubMed/Medline/Cochrane Library between January 2010 and October 2015 were evaluated. Reviews of implementation issues, non-hospital settings or remote care or patient-focused technologies were excluded from analysis. Methodological quality was assessed using a validated appraisal tool. Outcome measures were benefits and harms relating to electronic medical records (EMRs), computerised physician order entry (CPOE), electronic prescribing (ePrescribing) and computerised decision support systems (CDSS). Results are presented as a narrative overview given marked study heterogeneity.
Results
Nineteen systematic reviews and two reviews of systematic reviews were included from 1197 abstracts, nine rated as high quality. For EMR functions, there was moderate-quality evidence of reduced hospitalisations and length of stay and low-quality evidence of improved organisational efficiency, greater accuracy of information and reduced documentation and process turnaround times. For CPOE functions, there was moderate-quality evidence of reductions in turnaround times and resource utilisation. For ePrescribing, there was moderate-quality evidence of substantially fewer medications errors and adverse drug events, greater guideline adherence, improved disease control and decreased dispensing turnaround times. For CDSS, there was moderate-quality evidence of increased use of preventive care and drug interaction reminders and alerts, increased use of diagnostic aids, more appropriate test ordering with fewer tests per patient, greater guideline adherence, improved processes of care and less disease morbidity. There was conflicting evidence regarding effects on in-patient mortality and overall costs. Reported harms were alert fatigue, increased technology interaction time, creation of disruptive workarounds and new prescribing errors.
Conclusion
eHealth technologies in hospital settings appear to improve efficiency and appropriateness of care, prescribing safety and disease control. Effects on mortality, readmissions, total costs and patient and provider experience remain uncertain.
What is known about the topic?
Healthcare systems internationally are undertaking large-scale digitisation programs with hospitals being a major focus. Although predictive analyses suggest that eHealth technologies have the potential to markedly transform health care delivery, contemporary peer-reviewed research evidence detailing their benefits and harms is limited.
What does this paper add?
This narrative overview of 19 systematic reviews and two reviews of systematic reviews published over the past 5 years provides a summary of cumulative evidence of clinical and organisational effects of contemporary eHealth technologies in hospital practice. EMRs have the potential to increase accuracy and completeness of clinical information, reduce documentation time and enhance information transfer and organisational efficiency. CPOE appears to improve laboratory turnaround times and decrease resource utilisation. ePrescribing significantly reduces medication errors and adverse drug events. CDSS, especially those used at the point of care and integrated into workflows, attract the strongest evidence for substantially increasing clinician adherence to guidelines, appropriateness of disease and treatment monitoring and optimal medication use. Evidence of effects of eHealth technologies on discrete clinical outcomes, such as morbid events, mortality and readmissions, is currently limited and conflicting.
What are the implications for practitioners?
eHealth technologies confer benefits in improving quality and safety of care with little evidence of major hazards. Whether EMRs and CPOE can affect clinical outcomes or overall costs in the absence of auxiliary support systems, such as ePrescribing and CDSS, remains unclear. eHealth technologies are evolving rapidly and the evidence base used to inform clinician and managerial decisions to invest in these technologies must be updated continually. More rigorous field research using appropriate evaluation methods is needed to better define real-world benefits and harms. Customisation of eHealth applications to the context of patient-centred care and management of highly complex patients with multimorbidity will be an ongoing challenge.
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Price M. Circle of care modelling: an approach to assist in reasoning about healthcare change using a patient-centric system. BMC Health Serv Res 2016; 16:546. [PMID: 27716188 PMCID: PMC5050584 DOI: 10.1186/s12913-016-1806-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/29/2016] [Indexed: 11/23/2022] Open
Abstract
Background Many health system and health Information and Communication Technology (ICT) projects do not achieve their expected benefits. This paper presents an approach to exploring changes in the healthcare system to better understand the expected improvements and other changes by using a patient-centric modelling approach. Circle of care modeling (CCM) was designed to assist stakeholders in considering healthcare system changes using a patient centric approach. Methods The CCM approach is described. It includes four steps, based on soft systems methodology: finding out, conceptual modelling, structured discussion, and describing potential improvements. There are four visualizations that are used though this process: patient-persona based rich pictures of care flows (as part of finding out), and three models: provider view, communication view, and information repository view (as part of conceptual modelling). Results Three case studies are presented where CCM was applied to different real-world healthcare problems: 1. Seeking improvements in continuity of care for end of life patients. 2. Exploring current practices for medication communication for ambulatory patients prior to an update of a jurisdictional drug information system. 3. Deciding how to improve attachment of patients to primary care. The cases illustrate how CCM helped stakeholders reason from a patient centered approach about gaps and improvements in care such as: data fragmentation (in 1), coordination efforts of medication management (in 2), and deciding to support a community health centre for unattached patients (in 3). Discussion The circle of care modelling approach has proved to be a useful tool in assisting stakeholders explore health system change in a patient centric approach. It is one way to instantiate the important principle of being patient centered into practice when considering health system changes.
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Affiliation(s)
- Morgan Price
- Island Medical Program, University of British Columbia, Vancouver, Canada. .,Department of Family Practice, Medical Science Building, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
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Nicol E, Dudley L, Bradshaw D. Assessing the quality of routine data for the prevention of mother-to-child transmission of HIV: An analytical observational study in two health districts with high HIV prevalence in South Africa. Int J Med Inform 2016; 95:60-70. [PMID: 27697233 DOI: 10.1016/j.ijmedinf.2016.09.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 07/22/2016] [Accepted: 09/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevention of mother-to-child transmission of HIV (PMTCT) is a key maternal and child-health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programmes have been incorporated in the routine District Health Management Information System (DHMIS) which collects monthly facility-based data to support the management of public-health services. To date, there has been no comprehensive evaluation of the PMTCT information system. OBJECTIVES This study seeks to evaluate the quality of output indicators for monitoring PMTCT interventions in two health districts with high HIV prevalence. METHODS An analytical observational study was undertaken based on the Performance of Routine Information System Management (PRISM) framework and tools, including an assessment of the routine PMTCT data for quality in terms of accuracy and completeness. Data were collected from 57 public health facilities for six pre-defined PMTCT data elements by comparing the source registers with the routine monthly report (RMR), and the RMR with the DMHIS for January and April 2012. This was supplemented by the analysis of the monthly data reported routinely in the DMHIS for the period 2009-2012. Descriptive statistics, analysis of variance (ANOVA) and Bland Altman analysis were conducted using STATA® Version 13. RESULTS Although completeness was relatively high at 91% (95% CI: 78-100%) at facility level and 96% (95% CI: 92-100%) at district level, the study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and RMR of 51% (95% CI: 44-58%) and between the RMR and DHMIS database of 84% (95% CI: 78-91%). We observed differences in the data accuracy by organisational authority. The poor quality of the data was attributed partly to insufficient competencies of health information personnel. CONCLUSIONS The study suggests that the primary point of departure for accurate data transfer is during the collation process. Institutional capacity to improve data quality at the facility level and ensure core competencies for routine health information system (RHIS)-related tasks are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, RHIS processes, training and leadership are needed. In particular understanding is needed about how individual actions can bring about changes in institutional routines.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, South Africa; Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Lilian Dudley
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, South Africa; School of Public Health and Family Medicine, University of Cape Town, CapeTown, South Africa
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Tharmalingam S, Hagens S, Zelmer J. The value of connected health information: perceptions of electronic health record users in Canada. BMC Med Inform Decis Mak 2016; 16:93. [PMID: 27422571 PMCID: PMC4947362 DOI: 10.1186/s12911-016-0330-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As health care becomes more complex, it becomes more important for clinicians and patients to share information. Electronic health information exchange can help address this need. To this end, all provinces and territories (PTs) in Canada have created interoperable electronic health records (iEHRs). These secure systems offer authorized users an integrated view of a person's healthcare history across the continuum of care. They include information such as lab results, medications, diagnostic images, clinical reports and immunization profiles. This study explores user experiences and perceived outcomes of iEHR use. METHODS Surveys conducted between 2006 and 2014 asked iEHR users in six Canadian PTs about system, information and service quality; iEHR use and user satisfaction; and net quality and productivity benefits. The surveys had a core set of questions that used Likert-type scales. Results were synthesized across surveys for each evaluative dimension. Consensus among researchers and subject matter experts on whether to classify the outcomes as positive, mixed/neutral, or negative was established using a modified Delphi technique. RESULTS A total of 2316 iEHR users responded to the six surveys. Information quality was the most studied area. Results varied across PTs, but positive outcomes were more common than mixed/neutral or negative outcomes by a 19:1:1 ratio across this dimension. The next most frequently studied aspects were user satisfaction, the impact of iEHR use on quality of care, and the impact on productivity. In all three areas, there were more positive than mixed/neutral or /negative results (ratios of 13:1:1, 14:3:1, and 15:2:1respectively). CONCLUSIONS Overall, users of iEHRs that provide secure access to patient information collated from across the health system tend to report positive outcomes, including quality of care and productivity. This study is an important first step in understanding user perspectives on iEHRs and health information exchange more broadly.
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Affiliation(s)
- Sukirtha Tharmalingam
- Canada Health Infoway-Inforoute Santé du Canada, 150 King St. W., Ste 1300, Toronto, M5H 1 J9, ON, Canada.
| | - Simon Hagens
- Canada Health Infoway-Inforoute Santé du Canada, 150 King St. W., Ste 1300, Toronto, M5H 1 J9, ON, Canada
| | - Jennifer Zelmer
- Canada Health Infoway-Inforoute Santé du Canada, 150 King St. W., Ste 1300, Toronto, M5H 1 J9, ON, Canada
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Chiang KF, Wang HH. Nurses’ experiences of using a smart mobile device application to assist home care for patients with chronic disease: a qualitative study. J Clin Nurs 2016; 25:2008-17. [DOI: 10.1111/jocn.13231] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kuei-Feng Chiang
- College of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
- Planning Office, Tainan Sin-Lau Hospital; Tainan City Taiwan
| | - Hsiu-Hung Wang
- College of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
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Singer A, Yakubovich S, Kroeker AL, Dufault B, Duarte R, Katz A. Data quality of electronic medical records in Manitoba: do problem lists accurately reflect chronic disease billing diagnoses? J Am Med Inform Assoc 2016; 23:1107-1112. [PMID: 27107454 DOI: 10.1093/jamia/ocw013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/01/2016] [Accepted: 01/17/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine problem list completeness related to chronic diseases in electronic medical records (EMRs) and explore clinic and physician factors influencing completeness. METHODS A retrospective analysis of primary care EMR data quality related to seven chronic diseases (hypertension, diabetes, asthma, congestive heart failure, coronary artery disease, hypothyroidism, and chronic obstructive pulmonary disorder) in Manitoba, Canada. We included 119 practices in 18 primary care clinics across urban and rural Manitoba. The main outcome measure was EMR problem list completeness. Completeness was measured by comparing the number of EMR-documented diagnoses to the number of billings associated with each disease. We calculated odds ratios for the effect of clinic patient load and salary type on EMR problem list completeness of the 7 chronic diseases. RESULTS Completeness of EMR problem list for each disease varied widely among clinics. Factors that significantly affected EMR problem list completeness included the primary care provider, the patient load, and the clinic's funding and organization model (ie, salaried, fee-for-service, or residency training clinics). Average rates of completeness were: hypertension, 72%; diabetes, 80%; hypothyroidism, 63%; asthma, 56%; chronic obstructive pulmonary disorder, 43%; congestive heart failure, 54%; and coronary artery disease, 64%. CONCLUSION This study demonstrates the high variability but generally low quality of problem lists (health condition records) related to 7 common chronic diseases in EMRs. There are systematic physician- and clinic-level factors associated with low data quality completeness. This information may be useful to support improvement in EMR data quality in primary care.
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Affiliation(s)
- Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sari Yakubovich
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrea L Kroeker
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brenden Dufault
- George and Fay Yee Center for Healthcare Innovation; College of Medicine, University of Manitoba, Canada
| | - Roberto Duarte
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Frøen JF, Myhre SL, Frost MJ, Chou D, Mehl G, Say L, Cheng S, Fjeldheim I, Friberg IK, French S, Jani JV, Kaye J, Lewis J, Lunde A, Mørkrid K, Nankabirwa V, Nyanchoka L, Stone H, Venkateswaran M, Wojcieszek AM, Temmerman M, Flenady VJ. eRegistries: Electronic registries for maternal and child health. BMC Pregnancy Childbirth 2016; 16:11. [PMID: 26791790 PMCID: PMC4721069 DOI: 10.1186/s12884-016-0801-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/07/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women's, Children's and Adolescent's Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. METHODS In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middle-income countries, and a systematic search of literature from 2005-2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. RESULTS eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paper-based data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health information. More mature country capacity reflected by published health registry based research is emerging in settings reaching regional or national scale, increasingly with electronic solutions. 66 scientific publications were identified based on 32 registry systems in 23 countries over a period of 10 years; this reflects a challenging experience and capacity gap for delivering sustainable high quality registries. CONCLUSIONS Registries are being developed and used in many high burden countries, but their potential benefits are far from realized as few countries have fully transitioned from paper-based health information to integrated electronic backbone systems. Free tools and frameworks exist to facilitate progress in health information for women and children.
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Affiliation(s)
- J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Sonja L Myhre
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Michael J Frost
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- John Snow, Inc., Boston, MA, USA.
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Garrett Mehl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Socheat Cheng
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ingvild Fjeldheim
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Ingrid K Friberg
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Steve French
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Jagrati V Jani
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Jane Kaye
- HeLEX - Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - John Lewis
- Health Information System Programme (HISP) Vietnam, Ho Chí Minh, Vietnam.
- Department of Informatics, University of Oslo, Oslo, Norway.
| | - Ane Lunde
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Kjersti Mørkrid
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Victoria Nankabirwa
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Linda Nyanchoka
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Hollie Stone
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Mahima Venkateswaran
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland, Brisbane, Australia.
- International Stillbirth Alliance, Millburn, NJ, USA.
| | | | - Vicki J Flenady
- Mater Research Institute, The University of Queensland, Brisbane, Australia.
- International Stillbirth Alliance, Millburn, NJ, USA.
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Leon N, Brady L, Kwamie A, Daniels K. Routine Health Information System (RHIS) interventions to improve health systems management. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd012012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Natalie Leon
- South African Medical Research Council; Health Systems Research Unit; Cape Town South Africa
| | - Leanne Brady
- School of Public Health and Family Medicine, University of Cape Town; Health Economics Unit, Health Policy and Systems Division; Cape Town South Africa
| | - Aku Kwamie
- School of Public Health, University of Ghana; Department of Health Policy, Planning and Management; Accra Ghana
| | - Karen Daniels
- South African Medical Research Council; Health Systems Research Unit; Cape Town South Africa
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Kilsdonk E, Peute LW, Riezebos RJ, Kremer LC, Jaspers MWM. Uncovering healthcare practitioners' information processing using the think-aloud method: From paper-based guideline to clinical decision support system. Int J Med Inform 2015; 86:10-9. [PMID: 26725690 DOI: 10.1016/j.ijmedinf.2015.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether the use of the think-aloud method with propositional analysis could be helpful in the design of a Clinical Decision Support System (CDSS) providing guideline recommendations about long-term follow-up of childhood cancer survivors. MATERIALS AND METHODS The think-aloud method was used to gain insight into healthcare professionals' information processing while reviewing a paper-based guideline. A total of 13 healthcare professionals (6 physicians and 7 physician assistants) prepared 2 fictitious patient consults using the paper-based guideline. Propositional analysis was used to analyze verbal protocols of the think-aloud sessions. A prototype CDSS was developed and a usability study was performed, again with the think-aloud method. RESULTS The analysis revealed that the paper-based guideline did not support healthcare practitioners in finding patient-specific recommendations. An information processing model for retrieving recommendations was developed and used as input for the design of a CDSS prototype user interface. Usability analysis of the prototype CDSS showed that the navigational structure of the system fitted well with healthcare practitioners' daily practices. CONCLUSIONS The think-aloud method combined with propositional analysis of healthcare practitioners' verbal utterances while they processed a paper-based guideline was useful in the design of a usable CDSS providing patient-specific guideline recommendations.
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Affiliation(s)
- E Kilsdonk
- Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - L W Peute
- Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - R J Riezebos
- Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - L C Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, The Netherlands.
| | - M W M Jaspers
- Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands.
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Early Initiation of Antiretroviral Therapy Among Young Children: A Long Way to Go. J Acquir Immune Defic Syndr 2015; 70:e70-1. [PMID: 25886929 PMCID: PMC4577609 DOI: 10.1097/qai.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Eikey EV, Reddy MC, Kuziemsky CE. Examining the role of collaboration in studies of health information technologies in biomedical informatics: A systematic review of 25 years of research. J Biomed Inform 2015; 57:263-77. [DOI: 10.1016/j.jbi.2015.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 07/31/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
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Baig MM, GholamHosseini H, Connolly MJ. Multiple physical signs detection and decision support system for hospitalized older adults. Physiol Meas 2015; 36:2069-88. [PMID: 26289926 DOI: 10.1088/0967-3334/36/10/2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way healthcare is currently delivered. Smart monitoring systems automate patient monitoring tasks and thereby improve patient workflow management. Moreover, expert systems have the potential to assist clinicians and improve their performance by accurately executing repetitive tasks, to which humans are ill-suited. Clinicians working in hospital wards are responsible for conducting a multitude of tasks which require constant vigilance, and thus the need for a smart decision support system has arisen. In particular, wireless patient monitoring systems are emerging as a low cost, reliable and accurate means of healthcare delivery. Vital signs monitoring systems are rapidly becoming part of today's healthcare delivery. The paradigm has shifted from traditional and manual recording to computer-based electronic records and, further, to handheld devices as versatile and innovative healthcare monitoring systems. The current study focuses on interpreting multiple physical signs and early warning for hospitalized older adults so that severe consequences can be minimized. Data from a total of 30 patients have been collated in New Zealand hospitals under local and national ethics approvals. The system records blood pressure, heart rate (pulse), oxygen saturation (SpO2), ear temperature and blood glucose levels from hospitalized patients and transfers this information to a web-based software application for remote monitoring and further interpretation. Ultimately, this system is aimed to achieve a high level of agreement with clinicians' interpretation when assessing specific physical signs such as bradycardia, tachycardia, hypertension, hypotension, hypoxaemia, fever and hypothermia to generate early warnings. The performance of the vital signs interpretation system was validated through off-line as well as real-time tests with a high level of agreement between the system and physician.
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Affiliation(s)
- Mirza Mansoor Baig
- Department of Electrical and Electronic Engineering, School of Engineering Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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Cole-Lewis HJ, Smaldone AM, Davidson PR, Kukafka R, Tobin JN, Cassells A, Mynatt ED, Hripcsak G, Mamykina L. Participatory approach to the development of a knowledge base for problem-solving in diabetes self-management. Int J Med Inform 2015; 85:96-103. [PMID: 26547253 DOI: 10.1016/j.ijmedinf.2015.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop an expandable knowledge base of reusable knowledge related to self-management of diabetes that can be used as a foundation for patient-centric decision support tools. MATERIALS AND METHODS The structure and components of the knowledge base were created in participatory design with academic diabetes educators using knowledge acquisition methods. The knowledge base was validated using scenario-based approach with practicing diabetes educators and individuals with diabetes recruited from Community Health Centers (CHCs) serving economically disadvantaged communities and ethnic minorities in New York. RESULTS The knowledge base includes eight glycemic control problems, over 150 behaviors known to contribute to these problems coupled with contextual explanations, and over 200 specific action-oriented self-management goals for correcting problematic behaviors, with corresponding motivational messages. The validation of the knowledge base suggested high level of completeness and accuracy, and identified improvements in cultural appropriateness. These were addressed in new iterations of the knowledge base. DISCUSSION The resulting knowledge base is theoretically grounded, incorporates practical and evidence-based knowledge used by diabetes educators in practice settings, and allows for personally meaningful choices by individuals with diabetes. Participatory design approach helped researchers to capture implicit knowledge of practicing diabetes educators and make it explicit and reusable. CONCLUSION The knowledge base proposed here is an important step towards development of new generation patient-centric decision support tools for facilitating chronic disease self-management. While this knowledge base specifically targets diabetes, its overall structure and composition can be generalized to other chronic conditions.
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Affiliation(s)
- Heather J Cole-Lewis
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; ICF International, Rockville, MD, USA
| | - Arlene M Smaldone
- School of Nursing, Columbia University, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - Patricia R Davidson
- College of Health Sciences, Nutrition Department, West Chester University, West Chester, PA, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - Rita Kukafka
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - Jonathan N Tobin
- Clinical Directors Network, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - Andrea Cassells
- Clinical Directors Network, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - Elizabeth D Mynatt
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA; Georgia Institute of Technology, Atlanta, GA, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.
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Pires MRGM, Gottems LBD, Vasconcelos Filho JE, Silva KL, Gamarski R. The Care management Information system for the home Care Network (SI GESCAD): support for care coordination and continuity of care in the Brazilian Unified health system (SUS). CIENCIA & SAUDE COLETIVA 2015; 20:1805-14. [PMID: 26060958 DOI: 10.1590/1413-81232015206.00152014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/17/2014] [Indexed: 11/22/2022] Open
Abstract
The present article describes the development of the initial version of the Brazilian Care Management Information System for the Home Care Network (SI GESCAD). This system was created to enhance comprehensive care, care coordination and the continuity of care provided to the patients, family and caretakers of the Home Care (HC) program. We also present a reflection on the contributions, limitations and possibilities of the SI GESCAD within the scope of the Home Care Network of the Brazilian Unified Health System (RAS-AD). This was a study on technology production based on a multi-method protocol. It discussed software engineering and human-computer interaction (HCI) based on user-centered design, as well as evolutionary and interactive software process (prototyping and spiral). A functional prototype of the GESCAD was finalized, which allowed for the management of HC to take into consideration the patient's social context, family and caretakers. The system also proved to help in the management of activities of daily living (ADLs), clinical care and the monitoring of variables associated with type 2 HC. The SI GESCAD allowed for a more horizontal work process for HC teams at the RAS-AD/SUS level of care, with positive repercussions on care coordination and continuity of care.
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Affiliation(s)
| | | | | | - Kênia Lara Silva
- Departamento de Enfermagem Aplicada, Escola de Enfermagem, Universidade Federal de Minas Gerais, Brasil
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Kent B, Redley B, Wickramasinghe N, Nguyen L, Taylor NJ, Moghimi H, Botti M. Exploring nurses’ reactions to a novel technology to support acute health care delivery. J Clin Nurs 2015; 24:2340-51. [DOI: 10.1111/jocn.12881] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Bernice Redley
- Epworth Healthcare and Deakin University; Richmond Vic. Australia
| | - Nilmini Wickramasinghe
- Epworth Chair in Health Information Management; Epworth HealthCare and Deakin University; Vic. Australia
| | - Lemai Nguyen
- Deakin Business School; Department of Information Systems and Business Analytics; Deakin University; VIC. Australia
| | | | - Hoda Moghimi
- Epworth Research Institute; RMIT University; Richmond Vic. Australia
| | - Mari Botti
- Epworth/Deakin Centre for Clinical Nursing Research Epworth Health Care; Richmond Vic. Australia
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Price M, Bellwood P, Kitson N, Davies I, Weber J, Lau F. Conditions potentially sensitive to a personal health record (PHR) intervention, a systematic review. BMC Med Inform Decis Mak 2015; 15:32. [PMID: 25927384 PMCID: PMC4411701 DOI: 10.1186/s12911-015-0159-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/15/2015] [Indexed: 12/02/2022] Open
Abstract
Background Personal Health Records (PHRs) are electronic health records controlled, shared or maintained by patients to support patient centered care. The potential for PHRs to transform health care is significant; however, PHRs do not always achieve their potential. One reason for this may be that not all health conditions are sensitive to the PHR as an intervention. The goal of this review was to discover which conditions were potentially sensitive to the PHR as an intervention, that is, what conditions have empirical evidence of benefit from PHR-enabled management. Methods A systematic review of Medline and CINAHL was completed to find articles assessing PHR use and benefit from 2008 to 2014 in specific health conditions. Two researchers independently screened and coded articles. Health conditions with evidence of benefit from PHR use were identified from the included studies. Results 23 papers were included. Seven papers were RCTs. Ten health conditions were identified, seven of which had documented benefit associated with PHR use: asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension. Reported benefits were seen in terms of care quality, access, and productivity, although many benefits were measured by self-report through quasi-experimental studies. No study examined morbidity/mortality. No study reported harm from the PHR. Conclusion There is a small body of condition specific evidence that has been published. Conditions with evidence of benefit when using PHRs tended to be chronic conditions with a feedback loop between monitoring in the PHR and direct behaviours that could be self-managed. These findings can point to other potentially PHR sensitive health conditions and guide PHR designers, implementers, and researchers. More research is needed to link PHR design, features, adoption and health outcomes to better understand how and if PHRs are making a difference to health outcomes.
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Affiliation(s)
- Morgan Price
- Department of Family Practice, University of British Columbia, Vancouver, B.C., Canada. .,Health Information Science, University of Victoria, Victoria, B.C., Canada. .,Department of Computer Science, University of Victoria, Victoria, B.C., Canada.
| | - Paule Bellwood
- Health Information Science, University of Victoria, Victoria, B.C., Canada
| | - Nicole Kitson
- Health Information Science, University of Victoria, Victoria, B.C., Canada
| | - Iryna Davies
- Department of Family Practice, University of British Columbia, Vancouver, B.C., Canada
| | - Jens Weber
- Department of Family Practice, University of British Columbia, Vancouver, B.C., Canada.,Health Information Science, University of Victoria, Victoria, B.C., Canada.,Department of Computer Science, University of Victoria, Victoria, B.C., Canada
| | - Francis Lau
- Health Information Science, University of Victoria, Victoria, B.C., Canada
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World Workshop on Oral Medicine VI: Utilization of Oral Medicine-specific software for support of clinical care, research, and education: current status and strategy for broader implementation. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:172-84. [PMID: 25843941 DOI: 10.1016/j.oooo.2015.02.484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/28/2015] [Accepted: 02/11/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the current scope and status of Oral Medicine-specific software (OMSS) utilized to support clinical care, research, and education in Oral Medicine and to propose a strategy for broader implementation of OMSS within the global Oral Medicine community. STUDY DESIGN An invitation letter explaining the objectives was sent to the global Oral Medicine community. Respondents were interviewed to obtain information about different aspects of OMSS functionality. RESULTS Ten OMSS tools were identified. Four were being used for clinical care, one was being used for research, two were being used for education, and three were multipurpose. Clinical software was being utilized as databases developed to integrate of different type of clinical information. Research software was designed to facilitate multicenter research. Educational software represented interactive, case-orientated technology designed for clinical training in Oral Medicine. Easy access to patient data was the most commonly reported advantage. Difficulty of use and poor integration with other software was the most commonly reported disadvantage. CONCLUSIONS The OMSS presented in this paper demonstrate how information technology (IT) can have an impact on the quality of patient care, research, and education in the field of Oral Medicine. A strategy for broader implementation of OMSS is proposed.
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Alvares JK, Pinheiro TMM, Santos ADF, Oliveira GL. Avaliação da completitude das notificações compulsórias relacionadas ao trabalho registradas por município polo industrial no Brasil, 2007 - 2011. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18:123-36. [DOI: 10.1590/1980-5497201500010010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/18/2014] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Analisar a completitude dos campos de notificações dos agravos à saúde do trabalhador registrados em um município polo industrial brasileiro no período de 01/01/2007 a 31/12/2011. MÉTODOS: Pesquisa descritiva baseada em dados secundários e composta pela totalidade de registros relacionados ao trabalho (n = 2.345) no Sistema Nacional de Agravos de Notificação, utilizando critérios preconizados pelo Guidelines for Evaluating Public Health Surveillance Systems do Center for Disease Control and Prevention. Verificou-se a completitude dos campos presentes nas fichas de notificação e investigação por meio do percentual de campos preenchidos, do coeficiente de correlação de Spearman e de análise gráfica. RESULTADOS: Foi identificado um decréscimo no percentual de preenchimento para a maioria dos campos essenciais (n = 18; 64%). O grau de completitude dos campos obrigatórios foi elevado (> 85%), constatando-se que a maior parte dos campos não discriminados teve um preenchimento entre 0 e 25% e índices variados para os campos essenciais (0 - 98%). Foi verificada importante variabilidade na completitude dos campos essenciais, observando-se três variáveis com correlação negativa e significativa (rs= -0,9; p = 0,0347) e apenas uma com correlação positiva e também significativa. CONCLUSÃO: A qualidade da maioria dos dados armazenados foi classificada como regular a excelente para variáveis importantes quanto ao delineamento das condições de saúde do trabalhador e à deflagração de ações de vigilância. Todavia, recomenda-se o uso rotineiro de avaliações da qualidade dos dados dos sistemas de informação em saúde do trabalhador no Sistema Único de Saúde.
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Evaluation methods used on health information systems (HISs) in Iran and the effects of HISs on Iranian healthcare: a systematic review. Int J Med Inform 2015; 84:444-53. [PMID: 25746766 DOI: 10.1016/j.ijmedinf.2015.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The most important goal of a health information system (HIS) is improvement of quality, effectiveness and efficiency of health services. To achieve this goal, health care systems should be evaluated continuously. The aim of this paper was to study the impacts of HISs in Iran and the methods used for their evaluation. METHODS We systematically searched all English and Persian papers evaluating health information systems in Iran that were indexed in SID, Magiran, Iran medex, PubMed and Embase databases until June 2013. A data collection form was designed to extract required data such as types of systems evaluated, evaluation methods and tools. RESULTS In this study, 53 out of 1103 retrieved articles were selected as relevant and reviewed by the authors. This study indicated that 28 studies used questionnaires to evaluate the system and in 27 studies the study instruments were distributed within a research population. In 26 papers the researchers collected the information by means of interviews, observations, heuristic evaluation and the review of documents and records. The main effects of the evaluated systems in health care settings were improving quality of services, reducing time, increasing accessibility to information, reducing costs and decreasing medical errors. CONCLUSION Evaluation of health information systems is central to their development and enhancement, and to understanding their effect on health and health services. Despite numerous evaluation methods available, the reviewed studies used a limited number of methods to evaluate HIS. Additionally, the studies mainly discussed the positive effects of HIS on health care services.
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