Attitudes toward inter-hospital electronic patient record exchange: discrepancies among physicians, medical record staff, and patients

A comparison of daytime and out of hour mental health presentations to Beaumont Hospital Emergency Department between 2018 and 2020

BACKGROUND

In 2018, there were more than 12,000 self-harm presentations to emergency departments (EDs) in Ireland with 50% occurring between 7p.m. and 3a.m. There is evidence that the assessment quality and follow-up is variable across clinicians. To address this, The National Clinical Programme for the Management of Self-Harm in the ED (NCPSH 2016) was developed to set clear standards.

AIM

Our aim was to compare diagnosis and management of patients presenting to Beaumont Hospital (BH) ED, across a 3-year period, by the on-site Liaison Psychiatry Service, during normal working hours, to the off-site on call service outside of normal working hours (OOH).

METHODS

This is a retrospective audit of BH ED patients referred for psychiatric assessment between 2018 and 2020, using patient electronic records for data collection, and Pearson's chi square testing for group differences. Post hoc analysis was performed using adjusted residuals and Bonferroni correction.

RESULTS

Of 3659 psychiatric referrals to Beaumont ED from 2018 to 2020, alcohol-related disorders were the most common diagnosis and were diagnosed more frequently during normal working hours (n = 592, 16.2%; 22.9% normal hours vs 8.5% OOH, p < 0.001), while personality disorder was diagnosed more frequently out of hours. (n = 432, 11.8%; 9.6% normal hours vs 14.4% out of hours, p < 0.001). There was a statistically significant difference in referral to voluntary services out of hours (7.2% normal hours vs 0.3% OOH).

CONCLUSION

In contrast to previous findings, our study found higher rates of alcohol-related disorders diagnosed during normal hours vs OOH. Furthermore, voluntary and addiction services were under-utilised OOH and this presents an important teaching opportunity.

Blockchain Revolutionizing in Emergency Medicine: A Scoping Review of Patient Journey through the ED

BACKGROUND

Blockchain technology has revolutionized the healthcare sector, including emergency medicine, by integrating AI, machine learning, and big data, thereby transforming traditional healthcare practices. The increasing utilization and accumulation of personal health data also raises concerns about security and privacy, particularly within emergency medical settings.

METHOD

Our review focused on articles published in databases such as Web of Science, PubMed, and Medline, discussing the revolutionary impact of blockchain technology within the context of the patient journey through the ED.

RESULTS

A total of 33 publications met our inclusion criteria. The findings emphasize that blockchain technology primarily finds its applications in data sharing and documentation. The pre-hospital and post-discharge applications stand out as distinctive features compared to other disciplines. Among various platforms, Ethereum and Hyperledger Fabric emerge as the most frequently utilized options, while Proof of Work (PoW) and Proof of Authority (PoA) stand out as the most commonly employed consensus algorithms in this emergency care domain. The ED journey map and two scenarios are presented, exemplifying the most distinctive applications of emergency medicine, and illustrating the potential of blockchain. Challenges such as interoperability, scalability, security, access control, and cost could potentially arise in emergency medical contexts, depending on the specific scenarios.

CONCLUSION

Our study examines the ongoing research on blockchain technology, highlighting its current influence and potential future advancements in optimizing emergency medical services. This approach empowers frontline medical professionals to validate their practices and recognize the transformative potential of blockchain in emergency medical care, ultimately benefiting both patients and healthcare providers.

Acceptability of Health Information Exchange and Patient Portal Use in Depression Care Among Underrepresented Patients

BACKGROUND

Depression is often untreated or undertreated, particularly among underrepresented groups, such as racial and ethnic minorities, and individuals of lower socioeconomic status. Electronic health information exchange (HIE) is a recommended practice to improve care coordination and encourage patient engagement in services, but it remains underutilized in depression care. Understanding factors affecting acceptance and adoption of this technology among underrepresented patient populations is needed to increase dissemination of HIE within mental health treatment.

OBJECTIVE

The present study aims to identify patient barriers and facilitators towards the acceptance of HIE within the context of depression treatment and to examine how HIE impacts depression-related care coordination and patient activation.

DESIGN

Semi-structured qualitative interviews were conducted with 27 patients.

PARTICIPANTS

Respondents were English-speaking adults (> 18) receiving depression treatment within a large, safety-net primary care clinic.

APPROACH

A grounded theory approach was used to code and analyze data for emergent themes. Thematic analysis was guided by the Unified Theory of Acceptance and Use of Technology, a leading informatics theory used to predict end-user adoption of technology.

KEY RESULTS

Respondents reported that HIE made depression care more convenient, transparent, and trustworthy. Though respondents desired greater access to their health records, stigma surrounding depression inhibited acceptance of electronic communication and information sharing. Confusing electronic interface also diminished perceived benefits of HIE.

CONCLUSION(S)

Respondents desire greater transparency in their depression care. While HIE was perceived to improve the overall quality of depression care, stigma associated with mental illness undermined more robust adoption of this technology among underserved populations.

Psychological, social and technical factors influencing electronic medical records systems adoption by United States physicians: a systematic model

BACKGROUND

Wide adoption of electronic medical records (EMR) systems in the United States can lead to better-quality medical care at lower cost. Despite the laws and financial subsidies by the United States government for service providers and suppliers, interoperability still lags. An understanding of the drivers of EMR adoption for physicians and the role of policy-making can translate into increased adoption and enhanced information sharing between medical care providers.

METHODS

Physicians across the United States were surveyed to gather primary data on their psychological, social and technical perceptions towards EMR systems. This quantitative study builds on the theory of planned behaviour, the technology acceptance model and the diffusion of innovation theory to propose, test and validate an innovation adoption model for the healthcare industry. A total of 382 responses were collected, and data were analysed via linear regression to uncover the effects of 12 variables on the intention to adopt EMR systems.

RESULTS

Regression model testing uncovered that government policy-making or mandates and other social factors have little or negligible effect on physicians' intention to adopt an innovation. Rather, physicians are directly driven by their attitudes and ability to control, and indirectly motivated by their knowledge of the innovation, the financial ability to acquire the system, the holistic benefits to their industry and the relative advancement of the system compared to others.

CONCLUSIONS

Identifying physicians' needs regarding EMR systems and providing programmes that meet them can increase the potential for reaching the goal of nationwide interoperable medical records. Government, healthcare associations and EMR system vendors can benefit from our findings by working towards increasing physicians' knowledge of the proposed innovation, socializing how medical care providers and the overall industry can benefit from EMR system adoption, and solving for the financial burden of system implementation and sustainment.

Investigating Evaluation Frameworks for Electronic Health Record: A Literature Review

BACKGROUND: There are various electronic health records (EHRs) evaluation frameworks with multiple dimensions and numerous sets of evaluation measures, while the coverage rate of evaluation measures in a common framework varies in different studies. AIM: This study provides a literature review of the current EHR evaluation frameworks and a model for measuring the coverage rate of evaluation measures in EHR frameworks. METHODS: The current study was a comprehensive literature review and a critical appraisal study. The study was conducted in three phases. In Phase 1, a literature review of EHR evaluation frameworks was conducted. In Phase 2, a three-level hierarchical structure was developed, which includes three aspects, 12 dimensions, and 110 evaluation measures. Subsequently, evaluation measures in the identified studies were categorized based on the hierarchical structure. In Phase 3, relative frequency (RF) of evaluation measures in different dimensions and aspects for each of the identified studies were determined and categorized as follows: Appropriate, moderate, and low coverage. RESULTS: Out of a total of 8276 retrieved articles, 62 studies were considered relevant. The RF range in the second and third level of the hierarchical structure was between 8.6%–91.94% and 0.2%–61%, respectively. “Ease of use” and “system quality” were the most frequent evaluation measure and dimension. Our results indicate that identified studies cover at least one and at most nine evaluation dimensions and current evaluation frameworks focus more on the technology aspect. Almost in all identified studies, evaluation measures related to the technology aspect were covered. However, evaluation measures related to human and organization aspects were covered in 68% and 84% of the identified studies, respectively. CONCLUSION: In this study, we systematically reviewed all literature presenting any type of EHR evaluation framework and analyzed and discussed their aspects and features. We believe that the findings of this study can help researchers to review and adopt the EHR evaluation frameworks for their own particular field of usage.

Usability evaluation of an integrated electronic medication management system implemented in an oncology setting using the unified theory of the acceptance and use of technology

BACKGROUND

Medication management processes in an Oncology setting are complex and difficult to examine in isolation from interrelated processes and contextual factors. This qualitative study aims to evaluate the usability of an Electronic Medication Management System (EMMS) implemented in a specialised oncology unit using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework.

METHODS

The study was conducted in a 12-bed outpatient Oncology unit of a major teaching hospital 6 months following implementation of a commercial EMMS. In-depth semi-structured interviews were conducted with doctors, nurses and pharmacists using the system to assess usability. The UTAUT framework was used to analyse the results, which facilitated evaluation of interrelated aspects and provided a structured summary of user experience and usability factors.

RESULTS

Direct cross-comparison between user groups illustrated that doctors and pharmacists were generally satisfied with the facilitating conditions (hardware and training), but had divergent perceptions of performance (automation, standardised protocols and communication and documented) and effort (mental and temporal demand) expectancy. In counterpoint, nurses were generally satisfied across all constructs. Prior experience using an alternative EMMS influenced performance and effort expectancy and was related to early dissatisfaction with the EMMS. Furthermore, whilst not originally designed for the healthcare setting, the flexibility of the UTAUT allowed for translation to the hospital environment.

CONCLUSION

Nurses demonstrated overall satisfaction with the EMMS, whilst doctors and pharmacists perceived usability problems, particularly related to restricted automaticity and system complexity, which hindered perceived EMMS success. The study demonstrates the feasibility and utility of the UTAUT framework to evaluate usability of an EMMS for multiple user groups in the Oncology setting.

Knowledge, attitude and behaviour of dental health care providers towards health electronic record systems in Saudi Arabia

OBJECTIVES

The present study aimed to discuss the knowledge, attitude and behaviour of dental health care providers towards electronic health record system in Saudi Arabia.

METHODS

The study adopted a questionnaire survey in which information regarding demographics, maintenance and effectiveness of electronic health record systems (EHRs) were mentioned. The data were collected from 270 participants from five regions in Saudi Arabia.

DISCUSSION

Electronic health record systems were found to be an important tool in collecting the information of patients without wasting time. An agreement between participants regarding the potentiality of EHRs to reduce medical errors was also detected.

CONCLUSIONS

Few factors such as privacy concerns, staff compliance and cost were found to be the factors influencing the attitudes of health care providers towards the adoption of EHRs. Thus, EHRs can be made efficient by addressing the problems to change the perceptions of health care providers.

The Potential of Blockchain Technology for Health Information Exchange: Experimental Study From Patients' Perspectives

Background

Nowadays, a number of mechanisms and tools are being used by health care organizations and physicians to electronically exchange the personal health information of patients. The main objectives of different methods of health information exchange (HIE) are to reduce health care costs, minimize medical errors, and improve the coordination of interorganizational information exchange across health care entities. The main challenges associated with the common HIE systems are privacy concerns, security risks, low visibility of system transparency, and lack of patient control. Blockchain technology is likely to disrupt the current information exchange models utilized in the health care industry.

Objective

Little is known about patients’ perceptions and attitudes toward the implementation of blockchain-enabled HIE networks, and it is still not clear if patients (as one of the main HIE stakeholders) are likely to opt in to the applications of this technology in HIE initiatives. Thus, this study aimed at exploring the core value of blockchain technology in the health care industry from health care consumers’ views.

Methods

To recognize the potential applications of blockchain technology in health care practices, we designed 16 information exchange scenarios for controlled Web-based experiments. Overall, 2013 respondents participated in 16 Web-based experiments. Each experiment described an information exchange condition characterized by 4 exchange mechanisms (ie, direct, lookup, patient-centered, and blockchain), 2 types of health information (ie, sensitive vs nonsensitive), and 2 types of privacy policy (weak vs strong).

Results

The findings show that there are significant differences in patients’ perceptions of various exchange mechanisms with regard to patient privacy concern, trust in competency and integrity, opt-in intention, and willingness to share information. Interestingly, participants hold a favorable attitude toward the implementation of blockchain-based exchange mechanisms for privacy protection, coordination, and information exchange purposes. This study proposed the potentials and limitations of a blockchain-based attempt in the HIE context.

Conclusions

The results of this research should be of interest to both academics and practitioners. The findings propose potential limitations of a blockchain-based HIE that should be addressed by health care organizations to exchange personal health information in a secure and private manner. This study can contribute to the research in the blockchain area and enrich the literature on the use of blockchain in HIE efforts. Practitioners can also identify how to leverage the benefit of blockchain to promote HIE initiatives nationwide.

Determining the Hospital Information System (HIS) Success Rate: Development of a New Instrument and Case Study

BACKGROUND:

Hospital Information System (HIS) is a type of health information system which is widely used in clinical settings. Determining the success rate of HISs is an ongoing area of research since its implications are of interest for researchers, physicians and managers.

AIM:

In the present study, we develop a novel instrument to measure HIS success rate based on users’ viewpoints in a teaching hospital.

METHODS:

The study was conducted in Ebnesina and Dr Hejazi Psychiatric Hospital and education centre in Mashhad, Iran. The instrument for data collection was a self-administered structured questionnaire based on ISSM, covering seven dimensions, which includes system quality, information quality, service quality, system use, usefulness, satisfaction, and net benefits. The verification of content validity was carried out by an expert panel. The internal consistency of dimensions was measured by Cronbach’s alpha. Pearson’s correlation coefficient was calculated to evaluate the significance of associations between dimensions. The HIS success rate on users’ viewpoints was determined.

RESULTS:

A total of 125 users participated in the study. The instrument was validated by an expert panel with the Content Validity Index (CVI): 0.85 and Content Validity Ratio (CVR): 0.86. The overall Cronbach’s alpha value of the instrument was 0.93. The Pearson correlation coefficient showed significant positive relationships among the investigated dimensions. On average, HIS success rate in the hospital under study was 65% (CI: 64%, 67%). The dimensions of “usefulness”, “system quality”, and “net benefits” showed the highest rates of success, respectively.

CONCLUSION:

The instrument used in this study can be adopted for HIS evaluation in future studies. In the current study, a method was developed to determine the HIS success rate based on users’ viewpoints. This method allows for the comparison of HIS success rates in various hospitals. As well, our findings underscore the viewpoints of HIS users in a developing country.’

Healthcare staff digital literacy levels and their attitudes towards information systems

This study aimed to assess the digital literacy levels and attitudes towards information systems of staff in a health service that will be implementing an electronic health record so that barriers towards implementation could be addressed. A survey measuring staff confidence levels and their attitudes towards information systems was developed. Data were collected over a five-week period, with data analysed using frequency analysis and a chi-square analysis. There were 407 respondents to the survey. The majority (70-80%) of which reported high digital literacy levels, expressing confidence in using technology. Respondents also reported positive attitudes towards information systems. However, one-fifth reported anxiety using information systems. Given poor staff engagement with information systems adversely affects the safety and quality of patient care, health services should provide targeted education and training to address staff with low digital literacy levels and/or confidence with using information systems prior to implementation of an electronic health record system.

An Investigation into Healthcare-Data Patterns

Visualising complex data facilitates a more comprehensive stage for conveying knowledge. Within the medical data domain, there is an increasing requirement for valuable and accurate information. Patients need to be confident that their data is being stored safely and securely. As such, it is now becoming necessary to visualise data patterns and trends in real-time to identify erratic and anomalous network access behaviours. In this paper, an investigation into modelling data flow within healthcare infrastructures is presented; where a dataset from a Liverpool-based (UK) hospital is employed for the case study. Specifically, a visualisation of transmission control protocol (TCP) socket connections is put forward, as an investigation into the data complexity and user interaction events within healthcare networks. In addition, a filtering algorithm is proposed for noise reduction in the TCP dataset. Positive results from using this algorithm are apparent on visual inspection, where noise is reduced by up to 89.84%.

Challenges and Opportunities of Health Information Exchange (HIE) From Health Consumers' Perspective

The implementation of HIE depends on a number of entities and one of the key participants is health consumers. All potential gains of HIE cannot be achieved without consumers' favorable beliefs and support. However, little is known about the factors affecting consumers to endorse electronic information exchange between healthcare organizations. The primary objective of this article is to identify how and why patients would support HIE used by healthcare providers. The author has conducted an online questionnaire-based survey in the U.S. This study has shown that perceived value of HIE is significantly related to consumers HIE supportive intention. Moreover, perceived value fully mediates the effects of perceived benefit and cost of HIE implementation on consumer tendency to endorse HIE. The findings also provide evidence to highlight that consumers' attitude toward exchange model moderates the relationship between value perception and intention to support HIE. Relying on the results, this study offers several practical and theoretical contributions.

The Role of Artificial Intelligence in Clinical Decision Support Systems and a Classification Framework

Clinical decision support systems are meant to improve the quality of decision-making in healthcare. Artificial intelligence is the science of creating intelligent systems that solve complex problems at the level of or better than human experts. Combining artificial intelligence methods into clinical decision support will enable the utilization of large quantities of data to produce relevant decision-making information to practitioners. This article examines various artificial intelligence methodologies and shows how they may be incorporated into clinical decision-making systems. A framework for describing artificial intelligence applications in clinical decision support systems is presented.

Effects of Job Burnout and Emotional Labor on Objective Structured Clinical Examination Performance Among Interns and Residents in Taiwan

Medical education faces challenges concerning job burnout and emotional labor among junior physicians, which poses a potential threat to the quality of medical care. Although studies have investigated job burnout and emotional labor among physicians, empirical research on the association between job burnout, emotional labor, and clinical performance is lacking. This study investigated the effects of job burnout and emotional labor on clinical performance by using the objective structured clinical examination (OSCE) scores of interns and residents. Specifically, this cross-sectional study utilized the Maslach Burnout Inventory and the Emotional Labor Questionnaire as measurement instruments. A total of 225 interns and residents in central Taiwan answered structured questionnaires before beginning their OSCE. The major statistical analysis method employed was logistic regression. After adjustment for covariates, first-year residents were less likely than other residents to obtain high OSCE scores. The odds of high OSCE performance among interns and residents with high interaction component scores in emotional labor were significantly higher than those with low interaction scores. A high score in the interaction dimension of emotional labor was associated with strong clinical performance. The findings suggest that interventions which motivate positive attitudes and increase interpersonal interaction skills among physicians should receive higher priority.

Patients' support for health information exchange: a literature review and classification of key factors

Background

Literature indicates that one of the most important factors affecting the widespread adoption of Health Information Exchange (HIE) is patient support and endorsement. In order to reap all the expected benefits of HIE, patients’ acceptance of technology is a challenge that is not fully studied. There are a few studies which have focused on requirements of electronic medical information exchange from consumers’ views and expectations. This study is aimed at reviewing the literature to articulate factors that affect patients to support HIE efforts.

Methods

A literature review of current studies addressing patients’ views on HIE from 2005 was undertaken. Five electronic research databases (Science Direct, PubMed, Web of Science, CINAHL, and Academic Search Premiere) were searched to retrieve articles reporting pros and cons of HIE from patients’ opinion.

Results

One hundred and ninety six articles were initially retrieved from the databases. Out of 196, 36 studies met the inclusion criteria and were fully reviewed. Our findings indicate that patient’s attitude toward HIE is affected by seven main factors: perceived benefits, perceived concerns, patient characteristics, patient participation level in HIE, type of health information, identity of recipients, and patient preferences regarding consent and features.

Conclusions

The findings provide useful theoretical implications for research by developing a classification of significant factors and a framework based on the lessons learned from the literature to help guide HIE efforts. Our results also have fundamental practical implications for policy makers, current and potential organizers of HIEs by highlighting the role of patients in the widespread implementation of HIE. The study indicates that new approaches should be applied to completely underline HIE benefits for patients and also address their concerns.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-017-0436-2) contains supplementary material, which is available to authorized users.

Sustainability of health information systems: a three-country qualitative study in southern Africa

BACKGROUND

Health information systems are central to strong health systems. They assist with patient and program management, quality improvement, disease surveillance, and strategic use of information. Many donors have worked to improve health information systems, particularly by supporting the introduction of electronic health information systems (EHIS), which are considered more responsive and more efficient than older, paper-based systems. As many donor-driven programs are increasing their focus on country ownership, sustainability of these investments is a key concern. This analysis explores the potential sustainability of EHIS investments in Malawi, Zambia and Zimbabwe, originally supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR).

METHODS

Using a framework based on sustainability theories from the health systems literature, this analysis employs a qualitative case study methodology to highlight factors that may increase the likelihood that donor-supported initiatives will continue after the original support is modified or ends.

RESULTS

Findings highlight commonalities around possible determinants of sustainability. The study found that there is great optimism about the potential for EHIS, but the perceived risks may result in hesitancy to transition completely and parallel use of paper-based systems. Full stakeholder engagement is likely to be crucial for sustainability, as well as integration with other activities within the health system and those funded by development partners. The literature suggests that a sustainable system has clearly-defined goals around which stakeholders can rally, but this has not been achieved in the systems studied. The study also found that technical resource constraints - affecting system usage, maintenance, upgrades and repairs - may limit EHIS sustainability even if these other pillars were addressed.

CONCLUSIONS

The sustainability of EHIS faces many challenges, which could be addressed through systems' technical design, stakeholder coordination, and the building of organizational capacity to maintain and enhance such systems. All of this requires time and attention, but is likely to enhance long-term outcomes.

Health Information Exchange: What do patients want?

To determine whether emergency department patients want to share their medical records across health systems through Health Information Exchange and if so, whether they prefer to sign consent or share their records automatically, 982 adult patients presenting to an emergency department participated in a questionnaire-based interview. The majority (N = 906; 92.3%) were willing to share their data in a Health Information Exchange. Half (N = 490; 49.9%) reported routinely getting healthcare outside the system and 78.6 percent reported having records in other systems. Of those who were willing to share their data in a Health Information Exchange, 54.3 percent wanted to sign consent but 90 percent of those would waive consent in the case of an emergency. Privacy and security were primary concerns of patients not willing to participate in Health Information Exchange and preferring to sign consent. Improved privacy and security protections could increase participation, and findings support consideration of "break-the-glass" provider access to Health Information Exchange records in an emergent situation.