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Alexandre PK, Monestime JP, Alexandre K. The Impact of Market Factors on Meaningful Use of Electronic Health Records Among Primary Care Providers: Evidence From Florida Using Resource Dependence Theory and Information Uncertainty Perspective. Med Care 2024; 62:256-262. [PMID: 38447010 PMCID: PMC10939787 DOI: 10.1097/mlr.0000000000001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Using federal funds from the 2009 Health Information Technology for Economic and Clinical Health Act, the Centers for Medicare and Medicaid Services funded the 2011-2021 Medicaid electronic health record (EHR) incentive programs throughout the country. OBJECTIVE Identify the market factors associated with Meaningful Use (MU) of EHRs after primary care providers (PCPs) enrolled in the Florida-EHR incentives program through Adopting, Improving, or Upgrading (AIU) an EHR technology. RESEARCH DESIGN Retrospective cohort study using 2011-2018 program records for 8464 Medicaid providers. MAIN OUTCOME MU achievement after first-year incentives. INDEPENDENT VARIABLES The resource dependence theory and the information uncertainty perspective were used to generate key-independent variables, including the county's rurality, educational attainment, poverty, health maintenance organization penetration, and number of PCPs per capita. ANALYTICAL APPROACH All the county rates were converted into 3 dichotomous measures corresponding to high, medium, and low terciles. Descriptive and bivariate statistics were calculated. A generalized hierarchical linear model was used because MU data were clustered at the county level (level 2) and measured at the practice level (level 1). RESULTS Overall, 41.9% of Florida Medicaid providers achieved MU after receiving first-year incentives. Rurality was positively associated with MU ( P <0.001). Significant differences in MU achievements were obtained when we compared the "high" terciles with the "low" terciles for poverty rates ( P =0.002), health maintenance organization penetration rates ( P =0.02), and number of PCPs per capita ( P =0.01). These relationships were negative. CONCLUSIONS Policy makers and health care managers should not ignore the contribution of market factors in EHR adoption.
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Affiliation(s)
- Pierre K. Alexandre
- Health Administration Program, Dept of Management, College of Business, Florida Atlantic University, Boca Raton, FL 33431 USA
| | - Judith P. Monestime
- Health Administration Program, Dept of Management, College of Business, Florida Atlantic University, Boca Raton, FL 33431 USA
| | - Kessie Alexandre
- Department of Geography, University of Washington, Seattle, WA 98195-3560 USA
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Braddock AS, Bosworth KT, Ghosh P, Proffitt R, Flowers L, Montgomery E, Wilson G, Tosh AK, Koopman RJ. Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study. Appl Clin Inform 2024; 15:368-377. [PMID: 38458233 PMCID: PMC11078569 DOI: 10.1055/a-2283-9036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. OBJECTIVES We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. METHODS In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. RESULTS Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. CONCLUSION Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.
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Affiliation(s)
- Amy S. Braddock
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - K. Taylor Bosworth
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Parijat Ghosh
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Rachel Proffitt
- School of Health Professions, University of Missouri, Columbia, Missouri, United States
| | - Lauren Flowers
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Emma Montgomery
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Gwendolyn Wilson
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Aneesh K. Tosh
- Department of Child Health, University of Missouri, Columbia, Missouri, United States
| | - Richelle J. Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
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Alexandre PK, Monestime JP, Alexandre K. The impact of county-level factors on meaningful use of electronic health records (EHRs) among primary care providers. PLoS One 2024; 19:e0295435. [PMID: 38271332 PMCID: PMC10810449 DOI: 10.1371/journal.pone.0295435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/21/2023] [Indexed: 01/27/2024] Open
Abstract
This study examines the impact of county-level factors on "meaningful use" (MU) of electronic health records (EHRs) for 8415 primary care providers (PCPs) that enrolled in the Florida Medicaid EHR Incentive Program through adopting, improving, or upgrading (AIU) a certified EHR technology. PCPs received incentive payments at enrollment and if they used their EHRs in meaningful ways; ways that benefit patients and providers alike they received additional payments. We conducted a retrospective cohort study of these providers over the 2011-2018 period while linking their records to other state data. We used the core constructs of the resource dependence theory (RDT), a well-established organization theory in business management, to operationalize the county-level variables. These variables were rurality, poverty, educational attainment, managed care penetration, changes in population, and number of PCPs per capita. The unit of analysis was provider-years. For practical and computational purposes, all the county variables were dichotomized. We used analysis of variance (ANOVA) to test for differences in MU attestation rates across each county variable. Odds ratios and corresponding 95% confidence intervals were derived from pooled logistic regressions using generalized estimated equations (GEE) with the binomial family and logit link functions. Clustered standard errors were used. Approximately 42% of these providers attested to MU after receiving first-year incentives. Rurality and poverty were significantly associated with MU. To some degree, managed care penetration, change in population size, and number of PCPs per capita were also associated with MU. Policy makers and healthcare managers should not ignore the contribution of county-level factors in the diffusion of EHRs among physician practices. These county-level findings provide important insights about EHR diffusion in places where traditionally underserved populations live. This county-perspective is particularly important because of the potential for health IT to enable public health monitoring and population health management that might benefit individuals beyond the patients treated by the Medicaid providers.
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Affiliation(s)
- Pierre K. Alexandre
- Health Administration Program, Department of Management, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Judith P. Monestime
- Health Administration Program, Department of Management, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Kessie Alexandre
- Department of Geography, University of Washington, Seattle, Washington, United States of America
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Ngassam RGN, Ung L, Ologeanu-Taddei R, Lartigau J, Demoly P, Bourdon I, nicolas Molinari, Chiriac AM. An Action Design Research to Facilitate the Adoption of Personal Health Records. J ORGAN END USER COM 2022. [DOI: 10.4018/joeuc.288551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adoption and user perceptions are dominant on personal health records literature and have led to a better understanding of what individuals' behaviors and perceptions are about the adoption of personal health records. However, these insights are descriptive and are not actionable to allow creating personal health records that will overcome the adoption problems identified by users. This study uses action design research to provide actionable knowledge regarding user perceptions and adoption and their application in the case of the digital allergy card. To achieve this, we conducted interviews with patients and physicians as part of the evaluation of the digital allergy card mock-up and the first prototype. As results, we provided some research proposals regarding the benefits of, levers for, and barriers to adoption of the digital allergy card that can be tested for several other personal health records.
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Rhoades CA, Whitacre BE, Davis AF. Higher Electronic Health Record Functionality Is Associated with Lower Operating Costs in Urban—but Not Rural—Hospitals. Appl Clin Inform 2022; 13:665-676. [PMID: 35926839 PMCID: PMC9329141 DOI: 10.1055/s-0042-1750415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives
The aim of the study is to examine the relationship between electronic health record (EHR) use/functionality and hospital operating costs (divided into five subcategories), and to compare the results across rural and urban facilities.
Methods
We match hospital-level data on EHR use/functionality with operating costs and facility characteristics to perform linear regressions with hospital- and time-fixed effects on a panel of 1,596 U.S. hospitals observed annually from 2016 to 2019. Our dependent variables are the logs of the various hospital operating cost categories, and alternative metrics for EHR use/functionality serve as the primary independent variables of interest. Data on EHR use/functionality are retrieved from the American Hospital Association's (AHA) Annual Survey of Hospitals Information Technology (IT) Supplement, and hospital operating cost and characteristic data are retrieved from the American Hospital Directory. We include only hospitals classified as “general medical and surgical,” removing specialty hospitals.
Results
Our results suggest, first, that increasing levels of EHR functionality are associated with hospital operating cost reductions. Second, that these significant cost reductions are exclusively seen in urban hospitals, with the associated coefficient suggesting cost savings of 0.14% for each additional EHR function. Third, that urban EHR-related cost reductions are driven by general/ancillary and outpatient costs. Finally, that a wide variety of EHR functions are associated with cost reductions for urban facilities, while no EHR function is associated with significant cost reductions in rural locations.
Conclusion
Increasing EHR functionality is associated with significant hospital operating cost reductions in urban locations. These results do not hold across geographies, and policies to promote greater EHR functionality in rural hospitals will likely not lead to short-term cost reductions.
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Affiliation(s)
- Claudia A. Rhoades
- Department of Agricultural Economics, Oklahoma State University, Stillwater, Oklahoma, United States
| | - Brian E. Whitacre
- Department of Agricultural Economics, Oklahoma State University, Stillwater, Oklahoma, United States
| | - Alison F. Davis
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States
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Shen YC, Hsia TC, Hsu CH. Analysis of Electronic Health Records Based on Deep Learning with Natural Language Processing. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2021. [DOI: 10.1007/s13369-021-05596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lebcir R, Hill T, Atun R, Cubric M. Stakeholders' views on the organisational factors affecting application of artificial intelligence in healthcare: a scoping review protocol. BMJ Open 2021; 11:e044074. [PMID: 33753441 PMCID: PMC7986948 DOI: 10.1136/bmjopen-2020-044074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Artificial intelligence (AI) offers great potential for transforming healthcare delivery leading to better patient-outcomes and more efficient care delivery. However, despite these advantages, integration of AI in healthcare has not kept pace with technological advancements. Previous research indicates the importance of understanding various organisational factors that shape integration of new technologies in healthcare. Therefore, the aim of this study is to provide an overview of the existing organisational factors influencing adoption of AI in healthcare from the perspectives of different relevant stakeholders. By conducting this review, the various organisational factors that facilitate or hinder AI implementation in healthcare could be identified. METHODS AND ANALYSIS This study will follow the Joanna Briggs Institute framework, which includes the following stages: (1) defining and aligning objectives and questions, (2) developing and aligning the inclusions criteria with objectives and questions, (3) describing the planned approach to evidence searching and selection, (4) searching for the evidence, (5) selecting the evidence, (6) extracting the evidence, (7) charting the evidence, and summarising the evidence with regard to the objectives and questions.The databases searched will be MEDLINE (Ovid), CINAHL (Plus), PubMed, Cohrane Library, Scopus, MathSciNet, NICE Evidence, OpenGrey, O'REILLY and Social Care Online from January 2000 to June 2021. Search results will be reported based on The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. The review will adopt diffusion of innovations theory, technology acceptance model and stakeholder theory as guiding conceptual models. Narrative synthesis will be used to integrate the findings. ETHICS AND DISSEMINATION Ethics approval will not be sought for this scoping review as it only includes information from previously published studies. The results will be disseminated through publication in a peer-reviewed journal. In addition, to ensure its findings reach relevant stakeholders, they will be presented at relevant conferences.
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Affiliation(s)
- Reda Lebcir
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Tetiana Hill
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Rifat Atun
- T.H.Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Marija Cubric
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
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Yusif S, Hafeez-Baig A, Soar J. Change management and adoption of health information technology (HIT)/eHealth in public hospitals in Ghana: A qualitative study. APPLIED COMPUTING AND INFORMATICS 2020. [DOI: 10.1016/j.aci.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Ghana, as with other developing countries, there are several health information technology (HIT) initiatives as interventions to improve healthcare delivery. HIT implementation undoubtedly results in change. However, most studies relating to HIT implementation readiness have constantly neglected the role of change in successfully implementing HIT. This study intends to identify factors affecting successful change management as part of preparation towards successfully implementing HIT in public hospital in Ghana. To carry out this study, we conducted in-depth interviews with a matrix of HIT senior managers and thematically analyzed the data. The data was transcribed and uploaded into a Nvivo 11 software for analysis using thematic analysis techniques. Five (5) themes were discovered. They are: 1) Stakeholder participation; 2) Proof of experience in similar project; 3) Availability of committed change agents/all-levels-change representatives; 4) Clearly articulated change implementation strategy; and 5) Training and improvement mechanism (post-implementation). A fresh call is made for more attention to be paid to change as part of preparatory measures towards the adoption of HIT in Ghana using the five cardinal approaches identified as a guide.
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Ferrão JC, Oliveira MD, Janela F, Martins HMG, Gartner D. Can structured EHR data support clinical coding? A data mining approach. Health Syst (Basingstoke) 2020; 10:138-161. [PMID: 34104432 PMCID: PMC8143604 DOI: 10.1080/20476965.2020.1729666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/22/2019] [Indexed: 10/24/2022] Open
Abstract
Structured data formats are gaining momentum in electronic health records and can be leveraged for decision support and research. Nevertheless, such structured data formats have not been explored for clinical coding, which is an essential process requiring significant manual workload in health organisations. This article explores the extent to which fully structured clinical data can support assignment of clinical codes to inpatient episodes, through a methodology that tackles high dimensionality issues, addresses the multi-label nature of coding and optimises model parameters. The methodology encompasses transformation of raw data to define a feature set, build a data matrix representation, and testing combinations of feature selection methods with machine learning models to predict code assignment. The methodology was tested with a real hospital dataset and showed varying predictive power across codes, while demonstrating the potential of leveraging structuring data to reduce workload and increase efficiency in clinical coding.
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Affiliation(s)
- José Carlos Ferrão
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Mónica Duarte Oliveira
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Filipe Janela
- Investigação, Desenvolvimento e Inovação, SIEMENS Healthineers, Amadora, Portugal
| | - Henrique M. G. Martins
- Centre for Research and Creativity in Informatics (CI), Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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Liang J, Li Y, Zhang Z, Shen D, Xu J, Yu G, Dai S, Ge F, Lei J. Evaluating the Applications of Health Information Technologies in China During the Past 11 Years: Consecutive Survey Data Analysis. JMIR Med Inform 2020; 8:e17006. [PMID: 32039815 PMCID: PMC7055786 DOI: 10.2196/17006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background To achieve universal access to medical resources, China introduced its second health care reform in 2010, with health information technologies (HIT) as an important technical support point. Objective This study is the first attempt to explore the unique contributions and characteristics of HIT development in Chinese hospitals from the three major aspects of hospital HIT—human resources, funding, and materials—in an all-around, multi-angled, and time-longitudinal manner, so as to serve as a reference for decision makers in China and the rest of the world when formulating HIT development strategies. Methods A longitudinal research method is used to analyze the results of the CHIMA Annual Survey of Hospital Information System in China carried out by a Chinese national industrial association, CHIMA, from 2007 to 2018. The development characteristics of human resources, funding, and materials of HIT in China for the past 12 years are summarized. The Bass model is used to fit and predict the popularization trend of EMR in Chinese hospitals from 2007 to 2020. Results From 2007 to 2018, the CHIMA Annual Survey interviewed 10,954 hospital CIOs across 32 administrative regions in Mainland China. Compared with 2007, as of 2018, in terms of human resources, the average full time equivalent (FTE) count in each hospital’s IT center is still lower than the average level of US counterparts in 2014 (9.66 FTEs vs. 34 FTEs). The proportion of CIOs with a master’s degree or above was 25.61%, showing an increase of 18.51%, among which those with computer-related backgrounds accounted for 64.75%, however, those with a medical informatics background only accounted for 3.67%. In terms of funding, the sampled hospitals’ annual HIT investment increased from ¥957,700 (US $136,874) to ¥6.376 million (US $911,261), and the average investment per bed increased from ¥4,600 (US $658) to ¥8,100 (US $1158). In terms of information system construction, as of 2018, the average EMR implementation rate of the sampled hospitals exceeded the average level of their US counterparts in 2015 and their German counterparts in 2017 (85.26% vs. 83.8% vs. 68.4%, respectively). The results of the Bass prediction model show that Chinese hospitals will likely reach an adoption rate of 91.4% by 2020 (R2=0.95). Conclusions In more than 10 years, based on this top-down approach, China’s medical care industry has accepted government instructions and implemented the unified model planned by administrative intervention. With only about one-fifth of the required funding, and about one-fourth of the required human resources per hospital as compared to the US HITECH project, China’s EMR coverage in 2018 exceeded the average level of its US counterparts in 2015 and German counterparts in 2017. This experience deserves further study and analysis by other countries.
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Affiliation(s)
- Jun Liang
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Li
- Department of Burn and Plastic Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhongan Zhang
- Performance Management Department, Qingdao Central Hospital, Qingdao, China
| | - Dongxia Shen
- Editorial Department of Journal of Practical Oncology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Xu
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gang Yu
- IT Center, Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Siqi Dai
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Fangmin Ge
- International Network Medical Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianbo Lei
- Center for Medical Informatics, Peking University, Beijing, China.,Institute of Medical Technology, Health Science Center, Peking University, Beijing, China.,School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, China
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Yusif S, Hafeez-Baig A, Soar J. An Exploratory Study of the Readiness of Public Healthcare Facilities in Developing Countries to Adopt Health Information Technology (HIT)/e-Health: the Case of Ghana. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2020; 4:189-214. [DOI: 10.1007/s41666-020-00070-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
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Schwartz JT, Gao M, Geng EA, Mody KS, Mikhail CM, Cho SK. Applications of Machine Learning Using Electronic Medical Records in Spine Surgery. Neurospine 2019; 16:643-653. [PMID: 31905452 PMCID: PMC6945000 DOI: 10.14245/ns.1938386.193] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022] Open
Abstract
Developments in machine learning in recent years have precipitated a surge in research on the applications of artificial intelligence within medicine. Machine learning algorithms are beginning to impact medicine broadly, and the field of spine surgery is no exception. Electronic medical records are a key source of medical data that can be leveraged for the creation of clinically valuable machine learning algorithms. This review examines the current state of machine learning using electronic medical records as it applies to spine surgery. Studies across the electronic medical record data domains of imaging, text, and structured data are reviewed. Discussed applications include clinical prognostication, preoperative planning, diagnostics, and dynamic clinical assistance, among others. The limitations and future challenges for machine learning research using electronic medical records are also discussed.
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Affiliation(s)
- John T. Schwartz
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Gao
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric A. Geng
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kush S. Mody
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher M. Mikhail
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Tripathi G, Ahad MA, Paiva S. S2HS- A blockchain based approach for smart healthcare system. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2019; 8:100391. [PMID: 31753750 DOI: 10.1016/j.hjdsi.2019.100391] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Healthcare domain has emerged as one of the most preferred use cases of IoT and its related technologies. However, its widespread adoption is still a distant dream. The primary reason behind this is the security and privacy of the data and the participating entities. To overcome this, blockchain technology has emerged as a convenient means to improve the security and privacy of the data and its users. With the deluge of medical data generated through electronic medical records and other ICT based mechanisms, blockchain has found innumerable opportunities in the healthcare domain. The traditional healthcare systems are radically adopting modern day technologies for transitioning into the smart healthcare ecosystems. The convenience of the users and ease of use are the primary factors driving this transition. Even with smart healthcare systems (SHS) there exist numerous challenges and issues related to the security, transparency and privacy of the data and users. This paper explores the technological and social barriers in adoption of SHS by analyzing state-of-the-art expert views and user's perception. It further proposes a blockchain based SHS framework to provide intrinsic security and integrity of the system. Finally, the future research directions and use cases of blockchain in healthcare domain are discussed.
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Affiliation(s)
- Gautami Tripathi
- Department of Computer Science and Engineering, Jamia Hamdard, New Delhi, 110062, India.
| | - Mohd Abdul Ahad
- Department of Computer Science and Engineering, Jamia Hamdard, New Delhi, 110062, India.
| | - Sara Paiva
- Instituto Politécnico de Viana do Castelo, Portugal.
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Gefen D, Ben-Assuli O, Stehr M, Rosen B, Denekamp Y. Governmental intervention in Hospital Information Exchange (HIE) diffusion: a quasi-experimental ARIMA interrupted time series analysis of monthly HIE patient penetration rates. EUR J INFORM SYST 2019. [DOI: 10.1080/0960085x.2019.1666038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- David Gefen
- Decision Sciences and MIS, Bennett S LeBow College of Business, Drexel University, Philadelphia, USA
| | - Ofir Ben-Assuli
- Information Systems Management Department, Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel
| | - Mark Stehr
- Bennett S LeBow College of Business, Drexel University, Philadelphia, USA
| | - Bruce Rosen
- JDC - Brookdale Institute, Jerusalem, Israel
| | - Yaron Denekamp
- Clalit Health Services, Tel Aviv, Israel
- School of Public Health, Haifa University, Israel
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15
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Liang J, Zheng X, Chen Z, Dai S, Xu J, Ye H, Zhang Z, Ge F, Lei J. The experience and challenges of healthcare-reform-driven medical consortia and Regional Health Information Technologies in China: A longitudinal study. Int J Med Inform 2019; 131:103954. [PMID: 31513943 DOI: 10.1016/j.ijmedinf.2019.103954] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To achieve universal access to medical resources-a partial goal of the second ambitious health reform since 2010-the Chinese government aimed to build a regional medical consortium and enhance the efficiency of health information exchange (HIE). We analyzed the experience of constructing a medical consortium in Chinese hospitals, which was based on regional health information technology (RHIT) promoted by HIE. METHOD In this longitudinal study, we analyzed the results of the annual surveys that were conducted by the China Hospital Information Management Association from 2006 to 2015. The survey results mainly concerned whether hospitals should join the regional medical consortium, the methods used for sharing inter-hospital medical data, and the out-of-hospital information interaction system. The Bass diffusion model was adopted to fit and predict the proportion of Chinese hospitals joining the consortium from 2006 to 2025. RESULT As of 2015, the survey results of 7272 hospitals were obtained. The proportion of hospitals in partnership systems increased from 3.0% in 2007 to 57.2% in 2015. There has been a rapid development in the electronic sharing of medical data between hospitals. The proportion of hospitals that relied solely on paper documents for data interaction decreased from 43.3% in 2011 to 8.0% in 2015. There was a strong positive linear correlation between hospitals joining the consortium and the accessibility of electronic medical data exchange within hospitals (r = 0.925). The proportions of hospitals that supported dual referral systems and appointments, data browsing between hospitals and regional information systems, and remote consultation services increased to 65.0%, 61.6%, and 81.9% in 2015, as compared to 18.8%, 16.8%, and 10.9% in 2011, respectively. The Bass prediction model showed that the goal of recruiting 90% of the hospitals to the consortium by 2020 will likely be achieved (adjusted R2 = 0.93). CONCLUSION The Chinese government has applied a top-down, high-level design model to promote the rapid development of a medical consortium, in which the RHIT technologies are crucial technical enabler.
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Affiliation(s)
- Jun Liang
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xu Zheng
- Center for Medical Informatics, Peking University, Beijing, China
| | - Zhenying Chen
- Library of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Siqi Dai
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jie Xu
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Hui Ye
- Health Division, ThinkTank of Xinhua News Agency, Beijing, China
| | - Zhongan Zhang
- Performance Management Department, Qingdao Central Hospital, Qingdao, Shandong Province, China
| | - Fangmin Ge
- International Network Medical Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jianbo Lei
- Center for Medical Informatics, Peking University, Beijing, China; School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, Sichuan Province, China.
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Esdar M, Hüsers J, Weiß JP, Rauch J, Hübner U. Diffusion dynamics of electronic health records: A longitudinal observational study comparing data from hospitals in Germany and the United States. Int J Med Inform 2019; 131:103952. [PMID: 31557699 DOI: 10.1016/j.ijmedinf.2019.103952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/23/2019] [Accepted: 08/14/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND While aiming for the same goal of building a national eHealth Infrastructure, Germany and the United States pursued different strategic approaches - particularly regarding the role of promoting the adoption and usage of hospital Electronic Health Records (EHR). OBJECTIVE To measure and model the diffusion dynamics of EHRs in German hospital care and to contrast the results with the developments in the US. MATERIALS AND METHODS All acute care hospitals that were members of the German statutory health system were surveyed during the period 2007-2017 for EHR adoption. Bass models were computed based on the German data and the corresponding data of the American Hospital Association (AHA) from non-federal hospitals in order to model and explain the diffusion of innovation. RESULTS While the diffusion dynamics observed in the US resembled the typical s-shaped curve with high imitation effects (q = 0.583) but with a relatively low innovation effect (p = 0.025), EHR diffusion in Germany stagnated with adoption rates of approx. 50% (imitation effect q = -0.544) despite a higher innovation effect (p = 0.303). DISCUSSION These findings correlate with different governmental strategies in the US and Germany of financially supporting EHR adoption. Imitation only seems to work if there are financial incentives, e.g. those of the HITECH Act in the US. They are lacking in Germany, where the government left health IT adoption strategies solely to the free market and the consensus among all of the stakeholders. CONCLUSION Bass diffusion models proved to be useful for distinguishing the diffusion dynamics in German and US non-federal hospitals. When applying the Bass model, the imitation parameter needs a broader interpretation beyond the network effects, including driving forces such as incentives and regulations, as was demonstrated by this study.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Jens Hüsers
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Jan-Patrick Weiß
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Jens Rauch
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Ursula Hübner
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
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Giunti G, Guisado-Fernandez E, Belani H, Lacalle-Remigio JR. Mapping the Access of Future Doctors to Health Information Technologies Training in the European Union: Cross-Sectional Descriptive Study. J Med Internet Res 2019; 21:e14086. [PMID: 31407668 PMCID: PMC6709895 DOI: 10.2196/14086] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/05/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health information technologies (HITs) such as electronic health records (EHR) and telemedicine services are currently used to assist clinicians provide care to patients. There are many barriers to HIT adoption, including mismatches between investments and benefits, disruptions in the workflow, and concerns about privacy and confidentiality. The lack of HIT training of health professionals as a workforce is an increasingly recognized and understudied barrier. OBJECTIVE The purpose of this study is to describe what courses on HIT topics are available at the graduate level for future health professionals in the European Union (EU) and to explore possible determining factors for their exposure to these courses. METHODS A cross-sectional descriptive study of EU medical schools was performed to explore the prevalence of HIT courses. The curricula of all identified higher learning institutions that offer a medical degree were manually explored to identify graduate-level courses that offer specific training on HIT topics. HIT topics were defined as courses or subjects that provided knowledge on the design, development, use, and implementation of HIT. Associations among potential factors such as population, yearly medical graduates, total number of physicians, EHR presence, and gross domestic product (GDP) were explored. RESULTS A total of 302 medical schools from the 28 member states of the EU were explored. Only about one-third (90/302, 29.80%) of all medical degree curricula offered any kind of HIT course at the graduate level; in the medical schools that offered HIT courses, the courses were often mandatory (58/90, 64.44%). In most EU countries, HIT courses are offered in less than half of the medical schools, regardless of the country's GDP per capita. Countries with the highest percentages of HIT course presence have the lowest GDP per capita. There seems to be a weak inverse correlation (-0.49) between the two variables (GDP per capita and HIT course presence). There is a trend between the availability of medical human resources and an increase in the presence of HIT courses, with Romania, Croatia, and Greece as outliers in this respect. CONCLUSIONS The current state of medical training in the EU leaves much room for improvement. Further studies are required for in-depth analysis of the content and manner of instruction that would fit present and future needs of HIT.
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Affiliation(s)
| | - Estefania Guisado-Fernandez
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland.,Insight Centre for Data Analytics, Dublin, Ireland
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Bíró A. Reduced user fees for antibiotics under age 5 in Hungary: Effect on antibiotic use and imbalances in the implementation. PLoS One 2019; 14:e0219085. [PMID: 31251779 PMCID: PMC6599113 DOI: 10.1371/journal.pone.0219085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/16/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives In August 2016, new prescription guidelines were introduced in Hungary to reduce the co-payments for antibiotics among children aged 0-4. This study aims at analysing the implementation of this policy and its effect on the use of antibiotics. Methods The analysis is based on administrative prescription records between January 2010—February 2018, covering the entire population of Hungary aged 0-7. Spatial autocorrelation indices are calculated and settlement level regression models are estimated to analyse the spatial variation in the application of the new guidelines. The effect of reduced co-payments on antibiotic use is estimated with a difference-in-differences type model: the treatment and control groups are children aged 0-4 and 5-7, respectively; the treatment and control periods are August 2016—February 2018 and January 2010—July 2016, respectively. Results The new prescription guidelines are more widely applied in settlements with higher per capita income and lower unemployment rate. Adherence to the new guidelines is spatially clustered. A 10–15% decrease in the out-of-pocket costs of antibiotics is estimated to increase the consumption of antibiotics by about 5% (95% CI: 2.63%–7.55%). Conclusions In the absence of clear enforcement mechanisms, the adoption of the new prescription guidelines is selective, contradicting the aims of the policy of making antibiotics affordable for the poor children. The results point to the possible role of physicians’ information networks in the application of prescription guidelines. The use of antibiotics among children aged 0-4 is responsive to the price subsidy of antibiotics.
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Affiliation(s)
- Anikó Bíró
- Health and Population “Momentum” Research Group at the Institute of Economics, Centre for Economic and Regional Studies of the Hungarian Academy of Sciences, Budapest, Hungary
- * E-mail:
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Samhan B, Joshi K. Disruptive-Technology Avoidance in Healthcare. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2019. [DOI: 10.4018/ijhisi.2019040103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Disruptive innovation has transformed business activities as well as individuals throughout a variety of industries. In healthcare, the implementation of electronic health records (EHR) innovation has changed the way healthcare organizations handle patient records. Despite the potential benefits EHR can bring to healthcare organizations, there is evidence to show that healthcare providers are avoiding EHR innovations. Little research in information system mainstream research has addressed this phenomenon. To understand EHR avoidance, a mid-range theory is evoked from this textual analysis of responses gathered from healthcare providers at a large international hospital. The data was analyzed by applying a revealed causal mapping technique (RCM). Results of the study revealed not only the key constructs surrounding EHR avoidance, but also the underlying concepts that are shaping each of these constructs. This study demonstrated that the use of the RCM methodology yielded concepts and constructs of EHR avoidance that are not suggested by generalized theory, and revealed main interactions and linkages between these constructs.
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Affiliation(s)
| | - K.D. Joshi
- Washington State University, Pullman, USA
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20
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Or C, Tong E, Tan J, Chan S. Exploring Factors Affecting Voluntary Adoption of Electronic Medical Records Among Physicians and Clinical Assistants of Small or Solo Private General Practice Clinics. J Med Syst 2018; 42:121. [PMID: 29845400 DOI: 10.1007/s10916-018-0971-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
The health care reform initiative led by the Hong Kong government's Food and Health Bureau has started the implementation of an electronic sharing platform to provide an information infrastructure that enables public hospitals and private clinics to share their electronic medical records (EMRs) for improved access to patients' health care information. However, previous attempts to convince the private clinics to adopt EMRs to document health information have faced challenges, as the EMR adoption has been voluntary. The lack of electronic data shared by private clinics carries direct impacts to the efficacy of electronic record sharing between public and private healthcare providers. To increase the likelihood of buy-in, it is essential to proactively identify the users' and organizations' needs and capabilities before large-scale implementation. As part of the reform initiative, this study examined factors affecting the adoption of EMRs in small or solo private general practice clinics, by analyzing the experiences and opinions of the physicians and clinical assistants during the pilot implementation of the technology, with the purpose to learn from it before full-scale rollout. In-depth, semistructured interviews were conducted with 23 physicians and clinical assistants from seven small or solo private general practice clinics to evaluate their experiences, expectations, and opinions regarding the deployment of EMRs. Interview transcripts were content analyzed to identify key factors. Factors affecting the adoption of EMRs to record and manage health care information were identified as follows: system interface design; system functions; stability and reliability of hardware, software, and computing networks; financial and time costs; task and outcome performance, work practice, and clinical workflow; physical space in clinics; trust in technology; users' information technology literacy; training and technical support; and social and organizational influences. The factors are interrelated with the others. The adoption factors identified are multifaceted, ranging from technological characteristics, clinician-technology interactions, skills and knowledge, and the user-workflow-technology fit. Other findings, which have been relatively underrepresented in previous studies, contribute unique insights about the influence of work and social environment on the adoption of EMRs, including limited clinic space and the effects of physicians' decision to use the technology on clinical staffs' adoption decisions. Potential strategies to address the concerns, overcome adoption barriers, and define relevant policies are discussed.
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Affiliation(s)
- Calvin Or
- Department of Industrial & Manufacturing Systems Engineering, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Ellen Tong
- Health Informatics Department, Hong Kong Hospital Authority, Kowloon, Hong Kong
| | - Joseph Tan
- DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Summer Chan
- Health Informatics Department, Hong Kong Hospital Authority, Kowloon, Hong Kong
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Kannampallil TG, Denton CA, Shapiro JS, Patel VL. Efficiency of Emergency Physicians: Insights from an Observational Study using EHR Log Files. Appl Clin Inform 2018; 9:99-104. [PMID: 30184241 DOI: 10.1055/s-0037-1621705] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE With federal mandates and incentives since the turn of this decade, electronic health records (EHR) have been widely adopted and used for clinical care. Over the last several years, we have seen both positive and negative perspectives on its use. Using an analysis of log files of EHR use, we investigated the nature of EHR use and their effect on an emergency department's (ED) throughput and efficiency. METHODS EHR logs of time spent by attending physicians on EHR-based activities over a 6-week period (n = 2,304 patients) were collected. For each patient encounter, physician activities in the EHR were categorized into four activities: documentation, review, orders, and navigation. Four ED-based performance metrics were also captured: door-to-provider time, door-to-doctor time, door-to-disposition time, and length of stay (LOS). Association between the four EHR-based activities and corresponding ED performance metrics were evaluated. RESULTS We found positive correlations between physician review of patient charts, and door-to-disposition time (r = 0.43, p < 0.05), and with LOS (r = 0.48, p < 0.05). There were no statistically significant associations between any of the other performance metrics and EHR activities. CONCLUSION The results highlight that longer time spent on reviewing information on the EHR is potentially associated with decreased ED throughput efficiency. Balancing these competing goals is often a challenge of physicians, and its implications for patient safety is discussed.
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An organizational learning perspective on the assimilation of electronic medical records among small physician practices. EUR J INFORM SYST 2017. [DOI: 10.1057/palgrave.ejis.3000714] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Duretec K, Becker C. Format technology lifecycle analysis. J Assoc Inf Sci Technol 2017. [DOI: 10.1002/asi.23881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kresimir Duretec
- Information and Software Engineering Group; Vienna University of Technology, Institute of Software Technology and Interactive Systems, Favoritenstrasse 9-11/188; Vienna 1040 Austria
| | - Christoph Becker
- University of Toronto, Faculty of Information, 140 St George Street, Toronto, ON, M5S 3G6, Canada; and Information and Software Engineering Group, Vienna University of Technology, Institute of Software Technology and Interactive Systems, Favoritenstrasse 9-11/188; Vienna 1040 Austria
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The provider perspective: investigating the effect of the Electronic Patient-Reported Outcome (ePRO) mobile application and portal on primary care provider workflow. Prim Health Care Res Dev 2017; 19:151-164. [PMID: 28899449 PMCID: PMC6452954 DOI: 10.1017/s1463423617000573] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aim This qualitative study investigates how the Electronic Patient-Reported Outcome (ePRO) mobile application and portal system, designed to capture patient-reported measures to support self-management, affected primary care provider workflows. Background The Canadian health system is facing an ageing population that is living with chronic disease. Disruptive innovations like mobile health technologies can help to support health system transformation needed to better meet the multifaceted needs of the complex care patient. However, there are challenges with implementing these technologies in primary care settings, in particular the effect on primary care provider workflows. Methods Over a six-week period interdisciplinary primary care providers (n=6) and their complex care patients (n=12), used the ePRO mobile application and portal to collaboratively goal-set, manage care plans, and support self-management using patient-reported measures. Secondary thematic analysis of focus groups, training sessions, and issue tracker reports captured user experiences at a Toronto area Family Health Team from October 2014 to January 2015. Findings Key issues raised by providers included: liability concerns associated with remote monitoring, increased documentation activities due to a lack of interoperability between the app and the electronic patient record, increased provider anxiety with regard to the potential for the app to disrupt and infringe upon appointment time, and increased demands for patient engagement. Primary care providers reported the app helped to focus care plans and to begin a collaborative conversation on goal-setting. However, throughout our investigation we found a high level of provider resistance evidenced by consistent attempts to shift the app towards fitting with existing workflows rather than adapting much of their behaviour. As health systems seek innovative and disruptive models to better serve this complex patient population, provider change resistance will need to be addressed. New models and technologies cannot be disruptive in an environment that is resisting change.
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Eftekhari S, Yaraghi N, Singh R, Gopal RD, Ramesh R. Do Health Information Exchanges Deter Repetition of Medical Services? ACM TRANSACTIONS ON MANAGEMENT INFORMATION SYSTEMS 2017. [DOI: 10.1145/3057272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Repetition of medical services by providers is one of the major sources of healthcare costs. The lack of access to previous medical information on a patient at the point of care often leads a physician to perform medical procedures that have already been done. Multiple healthcare initiatives and legislation at both the federal and state levels have mandated Health Information Exchange (HIE) systems to address this problem. This study aims to assess the extent to which HIE could reduce these repetitions, using data from Centers for Medicare 8 Medicaid Services and a regional HIE organization. A 2-Stage Least Square model is developed to predict the impact of HIE on repetitions of two classes of procedures: diagnostic and therapeutic. The first stage is a predictive analytic model that estimates the duration of tenure of each HIE member-practice. Based on these estimates, the second stage predicts the effect of providers’ HIE tenure on their repetition of medical services. The model incorporates moderating effects of a federal quality assurance program and the complexity of medical procedures with a set of control variables. Our analyses show that a practice's tenure with HIE significantly lowers the repetition of therapeutic medical procedures, while diagnostic procedures are not impacted. The medical reasons for the effects observed in each class of procedures are discussed. The results will inform healthcare policymakers and provide insights on the business models of HIE platforms.
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Affiliation(s)
| | | | - Ranjit Singh
- State University of New York at Buffalo, Buffalo, NY
| | | | - R. Ramesh
- State University of New York at Buffalo, Buffalo, NY
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Oyekale AS. Assessment of primary health care facilities' service readiness in Nigeria. BMC Health Serv Res 2017; 17:172. [PMID: 28249578 PMCID: PMC5333428 DOI: 10.1186/s12913-017-2112-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/23/2017] [Indexed: 11/17/2022] Open
Abstract
Background Effective delivery of healthcare services requires availability of adequate infrastructure, diagnostic medical equipment, drugs and well-trained medical personnel. In Nigeria, poor funding and mismanagement often characterize healthcare service delivery thereby affecting coverage and quality of healthcare services. Therefore, the state of service delivery in Nigeria’s health sector has come under some persistent criticisms. This paper analyzed service readiness of Primary Health Care (PHC) facilities in Nigeria with focus on availability of some essential drugs and medical equipment. Methods Service Delivery Indicator (SDI) data for PHC in Nigeria were used. The data were collected from 2480 healthcare facilities from 12 states in the Nigeria’s 6 geopolitical zones between 2013 and 2014. Data were analyzed with descriptive statistics, Principal Component Analysis (PCA) and Ordinary Least Square regression. Results Medical disposables such as hand gloves and male condoms were reported to be available in 77.18 and 44.03% of all the healthcare facilities respectively, while immunization services were provided by 86.57%. Functional stethoscopes were reported by 77.22% of the healthcare facilities, while only 68.10% had sphygmomanometers. In the combined healthcare facilities, availability of some basic drugs such as Azithromycin, Nifedipine, Dexamethasone and Misoprostol was low with 10.48, 25.20, 21.94 and 17.06%, respectively, while paracetamol and folic acid both had high availability with 74.31%. Regression results showed that indices of drug and medical equipment availability increased significantly (p < 0.05) among states in southern Nigeria and with presence of some power sources (electricity, generators, batteries and solar), but decreased among dispensaries/health posts. Travel time to headquarters and rural facilities significantly reduced indices of equipment availability (p < 0.05). Conclusion It was concluded that for Nigeria to ensure better equity in access to healthcare facilities, which would facilitate achievement of some health-related sustainable development goals (SDGs), quality of services at its healthcare facilities should be improved. Given some differences between availability of basic medical equipment and their functionality, and lack of some basic drugs, proper inventory of medical services should be taken with effort put in place to increase funding and ensure proper management of healthcare resources.
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Affiliation(s)
- Abayomi Samuel Oyekale
- Department of Agricultural Economics and Extension, North-West University Mafikeng Campus, Mmabatho, 2735, South Africa.
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Hemmat M, Ayatollahi H, Maleki MR, Saghafi F. Future Research in Health Information Technology: A Review. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2017; 14:1b. [PMID: 28566991 PMCID: PMC5430110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
INTRODUCTION Currently, information technology is considered an important tool to improve healthcare services. To adopt the right technologies, policy makers should have adequate information about present and future advances. This study aimed to review and compare studies with a focus on the future of health information technology. METHOD This review study was completed in 2015. The databases used were Scopus, Web of Science, ProQuest, Ovid Medline, and PubMed. Keyword searches were used to identify papers and materials published between 2000 and 2015. Initially, 407 papers were obtained, and they were reduced to 11 papers at the final stage. The selected papers were described and compared in terms of the country of origin, objective, methodology, and time horizon. RESULTS The papers were divided into two groups: those forecasting the future of health information technology (seven papers) and those providing health information technology foresight (four papers). The results showed that papers related to forecasting the future of health information technology were mostly a literature review, and the time horizon was up to 10 years in most of these studies. In the health information technology foresight group, most of the studies used a combination of techniques, such as scenario building and Delphi methods, and had long-term objectives. CONCLUSION To make the most of an investment and to improve planning and successful implementation of health information technology, a strategic plan for the future needs to be set. To achieve this aim, methods such as forecasting the future of health information technology and offering health information technology foresight can be applied. The forecasting method is used when the objectives are not very large, and the foresight approach is recommended when large-scale objectives are set to be achieved. In the field of health information technology, the results of foresight studies can help to establish realistic long-term expectations of the future of health information technology.
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Affiliation(s)
- Morteza Hemmat
- Department of Health Information Management at Iran University of Medical Sciences in Tehran, Iran
| | - Haleh Ayatollahi
- Department of Health Information Management at Iran University of Medical Sciences in Tehran, Iran
| | - Mohammad Reza Maleki
- Department of Health Management, Iran University of Medical Sciences in Tehran, Iran
| | - Fatemeh Saghafi
- School of New Sciences and Technologies at Tehran University in Tehran, Iran
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Abstract
The rise of genomically targeted therapies and immunotherapy has revolutionized the practice of oncology in the last 10–15 years. At the same time, new technologies and the electronic health record (EHR) in particular have permeated the oncology clinic. Initially designed as billing and clinical documentation systems, EHR systems have not anticipated the complexity and variety of genomic information that needs to be reviewed, interpreted, and acted upon on a daily basis. Improved integration of cancer genomic data with EHR systems will help guide clinician decision making, support secondary uses, and ultimately improve patient care within oncology clinics. Some of the key factors relating to the challenge of integrating cancer genomic data into EHRs include: the bioinformatics pipelines that translate raw genomic data into meaningful, actionable results; the role of human curation in the interpretation of variant calls; and the need for consistent standards with regard to genomic and clinical data. Several emerging paradigms for integration are discussed in this review, including: non-standardized efforts between individual institutions and genomic testing laboratories; “middleware” products that portray genomic information, albeit outside of the clinical workflow; and application programming interfaces that have the potential to work within clinical workflow. The critical need for clinical-genomic knowledge bases, which can be independent or integrated into the aforementioned solutions, is also discussed.
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Affiliation(s)
- Jeremy L Warner
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA. .,Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA. .,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
| | - Sandeep K Jain
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA.,Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - Mia A Levy
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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Menachemi N, Ford EW, Beitsch LM, Brooks RG. Incomplete EHR Adoption: Late Uptake of Patient Safety and Cost Control Functions. Am J Med Qual 2016; 22:319-26. [PMID: 17804391 DOI: 10.1177/1062860607304990] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many functions important to realizing the full potential from electronic health records (EHRs) may not be selected by all physicians using EHRs in the ambulatory setting. This article examines the extent to which EHR systems used by Florida physicians include functionalities that the Institute of Medicine has designated as being critical for optimal performance. Results indicate that EHR systems used by recent adopters, when compared with early adopters, appear to be missing key patient safety and cost control functions. Overall, many physicians are only partially adopting EHR technologies, suggesting that published adoption rates may be exaggerating the true rate of diffusion.
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Affiliation(s)
- Nir Menachemi
- Center on Patient Safety, Florida State University College of Medicine, Tallahassee 32306-4300, USA.
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Sherer SA, Meyerhoefer CD, Peng L. Applying institutional theory to the adoption of electronic health records in the U.S. INFORMATION & MANAGEMENT 2016. [DOI: 10.1016/j.im.2016.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Behkami N, Daim TU. Exploring technology adoption in the case of the Patient-Centered Medical Home. HEALTH POLICY AND TECHNOLOGY 2016. [DOI: 10.1016/j.hlpt.2016.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Collective mindfulness in post-implementation IS adaptation processes. INFORMATION AND ORGANIZATION 2016. [DOI: 10.1016/j.infoandorg.2016.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bruns EJ, Hyde KL, Sather A, Hook AN, Lyon AR. Applying User Input to the Design and Testing of an Electronic Behavioral Health Information System for Wraparound Care Coordination. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:350-68. [PMID: 26060099 PMCID: PMC4675692 DOI: 10.1007/s10488-015-0658-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Health information technology (HIT) and care coordination for individuals with complex needs are high priorities for quality improvement in health care. However, there is little empirical guidance about how best to design electronic health record systems and related technologies to facilitate implementation of care coordination models in behavioral health, or how best to apply user input to the design and testing process. In this paper, we describe an iterative development process that incorporated user/stakeholder perspectives at multiple points and resulted in an electronic behavioral health information system (EBHIS) specific to the wraparound care coordination model for youth with serious emotional and behavioral disorders. First, we review foundational HIT research on how EBHIS can enhance efficiency and outcomes of wraparound that was used to inform development. After describing the rationale for and functions of a prototype EBHIS for wraparound, we describe methods and results for a series of six small studies that informed system development across four phases of effort-predevelopment, development, initial user testing, and commercialization-and discuss how these results informed system design and refinement. Finally, we present next steps, challenges to dissemination, and guidance for others aiming to develop specialized behavioral health HIT. The research team's experiences reinforce the opportunity presented by EBHIS to improve care coordination for populations with complex needs, while also pointing to a litany of barriers and challenges to be overcome to implement such technologies.
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Affiliation(s)
- Eric J Bruns
- University of Washington School of Medicine, Seattle, WA, 98105, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington, 2815 Eastlake Ave E, Suite 200, Seattle, WA, 98102, USA.
| | | | - April Sather
- University of Washington School of Medicine, Seattle, WA, 98105, USA
| | - Alyssa N Hook
- University of Washington School of Medicine, Seattle, WA, 98105, USA
| | - Aaron R Lyon
- University of Washington School of Medicine, Seattle, WA, 98105, USA
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Djalali S, Ursprung N, Rosemann T, Senn O, Tandjung R. Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange. Int J Med Inform 2015; 84:920-32. [PMID: 26296433 DOI: 10.1016/j.ijmedinf.2015.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 07/30/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption. OBJECTIVE We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows. METHODS Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score. RESULTS A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger. CONCLUSION At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians.
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Affiliation(s)
- Sima Djalali
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
| | - Nadine Ursprung
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland
| | - Ryan Tandjung
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland
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Mennemeyer ST, Menachemi N, Rahurkar S, Ford EW. Impact of the HITECH Act on physicians' adoption of electronic health records. J Am Med Inform Assoc 2015; 23:375-9. [PMID: 26228764 DOI: 10.1093/jamia/ocv103] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The Health Information Technology for Economic and Clinical Health (HITECH) Act has distributed billions of dollars to physicians as incentives for adopting certified electronic health records (EHRs) through the meaningful use (MU) program ultimately aimed at improving healthcare outcomes. The authors examine the extent to which the MU program impacted the EHR adoption curve that existed prior to the Act. METHODS Bass and Gamma Shifted Gompertz (G/SG) diffusion models of the adoption of "Any" and "Basic" EHR systems in physicians' offices using consistent data series covering 2001-2013 and 2006-2013, respectively, are estimated to determine if adoption was stimulated during either a PrePay (2009-2010) period of subsidy anticipation or a PostPay (2011-2013) period when payments were actually made. RESULTS Adoption of Any EHR system may have increased by as much as 7 percentage points above the level predicted in the absence of the MU subsidies. This estimate, however, lacks statistical significance and becomes smaller or negative under alternative model specifications. No substantial effects are found for Basic systems. The models suggest that adoption was largely driven by "imitation" effects (q-coefficient) as physicians mimic their peers' technology use or respond to mandates. Small and often insignificant "innovation" effects (p-coefficient) are found suggesting little enthusiasm by physicians who are leaders in technology adoption. CONCLUSION The authors find weak evidence of the impact of the MU program on EHR uptake. This is consistent with reports that many current EHR systems reduce physician productivity, lack data sharing capabilities, and need to incorporate other key interoperability features (e.g., application program interfaces).
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Affiliation(s)
- Stephen T Mennemeyer
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Saurabh Rahurkar
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric W Ford
- Department of Health Policy, Bloomberg School of Public Health, Johns Hopkins University, Baltimore MD, USA
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Rosenthal MM, Houle SK, Eberhart G, Tsuyuki RT. Prescribing by pharmacists in Alberta and its relation to culture and personality traits. Res Social Adm Pharm 2015; 11:401-11. [DOI: 10.1016/j.sapharm.2014.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/10/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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KOSTOPOULOS GIANNIS, RIZOMYLIOTIS IOANNIS, KONSTANTOULAKI KLEOPATRA. DETERMINANTS OF PHYSICIANS' PURCHASE INTENTION FOR INNOVATIVE SERVICES: INTEGRATING PROFESSIONAL CHARACTERISTICS WITH TECHNOLOGY ACCEPTANCE MODEL AND THEORY OF PLANNED BEHAVIOUR. INTERNATIONAL JOURNAL OF INNOVATION MANAGEMENT 2015. [DOI: 10.1142/s1363919615500243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper seeks to explore the factors that influence physicians' purchase intention for supplementary professional services that have been recently introduced to the market. For that reason, a model has been developed and empirically tested using data collected from 100 physicians regarding an innovative e-detailing service. Results show that physicians' purchase intention is significantly influenced by five factors. Three of them derive from the integration of Technology Acceptance Model (TAM) with the Theory of Planned Behaviour (TPB), i.e., perceived usefulness, perceived ease of use and professional image. The rest, namely work experience, working status and innovativeness, refer to physicians' professional characteristics. Work experience and innovativeness were found to have a significant effect on physicians' perceptions of the innovative service, whereas, physicians' current working status was not found to have significant influence on either their perceptions of the innovative service or their purchase intention.
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Affiliation(s)
- GIANNIS KOSTOPOULOS
- Leeds Business School, Leeds Beckett University, 304 Rose Bowl, City Campus, Leeds LS1 3HL, United Kingdom
| | - IOANNIS RIZOMYLIOTIS
- Brighton Business School, University of Brighton, Mithras House, Lewes Road Brighton, BN2 4AT, United Kingdom
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Pantaleoni JL, Stevens LA, Mailes ES, Goad BA, Longhurst CA. Successful physician training program for large scale EMR implementation. Appl Clin Inform 2015; 6:80-95. [PMID: 25848415 DOI: 10.4338/aci-2014-09-cr-0076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/01/2015] [Indexed: 11/23/2022] Open
Abstract
End-user training is an essential element of electronic medical record (EMR) implementation and frequently suffers from minimal institutional investment. In addition, discussion of successful EMR training programs for physicians is limited in the literature. The authors describe a successful physician-training program at Stanford Children's Health as part of a large scale EMR implementation. Evaluations of classroom training, obtained at the conclusion of each class, revealed high physician satisfaction with the program. Free-text comments from learners focused on duration and timing of training, the learning environment, quality of the instructors, and specificity of training to their role or department. Based upon participant feedback and institutional experience, best practice recommendations, including physician engagement, curricular design, and assessment of proficiency and recognition, are suggested for future provider EMR training programs. The authors strongly recommend the creation of coursework to group providers by common workflow.
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Affiliation(s)
- J L Pantaleoni
- Department of Pediatrics, Stanford University School of Medicine , Stanford, California ; Department of Clinical Informatics, Stanford Children's Health , Palo Alto, California
| | - L A Stevens
- Department of Pediatrics, Stanford University School of Medicine , Stanford, California ; Department of Clinical Informatics, Stanford Children's Health , Palo Alto, California
| | - E S Mailes
- Department of Clinical Informatics, Stanford Children's Health , Palo Alto, California
| | - B A Goad
- Department of Clinical Informatics, Stanford Children's Health , Palo Alto, California
| | - C A Longhurst
- Department of Pediatrics, Stanford University School of Medicine , Stanford, California ; Department of Clinical Informatics, Stanford Children's Health , Palo Alto, California
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Angst CM, Devaraj S, D'Arcy J. Dual Role of IT-Assisted Communication in Patient Care: A Validated Structure-Process-Outcome Framework. J MANAGE INFORM SYST 2014. [DOI: 10.2753/mis0742-1222290209] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Corey M. Angst
- a Management Department, Mendoza College of Business, University of Notre Dame
| | - Sarv Devaraj
- a Management Department, Mendoza College of Business, University of Notre Dame
| | - John D'Arcy
- b Lerner College of Business and Economics, University of Delaware
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Baird A, Furukawa MF, Raghu TS. Understanding Contingencies Associated with the Early Adoption of Customer-Facing Web Portals. J MANAGE INFORM SYST 2014. [DOI: 10.2753/mis0742-1222290210] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Michael F. Furukawa
- b Department of Health and Human Services, National Coordinator for Health Information Technology (ONC), Washington, DC
| | - T. S. Raghu
- c Master of Science in Information Management (MSIM) Program, W.P. Carey School of Business at Arizona State University
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Elison S, Ward J, Davies G, Moody M. Implementation of computer-assisted therapy for substance misuse: a qualitative study of Breaking Free Online using Roger's diffusion of innovation theory. DRUGS AND ALCOHOL TODAY 2014. [DOI: 10.1108/dat-05-2014-0025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to explore the adoption and implementation of computer-assisted therapy (CAT) using Breaking Free Online (BFO) in a social care and health charity working with people affected by drugs and alcohol dependence, Crime Reduction Initiatives (CRI).
Design/methodology/approach
– Semi-structured interviews were conducted with service managers, practitioners, peer mentors and service users. Data were thematically analysed and themes conceptualised using Roger's Diffusion of Innovation Theory (Rogers, 1995, 2002, 2004).
Findings
– A number of perceived barriers to adoption of BFO throughout CRI were identified within the social system, including a lack of IT resources and skills. However, there were numerous perceived benefits of adoption of BFO throughout CRI, including broadening access to effective interventions to support recovery from substance dependence, and promoting digital inclusion. Along with the solutions that were found to the identified barriers to implementation, intentions around longer-term continuation of adoption of the programme were reported, with this process being supported through changes to both the social system and the individuals within it.
Research limitations/implications
– The introduction of innovations such as BFO within large organisations like CRI can be perceived as being disruptive, even when individuals within the organisation recognise its benefits. For successful adoption and implementation of such innovations, changes in the social system are required, at organisational and individual levels.
Practical implications
– The learning points from this study may be relevant to the substance misuse sector, and more widely to criminal justice, health and social care organisations.
Originality/value
– This study is the first of its kind to use a qualitative approach to examine processes of implementation of CAT for substance misuse within a large treatment and recovery organisation.
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Gajanayake R, Sahama T, Iannella R. The Role of Perceived Usefulness and Attitude on Electronic Health Record Acceptance. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2014. [DOI: 10.4018/ijehmc.2014100107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Information and communications technologies are a significant component of the healthcare domain, and electronic health records play a major role in it. Therefore, it is important that they are accepted en masse by healthcare professionals. How healthcare professionals perceive the usefulness of electronic health records and their attitudes towards them have been shown to have significant effects on the overall acceptance in many healthcare systems around the world. This paper investigates the role of perceived usefulness and attitude on the intention to use electronic health records by future healthcare professionals using polynomial regression with response surface analysis. Results show that the relationships between these variables are more complex than predicted in prior research. The paper concludes that the properties of the above determinants must be further investigated to clearly understand: (i) their role in predicting the intention to use electronic health records; and (ii) in designing systems that are better adopted by healthcare professionals of the future.
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Affiliation(s)
| | - Tony Sahama
- Queensland University of Technology, Brisbane, Australia
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Ajami S, Arab-Chadegani R. Barriers to implement Electronic Health Records (EHRs). Mater Sociomed 2014; 25:213-5. [PMID: 24167440 PMCID: PMC3804410 DOI: 10.5455/msm.2013.25.213-215] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/25/2013] [Indexed: 11/29/2022] Open
Abstract
Introduction: During the past 20 years, with huge advances in information technology and particularly in the areas of health, various forms of electronic records have been studied, analyzed, designed or implemented. An Electronic Health Records (EHRs) is defined as digitally stored healthcare information throughout an individual’s lifetime with the purpose of supporting continuity of care, education, and research. The EHRs may include such things as observations, laboratory tests, medical images, treatments, therapies; drugs administered, patient identifying information, legal permissions, and so on. Despite of the potential benefits of electronic health records, implement of this project facing with barriers and restriction ,that the most of these limitations are cost constraints, technical limitations, standardization limits, attitudinal constraints–behavior of individuals and organizational constraints. Aim: The aim of this study was to express the main barriers to implement EHRs. Methods: This study was unsystematic-review study. The literature was searched on main barriers to implement EHRs with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. For our searches, we employed the following keywords and their combinations: Electronic health record, implement, obstacle, and information technology in the searching areas of title, keywords, abstract, and full text. Results and discussion: In this study, more than 43 articles and reports were collected and 32 of them were selected based on their relevancy. Many studies indicate that the most important factor than other limitations to implement the EHR are resistance to change.
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Affiliation(s)
- Sima Ajami
- Department of Health Information Technology, Health Management & Economics Research Center, School of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Najaftorkaman M, Ghapanchi AH, Talaei-Khoei A, Ray P. A taxonomy of antecedents to user adoption of health information systems: A synthesis of thirty years of research. J Assoc Inf Sci Technol 2014. [DOI: 10.1002/asi.23181] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mohammadreza Najaftorkaman
- School of Information and Communication Technology, Room 2.31, Building G23; Griffith University; Gold Coast Campus, Parklands Drive Southport Qld 4222 Australia
| | - Amir Hossein Ghapanchi
- School of Information and Communication Technology, Room 1.60, Building G09; Griffith University; Gold Coast Campus, Parklands Drive Southport Qld 4222 Australia
- Institute for Integrated and Intelligent Systems; Gold Coast Qld 4222 Australia
| | - Amir Talaei-Khoei
- School of Systems; Management and Leadership; University of Technology Sydney; CB10.04.346, P.O. Box 123, Broadway Ultimo NSW 2007 Australia
| | - Pradeep Ray
- Asia-Pacific ubiquitous Healthcare research Centre (APuHC), Room 1039, Quadrangle Building; Australian School of Business; University of New South Wales; Sydney NSW 2052 Australia
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Mann LM, Atayee RS, Best BM, Morello CM, Ma JD. Urine specimen detection of zolpidem use in patients with pain. J Anal Toxicol 2014; 38:322-6. [PMID: 24802157 DOI: 10.1093/jat/bku044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined zolpidem and concurrent opioid, benzodiazepine, other central nervous system (CNS) depressants, and alcohol use. Urine specimens were analyzed using liquid chromatography-mass spectrometry (LC-MS/MS). Specimens were tested for zolpidem (n = 71,919) and separated into a provider-reported medication list documenting (n = 5,257) or not documenting zolpidem use (n = 66,662). Zolpidem-positive specimens were further separated into reported and unreported use cohorts. The total number of zolpidem-positive specimens in the reported and unreported use cohorts was 3,391 and 3,190, respectively. Non-informed prescribers were 4.4% (3,190/71,919) among the general population and 48.5% (3,190/6,581) when only zolpidem users were considered. In the zolpidem user population, the most common concurrent opioids in both cohorts were hydrocodone and oxycodone. Alprazolam and clonazepam were higher in the unreported use cohort (P ≤ 0.05). The unreported use cohort also had a higher detection of zolpidem plus a benzodiazepine (49.7 vs. 46%; P ≤ 0.05), zolpidem plus an opioid and a benzodiazepine (40.8% vs. 37.4%; P ≤ 0.05) and zolpidem plus an opioid, a benzodiazepine, and an other CNS depressant (12.9 vs. 10.9%; P ≤ 0.05). Concurrent use of zolpidem, an opioid, a benzodiazepine and an other CNS depressant is prevalent in a pain patient population.
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Affiliation(s)
- Lindsey M Mann
- University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
| | - Rabia S Atayee
- University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Doris A. Howell Palliative Care Services, San Diego, CA, USA
| | - Brookie M Best
- University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA UCSD Department of Pediatrics, Rady's Children's Hospital, San Diego, CA, USA
| | - Candis M Morello
- University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Diabetes Intense Medical Management Clinic, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Joseph D Ma
- University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Doris A. Howell Palliative Care Services, San Diego, CA, USA
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Zandi F. A bi-level interactive decision support framework to identify data mining-oriented electronic health record architectures. Appl Soft Comput 2014. [DOI: 10.1016/j.asoc.2014.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Singh R, Mathiassen L, Switzer JA, Adams RJ. Assimilation of web-based urgent stroke evaluation: a qualitative study of two networks. JMIR Med Inform 2014; 2:e6. [PMID: 25601232 PMCID: PMC4288061 DOI: 10.2196/medinform.3028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/31/2013] [Accepted: 01/10/2014] [Indexed: 12/03/2022] Open
Abstract
Background Stroke is a leading cause of death and serious, long-term disability across the world. Urgent stroke care treatment is time-sensitive and requires a stroke-trained neurologist for clinical diagnosis. Rural areas, where neurologists and stroke specialists are lacking, have a high incidence of stroke-related death and disability. By virtually connecting emergency department physicians in rural hospitals to regional medical centers for consultations, specialized Web-based stroke evaluation systems (telestroke) have helped address the challenge of urgent stroke care in underserved communities. However, many rural hospitals that have deployed telestroke have not fully assimilated this technology. Objective The objective of this study was to explore potential sources of variations in the utilization of a Web-based telestroke system for urgent stroke evaluation and propose a telestroke assimilation model to improve stroke care performance. Methods An exploratory, qualitative case study of two telestroke networks, each comprising an academic stroke center (hub) and connected rural hospitals (spokes), was conducted. Data were collected from 50 semistructured interviews with 40 stakeholders, telestroke usage logs from 32 spokes, site visits, published papers, and reports. Results The two networks used identical technology (called Remote Evaluation of Acute isCHemic stroke, REACH) and were of similar size and complexity, but showed large variations in telestroke assimilation across spokes. Several observed hub- and spoke-related characteristics can explain these variations. The hub-related characteristics included telestroke institutionalization into stroke care, resources for the telestroke program, ongoing support for stroke readiness of spokes, telestroke performance monitoring, and continuous telestroke process improvement. The spoke-related characteristics included managerial telestroke championship, stroke center certification, dedicated telestroke coordinator, stroke committee of key stakeholders, local neurological expertise, and continuous telestroke process improvement. Conclusions Rural hospitals can improve their stroke readiness with use of telestroke systems. However, they need to integrate the technology into their stroke delivery processes. A telestroke assimilation model may improve stroke care performance.
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Affiliation(s)
- Rajendra Singh
- Arnold School of Public Health, Health Services Policy and Management, University of South Carolina, Columbia, SC, United States.
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Electronic health record acceptance by physicians: Testing an integrated theoretical model. J Biomed Inform 2014; 48:17-27. [DOI: 10.1016/j.jbi.2013.10.010] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 08/05/2013] [Accepted: 10/21/2013] [Indexed: 11/22/2022]
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50
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Bordson SJ, Atayee RS, Ma JD, Best BM. Tricyclic Antidepressants: Is Your Patient Taking Them? Observations on Adherence and Unreported Use Using Prescriber-Reported Medication Lists and Urine Drug Testing. PAIN MEDICINE 2014; 15:355-63. [DOI: 10.1111/pme.12300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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